Skippy has passed; 12 y/o Yorkie with likely pituitary tumor (Trilostane)

Thanks Annie, Kathy, Sharleen and everyone for your kind comments and support. Skippy spent nearly 12 hours at Purdue yesterday and enjoyed a fire drill whereby all of the peeps and pups were required to leave the clinic! Might as well start with the Cushing’s – he still has it of course. Fasted ACTH Stim #’s: pre – 10 and post – 30 plus. He’s been off Vetoryl for a week and counting. The IMS who saw Skippy yesterday was going to consult with Dr. Scott-Moncrieff, who’s away, regarding further treatment of his Cushing’s.

After another CBC yesterday, Purdue called requesting approval for another ultrasound. (This was number four in the past year.) I guess the good news is that the ultrasound revealed no masses, stones or other abnormalities. They characterized his condition as chronic kidney disease based on the last two BUN and Creatinine results but offered no firm opinion as to stage, maybe Stage II based on Creatinine of 1.9 yesterday and 2.7 on 10/24. Skippy’s liver values remain high but typical for uncontrolled Cushing’s. Pancreas and gall bladder values are high as well. Sinking into gloom, I spent my day researching kidney disease, a condition that I knew little more than zero about. Tonight, I received a call from the IMS who had consulted at length with Dr. Scott-Moncrieff and had gone back through the past year of testing. She found that his kidney values, especially the BUN, have been widely varied on both the high and low side. She now thinks that these values combined with his frequent episodic bouts of diarrhea are elevating his kidney numbers, perhaps creating false positives. They now suspect that he has ulcers in his digestive track that may be causing kidney, pancreas, gall bladder values to increase. I started him on Urisodol (sp.?) yesterday. She will prescribe another antibiotic for the anticipated diarrhea, Prilosec tablets, and another drug that I honestly can’t remember except it’s administered in slurry. Scott-Moncrieff wants me to start him back on Vetoryl 15mg twice a day, immediately. They sent me home with six kinds of renal kibble and when mixed with low fat, low salt beef broth, he’s eating it. Skippy is very hungry and is peeing like a drunken sailor, much more than before stopping the Vetoryl. I was up at 4, 5, and 6 for outs and he still peed once in the house. Total outs overnight were 7 or 8. I am very scared to restart the Vetoryl but will tomorrow; I’m equally scared, maybe more so, that he may have kidney disease as that is likely game over, sooner than later. Skippy remains about the same, pretty lethargic, will walk with gentle encouragement, but sleeps his days away; he will be tested again in two or three weeks and Scott-Moncrieff will see him then. I am well aware that Drecha recommends stopping Vetoryl when kidney disease is diagnosed, but Purdue is confident that they can manage him regardless. I wish I knew more, not to second guess, but just to understand more. I did ask about the SDMA test and the response was that it is used for diagnosis but they could do one and send to IDEXX, if I request it. I can post his blood and urine results but didn’t want to make this post longer still. If those of you who know light years more than me (probably everyone) have thoughts, ideas or feedback, I would be grateful for your input.

I've got nothing right now but hugs for you. All you want.

I'll sit with you and wait for someone else to come along.

Hey Doxie Mama, you are so good and kind. Big thanks to you and hugs back!

Personally, I would want the SDMA. And I would want those results before I restarted the Vetoryl. Dechra specifically says it is not to be used with kidney or liver disease. So I would want to be armed with all the info possible so I could decide how Skippy would want me to deal with things. :) But others with much more understanding of this drug than I may feel differently....just sharing what I would do in your shoes. ;-)

You're a good mom and I know whatever you decide will be done out of love for Skippy.
Hugs,
Leslie

Hi Leslie,
The IMS at Purdue is supposed to email me today with further instructions. I will ask if I could run Skipp over for an SDMA; if not there I could call the local vet. The new pharmaceuticals are now awaiting my pick-up. I haven't started the Vetoryl, yet. He is now scheduled for a recheck with Scott-Moncrieff on the 21st. Thanks for your opinion and I surely don't disagree if I can make it happen. I do think Purdue thought he might be in an Addison's state. Thank you,

Carole

Hi Carole,

You and Skippy are an inspiration to us all, I'm in awe of the courage you both are showing while dealing with everything that you both are going through...sending super loving hugs to you both.

Harley was diagnosed with kidney disease so if there is any way I can help please let me know.

Other things besides kidney disease can cause elevations in the BUN and creatinine. Dehydration, UTI, a high protein meal, and even some medications such as the ones used for high blood pressure can make those levels increase So, I agree with Leslie's recommendation on having the SDMA test performed to see if there is a loss of glomerular filtration rate. What are the reference ranges for the BUN and creatinine?

Lori

They should have a mini kidney panel they can do to evaluate where his levels are. I use to get BUN/Creatinine and an SDMA at every appt. The IMS did this on the inhouse panel which was cheaper and would give us a quick snapshot to anything going on and we would do an IDEXX panel if it looked like something was changing. We did this for a year. But I agree, I would want the SDMA and I used it as a consistent base of where Molly's kidneys were at and going. Along with the BUN and Creatinine.

Hi Carole & Skippy,
Just letting you know I'm thinking of you guys & hoping for the best, as always.
Hugs to you Both!

Hi everyone and thanks as always for your kind words and the helpful info regarding kidney evaluation. I had an email exchange with the Purdue Docs after his visit last week. They were confident that Skippy’s high BUN and Creatinine numbers are caused by ulcers and that with treatment and restarting the Vetoryl, we will soon have him back on track. Not so much. Beyond the treatment regime, Denamarin, Benazepril, Tylosin, Sucralfate slurry (his favorite/ not), Pepcid OC, Ursodiol, and Vetoryl, there is Royal Canin’s finest renal kibble and cans. He ate the kibble lightly twice after heavily doctoring it with a chicken thigh and no salt broth. (I tasted the broth; it’s pure poison!) For the past three days, it’s been an accelerating slide downhill from eating modest but adequate amounts of food, to handfeeding his favs, to nothing last night. I’ve tried eggs with parmesan, Stouffer’s chipped beef, hamburger, steak, chicken, salmon, cheese, spam, etc. He ate the Spam yesterday but no go last night. I stopped the Vetoryl but got the other meds down with chipped beef sauce. Emailed Purdue IMS yesterday morning stating no food, no Vetoryl; she replied that maybe we were trying to transition him too fast! I replied that he won’t eat anything! No response.
Question: Is it likely that he’s nauseous? Should I ask Purdue for a med for that? No vomiting or diarrhea and he’s drinking and walking pretty well when he’s not sleeping. He doesn’t appear to be in pain.
Although my mind is a bit of a blur surrounding Skippy’s tolerance of Vetoryl, I believe his loss of appetite has been a consistent problem each time we increased the dose beyond 20mg daily. His cortisol has never been under control since diagnosis. Soon he will weigh 20lbs so I can reduce the dose if I can ever restart treatment. Purdue is adamant that getting his cortisol under control is critical to his so called “long-term” health. He’s scheduled for a recheck on 11/21.
I’ve been researching KD; my head is swimming and I am awash in frustration and anxiety; this entire saga is like the Myth of Sisyphus. How many more times can I push the boulder up the hill and watch it roll back down?

It is very frustrating, Carole, that's for sure. The 21st seems a long way off to me.