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Thread: Kashmir - Cushpup with possible macro adenoma (Kashmir is now free)

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    Join Date
    Jun 2019
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    Milwaukee, WI
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    Default Kashmir - Cushpup with possible macro adenoma (Kashmir is now free)

    Hello everyone, I'm new here and hoping to benefit from the support and the wealth of collected knowledge I'm finding on this forum. My dog Kashmir is an approximately 12 year old Chow/Heinz 57 mix who was diagnosed with Cushing's in 2017. He was started on Vetoryl and over the next ~18 months the dose was continually reduced based on his ACTH-stim results to avoid over-suppression. He did end up having 2 Addisonian episodes anyway; not full-on crises but stopped eating his food and lost weight (he had extra to lose at this point), yet bounced back quickly with a round of prednisone. After the second episode last fall, he was taken off Vetoryl completely and his February stim test showed him within normal ranges. Even with the constant testing and subsequent adjustments, Kash did well on the Vetoryl and things were good through December 2018.

    Early this year Kash seemed to start losing his spark, was more lethargic, slept more, and wagged his tail less and kept it down instead of curled over his back. He also started panting more again and his belly was more distended, and he got tired quickly on our walks. Around mid-April his appetite started to dwindle and has steadily gotten worse, although I keep enticing him with new things and so far I'm able to keep him eating.

    In April we went to his regular vet for his annual checkup; blood tests showed a low thyroid but everything else looked good. So he started on 0.4 mg of Levothyroxene twice per day. It seemed to help energize him a little at first but he quickly plateaued and regressed. He has also started drinking more water again although not to the degree he did prior to the Vetoryl. Most of the time he just seems zoned out and blah. He sleeps a lot, can be a bit wobbly, has a little trouble navigating stairs, an occasional stumble here and there...

    Because of my gut concern that something was/is wrong, we saw the IMS last week and he ordered a full CBC, thyroid panel, abdominal ultrasound and chest x-rays. Everything looked pretty good other than his Levothyroxine was lowered to 0.4 mg/day. The IMS brought up the possibility of macroadenoma or canine cognitive dysfunction since the tests ruled out other problems. I found this website over the weekend and after reading the macro thread and several dogs' individual stories I am convinced Kash has a macro, even though the IMS tells me I shouldn't jump to conclusions.

    We have a consultation with the neuro vet on Monday June 10 where I will learn more about MRI diagnosis, radiation, other treatment options (are there any? steroids perhaps?), cost, prognosis, etc. If anyone has information I should be equipped with when I go in, or knows of questions I should be asking, I'd sure appreciate you sharing those with me. I also learned today that the clinic has a newer generation unit that can perform "stereotactic radiosurgery", that can generally accomplish in 3 treatments what traditionally would require 15-18 treatments. Does anyone have experience with stereotactic radiosurgery? Are the outcomes better, even if the tumor is large in size or in comparison to brain size? To be clear I have not made any decisions yet and if anything I'm leaning towards not putting Kashmir through RT as he has come to dread vet appointments; between Cushing's and rehab for a separate issue, there have been many.

    The IMS's remarks are pasted below. I will just add that although the vet describes Kash as "medically stable", that does not mean he is thriving.

    Thank you in advance, everyone, for your thoughts and guidance.

    "Kashmir's abdominal ultrasound showed mostly changes suggestive of slowly progressive, degenerative processes
    as opposed to an obvious new and active process to explain the recent concerns. His thoracic X-rays were essentially
    normal.

    On labwork, Kashmir has the typical elevations in liver enzymes we've seen previously, but no signs of dysfunction,
    and the rest of his organ systems are working fine. His urine analysis was unremarkable. His T4 (thyroid hormone
    level) came back slightly higher than the high end of the target range for dogs on supplementation, so we could
    consider dropping the dose some (or just going to once daily at the 0.4mg dose). With that said, the typical symptoms
    of excessive thyroid hormone supplementation are generally what you would expect from giving too much of a
    stimulant - hyperactive, agitation, increased appetite, potentially weight loss due to increased metabolic rate,
    irritability/aggression, etc. None of the concerns we discussed sound like thyroid excess to me at all.

    Based on the fairly thorough information we currently possess, the scenarios that we should be considering most
    closely would be age-related change (such as canine cognitive dysfunction, CCD, which is somewhat similar to
    Alzheimer's disease in people), or a pituitary macroadenoma. To differentiate between these we would likely need an
    MRI performed through our Neurology department. If you do not want to pursue this information, we could consider
    some of the supplemental/nutritional approaches that are used for CCD.

    Based on how medically stable Kashmir appears to be otherwise, I do not think you need to rush a decision about
    how to proceed, but let me know how I can help."
    Last edited by Lori C; 06-05-2019 at 11:08 AM. Reason: Length and clarity

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