Introducing Doccy question about radiation

HI, I am new to the forum and wanted to introduce Doc. He's my wonderful 12yo Border Collie. We have just been diagnosed with a functioning pituitary adenoma (brain tumor). He was diagnosed by an MRI. As you can imagine, I'm still spinning. The neurologist said it was functioning so that he has Cushing's. We are going to pursue radiation therapy in order to reduce or kill the tumor. The radiation they recommend is 5 doses in a week's time. I am calling tomorrow to schedule this. Doc's symptoms started in July and we had xrays done and showed arthritis in the spine. We just thought we had an old dog. But, he started to do other things like dropping his neck, getting very quiet, drinking a lot and peeing a lot, dragging his nails on walks, and general confusion. They thought he had degenerative myelopathy, but last week confirmed that it is a tumor. Right now, they want to do the radiation then focus on the after support when they get an idea if he needs steroids or not. I have him on Chinese herbs, he is getting acupuncture, and massage. I am so happy I found this forum and so glad there is a community of people who don't think I'm crazy for what I do for my boy. My question is, does anyone have any experience with the radiation therapy and what to expect afterwards? Thanks and I look forward to being a part of this community.

Hi and welcome to you and Doc,

I am sorry for the circumstances that brought you here, but am sure glad you found us. There will be many to come by and welcome you and help you and Doc through this. We have had a few members that have had their pups go through radiation treatment. I am sure they will stop by.

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Welcome to the family, this site is awesome and you will learn a lot.

Hello. Glad you found us - this is a great resource. First off 85% of cushing's dogs have pituitary form (tumors). They are typically teeny tiny microscopic sized non-cancerous tumors that transmit messed up messages to the adrenal glands telling them to create more cortisol when in fact their bodies have enough already. This is what creates cushings.

A very small % of pituitary tumors are classified as macros (meaning larger) and they grow and become invasive to the brain. This is when we normally see radiation therapy being discussed. If not a macro traditional meds are used to treat (lysodren and trilostane/vetoryl)

Tell us more about your dog, the symptoms and the tests that were done to diagnose. We see alot cases and tests are not fool proof so we like to confirm that cushings is really at play.

I understand your fear as I was there once too. Please know that it is not a death sentence and your dog can lead a normal life with treatment.

We have had members do radiation therapy with some success. It is pretty rare here in the US - more common in Europe.

Since treatment using meds is easy and less expensive than radiation I am wondering why your vet is recommending radiation? I know it might be difficult but since it is so rare - if you don't know the answer to the question you need to ask. It'd be like scheduling a stent to be put into the heart to treat heartburn. I exaggerate a bit but you get my point. I just don't want you to rush into something without fully understanding it.

Generally there is absolutely NO rush to treat cushings as it does not pose immediate health risks - just frustrating with the frequent urination.

It is so frequently MISDIAGNOSED that multiple tests are required to confirm in fact you are looking at cushings. Diabetes and thyroid problems mimic cushings symptoms. When a dog is ill their cortisol is high as their bodies fight other illnesses and can cause false positives on cushings tests.

That is why we IMPLORE new members to share with us all tests done to diagnose.

I've rambled enough - sorry... just really want to make sure we get all the info. Here's a link to some intro info on this disease.

Kim

http://www.k9cushings.com/forum/showthread.php?t=180

Hello and welcome.

It sounds like the MRI must have diagnosed a macro tumor if they want to do radiation. Can you confirm that? If it isn't and it is just a very small one, microscopic size, then normally they would treat with either trilostane or lysodren.

You have come to a good site to get support for whole cushings experience. I hope some of the members who have gone through radiation will stop by and give you their take on the issue.

Sharlene and Molly Muffin

As Sharlene says, I'm guessing that the MRI has indicated that your dog's pituitary tumor is large enough to be causing the neurological problems that you are describing, and that is the reason why the radiation is being recommended.

Historically, conventional radiation for these types of tumors involved approx. 12 treatments spread over the time period of a month of so. We are aware that newer, experimental protocols are being introduced at different centers around the country, especially in conjunction with some of the cutting-edge "cyber" treatment technologies. If your specialists are proposing a single 5-day series of treatments, I'm guessing they are talking about one of these newer types of treatments. If so, if it were me, I'd want to know the specifics as far as how many of these procedures have they performed and what has been their success rate.

In the past, the goal of radiation treatment was to reduce the size of the tumor and eliminate the neurological symptoms, as least for a time. Conventional radiation could not remove the tumor entirely, so over time, the tumor did regrow. However, some dogs were free of the need for Cushing's treatment for an extended time period. So this was a bonus in addition to alleviating the neurological problems.

Bottom line, as I say, I'd want to make sure that the specialists who are proposing the radiation treatment are experienced and have had good results with the protocol that they are recommending to you.

Marianne

Hi, I can offer no words of advice in regards to radiation, but I can say welcome. And you are right, you found a place where everyone understands and doesn't think you are crazy for treating Doccy. The truth is we are all equally insane and would do anything for our babies, so have no worries, we get it.

Good luck with everything, I look forward to hearing more about Doccy and his progress.

Hi Everyone and thanks for the welcome. A little more information:
Doc's tumor is a macrotumor that is causing some pressure. We were diagnosed and will do the treatment at University of Florida. His cortisol is elevated as is his ALT (SGPT) and Alk Phosphatase. The MRI clearly showed the tumor in the pituitary, the ultrasound showed some nodules on liver and spleen (which came back normal). As for the 5x, they feel that they can do the therapy with 5 doses instead of the traditional 20 or 30. They recommend this to cut down on the anesthesia risks. They have a good success rate in shrinking this type of tumor. The mean life expectancy is 18 months with ~68% of dogs living beyond the mean. They are not sure just how "functioning" this tumor is, so they are waiting for any treatment in that regard until they do the radiation. They have put him on Chinese herbs to include an antioxidant formula, arthritis formula, and cancer formula, along with Stasis mansion of the mind. We go down Thursday for the catscan to start the process for the radiation plan. They are giving him 3 months to live with no treatment due the pressure that the tumor is causing on the brain. I'm glad I found this out because he's been essentially living with a headache for months which just kills me. The neurologist is fairly certain we will be dealing with treating cushings after they try to shrink the tumor.

Are there any other questions I should specifically ask them? Any more I need to answer here? My mind is all over the place--we found this out last Thursday (17th).

I am so glad I found this site. Some family and friends have expressed that I'm wasting my time and money and it really is just so hurtful that they can't understand the love that I have for him and that I will do anything to help him. Thanks again for being here to all of you.

I am so happy to hear that Doc is being seen at Florida. The fact that the treatment will be conducted in a university setting puts my mind at ease. And yes, limiting the amount of anesthesia is an enormous plus.

It does make sense to me that they are postponing decisions re: cortisol control until after the procedure. Doc's entire hormonal picture may change radically one the tumor is reduced.

So in honesty, I can't think of any other questions right now. But we will be anxously awaiting any and all updates, because you and Doc will be pioneers for us all as we continue to learn more about newly emerging radiation treatment options. I'm so sorry you are having to deal with this, but we will be right beside you every step of the way!

Marianne

We have had a couple of members who moved forward with radiation for their pups. I found one of the threads which I've provided the URL below. This particular pup, Tessie, had radiation in September 2009 at a very senior age of 15 or 16. An MRI done over a year later showed no sign of a pituitary tumor so radiation was a complete success. It was a bit of a recovery but Dottie did get her old Tessie back. Sadly Tess passed of renal failure about two years after radiation.

http://k9cushings.com/forum/showthre...ight=radiation

Glynda

Thanks for the info. I know from reading here that the U of FL has an AWESOME group of vets/surgeons. I am relieved they are involved. Kim

Oh yes, I agree with everyone else, very glad that you are having this done at U of F.
It's also true, that you don't know if there will be any cushings symptoms afterwards or not. It depends on how much the radiation shrinks the pituitary tumor and how active that tumor was involved in cortisol production.

It's a good start that things are moving fast since the initial findings last week.

Sharlene and MollyMuffin

Glynda, thanks for posting the thread about Tess. While she went through a lot, it really was positive to read and Dottie was a hoot. Doc and I are headed to UF tomorrow for the catscan to start the radiation plan and then if all goes well for radiation Monday through Friday. I'm so so so nervous, but in my heart I feel I'm doing the right thing. Thanks to everyone for caring and I'll keep everyone updated with Doc's journey. He's my brave, little bubby.

Good Luck!!! We'll all be hoping for the very best!!!

Sharlene and Molly Muffin

Hi Guys,
Doc and I joined here a couple of weeks ago. We were just diagnosed with a pituitary tumor (macroadenoma). We decided to undergo radiation. He had stereotactic radiation. 5 doses. Everything went well last week. Doc had no issues with anesthesia and he was even really pepping up on Thursday. He tore out his IV chewed up the bandages and put all pieces and IV in his water dish. Then when they opened his kennel on Friday, he threw the water dish at them. Now that is my Doccer. :p I picked him up on Friday and they really are quite surprised at how well he is doing. They are very optimistic. They have put Doc on prednisone to combat the swelling from radiation. He is responding well. He will be on that for 1 month at the current dosage (20mg 1x/day). Doc weighs 50lbs. Then if everything is going well, we will wean him off the pred over the following 2 months. So...he will be on it for at least 3 months. The want to do the ACHT (not sure of spelling) test after he is off prednisone. They are fairly certain the tumor is functioning, but they feel his Cushing's will be mild. But time will tell that. We get another MRI in three months to see if the radiation was successful at shrinking tumor. Sooo....on to my question. He is really drinking, eating, and peeing ALOT. What do you guys do to mitigate this? At night, he is up 2-3 times during the night to pee (he's never done this before) and he pants and seems a little restless (unless he's just eaten). Do you give snacks in the middle of the night? I don't want to make him gain too much weight, so I have taken his normal food amount and I feed him 3x a day with a snack in the evening. Should I give him a snack right before bed and then one of the times he wakes me up? Should I pull his water at some time in the evening? It just seems mean to pull water if he is so thirsty. Not sure what to do here. Also, will this throw off his electrolytes? Thanks for any input. I know being on prednisone seems counterintuitive for cushings, but they said he would need it for the radiation swelling. Thanks everyone and thanks for caring about Doccy.

Just wanted to let you know I've added your newest reply to your original thread. This way, all your history and treatment info will be housed in one place. ;)

Marianne

I just want to say welcome to the group. It sounds like Doc's surgery went well, however, the symptoms sound very cushing like. I am too new and not qualied to give any advice or suggestions, I will leave that to the others who are more qualified than me. Just wanted to welcome you to the forum. It is such a wonderful supportive group with a wealth of knowledge.:D
Hoping you find the answers and a good solution so Doc may get back to being a healthy happy pup.

(((Hugs)))

Sharon, Norman and Millie

Thanks Marianne. I wondered about that and wasn't sure if I needed to do a new thread or not. Thanks Sharon, Norman, and Millie. He is so much more himself that I truly feel blessed and I'm just living in the joy of having my pup back no matter how long or short it lasts. :-)

Quote:

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Originally Posted by Doccy

Hi Guys,
Sooo....on to my question. He is really drinking, eating, and peeing ALOT. What do you guys do to mitigate this? At night, he is up 2-3 times during the night to pee (he's never done this before) and he pants and seems a little restless (unless he's just eaten).

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For the increased urination, would pee pads be adequate?

Quote:

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Originally Posted by Doccy

Do you give snacks in the middle of the night? I don't want to make him gain too much weight, so I have taken his normal food amount and I feed him 3x a day with a snack in the evening. Should I give him a snack right before bed and then one of the times he wakes me up?

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You could give some low fat snacks such as carrots and/or frozen green beans.

Quote:

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Originally Posted by Doccy

Should I pull his water at some time in the evening? It just seems mean to pull water if he is so thirsty. Not sure what to do here. Also, will this throw off his electrolytes? Thanks for any input. I know being on prednisone seems counterintuitive for cushings, but they said he would need it for the radiation swelling. Thanks everyone and thanks for caring about Doccy.

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One never wants to restrict water, dogs that have Cushing's or that are on prednisone do have increased thirst and urination because the kidneys are working harder. Since the kidneys are doing more work (peeing) the dog needs to drink more water to keep up.

Glad to hear that Doc is doing well and you both will be in my thoughts and prayers.

Love and hugs,
Lori

Hi Lori,
Thanks for the reply. I have a washable pee pad and I will try to see if he'll use that. He's always been adverse to getting on anything like a towel or bed, but I'm sure I could train him to the pee pad. Right now, I'll just get up at night as needed and let him out. Thanks for the tip on the carrots and green beans. I'm not pulling his water and he seems to be "thirstier" some days. He also drinks more at work (he goes to work with me) than at home. We're just adjusting to our new schedule. Hopefully when they start backing him down, this will get better. Thanks again!

Hi Doccy. You'd asked what might be causing the excessive thirst, hunger, etc after the radiation treatment. You mentioned that he's on prednisone to reduce swelling. That can also cause all of these symptoms you describe. (My furbaby Dudley had all of these symptoms when he was on Prednisone for a herniated disc; in fact, I think he drank more water on the Pred than when he was diagnosed with Cushings.) Once you have weaned him off of the steroids, assess his symptoms again with your vet to see if you need to treat for Cushings.

Hi,
I am so excited for you & Doccy. Seems like things are going really well. I love hearing this!!

Amy

I missed your post that the radiation had been completed! :o That is great news and I LOVED the bit about Doccy throwing his water bowl at them! :D:p LOL That is priceless!

I so hope the radiation was a success and accomplishes what we all want to see - that tumor shrunk to nuttin'! ;) It's great that he is feeling so well so soon after the procedure and I hope that trend continues.

With the pred on board, you can expect those cush signs unfortunately but Lori gave some great answers, as usual, to your questions. Don't hesitate to ask anytime...someone is bound to have some input. ;)

Keep in touch and let us know how things are going.
Hugs,
Leslie and the gang

Thanks everyone. Doc is doing well. He's been a bit wobbly, but they said to expect his same neurological signs as before. The goal is to stop the tumor from growing. The hope is to kill the bugger. I'm just dealing with the extra bathroom breaks. He's had some accidents in the house, but that is what my carpet shampoo machine is for. He has been really good about getting me up gently to go out in the night and I am just going to adjust to what I need to adjust to. The drinking and eating seem to wax and wane. We have our 2 week follow-up this Thursday. The real news won't come until we get an MRI in 3 months. Hopefully they will start to wean off of the pred in about 2 weeks, so I may see a lessening of the symptoms, but really in the end, I'll just do what I have to do. BTW, it never would have occurred to me to give frozen green beans. I love this site for all the great advice! (and support).

Great news. I too hope it is gone at the 3 month MRI. Do they think the neurological signs will ever disappear if the tumor goes?
Yes, once weaned off the prednisone then hopefully the water/peeing will slow down too.

Sharlene and Molly Muffin

Jessica-Hope everything is still going great with Doc. How did the 2 week check up go?

This is really interesting, hope all is going well with Doc and his post treatment recovery, love to hear how he is doing and hope the checkup went well!
Trish

Hi Everyone,
Doc is doing really well with his treatment. We had the 2-week follow-up on Valentine's Day. He is exceeding their expectations and they are very surprised and happy with how well he is doing. He is pretty much back to his old self. He stills has a little bit of atxia on uneven surfaces, but otherwise he is alert, playful, and energetic. He does have a yeast issue on his paws so I have to wash twice a week with oatmeal shampoo, and he is having some pain with arthritis that we are treating with Tramadol (1/2 dose). He's still on prednisone and we will start backing that off this week maybe. We are at a critical time as he may start to have some swelling, but overall he seems ok for now. We go back beginning of May to get blood tests and another MRI to see if the tumor has shrunk. They said not to be dismayed if it hasn't shrunk that the fact that he has reversed most of his neurological symptoms is good. We'll see. I'm afraid to jump for joy that it will all be taken away from me, but I am so happy. I can't say enough about the staff and care at UF. They are top notch and they really do care. I'm happy we were able to go there. Turns out they and University of Colorado are the only ones who do the stereotactic radiation. I just feel blessed right now and each and everyday I get to spend with my Doccers.

What a great update on Doccy! :):cool::) I can only imagine how happy you are to see him acting so much better and I hope the test that is coming up gives you more reason to rejoice. Keep in touch and let us know how things are going.

Hugs,
Leslie and the gang

Doc has had a really dry nose the last few days. I don't think it is an infection but I want to treat it before it cracks and becomes one. Do any of you have any suggestions for what to put on it? Olive oil? Afraid to put vaseline on it because it is petroleum based and he's sure to lick it off. Thanks!

Moderator's Note: I have merged your latest update on Doc into Doc's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other member's to refer back to the pup's history, if needed.

Although I think the vaseline would be fine, Vit E could be used.

I would just keep dotting water on Tia's nose and that seemed to do the trick. I don't know if it means they are dehydrated but I noticed it more after she hadnt had a drink for a while

Hi Everyone,
Thanks for the advice on Doc's nose. I did put some Vit. E on his nose and it seemed to help, even though he licked it off. On other news, we backed off the prednisone by 1/4 pill (1 pill is 20mg). He seems to be doing fine, but is a touch more quiet. Not sure if it is his arthritis or pressure from the tumor. Trying not to obsess since he is alert, wanting to play, walk, etc. Having to keep him in check with activities because of the arthritis. But, just wanted to give an update. We are one month since radiation and now we are starting the slow progression of getting off pred. Have a follow-up with UF in a week and every two weeks until another MRI in May. In any event, thanks everyone for the great advice and for the support.

awww, poor Doc. Hope he feels better. It's always a bit hard when you start lowering the prednisone. They get use to it, they feel good with it, so it's an adjustment with each decrease. :( I know I had my golden on it for a very long time, any decrease and she didn't feel like herself. Hopefully the decrease stages will pass quickly. He's come so far and is doing so well. He's an amazing guy.

hugs,
Sharlene and Molly muffin

Hi Guys,
Just wanted to give everyone an update. We've progressed to the second stage of backing down the Pred. He's on 1/2 pill each day now. He seems to be doing ok. I've started giving him Tramadol each night for his arthritis and he is responding well. I have to constantly keep asking him to "rest". His old Border Collie self is back (obsession with toys). His peeing/drinking symptoms seem to be come and go given the day but the eating and desire to eat are still there very strong. Haha. His nose is still dry, but it is getting better. On our last visit to UF, they talked to me about the weight loss, (they want him to lose 4 pounds). I had to laugh and said to them that they must think he is doing well if they are getting on to me about his weight. The Dr. laughed back and said it was true. I take it day by day, but am still very grateful for this board and all the support on here.:D

I was just reading some of your posts and wondered if you could kinda explain what you mean when you said your pup drops his neck. Simba will turn his head in a odd way sometimes so wondered if that was the same..

Such awesome news!! So happy to hear that Doc is on track. Love that!

hugs,
Sharlene and Molly Muffin

YAY! Doc and Mom! :):cool::):cool: That is so good to hear and I hope he continues to improve each day that passes. I can just imagine how happy it must make you to see him playing with his toys again. That is just wonderful! :)

Hugs,
Leslie and the gang

Great news about Doc. Hope it keeps getting better.

HI Letti and Simba,
By dropping his head, he would lower his head below his shoulders as he walked. The neurologist said that it can be a sign of neurological problems, headaches, or just not feeling well. It was noticeable for Doc since he holds his head high with alert ears usually when walking or going anywhere. Not sure what you mean by "odd"way but I can tell you that Doc was not "turning" his head. It just appeared like his head was too heavy for him to lift. After his radiation, he's been on prednisone for swelling and I give him tramadol at night for his arthritis. He's not doing the head droop thing anymore. Have you talked with your vet about the head turning? Sending good vibrations Simba's way!

Hugs,
Jessica and Doc