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

Hi Lori,
I posted an update on the situation with Skippy below a little while ago. But, I just realized that I didn't respond to your question about his kidney values. On 10/31 his Creatinine was 1.90 with a reference range of .50 to 1.50. and his BUN was 117 with a range of 7 -32. I stopped the Vetoryl yesterday as he just won't eat. The IMS thinks it an ulcer. I just emailed Purdue again saying, "help"! I am certain that they think I'm a pain in the butt but I really don't care what they think at this point. Thank you for your kind comments although I don't feel inspirational - just someone in way over her head. Ole Skippy is tough little mongrel though. Best,

Carole

Purdue will see Skippy tomorrow. At least they are concerned about why he is refusing to eat.

Yes, he needs to eat, or get some nutrition in some other way. That has to come first. So , so frustrating. Can't dose Vetoryl unless he's eating, so his cortisol will remain high until then. Glad he's getting in tomorrow.

[/QUOTE] Purdue is adamant that getting his cortisol under control is critical to his so called “long-term” health.[/QUOTE]

I feel for you, I really understand the frustration of getting them to eat, offering anything, ANYTHING and just hoping & praying for a few bites. This coupled with all the questions and concerns and changing situations is so much to deal with. So thankful that he will be seen tomorrow. Wishing you both a restful night.

Thanks Annie, how well I recall that you know. I mean KNOW. There is some confusion between vets about taking hin to Purdue tomorrow but I hope to work through it in the morning. Skippy ate a few bites of Stouffer's barbecue chicken and potato parmesan tonight. I tasted it and the bbq was terrible, but...Can[t medicate him with anything without food...I will push for more kidney tests if they will see him tomorrow. Best to you and Tex. How did you name him Tex btw? Best to you,

Carole

Did you go to Purdue today? What did they say?

I agree this not eating is Very concerning. Have they confirmed there is an ulcer?

Hi Sharlene, My battery went dead in the Purdue parking lot (after five hours there); I had to call for a jump and then a new battery purchase at Sears so I just got back. Skippy is on IV hydration at Purdue overnight. Physical exam offered no evidence of dehydration but after CBC his Createtime had jumped from 1.9 to 2.9 in less than a week, with a reference range of 0.50 - 1.50. The IMS didn't give me any other numbers but was insistent on hydrating him overnight and they had given him some kind of nausea suppressant/appetite stimulant by injection. They are supposed to call me in the morning. She mentioned a test that they could perform to confirm an ulcer but I just can't remember the name. Maybe my mistake was failing to try to somehow get the kidney meds down him since last Sunday night, but I just didn't know how to force them down his throat. I really don't think the Purdue IMS (this is the junior who I hope is consulting with the senior) knows what's wrong with him except that he is in kidney failure. I asked again today about the SDMA and she responded that they would secure his blood chemistry values. (This was early in the day.) I am going to send her an email next and request the SDMA test; I have no idea why they aren't recommending it. Before going to Purdue, Skippy did get up and eat a small bowl full of boiled chicken thigh and I think he would have eaten more, but he wouldn't touch the renal kibble. Since three days of reading, I know now that I could home cook food for Skippy and I will if he makes it through this. It goes without saying I am very, very worried that we have reached the end of this over a year long often tortured journey. If I can't get this kidney disease under control and get his cortisol down, I see little way forward. And, I am prepared intellectually, not so emotionally. I will ask/ request the ulcer test and the SDMA. I truly wish I had the medical knowledge to comprehend all of this to figure out the best path forward, if there is one. I've read about canine ulcers, periodontal disease (Purdue says his is severe although his teeth were cleaned about a year ago.), binders, commercial food, home cooked food, a ton of holistic meds, but I feel like I'm fattening frogs for snakes at this point. Thanks for letting me vent, yet again. I would welcome any wisdom from any of you who are so knowledgeable and experienced.

Carole

Hi Carole,

I so wish I had something helpful or informative to add, but I’m afraid I am stumped and would need to defer to Pudue’s expertise just as you are doing. It is such a complicated situation with so many inter-locking puzzle pieces. I am guessing that perhaps they are thinking about an endoscopy to check for an ulcer? This would involve sedating him and putting a tube/camera down his throat and into his stomach. I don’t know that there’s any other way to definitively diagnose it without imaging.

Anyway, I’m hoping that you’ll hear a more positive update this morning! We’re here, anxiously waiting alongside you.

Marianne

Thanks Marianne, I just spoke with Purdue and the immediate crisis has past. His Createtime is back to 1.9 this morning. Skippy is eating and jumping around. But, they still don't know what's wrong with him. I'm going to see him now. The IMS treating him is consulting with a nephrologist and with Dr. Scott-Moncrieff at Purdue. They are looking for a kidney infection. She doesn't want to restart Vetoryl now although Skippy is eating. The IMS is now saying that they may have overloaded him with meds. His BP is near normal but he's still spilling protein. They are keeping him again overnight to continue fluids and testing. The IMS mentioned Miotane or the possibility of low dose Vetoryl if they try to lower the cortisol slightly versus simply trying to manage the multitude of other symptoms and conditions. IMS hasn't ruled out ulcers but seems to be discounting it more. I no longer know what to think and the cost has truly become astronomical; I could now open a pet pharmacy with the array of meds that have now been discontinued. I am certainly glad that he's feeling better and eating but I am beginning to lose confidence, yet again, that they have a clue of whether or how to treat him. Would you all seek a second opinion? His paper records are now at least two inches thick. Dr. Bruyette now offers a vet consulting service but I think he would defer to Dr. Scott-Moncrieff but, she really isn't treating him at the moment although she supervises the IMS who is. Thanks,
Carole

Many of you who weighed in on restarting Vetoryl were correct. Not because it has resulted in Skippy's adenoma growing, but because it has caused acute/chronic kidney disease. His BUN and Creatinine levels are jumping up and down by at least a point, i.e., 1.7 yesterday to 2.9 this morning. (Reference range 0.50 - 1.50) I've been visiting Skippy daily and they will keep him at least until Monday. They have no idea as to whether or not they can stabilize him or for how long. They took the IV out of him and I took him for a long walk today. Now, he seems alert, eating, pooping, peeing. But, if Creatinine increases each time they slow the fluids, we are likely done. He can't live on fluids in a cage at Purdue indefinitely. I will not give up and they are running more tests to try to figure out what is causing this but I'm pretty certain it's not treatable. And, I will not let this go on much longer as we are where we are. I could look back at my mistakes over the last two months, but I took a calculated risk. I could have never restarted the Vetoryl and certainly not restarted it three weeks ago when his kidney levels were creeping higher. But, I so wanted to control the cortisol/Cushing's. They were wrong and so was I. Thanks,

Carole