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Thread: Advice for a newly diagnosed pooch in the UK

  1. #21
    Join Date
    Jul 2019
    Location
    Stoke on Trent, England
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    15

    Default Re: Advice for a newly diagnosed pooch in the UK

    Hi all.
    Sorry I’ve not been on for a while, hope you and your fur babies are all doing ok?
    Louis’s arthritis has been taking centre stage so I’ve neglected to post on here for a bit. The response to the Gabapentin seemed to have been a bit of a fluke. After that really good spell he slowly went back to being very disinterested and lethargic. So the vet tried a different drug called Galliprant. No instant improvement like before but he is only on a half dose to begin with. Although he wasn’t playing with his ball he certainly seemed interested if reluctant and just brighter in himself.
    However last Friday he seemed to go extremely quiet. When he’s tired he’s VERY tired, I had visitors around on Sunday (no one we knew, I sold my car!) and he didn’t get up from the sofa to come and say hi. There have been a few times over the weekend when I’ve had to really coax him to get up and about. Still seems interested in his ball when I throw it up and catch it but as soon as I offer it to him he refuses. So, we went back to the vets today for a check up and a pre pill cortisol check. The vet has rang since with the blood work results and everything seems ok apart from his liver enzymes are raised which we expected as he’s only on a 10mg dose of Vetoryl at the moment. We’re still waiting for the cortisol results. When chatting to the vet he aired concerns that Louis is losing a bit too much weight for his liking (he’s down to around 22.5kg, his normal weight for years was around 24/25) and the lack of any real effect on his lethargy from either the Vetoryl or the painkillers. He’s now beginning to suspect an adrenal tumour rather than pituitary, and possibly malignant too. I feel a bit like the rug’s been pulled from under me! The vet has suggested a chest X-ray which I think is to check for any spreading and therefore malignancy and a specialist scan to locate the adrenal glands to confirm a tumour there. Statistically it’s 50/50 that it could be benign/malignant.
    While I’m trying to get my head around this and the possibility of putting my boy through yet more tests what experience do you guys have of adrenal Cushings, and possible tumour problems? Any experiences, info or just plain words of comfort and encouragement would be greatly appreciated at the moment x

  2. #22
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,042

    Default Re: Advice for a newly diagnosed pooch in the UK

    Hello and welcome back, although I surely wish that Louis was feeling better. Assuming that his cortisol level doesnít come back too low, I understand why your vet is wondering about other possibilities for Louisí weight loss and lethargy. Although overall they are in the minority, over the years we have indeed had many members with adrenal tumors. Unfortunately, there is no standard prognosis. As you already know, there can be a number of variables that affect the disease and tumor progression. Most importantly, is the adrenal tumor cancerous, has it spread, and is it threatening invasion into nearby important blood vessels? Your vet is correct that obtaining an actual image via abdominal ultrasound provides the best information about the status of the adrenal glands and any associated growths. Additionally, an ultrasound can reveal helpful info about the status of other internal organs such as liver, kidneys, and spleen. So I cannot argue with that recommendation, given the diagnostic information it may reveal.

    Depending upon size and location, adrenal tumors have the possibility of total surgical removal. However, the surgery is risky and it is quite expensive here in the U.S. Depending upon a dogís age and other health issues, surgery may not even be a viable option, regardless of cost. If not, then Vetoryl remains the medical treatment of choice for adrenal tumors among the majority of specialists here. If the tumor is not malignant nor growing rapidly, then an extended period of relative stability may be expected. However, if itís cancerous and rapidly expanding, the outlook is much more sinister.

    I surely sympathize with the spot youíre in. Clearly, Louis is not flourishing and the question is, ďWhy?Ē For your own peace of mind and some guidance in terms of charting the path forward, as I say, I canít argue with the benefit of an ultrasound. You might discover that Louis is suffering from some other internal condition that can be treated more easily. But if you feel as though aggressive intervention of any type is more than youíd want to ask of him, then that might also limit the extent of the diagnostics that you want to involve yourself in.

    Iím guessing that my reply will not really help to settle things in your own mind. There are just too many uncertainties. But these are some of the considerations that Iíd be mulling over myself, if I was in your shoes. Please feel free to continue to talk things over with us, OK? And please give Louis a big pat from his family here.

    Marianne

  3. #23
    Join Date
    Jul 2019
    Location
    Stoke on Trent, England
    Posts
    15

    Default Re: Advice for a newly diagnosed pooch in the UK

    Louis has had a mega big pat and squeeze from you!
    I’m starting to get a bit of a theory and please point out any flaws in it as I’m thinking in very simple “I have no expertise” terms. When we stopped the Vetoryl a few weeks back he had his last dose of 30mg on the Friday. He then went until the following Wednesday with no medication at all, then started the Gabapentin on that Wednesday. Could it be that we hit a sweet spot as his cortisol started to rise a bit and the pain relief also started to help? I have no idea how long after stopping Vetoryl cortisol levels start to rise so that could blow my theory straight out of the water!
    He’s never been on a dose higher than 10mg Vetoryl and pain relief at the same time. I’m thinking of suggesting to the vet that could we try increasing the Vetoryl up to 20mg for a week or two before we go ahead with any more tests. Is that long enough to see an improvement, even if very small, or will the delay in not doing the tests be detrimental? I’m wondering if I’m clutching at straws but it seems to be the one thing we’ve not tried yet x

  4. #24
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,042

    Default Re: Advice for a newly diagnosed pooch in the UK

    Iím so glad Louis got his hug!!

    As for the Vetoryl increase, can you tell us what his cortisol level was on the blood that was tested this week? That would really be a prime determining factor in my mind because it will help us judge the effectiveness of his current dose, and whether an increase would be safe to consider.

    Marianne

  5. #25
    Join Date
    Jul 2019
    Location
    Stoke on Trent, England
    Posts
    15

    Default Re: Advice for a newly diagnosed pooch in the UK

    Hi Marianne.
    I’m just waiting for the vet to ring with Lou’s latest cortisol result, it could be any time up until around 7 pm UK time before I hear from him. I’m expecting it to have gone up, I suppose the question is how much. His liver enzymes had increased from where they were last time, heading back up to the levels seen before the Cushings diagnosis. I’m not sure of the exact numbers or units the vets uses but I’ll ask. He just said they were going back up. I’m using this as my basis for assuming his cortisol levels will be raised too x

  6. #26
    Join Date
    Jul 2019
    Location
    Stoke on Trent, England
    Posts
    15

    Default Re: Advice for a newly diagnosed pooch in the UK

    I’ve just had a chat with the vet, Louis’s cortisol levels have come back at just over 190 nmol/L. We’re going to increase the Vetoryl to 20mg to see if that has any effect. His weight loss is most noticeable around his back and back legs so I’m hoping that this is muscle loss associated with the Cushings rather than something else, possible sinister. For the last week or so he’s had quite bad flaky skin too which I think could be Cushings related? We’ll try this for a couple of weeks, if it doesn’t seem to be helping then I think we’ll have to look at having a good look at the adrenal glands or even another condition altogether x

  7. #27
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,042

    Default Re: Advice for a newly diagnosed pooch in the UK

    Thanks so much for this update. And yes, with a pre-pill cortisol level of 190 nmol/L (that translates into close to 7 ug/dL for our U.S. readers), a dosage increase indeed seems safe and even advisable. We surely hope you’ll soon see improvements, if even just subtle ones! Please do let us know.

    Marianne

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