New to the forum - Ambro is now at Rainbow Bridge

[PittieLovers]

Hi guys. Brand new to this forum, and at a complete loss over our 70 pound (started this venture at 80.5lbs on 2/22/21) 10 year old pit/lab mix (Ambro). I’m going to draw out the timeline of events to see if any of you have suggestions or similar situations. We are desperate for answers and just don’t know what to do.

-Mid-Late February 2021—Ambro got up onto our kitchen table and pulled nearly an entire king cake down and ate it. If you guys don’t know what that is, it’s an iced bread cake that has cream cheese filling in it, and sugar sprinkles on top as well.
-Late February 2021 (about 2-3 days later from the King Cake incident) we noticed increased urination and accidents in house, increased drinking.
- Diagnosed early March 2021 with Cushings after going to vet for blood panel and ACTH test
- Mid March 2021 Started taking Trilostane (30mg Tabs 2x a day)
- Was bumped up in early April to 1.5tabs twice a day (per vet)
- May 2021 received 2nd ACTH Stem test, results were normal
- End of June 2021- Became extremely lethargic, lost interest in food, slight limp (Has arthritis in back leg and hips). At the time, we thought it could be pain related since he was so lethargic and uninterested in food and when you google symptoms, that’s what comes up. Prompted a discussion with the vet.
- July 12th, started 300mg of Gabapentin 2x a day to help with pain. He became very confused, unsteady, and just weird.
- Stopped gabapentin within two days (7/14)
- Began to research the effect of Trilostane and decided to take him off it entirely with last dose of 30mg on 7/17 am
- Within 24hrs of stopping Trilostane, we had a complete 180 (playing with toys, eating, drinking, etc.)
- Had vet visit on 7/19 to go over arthritis and using something different than gabapentin and to discuss stopping the trilostane and the results of that. Vet then prescribed Vetprofen to replace gabapentin. Said that he could have had an overdose of trilostane and to stay off of it for now. (at this time, he was still much better than he had been before stopping the trilostane).
- by 7/21, within 48hrs of stopping Trilostane, symptoms came back but worse. Began panting, pacing, circling, no interest in food, drinking minimal water.
- Emergency visit on 7/23 to check electrolytes...vet said test came back normal indicating that system was not suppressed. She suggested it was entirely pain related and he now had possible nerve pain in his back. He was given fluid under the skin for hydration and we were told to begin original Trilostane dosing (30mg 2x a day) once interest in food returned. We began fully picking him up to go to the bathroom up and down the stairs and up onto the couch, etc. to eliminate extra use of his leg.
- Began a chicken, rice, broth diet to promote eating starting 7/23 night.
- Appetite came back slightly, however symptoms did not stop on 7/24. Water intake minimal and had to use syringe to get water into him. Felt little tremors on sides of his head when touching it and every now and then he tried shaking his ears like dogs do, but just sort of flopped his head and couldn’t fully shake it. Began Trilostane 30mg dose on 7/24 pm since his appetite had come back. And continued with original dose on 7/25 (30mg am and 30mg pm)
- Stopped drinking almost entirely on Sunday, 7/25. Would stand over bowl not drinking acting drunk/dizzy when walking around. Stumbling over toys on the floor, kind of bumping into water bowl.
-7/26—Gave a larger dose of Vetprofen (100 mg) in the morning. Not an incredible amount of panting, but still present at times. Still circling/pacing. Still woozy, lethargic. Vet checked in and insisted that all symptoms were pain related and not at all related to Cushing’s. Suggested to add in tramadol and said if pain couldn’t be managed, euthanasia would be an option. Still extremely lethargic, on and off panting/pacing. Vet also said it could be meningitis, a spinal tumor or nerve pain now radiating to his neck or doggie dementia. Suggested treatment with a neurologist.
-Got his first dose of tramadol in him and he was completely zonked. Had to lift him up to get him to get out of his bed. Still no drinking. Still pacing when up. Minimal panting. Didn’t give him second dose of Vetprofen or trilostane.
-Decided that that maybe we eliminate all medications and start from a baseline to see what symptoms remain. Last dose of everything was 7/26 pm.
7/27 AM—Nonstop panting and pacing. Tried to walk down stairs by himself and successfully did. Panting once outside heavily. Ate breakfast, but still did his pacing and circling after each bite. Still acting woozy, and bumping into water bowl, barely sipping. It’s 9:50 and just gave him a dose of Vetprofen to see if that helps him to stop pacing and panting. 10:08 and has finally laid down and stopped panting/pacing.
- Another dog had eye infection so went to the vet today (7/27) and spoke to the other vet that had seen Ambro before. We asked about possibly hyper or hypoglycemia. He said absolutely not. And said that the improvement we saw with taking him off trilostane initially was possibly just a fluke. Said to go to neuro appt and that’s the next step.

We have a neuro appt. on Thursday, but we just can’t shake the feeling that something else is going on. He’s had arthritis for a bit...never has been this bad of an issue to where he can’t function. He has no interest in playing, getting attention, drinking water, etc. He is uninterested in life whether he is on a pain med or off. We can’t help but keep questioning why taking him off trilostane and for those 48 hours he responded so well? He came back to life. Was that really just a fluke? We have driven ourselves CRAZY with nonstop research. Everything feels like it leads us in a big circle. We aren’t ready to just accept that this is literally unmanageable arthritic/nerve pain, but aren’t so blinded that we won’t accept the idea if that’s really it. But then why did taking him off trilostane help briefly? Why is he woozy/confused, even off pain meds??

Looking forward to hearing from everyone!

[labblab]

Hello and welcome, although I’m so sorry about Ambro’s problems. I’ll 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 don’t say whether or not Ambro has been diagnosed with Cushing’s arising from a pituitary vs. an adrenal tumor. If he’s believed to have a pituitary tumor, then it’s possible that his problems are being caused by enlargement of that tumor (“Macroadenoma”) and the pressure that it may be placing on adjacent areas of his brain. I’m going to give you a link to a thread elsewhere on our forum that’s 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 Ambro’s 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. You’ll 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

[BetsyFoxhoundMix]

I don’t know if normal people are allowed to answer or just the moderators so I’ll take a chance. I love pitbulls I have two of them here. My first pitbull died of a frontal lobe brain tumor at age 12. Pacing and circling can be signs of increased intracranial pressure. Also some brain tumors can cause blindness in 1 eye. When my dog started banging into things I immediately tested her sightand realized she was blind in one eye which happened suddenly one morning. Along with pacing and circling. The other thing is veterinarians will give tramadol for pain but tramadol is not metabolized well enough in dogs for pain relief. It’s sedates them giving the appearance of relieving pain. The large new dog pain management centers do not use tramadol! So your dogs pain might not have been treated well enough. Also Galliprant which is a piprant cousin of dog NSAIDs is new in the last few years and many people have better luck with it for pain relief and it also seems to have a better side effect profile. That is the one I’ve been using on my dogs since 2018 when they have some sort of arthritis or disc problem. My other pitbull is on it right now because she had ACL surgery on Tuesday. I’m so glad your dog will be seeing a neurologist. Even if the pituitary tumor, if your dog has a pituitary tumor, even if that has not enlarged and is causing trouble, it is possible the dog might have a different brain tumor. You could have a few things going on at once. I did find out when my dog had a brain tumor that the neurologist do not like CBD products because they can cause neurological side effects that confuse the situation. Good luck and kiss your pitbull for me!

[labblab]

Dear Betsy’s Mom,

Absolutely you are free to post on anybody’s thread! That’s the huge benefit of a forum like this — that all our members can share their support, thoughts and suggestions. What you’ve written above is very informative and helpful, so thank you from us all!

Marianne

[PittieLovers]

Hello and welcome, although I’m so sorry about Ambro’s problems. I’ll 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 don’t say whether or not Ambro has been diagnosed with Cushing’s arising from a pituitary vs. an adrenal tumor. If he’s believed to have a pituitary tumor, then it’s possible that his problems are being caused by enlargement of that tumor (“Macroadenoma”) and the pressure that it may be placing on adjacent areas of his brain. I’m going to give you a link to a thread elsewhere on our forum that’s 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 Ambro’s 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. You’ll 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

Thank you so much. We went through those posts and he seems to tick a majority of those boxes. Panting, pacing, confusion/wobbliness, tremors in hind legs (he's had those for a while..even well before his Cushing's diagnosis), foggy/drunk acting, diminished interest in food, nearly no interest in water, and absolutely no interest in playing, getting attention, etc. Our vet diagnosed him with pituitary cushings (she said that 90-95% of dogs have that kind. We didn't have an MRI or CT performed). She did mention yesterday that we could try a steroid but that she gets cautious with dogs with cushings because it can cause issues. We just called the vet to inquire if he could be put on the steroid just to see (I assume prednisone?). We are not extremely well off, and live in NY where vet care is outrageously expensive. An MRI would cost nearly 5,000 and we just don't have that type of money. However, a CT would run us about 500 and we could definitely swing that. Would the tumor show on a CT? Just getting questions ready for the neurologist as well.

[PittieLovers]

It should be noted that he is not on Trilostane right now. His last dose was yesterday AM (30mg). I am not sure if that would be a huge factor if we ended up starting him on the steroid if our vet prescribed it.

[PittieLovers]

I don’t know if normal people are allowed to answer or just the moderators so I’ll take a chance. I love pitbulls I have two of them here. My first pitbull died of a frontal lobe brain tumor at age 12. Pacing and circling can be signs of increased intracranial pressure. Also some brain tumors can cause blindness in 1 eye. When my dog started banging into things I immediately tested her sightand realized she was blind in one eye which happened suddenly one morning. Along with pacing and circling. The other thing is veterinarians will give tramadol for pain but tramadol is not metabolized well enough in dogs for pain relief. It’s sedates them giving the appearance of relieving pain. The large new dog pain management centers do not use tramadol! So your dogs pain might not have been treated well enough. Also Galliprant which is a piprant cousin of dog NSAIDs is new in the last few years and many people have better luck with it for pain relief and it also seems to have a better side effect profile. That is the one I’ve been using on my dogs since 2018 when they have some sort of arthritis or disc problem. My other pitbull is on it right now because she had ACL surgery on Tuesday. I’m so glad your dog will be seeing a neurologist. Even if the pituitary tumor, if your dog has a pituitary tumor, even if that has not enlarged and is causing trouble, it is possible the dog might have a different brain tumor. You could have a few things going on at once. I did find out when my dog had a brain tumor that the neurologist do not like CBD products because they can cause neurological side effects that confuse the situation. Good luck and kiss your pitbull for me!

Hey!

Thank you so much for sharing your experience! As of right now, Ambro isn’t showing any signs that indicate blindness in either of his eyes. He responds well to stimuli in both.

In regards to the tramadol, we weren’t fond of the way he acted on his first dose, so we actually haven’t taken him off of it and he is only talking the Vetprofen at the moment.

As mentioned in the above post, we are def reaching out to our vet to inquire about starting a low dose prednisone prior to our neuro appt.

Thank you so much!

[PittieLovers]

Just an update:

Our primary vet is refusing to try a trial of prednisone, even after suggesting it during a phone call yesterday.

Her reasoning: She has never seen an enlarged pituitary tumor cause this type of response.

[labblab]

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.

[labblab]

And I'm back with a quick P.S. to what I wrote above. According to this article, an MRI is the preferred imaging for a pituitary macroadenoma, but a CT can also reveal the presence of an enlarging tumor.

Also, here are some of the clinical signs listed by the article that are associated with a macroadenoma:

Mental dullness, disorientation, blindness, head pressing, behavioral changes and seizures may occur secondary to direct compression of the overlying diencephalon or the adjacent optic chiasm. Increases in intracranial pressure due to the mass or associated vasogenic edema may also contribute to the general deterioration in mental status.

https://www.avmi.net/information/ima...-macroadenoma/

Also, here's a very technical, jargon-filled research article, but even by skimming it, you definitely pick up on the fact that an enlarged pitutiary tumor could be responsible for the types of problems that Ambro is experiencing:

https://www.tandfonline.com/doi/full...6.2019.1622819

Really, all you need to do is Google "Canine Pituitary Macroadenoma" and you'll come up with numerous lists of corresponding symptoms, so I remain baffled by your vet's apparent lack of familiarity with the issue :-(((((

Marianne