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

It is always good to have a plan and it does sound like you have one now for Skippy. The research portion is usually the most exhausting nad nerve wrecking.

Let us know what the ct scan shows and when they can expect to start radiation and how many radiation treatments there will be.

Hello everyone and thanks again for your kind words. I met the fourth person in Purdue's oncology department today while leaving Skippy for his CT. She asked that they also do a CT of his abdomen, otherwise they would have to do an ultrasound of it before radiation. They will not likely be able to tell if his macro is larger unless it is much larger as the CT cannot differentiate so accurately between swelling around the tumor and pituitary and the tumor itself. (At least I think that is what she said.) They do use the MRI and somehow integrate it with the CT for developing the radiation plan. It takes a week or more to develop the plan that will involve three treatments, likely next week. I quizzed her again about three versus ????. Again she mentioned his BP but then said that they are confident that they can get a good result with the three treatments. The conversation was a little like debating in English when all you speak is Spanish. Besides, at this point, I have surrendered in respect to recommended treatment. I simply don't know enough to have an informed opinion. I even said DNR regarding the anesthetic.

I can only hope that this experience is less grueling for Skippy than it is for me. My cortisol has skyrocketed. More soon.

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Originally Posted by Carole Alexander

I can only hope that this experience is less grueling for Skippy than it is for me. My cortisol has skyrocketed. More soon.

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Hugs. Remember to breathe.

Hugs from me too. With you in spirit. I'll be praying for both of you.

Four hours, $480, and an xray of Skippy's lungs; he has pneumonia! No CT. Thank you Cushing's. Purdue put him on Clavamox for two weeks. Then recheck, then a CT if he is okay, all stretched out for three more weeks. Cushing's is truly the gift that keeps on giving. The good news until this morning is he has been asymptomatic, no coughing, fever, vomiting, and diarrhea (thought to be caused by the Cabergoline). A few hours ago he declined chicken and kibble, became very agitated and has been panting and trembling. He may be nauseous as he can only settle for ten minutes at a time. Maybe the macro, the pneumonia? I think I need to call Purdue.

Sorry but I only have a second to post right now, so this will have to be short.

Unfortunately, all of the symptoms you describe below are common with a macro. When our pups are unable to settle, pain is often involved.

I am so very sorry.
Kathy

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Originally Posted by Carole Alexander

, became very agitated and has been panting and trembling. He may be nauseous as he can only settle for ten minutes at a time.

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Called Purdue radiology who said dogs with aspiration pneumonia can deteriorate rapidly but I would have to take him in thru emergency medicine. Called local vet who is in surgery; left a message for a call back. Radiology suggested that I watch him today "for awhile". yKathy,
I know that it may be the macro as Clavamox does not have these side effects but I appreciate your feedback. Skippy has stopped pacing, trembling for the time being. I will watch and wait.

Oh my, poor Skippy :(

My dog, Cassidy (Mojo's sister) has a back condition and when it flares up she won't settle. It is so unsettling for me ...

I totally understand how you feel right now - prayers going out to you and Skippy for a pain-free day and some answers.

Please keep us posted.

Thank you Kathy. Skippy has quieted and trembling has stopped. I do fear it is the macro and I may have waited too long.

Thank you Liltara for your kind words. Unless it is a reaction to the anesthesia yesterday, it must be the macro. I'm not sure what I gain from taking him to a vet today. He is drinking, ate a little chicken and took his meds. Trembling and pacing has stopped. Wait and see.

Carole -- I am so sorry that Skippy has to deal with pneumonia on top of everything else. My Abbie recently finished six weeks of amoxicillin after being diagnosed with pneumonia. We went in to the vet every week for the first four weeks for repeat x-rays. Abbie was very lethargic for the first couple of weeks and gradually had more energy. I am glad that the symptoms you were seeing have subsided -- hugs to both of you!

Judy, thanks for sharing your experience; it is helpful. Skippy ate a little but he is continuing to tremor lightly even when lying quietly. He has stopped pacing and panting. I will have him seen tomorrow at local vet who can at least check his BP and temp. I don't really know what else to do but it so hard to watch him trembling and feel this helpless. The Purdue IMS that he sees is on vacation this week and they have no appointments this week in internal medicine, period.

Do you have any tramadol that you could give Skippy for pain? That might help with the trembling.

Kathy, no Tramadol among my multitude of meds for him. I just spoke with local vet; she thinks he is reacting very badly to the Clavamox; she said they rarely use it because it can be so harsh and cause massive pain and digestive upset. I called Purdue back to confirm their diagnosis of aspiration pneumonia; they couldn't confirm, only that he has pneumonia. They then agreed that it could be a bad reaction to the drug and offered to change it immediately. Local vet said to give him a baby aspirin and I'll take him in first thing tomorrow and ask local vet to call radiology regarding the diagnosis. I am incredibly relieved that his condition is not likely macro related. But nothing should be this hard, as someone said. Another day of worry for me and pain for him that we won't get back. I will ask local vet for Tramadol.

Carole -- my vet had me give Abbie two different antacids along with the amoxicillin. In the evening I gave her omeprazole (got best price from California Pet Pharmacy) and famotidine in the mornings. He is actually having me continue the omeprazole for a month after the amoxicillin was finished.

Judy, thank you, thank you. I will ask about these drugs in the morning. I think local vet is inclined to switch antibiotics but may want to talk to Purdue first. Why didn't Purdue mention the Clavamox reaction possibility at 8 am this morning? The answer I think is because radiology is not internal medicine and they didn't want to speculate about what was happening. It is beyond enraging.

oh my gosh, pneumonia! Poor Skippy and you, just can't catch a break it seems.

Hopefully a quick recovery from this and just a minor setback on the journey.

yay Judy for knowing exactly what might help!!

No, no breaks for Skippy, Sharlene. He was seen this morning at local vet. He is weak, lethargic, panting and still trembling at times. He is eating and drinking again. The vet thinks that he has soreness in his disc and panting and trembling are indicative of pain. Now, she does not believe that he is reacting to the Clavamox as that generally results in diarrhea and vomiting. She did not prescribe antacids, instead she put him on Carprofen and gave me some Tramadol. The vet said that Purdue now thinks it branchial pneumonia and only one lobe and/or a tiny part therein is affected. She does not believe that his symptoms are related to his Macro. The good news is that his BP is still lower at about 130, that's about a 100 point drop since April. Don't know what more to say except thank you to everyone; I so appreciate your support.

Carole -- another caution from me based on Abbie's recent history. She has IVDD (interverbral disc disease) and had frequent back leg collapses and a lot of pain upon stimulation of her lower back. I had been giving her tramadol but she was still in pain so the vet started her on Deramaxx. At that point she was only eating a small amount of food -- then, about three weeks after treatment with the Deramaxx started, she stopped eating, stopped walking, was very lethargic and had black, tarry stools. The vet determined that she had an ulcer from the Deramaxx (also an NSAID like Carprofen is). We immediately stopped the Deramaxx, she had two sub-q fluid treatments and tried to get her to eat some easily digestible food. Her stools gradually improved and she gradually gained back some energy.

With Skippy not eating regularly, I am concerned that the Carprofen (on top of taking the Clavamox) will be too harsh on her stomach, especially without having antacids on board. I regret giving you one more thing to worry about but, if me, I would rather be informed.

Oh Carole, I don't have many words.

Hang in there and I pray that Skippy's pain subsides.

Both of my dogs had pneumonia when they were puppies and made full recoveries if that is any consolation.

Please keep us posted.

Skippy ate yesterday with great encouragement and this morning with less; I am continuing to give him the Clavamox and last night I gave him half a Tramadol. He is very lethargic and quiet but he will walk out to pee - no tremoring or panting. Judy, I hear you on the Clavamox and Carprofen. I am really reluctant to give him the Rimadyl and when the vet tried to give me more, I declined. I actually think I threw the last bottle away. Also, I am not so sure about the disc problem being the source of his pain although it was noted on the MRI and they could have pulled something during x ray. I could continue him on the baby aspirin and see if that helps at all. He is such sick boy; I no longer know whether or what to treat. Thanks Liltara for sharing your experience. The vet said that the pneumonia should clear with one round of the Clavamox. We'll see.

Your GP vet does not think that Skippy's pain/tremoring is due to his macro. All of the symptoms that you described previously, are Symptoms of an enlarging macro tumor. Yes, a disk problems can cause similar symptoms, but I would be reluctant to rule out the macro as the source of Skippy's pain. I am glad that the Tramadol seems to be helping.

Kathy

Kathy, I too think his macro could be the source of his pain. The only thing that is suspicious is that the pain began immediately after his trip to Purdue and starting the Clavamox, within ten hours. It would be a remarkable coincidence of timing. Vet was able to elicit a reaction in disc upon physical exam but it was not pronounced. So, we have the Macro, the Clavamox, the potential disc, the pneumonia and Cushing's. If it is the Macro causing the pain, do you know or have an opinion about whether he is still a candidate for radiation? I do know the larger the tumor and the more symptoms it is less likely that radiation will lead to an improved quality of life. And, Purdue may decline radiation and I will have my answer. Thank you for your thoughts.

Carole

Hi Carole,

I am sorry. I cannot answer your radiation question because I am not a vet. I do know that the neurosurgeon that was overseeing buddy's case advised me against radiation. His symptoms were advanced and she didn't feel he was strong enough and that it wouldn't buy him much time. That's really something you need to ask Skippy's vet because each of our fur babies are different.

Thank you Kathy and I will ask radiologists and IMS when I take him in for x rays next week. He is weak after the Wednesday/Thursday episode, but is beginning to return to the old/new normal. I just don't know what to think. Macro, pneumonia, disc, Clavamox, Cushing's or all of the above. He reluctantly walked for a few blocks tonight and is back to ravenous in general. I am not giving him Tramadol or Rimadyl for the time being as he does not appear to be in pain currently.

I remember Buttercup has horrible headaches from her macro tumor and they did the 3 treatment radiation at Davis. (I just reviewed her thread earlier and came across that) It didn't prevent the radiation from being done.

Poor Skippy hopefully he can get over these other issues so the main macro issue an be treated and he will feel better

Thanks Sharlene for reminding me about Buttercup. I too read his thread recently. Skippy goes back for another round of x rays on the 15th. Last night he was panting and restless and while it is hot here, he is in air conditioning. I gave him a Tramadol and he was able to settle. I have an appointment tomorrow with Dr. Scott-Moncrieff, his IMS. I doubt that she can offer any meaningful assessment until after they clear up the pneumonia and he has the CT scan. However, I do want to discuss the incident last week and the question of whether he is currently in pain with the panting and pacing. Thanks for offering a little hope.

Carole -

My dog Cassidy (Mojo's sister) has back disc issues and when she slips one her pain manifests as panting, shaking and inability to lay down and settle. The disc slipping for a dog is very painful and it is always frightening to see her like that.

Her eyes also tell me the story of her pain - glassy.

I hope this helps in some way as you try to assess if Skippy is in terrible pain - each dog is different, and it is so hard with a macro to deal with too, so follow your instincts. You know Skippy better than any vet or person here on this forum.

It would be so much easier if they could just talk to us, eh?

Wishing you and Skippy good luck today and positive outcomes.

Hi Liltara, such a thoughtful and sensitive comment, thank you. Skippy's IMS thinks the pain last week was due to radiology staffr twisting his body during radiographs. (This was also the opinion of the local vet.) Whether they are right or wrong, time will tell. The IMS doesn't feel that Skippy's condition has changed much although the crisis of yesterday was a student finding another nodule in his back leg. They have aspirated Skippy's nodules for Lymphoma several times previously and the findings were negative. However, it continues to be a question and that would mean "game over". While aspiration yesterday was not conclusive, it was not positive. Just too much blood in the draw and not enough fluid to accurately evaluate. Skippy goes again tomorrow for radiographs of lungs to see if we have cured bronchial pneumonia and another aspiration of the nodule. I did state that we must resolve the Lymphoma question before we proceed with CT and they agreed. Skippy and I are both worn down from this journey, the heat, the escalating expense and the uncertainty of it all. But we will both soldier forward. In for a dime, in for a dollar. He is weak and very Cushing's but quite the trooper.

I really don't know what to say, other than repeating myself by saying that I'm thinking & worrying about you & Skippy. You're doing everything you possibly can to help him and he loves you for it!

I have no wisdom to share either, I just wanted you to know that you both are in my thoughts and prayers. (((((Hugs)))))

Annie and Lori, I am pretty much without words too so I will just keep putting my bank card and one foot in front of another, although at times it is feeling like a B movie version of a Bataan Death March. Skippy had more x rays this morning and his nodule aspirated again. He remains on Clavamox as the pneumonia has not completely cleared. Again, the nodule bled and while three vets who examined the discharge could not completely rule out lymphoma, they are fairly certain that it's not. Because they feel that he is clinically stable (relatively speaking) we will proceed with the CT Scan next Monday. They will thoroughly scan his abdomen and lower body to search for lymphoma or anything else. If they find nothing, they will proceed with radiation the following week.

Except for the incident after x rays last week, Skippy is tolerating all of these vet trips incredibly well. I just gave him fresh chicken and meds including Tramadol to try to head off another event. I am so grateful that he is eating. He rides in my lap to and from Purdue which I know is illegal and now my driver's license just expired and I can't renew until I get back to Maryland. But if this is as close as we get to living on the edge, no worries. Thanks for your support.

In spite of my worst fears, Skippy tolerated the CT scan well today, although, it was a long recovery which they say is typical with Macro's. They scanned his abdomen and then did an ultrasound to check his liver, which is enlarged from the Cushing's. They will compare the ultrasound with the one done in December 2016 but they are not alarmed. Radiation will begin next Monday. No Lymphoma on CT or ultrasound. All of this is a gift, for a moment - to Skippy and me...

Carole,

This is wonderful news - so happy to hear that Skippy's CT did not show anything alarming.

These doggies are such troopers ... looking back now, I am amazed at how brave and strong my Mojo was while battling this awful disease. He just took it all in stride as much as he could and with the exception of being totally obstinate when I gave him pills he was a perfect patient.

This is truly a gift we are given when we get a reprieve from all of the bad news that comes with this illness. Enjoy the next few days with Skippy doing all the things you love to do together!

Sending positive thoughts for radiation on Monday and praying it brings some much needed relief to both you and Skippy.

Oh I am so glad nothing untoward was found on the US! Now all you have to do is hold on til Monday. Do that one breath at a time if need be and love on that sweet boy every second you can. We are here anytime you need or want to chat but we also understand Skippy is your priority right now...as he should be. ;)

Hugs,
Leslie and the gang

Beaming all my positive thoughts and well wishes your way, too! Skippy is such a trooper and you have been working tirelessly, Carole, to grant him the best possible care. I surely will be hoping for the best possible result on Monday!

Sending gentle hugs to you both,
Marianne

Liltara, Leslie and Marianne, thank you for posting, your comments are so kind, supportive and thoughtful. I have avoided this site all week as I've been trying to stay focused on the task ahead and not be emotional about it all. Skippy remains stable, but weak, mostly quiet and very much into himself. His appetite is steady and all of his Cushing's symptoms are in full flower. He now has his own personal small floor fan that he parks himself in front of. His belly is gnormous and I think he has gained three or more lbs. in the past several months, either bloat or food.

If I understand what Purdue vet is saying, there hope is that radiation will at least sustain the tumor at its current size, possibly shrink it and reduce the swelling around the tumor so as to diminish the neurological symptoms, until it starts to grow again. Mostly, I'm pretty stoic at this point as it is his only viable shot for an improved quality of life. I don't know how I'll feel if he doesn't survive this or if it has no effect but I'm trying hard to move to a point of acceptance. While I have often called Skippy "Flower" over the years because he has such fine features and at times appears so delicate, in reality he was a very tough boy. I hope that toughness is still in there somewhere. I'll let folks know how he does and thanks again for your many kind and helpful thoughts.

Carole

I can't help it- I'm laughing out loud at the thought of Skippy in front of his fan. So so cute, I can just picture it. Such a little trooper he is. Thinking of you & sending hugs.

Thanks Annie and I hope you are doing okay and getting ready for Italy. If I can figure it out, I'll post a photo of Skippy with his chubby belly and his fan. He is a sight!

Carole - oh, my heart is breaking for you. I felt the same during Mojo's journey and it is soul crushing.

They are so much stronger than we ever think - Skippy is a little warrior and I wish you both the best outcome possible from his radiation treatment. I hope it brings him some much needed relief.

You are in my thoughts.