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

I hope Skippy is feeling better this morning!

My thanks to all of you for your concern about Skippy; he is a little better as he has returned to eating with the offer of very enticing food and stopping the Vetoryl. All of his behavioral (neurological?) signs continue but slightly different from when he's on Vetoryl. Purdue called yesterday to check-in; IMS agreed with stopping Vetoryl until he's seen next week. Purdue does have an MRI clinical trial underway but don't know if Skippy would be eligible. Finally, I contacted Holly on this forum as she is the one owner who I could find whose dog underwent radiation successfully. She said she is travelling and will respond this week end but that Skippy's symptoms were "remarkedly similar". And, of course there is the possibility that he has a malignancy in some other part of his body.

I wish I had clearly understood three months ago what a good response to Vetoryl looked like. But that's my bad and we are where we are. I pushed as hard as I thought I could, but...Thank you again and I'll post when I know more.

Carole -- so glad that Skippy has decided to eat again. I hope that the IMS has good insight into Skippy's issues.

It doesn't hurt to ask about the MRI clinical trial. All they can say is no.

Well if we all knew what we needed to know at the beginning of this journey, it would have been easier for sure. Even reading what it Should look like or what one hopes it will be, then has to be applied to what is and that can be darn difficult.

You are doing a great job with the hand that has been dealt and that is all you can do. One day at a time.
Hugs!

Thanks Sharlene, I wonder how many times in our lives that we wish we were smarter, more knowledgeable, wiser and sooner. Such is life. But I am so thankful to all of you on this forum for your wisdom, support and experience. You all have helped to advance my knowledge light years. While I know that the next chapter in Skippy's life is likely to be the last one, I have learned so much and on his behalf, I am grateful beyond words.

Hi Carole, you and Skippy have been on my mind. How did the appointment with the specialist go yesterday?

Laurie

Hey there, checking in on your and Skippy!!! hows it going?

Hi Laurie,
Thanks for asking about Skippy and I’m truly sorry that you can’t find a pred dose to help make Charlotte more comfortable; I so appreciate and share your struggle about what to do next. What follows is a lengthy Skippy update:
Relative to last week when Skippy wouldn’t eat and looked as if he was dying, he is vastly improved. The tremoring has nearly stopped; he is walking again, interacting more and is willing to engage a bit. Also, Purdue thinks the adenoma on his butt is actually smaller. Go figure. But, lest anyone think this is a radical transformation, Skippy is far, far from my dog of six or eight months ago in respect to his cognitive and behavioral functioning. And, of course, off Vetoryl, the eating, drinking and peeing are back to square one…
Dr. Scott-Moncrieff saw Skippy and she had carefully reviewed his history, ultra sounds, etc. She had told me last week to stop the Vetoryl and Tuesday she said that Skippy clearly cannot tolerate the drug at any dose. At this point she does not think he has a macro tumor based on his symptoms. (He is eating, no head hanging, circling or going into corners.) But now no barking, lots of lethargy and I still see some staring. He is still mostly distant but is willing to be petted. I ask about senility but got no real answer. Scott-Moncrieff said that 40 to 50% of all dogs with a pituitary tumor will develop a macro.

They examined Skippy for several hours: measured his lymph nodes in six areas as there is some suspicion of lymphoma and they may want to biopsy; they measured the adenoma again, looked at his gait, looked at his belly and the pot has decreased slightly. They took a urine sample and want to secure a baseline cortisol next week. His BP has jumped from 150 to 220 in the last two weeks; they will test again Friday and if still high they will medicate; his heart has a small murmur but otherwise his liver, kidneys and pancreas are okay. Finally, they dilated his eyes and said there was no retinal detachment.
Scott-Moncrieff's recommendation was to try Skippy on Lysodren or to not treat at all if I can endure the Cushing's symptoms. She said that if it were her dog she would not do an MRI yet and she committed to following Skippy and managing the induction if I decided to try Lysodren. I failed to ask whether she thought that Lysodren, if successful, would improve energy, alertness and cognitive functioning or just the PU/PD.

I will watch Skippy carefully for the next three weeks and see how he is cognitively as I really don't know what I will do next. I am tempted to try Lysodren now that Scott-Moncrieff has agreed to follow Skippy. But, I still suspect he has a macro and I'm just fattening frogs for snakes with further chemical treatment. I can live with the PU/PD and I will provide palliative care to Skippy if this is as good as it gets.

Finally, I need to think about whether I request an MRI and would pursue radiation if he has a treatable macro. Last week I was sure. Now, I'm not so sure after doing more reading and my very helpful correspondence with Holly B. (Holly said she would post here, but until she does and in brief summary: after her dog, Nola underwent successful radiation and was great for some months, the Cushing's and new behavioral symptoms have come roaring back-now sadly, Holly is providing palliative care.) Also, for Skippy, the lymphoma must be ruled out but Purdue is doubtful that he has lymphoma.

Emotionally, I have moved from frantic efforts to save Skippy to being stoically determined to learn whether he even can be saved. I am deeply troubled that four different vets strung me along for nearly six months without ever telling me that there was a forty to fifty percent chance my dog has a macro tumor and that chemical treatment would not control his symptoms. An MRI in November or December would have cost little more than the thousands I have spent on Vetoryl and the fistfuls of diagnostic and near weekly stim tests. Because most pet owners will do everything within their capacity to help their Cushing's dog, veterinarians have an ethical responsibility to be honest and clear about the complexity of Cushing's, the limited research, the odds that a pituitary tumor will or has grown, and their own often limited understanding of treatment protocols that may result in harm or the death of someone's pet. I know that pets are merely property in the United States, maybe in other countries too. And, the standards of care are much lower for animals than for people, but in the US alone, we spend nearly 60 billion on pets annually, an estimated 15 to 20 billion goes for veterinary services. I know that veterinary practice is a challenging profession. However, collectively we have tremendous power to demand ethical, skilled and informed care. Whatever Skippy’s future holds, I have now become a highly discerning consumer and fierce advocate. I will not give up without answers and accountability. And, I hope you all won’t either.

I know you will never give up, but that you will make the decisions that are best for Skippy, whatever that might be, pallitive, further testing, treatment, whatever.
I don't think I ever heard that 40 - 50% will have macros. That seems very high. I don't think we've seen that sort of ratio here on the forum, based on the number of members we get, although we have seen a lot, they tend to in general be with the short nosed breeds like boxer, boston, bulldog, etc. As far as an in general statement goes.

You will likely be able to make a decision about lysodren once you know what the cortisol levels are now.

Dear Carole,
Wow, poor Skippy had quite a day! You are an amazing dog mommy and have done so much to help him. How stressful and frustrating for both of you. Since I've joined here, It's just really hard to believe that so many vets have gone through all the years of schooling and experience in their offices and still don't have a clue about Cushing's and the proper dosing protocols. I do believe that Whiskey was misdiagnosed, and somehow survived being on Vetoryl all those months. I hate to think about the small fortune I spent on ACTH tests & the pills, just greatful he survived & that I found this forum which gave me the knowledge to see the signs & stop the drug on my own. I don't even like thinking about it or admitting it, but its true.
Please know that I think about Skippy and you often and wish you both all the best. Sending huge hugs to both of you, Annie & Whiskey