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Thread: New to the forum - Ambro is now at Rainbow Bridge

  1. #11
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    Default Re: New to the forum and seeking experienced assistance!

    Quote Originally Posted by labblab View Post
    Well, um, then I'd have to venture a guess that your vet has not had a lot of experience with treating Cushing's dogs. Please bear in mind that I'm not a vet myself, but I did learn a lot about macrotumors back when my own dog was ill, and as you've read, we've had a number of dogs here with confirmed enlarged pituitary tumors that have suffered from symptoms that are consistent with Ambro's.

    Since you only have one more day to wait until Thursday, it's likely not a big deal to hold off on the prednisone. It's probably best to get the neurologist's opinion about that, anyway. But it seems striking to me that your vet hasn't even entertained the possibility of a macrotumor. Back when my own dog was ill, our internal medicine specialist said that any time he sees a Cushing's dog with a cortisol level that hasn't dropped too low but who is inappetant, the first thing he suspects is a macrotumor due to the possibility that the tumor is placing pressure on the part of the brain that controls hunger and thirst.

    As far as the helpfulness of a head CT, the neurologist will be your best guide in that regard. My general understanding is that both a CT and an MRI can reveal the presence of a pituitary tumor, but I've never been clear as to their relative advantage or disadvantage in terms of the best imaging for this purpose.

    Just to let you know, when dogs are initially diagnosed with Cushing's, it's typically an abdominal ultrasound that is performed in order to determine whether the disease is likely due to a pituitary or adrenal tumor. This is because abnormalities with the adrenal glands will give you important clues. When Cushing's is pituitary-based, both adrenal glands will typically be enlarged. However, a mass or growth seen in one adrenal gland alongside a shrinking of the other gland suggests that an adrenal tumor is the culprit.

    At this point, however, my guess is that if you are able to spend money on imaging and the neurologist recommends it, a view of Ambro's head would be the top priority. As Betsy's mom says, even if he doesn't have a pituitary tumor, he could be suffering from some other brain tumor. As you saw in my post on the Macroadenoma thread, my husband and I didn't proceed with any head imaging, partly due to the expense and partly due to the fact that in our boy's case, we wouldn't have felt able to launch into the extensive radiation treatment that would have been necessary to try to treat him in the event that he did have a macrotumor. So I definitely understand that it's not an easy decision to proceed with any imaging.

    But the first step will be to let the neurologist examine him and find out his impressions and recommendations. At that point, you can make your decision about moving forward. I confess that I'm a bit bothered that the ER vet apparently didn't check his cortisol level in addition to his electrolytes, because dogs treated with trilostane can suffer effects of adrenal oversuppression even in the face of apparently normal sodium and postassium levels. However, since you report that Ambro had worsened again even during the time that his trilostane was halted, in my own mind that does point more towards neurological issues separate from medication effects. However, once again, the neurologist should be much better able to draw some conclusions after examining Ambro and going over his history of problems.

    No matter what, please do keep us in the loop and let us know how things go. Again, I'm so very sorry that you guys are going through this, including sweet Ambro. I'll never forget the difficult days and nights I spent worrying about my own Cushpup. If only they could talk, and tell us what is wrong. It's such an awesome responsibility to try to figure out the best path forward, but I believe you're doing exactly the right thing at the moment. So hang in there, and keep us updated.

    IMO opinion, they have become frustrated with my wife and I regarding our input into ¬ďtheir profession¬Ē. My wife handled the phone call this afternoon as I am too short fused to listen to the vet tell me why she has suddenly changed her mind on the possibility of using a steroid and that her ¬ďnever seeing this before¬Ē as another reason. Not saying that she¬ís not good at what she does, but she has only been practice since 2018.

    We received pricing for imaging in addition to our consult Thursday and a CT SCAN is absolutely in the cards for us. Unfortunately, an MRI is just out of the question financially at the moment.

    We actually have halted all meds at the moment, except for vetprofen this AM. But stopping that tonight as the vet used it as another excuse for not attempting prednisone.

    I greatly appreciate all of your advice and input on this. We will absolutely update the thread after his Neuro appt Thursday morning.

  2. #12
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    Default Re: New to the forum and seeking experienced assistance!

    Quote Originally Posted by labblab View Post
    Hello and welcome, although Iím so sorry about Ambroís problems. Iíll come back later to write a more thorough response, but I wanted to quickly give you my best guess as to what may be going on so that you can do some quick researching in advance of your Thursday visit. You donít say whether or not Ambro has been diagnosed with Cushingís arising from a pituitary vs. an adrenal tumor. If heís believed to have a pituitary tumor, then itís possible that his problems are being caused by enlargement of that tumor (ďMacroadenomaĒ) and the pressure that it may be placing on adjacent areas of his brain. Iím going to give you a link to a thread elsewhere on our forum thatís devoted to discussion of the problems caused by Macroadenomas. It includes my experiences with my own Cushpup. I encourage you to take a look at this thread and then we can talk more if Ambroís symptoms seem to be consistent.

    As to why he may have temporarily improved after stopping the trilostane, of course the first thought would be that he was being overdosed on the medication. But if that is *not* the case and he does indeed suffer from a Macroadenoma, it may be the case that the initial elevation in his cortisol had an anti-inflammatory effect on brain tissue that is being encroached upon by the tumor. For dogs with known Macroadenomas, treatment can consist of actually adding prednisone alongside the trilostane in order to maintain a consistent but more therapeutic level of circulating steroid. Youíll read more about that on the thread. Anyway, here it is, and after you look it over we can talk further.

    https://www.k9cushings.com/forum/sho...-Macroadenomas

    Marianne
    Hey,

    My wife and I have been going back and re-reading the posts from the link you supplied.

    Are we understanding correctly that surgery or Radiation is the only viable treatment for an enlarged pituitary tumor or is prednisone also a treatment option? It seems all the posts discuss radiation as the main form of treatment.

  3. #13
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    Default Re: New to the forum and seeking experienced assistance!

    As far as I know, radiation remains the most common intervention aimed at physically reducing the size of the tumor. The treatment doesnít totally remove the tumor, but it reduces its size so as to minimize the encroachment on brain tissue thatís responsible for producing the neurological symptoms. Ultimately the tumor will likely continue to grow again, but youíre trying to provide an interim symptom-free time period.

    I donít believe that prednisone affects the size of the tumor, but instead may relieve swelling and inflammation of the brain tissue thatís being invaded. So you may hopefully see at least some short-term relief from the worst of the neurological symptoms.

    Again, though, the neurologist will be a more reliable resource re: the current state of available treatment options should he think a macrotumor is likely. And of course it may be the case that he doesnít think this is the problem at all. If so, Iíll be sorry that Iíve placed this worry in your minds ó I know it has to be a big worry for you now. But I just wanted you to be prepared to ask any related questions about this possibility on Thursday.

    Marianne

  4. #14
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    Default Re: New to the forum and seeking experienced assistance!

    I’ve just now gone back to re-read that thread myself, and I see some of our members talking about prednisone shrinking the tumor size for their dogs. So I may be wrong in saying that I think it only reduces swelling/inflammation. Once again, the neurologist should be able to clarify that for you.

  5. #15
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    Default Re: New to the forum and seeking experienced assistance!

    Quote Originally Posted by labblab View Post
    I’ve just now gone back to re-read that thread myself, and I see some of our members talking about prednisone shrinking the tumor size for their dogs. So I may be wrong in saying that I think it only reduces swelling/inflammation. Once again, the neurologist should be able to clarify that for you.
    UPDATE:

    We just got home from the neuro and it is what we feared. Ambro has a Macroadenoma and according to the doc, we are pretty far along. No CTscan or MRI done because we ruled out the possibility of surgery and radiation is way to expensive. He did support the Prednisone theory, but strongly discouraged the use of Trilostane and Prednisone together, basically saying that you are “robbing Peter to pay Paul”.

    So for now, Prednisone is the course of action. With the hope that we can see a quality of life improvement and give him an enjoyable next few weeks to months.

    Thank you again for all of the insight and information!

  6. #16
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    Default Re: New to the forum and seeking experienced assistance!

    Oh my. Gosh, I’m so sorry I was right about this. But hopefully there may be at least a little peace in knowing what the problem is so that you can focus 100% on loving him instead of chasing more diagnostics. I know you’ll do exactly that — shower him with love and praise for being such a good brave boy.

    I’ll sure be hoping that the prednisone will buy you more good quality time together. With my own sweet boy, it was his loss of appetite and thirst that we just couldn’t work around for very long. But we also didn’t have the chance to try prednisone, and maybe that would have helped him. I surely hope it will be a help for you guys.

    Please do keep checking in if we can continue to be a help to you in any way. Plus, we’ll just be anxious to know how things are going.

    Please give Ambro a big hug for his family here, OK? And I’m sending a big hug for you and his mom, too. I know this is a lot to take in and deal with. Don’t forget we’ll always be here to listen and talk.

    Marianne

  7. #17
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    Default Re: New to the forum and seeking experienced assistance!

    Quote Originally Posted by labblab View Post
    Oh my. Gosh, I’m so sorry I was right about this. But hopefully there may be at least a little peace in knowing what the problem is so that you can focus 100% on loving him instead of chasing more diagnostics. I know you’ll do exactly that — shower him with love and praise for being such a good brave boy.

    I’ll sure be hoping that the prednisone will buy you more good quality time together. With my own sweet boy, it was his loss of appetite and thirst that we just couldn’t work around for very long. But we also didn’t have the chance to try prednisone, and maybe that would have helped him. I surely hope it will be a help for you guys.

    Please do keep checking in if we can continue to be a help to you in any way. Plus, we’ll just be anxious to know how things are going.

    Please give Ambro a big hug for his family here, OK? And I’m sending a big hug for you and his mom, too. I know this is a lot to take in and deal with. Don’t forget we’ll always be here to listen and talk.

    Marianne
    There is definitely some “relief” in having an answer. Me and my wife were talking it over last night and it’s really a double edge sword of emotions. We get him back, to whatever degree the prednisone will help, but at the same time we have to watch him make the turn again at SOME POINT. When that is, who knows, and that’s the worst part I think.

    With that said, we are into our first 24hrs on prednisone. Appetite and drinking are back to full power, as well as the peeing. He’s done extremely well with warning us that he has to go outside. And as long as we are paying attention, he has a very easy tell that it’s time to go outside. Still very tired, as anyone would be after dealing with what he has for the past 2 weeks. He has stopped the constant pacing and only pants for 5-10mins at a time as opposed to pacing and panting for 1-2hours straight. We have seen glimpses of the playful boy that we knew prior to everything starting.

    We unfortunately have a trip coming up that we scheduled back in April and will be leaving for 8 days on Monday. My wife and I are both kind of dreading it. Luckily we have a really good support system and sitter here at home, and are really hoping that he continues this upward trend while we are gone.

    Marianne, we cannot thank you enough for all of your kind words and advice. Even though the info you were giving us was SPOT ON and it really pained to see that he may have that, it helped us tremendously for the mental prep. Once we read your input and then combed every inch of the Macroadenoma Thread, we had all the questions that we needed prepared for the Neuro. He even commented on our prep when he came to the room and admitted that we had basically diagnosed Ambro and the only reason we were really there is because our regular vet refused to acknowledge our findings.

    We honestly can’t thank you enough for EVERYTHING you do for those of us with cushpups!
    Last edited by PittieLovers; 07-30-2021 at 04:52 PM.

  8. #18
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    Default Re: New to the forum and seeking experienced assistance!

    Oh my, you’re so welcome for any help I’ve been able to give. I’m truly just “paying it forward,” though, for the support I got back when my boy was so ill. Those were some of the worst days of my life, I was so worried and confused about what I ought to be doing to help him. I know I made mistakes along the way, and that made things even harder for me. But I swore I’d try to help others from the things I had learned, and in that way I feel like I’m continuing to honor his own bravery every day that I’m here.

    I know the week away will be very bittersweet for you, and I surely hope alongside you that he’ll continue to stabilize on the prednisone while you’re gone. Just for the sake of conjecture, if you find that his Cushing’s symptoms really rebound with a vengeance that’s making him uncomfortable (thirst, urination, etc.), that might be reason to revisit the trilostane/prednisone combo with your neurologist. I’ve never known for sure, but I think the combo has been prescribed in the past in order to keep the total steroid level from becoming unpredictably high and uncontrolled. In other words, if you keep the cortisol level under control with the trilostane, you can then add a consistent and predictable amount of supplemental prednisone. Just something that might be worth talking over with the specialist — or not. Keeping Ambro eating and drinking will be crucial. And if keeping him off the trilostane altogether bucks up his appetite, then that alone will be worth it.

    One quick question for you. Did the neurologist indicate whether the prednisone actually shrinks the tumor itself or whether it just eases brain swelling or inflammation? As I wrote earlier, I’ve never known the exact answer to that and I’d like to be able to advise people more accurately if I can.

    In the meantime, do travel safely and we continue to send our healing hugs to Ambro.
    Marianne

  9. #19
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    Default Re: New to the forum and seeking experienced assistance!

    Quote Originally Posted by labblab View Post
    Oh my, you’re so welcome for any help I’ve been able to give. I’m truly just “paying it forward,” though, for the support I got back when my boy was so ill. Those were some of the worst days of my life, I was so worried and confused about what I ought to be doing to help him. I know I made mistakes along the way, and that made things even harder for me. But I swore I’d try to help others from the things I had learned, and in that way I feel like I’m continuing to honor his own bravery every day that I’m here.

    I know the week away will be very bittersweet for you, and I surely hope alongside you that he’ll continue to stabilize on the prednisone while you’re gone. Just for the sake of conjecture, if you find that his Cushing’s symptoms really rebound with a vengeance that’s making him uncomfortable (thirst, urination, etc.), that might be reason to revisit the trilostane/prednisone combo with your neurologist. I’ve never known for sure, but I think the combo has been prescribed in the past in order to keep the total steroid level from becoming unpredictably high and uncontrolled. In other words, if you keep the cortisol level under control with the trilostane, you can then add a consistent and predictable amount of supplemental prednisone. Just something that might be worth talking over with the specialist — or not. Keeping Ambro eating and drinking will be crucial. And if keeping him off the trilostane altogether bucks up his appetite, then that alone will be worth it.

    One quick question for you. Did the neurologist indicate whether the prednisone actually shrinks the tumor itself or whether it just eases brain swelling or inflammation? As I wrote earlier, I’ve never known the exact answer to that and I’d like to be able to advise people more accurately if I can.

    In the meantime, do travel safely and we continue to send our healing hugs to Ambro.
    Marianne

    He basically said that we are relieving pressure and swelling. That’s the one question that we didn’t ask though (shrinking). We are hopeful that with the prednisone, Ambro will experience SOME shrinkage. Prior to being diagnosed with Cushings, there were ZERO Neuro symptoms. He was healthy, happy, and playful. So we are hoping that maybe his cortisol was SO suppressed(he was on 90mg of Trilostane/day) that the size of the tumor is actually fairly small and an “early” macro that just ran rampant with the complete lack of cortisol. A CT scan would give us a finite answer and we may still opt for it once Ambro stabilizes on the prednisone. He is on 20mg of prednisone a day and gets bumped down on Thursday next week to 10mg a day, then the following week 10mg every other day. Neuro said that he wanted to load him up and then go down to a lower dose. Reason being 2 fold: 1. He had/has swelling and that was priority. 2. As we move down the dosage, we can gauge his cognitive signs and if we see them start returning, we can find a holding a lot for the prednisone dosage.

    We are really hoping that we can get down to the every other day dosage without seeing any signs return. With the hopes that a response like that would indicate a smaller tumor overall. So, we will see!
    Last edited by PittieLovers; 07-31-2021 at 08:28 AM.

  10. #20
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    Default Re: New to the forum and seeking experienced assistance!

    Yesterday was day 2 on Prednisone for Ambro.

    Overall, a down day behaviorally. Appetite and water intake is definitely up, just not very active overall until late afternoon. Late afternoon he played with the football with my Brother-in-law while we were out picking up some groceries. Another positive is no noticeable pacing and very limited panting.

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