Mojo-Cushing's/macroadenoma - sweet Mojo has crossed The Bridge

[liltara]

Hi Everyone,

I am new here as a posting member but not as a researcher! I've been using this site as my font of information every since my dog Mojo's diagnosis with Cushing's in August last year.

I am posting today because after countless frustrations and stress I am finally at a point where we understand what is going on.

In the interest of not writing a novel, suffice it to say that Mojo (9.5 years old) probably had Cushing's/macroadenoma for several years prior to our diagnosis. As with almost everyone else here, I started to notice things but never put together the whole puzzle until the pd/pu started to become bothersome.

Anyway, he was started on trilostane and it's been a roller-coaster. He did ok for a few months on it, but it became increasingly difficult to manage his inappetence while on the drug. I became exasperated and finally called Dechra and opened a case with them to try and figure out what the deal was - no dosage seemed to work consistently and every time he would become anorexic.

I am posting today to share a few things: first, the Dechra vet tech services team is AMAZING. They assigned Mojo a case number and we've been in consistent consultation to try and get him on a good dose. Second, it was the doctor at Dechra who FINALLY said that she suspects a macro adenoma considering all of the symptoms, but mostly his inappetence every time we seemed to be hitting our stride.

She explained that the trilostane controlling the cortisol likely reduces the anti-inflammatory response and the tumor begins to swell because it is no longer being "anti-inflamed". Since the pituitary is adjacent to the area that controls appetite and vomit response, when the tumor swells (when cortisol is controlled) it interferes with those responses and hence the inappetence and sporadic vomiting. Eureka! This makes perfect sense and matches his symptoms.

So,from what I can see on other posts in this thread many have encountered similar frustrations when trying to treat Cushing's and macroadenoma. I thought this information could be helpful for others - for me, the most stressful part of this journey has been trying to manage the inappetence. Now at least I understand what is happening and I know it is not just a side-effect of the medicine.

Mojo is still with me and we are managing as best we can. He continues to decline and all seems to be in line with the progressing macroadenoma. He is off the trilo for now and we are managing his symptoms the best we can. He is not suffering terribly at this point, but I do see the end is coming. Probably sooner than I am prepared for but then again are we ever really prepared?

I might try some prednisone to help with his symptoms (counter-intuitive, I know but it makes sense to try and shrink the tumor a little for his comfort) but other than that, we will not be taking extreme measures. Radiation therapy at this point would be cruel - he is very weak and the drama of weekly car trips and anesthesia is not fair to him. We are enjoying every minute and taking it one day at a time.

This is an awful disease and I am grateful for this forum. The wisdom shared here has helped me so much during this journey ... and it has provided me with a platform of knowledge so I know what to expect as Mojo heads toward the rainbow bridge. Thank you for helping us!!!

[Harley PoMMom]

Hi and welcome to you and Mojo!

You will see that I have taken the liberty of copying your reply from our Macroadenoma thread where you originally posted, and I instead shifted it here to create a new thread that is your very own. This way, it will be much easier for our members to reply to you directly.

Thank you so much for sharing Mojo's Cushing's journey with us, and I am happy that we were able to help in some way but I am sorry for the reason that brought you here.

Cushing's sure is a frustrating and terrible disease and one that I so wish that our sweet babes didn't get...it's definitely a roller coaster ride.

Re: the prednisone; I believe that the primary concern for our furbabies is their quality of life and on the forum we have seen where prednisone usage is recommended when a dog has a macro to help relieve some of that swelling.

I want you to know that we are are here for you and Mojo and will support you both.

Hugs, Lori

[labblab]

Hi again! I'm so glad Lori went ahead and set up this thread for you. I'm going to go ahead and also add a portion of the reply I already posted to you on the "Macroadenoma" thread. That way, it will be in both places, too!

One additional thought that I might add is that some neurologists have chosen to give Cushpups suffering from macrotumors a combo of both trilostane and prednisone, which truly seems counterintuitive. But to the best of my understanding, it is for this reason. In situations where a steroid is thought to be helpful in reducing swelling and inflammation, you want it to be dosed in a consistent and predictable way. That means that for a dog with Cushing's, you may want to make sure that the dog's own cortisol level remains under reasonable control before adding in the supplemental steroid. Otherwise, the natural cortisol can elevate by leaps and bounds, and you have no idea whether or how much supplemental prednisone to be adding into the mix. As I say, just one more thought to add.

Marianne

[liltara]

Thank you for a special thread for my Mojo!

I am so grateful for your replies - and I am going talk to my vet about trilostane and prednisone together. It is unconventional for sure, but it makes medical sense if you really think about it.

He has good days and bad days - just going to be working to make more good than bad as we deal with his palliative care.

He's given me so much joy and happiness the least I can do is make his time here as comfortable as possible.

[Carole Alexander]

Thank you for posting your experience with your efforts to treat Mojo with Vetoryl as I too am struggling to figure out an accurate diagnosis for my dog, Skippy; he was treated with Vetoryl for about five months after the pituitary Cushing's was confirmed. PU/PD improved but his cortisol was never under control and increasing doses caused extreme trembling, generally unwell, and finally refusal to eat. He has other behavioral/cognitive symptoms on and off Vetoryl but they are not typical of a macro as I read about the condition, e.g., no circling, head hanging, standing in corners. Mostly I see extreme lethargy, dullness, distancing, sometimes reluctance to walk, little interaction unless he wants to eat, go out or have a treat. His IMS doesn't think he has a macro, I am less certain. Off of Vetoryl, Skippy's BP skyrocketed to 220 and he is being treated for that. We go back to the IMS in early April but I am not sure where to go now. The IMS is recommending Lysodren.

What symptoms did Mojo have that led you to the macro conclusion? How is he behaving now? How was he on Vetoryl; was his cortisol under control? I know macro symptoms can be very subtle and nuanced but many Cushing's symptoms are very similar. I would really appreciate any additional detail that you could provide as I have become obsessed with figuring this out and am reaching the end of my rope. Thank you so much.

[liltara]

Hi! I am so sorry to hear about your Skippy and I sympathize with your frustration. This is a terrible disease and very upsetting for dog parents.

Re: your questions - basically, the macro diagnosis is one of elimination and not confirmed with an MRI. The continued difficulty of Mojo's inappetance when on even minimal doses of trilo was the main symptom that led to this conclusions. Based on my daily observation of him I concur with this diagnosis but I will never know for sure.

Mojo doesn't have the circling but he does generally just space out sometimes. He also exhibits all of the symptoms you listed down to the letter.

He is currently on 5mg every other day of trilo just to see if that will help a little with the pu/pd - this is an unorthodox approach but the vet scientist at Dechra recommended this based on Mojo's unique case. So far, I am seeing slight improvement and it is not causing inappetance so I will stick with it for a while.

For us, after so many months of frustrations we are managing his symptoms as best we can and learning to live with our new normal. It is challenging but we are enjoying each day and I've let go of my obsession to figure it out - it was all consuming and stressful. I am content with the likely diagnosis of a macro as it makes logical sense to me based on what I've learned and what I observe. It might not be the case, but for whatever reason Mojo just can't tolerate trilo at therapeutic doses.

I hope you find a place with Skippy's treatment that helps him as much as possible and allows you to enjoy spending time with him vs managing his illness all the time. I was literally obsessed with trying to find the perfect treatment that I was not enjoying the time I have with my little man. This is such a terrible illness and it really does deeply effect us.pet parents.

[liltara]

Carole - I continue to follow Skippy's journey and I am still inspired by your commitment to his care and quality of life. Had I known at the beginning of Mojo's journey that the trilostane would hasten the growth of his tumor, I would absolutely have considered radiation (no matter what the cost).

Common sense and my research tells me that the future of macro treatment does not include Vetoryl as a first line of defense and that radiation or other tumor controlling/shrinking treatments will be at the forefront. Of course, there is much research to be done and such but having watched my Mojo go through the disease progression I can say with full confidence that macro treatment must be considered differently than controllable (typical) Cushing's.

That said, I just wanted to post one last time here and say how much I've appreciated the support that you and others gave me during my darkest days with Mojo. I do hope I was able to return the favor in even the smallest way.

Coming here now, at this point in my grieving process, is not positive for me - I am finally thinking of Mojo with smiles and not tears (at least not every day!) and visiting this site reminds me of the great sadness I experienced during the late stages of his illness. I am eternally grateful for this site and will keep it bookmarked for future use if I should ever, God forbid, have another dog afflicted with this terrible illness.

I will continually pray for Skippy and you - I wish you both the best of days and experiences and happiness as you continue your journey together. You are what all pet parents should be, Carole.

[labblab]

Carole - I continue to follow Skippy's journey and I am still inspired by your commitment to his care and quality of life. Had I known at the beginning of Mojo's journey that the trilostane would hasten the growth of his tumor, I would absolutely have considered radiation (no matter what the cost).

Common sense and my research tells me that the future of macro treatment does not include Vetoryl as a first line of defense and that radiation or other tumor controlling/shrinking treatments will be at the forefront. Of course, there is much research to be done and such but having watched my Mojo go through the disease progression I can say with full confidence that macro treatment must be considered differently than controllable (typical) Cushing's.

That said, I just wanted to post one last time here and say how much I've appreciated the support that you and others gave me during my darkest days with Mojo. I do hope I was able to return the favor in even the smallest way.

Coming here now, at this point in my grieving process, is not positive for me - I am finally thinking of Mojo with smiles and not tears (at least not every day!) and visiting this site reminds me of the great sadness I experienced during the late stages of his illness. I am eternally grateful for this site and will keep it bookmarked for future use if I should ever, God forbid, have another dog afflicted with this terrible illness.

I will continually pray for Skippy and you - I wish you both the best of days and experiences and happiness as you continue your journey together. You are what all pet parents should be, Carole.

Dear liltara,

I saw that you had posted this very sweet closing note on Carole's thread earlier this morning, and I have placed a copy here on your own thread, as well. It is such a fitting tribute to sweet Mojo, and also a tribute to the loving support that you've so kindly provided to so many others here.

You and Mojo will forever remain treasured members of our family. I totally understand why this chapter is closing for you. But if you should ever wish to return in the future, we'll always be here to greet you once again with open arms.

All best wishes to you, always. And please know that sweet Mojo will forever remain in the loving memory of our K9C family.

Marianne