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

Oh Carole, I hope he can be stabilized. I totally understand how heartbreaking it is to try and do the right thing, the thing that will make everything better, and then the worry, fear that it might have done the opposite. I've been there with my molly and the cortisol levels and kidney disease. We too tried everything and did what we could to give her every chance. I know that you are doing that now for Skippy and I sincerely hope that he can turn this around.

It sure is a sucky position to be in, but remember, every decision made is made with the information you had then, not what you have now.

Carole, have the folks at Purdue told you that they think the Vetoryl actually caused kidney damage? I may definitely be wrong, but my understanding is that the warning against treating kidney patients with Vetoryl is not so much that it directly damages the kidneys, but instead that Vetoryl levels will accumulate at a higher level in the body than expected if dysfunctional kidneys are not efficiently “clearing” the metabolites out of the system. As a result, overdosing becomes more unpredictable and a greater risk.

I write this is an effort to keep you from judging yourself, or even Purdue, harshly. Restarting the Vetoryl may not have been a mistake at all, since uncontrolled Cushing’s, itself, can cause kidney damage. It has been such an extreme challenge to balance all of Skippy’s competing needs — as it turns out, perhaps just too great a challenge to overcome. But you have done a superhuman job of giving him every possible chance to rebound, all along the way. I sooooo hope that he’ll rebound once again. But no matter what, you’ve all done the very best you could with the information that was available at any given time and day.

Sending healing thoughts to you both, and my hopes that tomorrow will bring much better news.
Marianne

I just want to say that marianne is right about not knowing if vetroyl causes kidney damage and in our case, we know that the kidney damage was not caused by vetroyl, due to timing. We had hops that bringing the cortisol down would help with the protein leaking but likely the high cortisol is what caused the damage.

It doesn't matter, because no matter, what one does, you always tend to, being human and all, look back and say, what if I didn't do this or if I did that. The thing is that non of us knows what would have happened if the decisions had been different. Things could have just as easily been even worse instead of better, so don't go down that path. It won't help. I know.

You all are right of course; it doesn't matter whether it was Cushing's or vetoryl and likely it will always be speculation; the IMS thought Vetoryl because of the timing, i.e., the kidney labs have been normal for the past year until when we restarted the Vetoryl The student called this morning to say that they have confirmed that Skippy has an infection; the student doesn't know if the infection is bladder, urinary tract or kidney. They are treating him now with antibiotics. A major, perhaps fatal problem is that each time they reduce the BUN and Creatinine to near normal with the fluids and then reduce the flow, the numbers jump back up to acute levels. Skippy is eating, drinking and peeing still. The student said that the IMS and Scott-Moncrieff are working on a treatment plan, whatever that means. I know nothing but will go see him this afternoon.

Oh poor little guy & you too Carole. It must be so hard to be away from him during all this. Marianne and Sharlene are so right about beating yourself up over decisions you have made. I went through it, still am. "Should I?, what if we had?, maybe we shouldn't have?" over and over. But we do the best we can with what we have at the time, and in our cases, all decisions are made out of love. So there is no right or wrong answer, and all of us are here for you! Enjoy your visit with your sweet boy, and extra belly rubs and hugs from me & Tex too.
Annie

I really think that once the infection is gone the creatinine and BUN will drop down to more normal levels and stabilize. Sending huge loving hugs. Please stop being so hard on yourself, it is so very difficult making treatment decisions for our precious pups and most definitely those decisions are made with the deepest love we have for them. You are being an exceptional advocate for your boy.

I went to see Skippy again early this morning . He is a bit disoriented but was glad to get out of there for his fifteen minutes off the IV. I took him to a field close by for a walk; it was raining but he walked and then ate the small pile of chicken I brought him. His Creatinine was down to to 2.1 but BUN still over 100. Tonight the IMS called to say that she is going off clinic rotation and another IMS Doc will be assigned tomorrow. She has been consulting with the nephrologist and he says "patience". "Don't throw the book of meds at Skippy; let's see if the culture indicates that we are treating him with the correct antibiotic." Every time they try to lower the flow of fluids his blood values skyrocket and the IMS doesn't know why. I was pretty distraught and said that I don't want to continue to torture Skippy. The IMS suggested that I come over and
"look at Skippy tomorrow" to make a decision about whether to go forward. Of course, I will go over but what am I supposed to see?? The same Skippy that I saw today? I am going to try to reach Scott-Moncrieff in the morning to have a straight conversation. I don't know if everyone there speaks in code or if they don't actually know what's going on with him. If you all have any wisdom I would deeply appreciate your thoughts.

Skippy with you at his side, has fought a long courageous battle. You know him better than anyone. Would he want to continue in this way, or is he pushing through for you? Only you can answer that question. It is the hardest one that any of us ever have to answer.

We remain here for you always, regardless of what you decide to do. I am so very sorry.

Kathy

Oh Carole, I wish I could tell you what to do. Yesterday was 6 months that we said goodbye to Whiskey, it was truly one of the worst days of my life. My vet told us it was time, but more importantly, Whiskey himself told us in a way only he could. But we had a definite turning point and things went downhill quickly. It would be so helpful if the vets you are working with could not "speak in code", as you said, but hopefully you'll have some answers soon.
You're both in my thoughts.

Sweetheart, you know Skippy best of all. Listen to him when you see him and he will tell you what he needs. Know we are with you all the way and trust you as your precious boy does.

Hugs,
Leslie