To treat or not to treat?

[inheriteddog]

This is standard with Vetoryl/Trilostane. It is not a stable drug so it doesn't maintain control very well over time in most dogs. This is why it is so important 1) to know the signs of not only low cortisol but high and 2) to keep up the very sspecific testing schedule for this drug. The monitoring ACTHs are the only way to be sure the cortisol is once again elevated (and rule out other possibilities for the changes seen) so be sure to have that done before the vet increases the dose. Typically increases are no more than 25% of the current dose. Just a reminder....once the dose is increased the testing schedule starts all over at the 2 week mark.

I'm lazy today and haven't read back thru Kobe's thread so I apologize you have already given this info....has his skin been checked for Calcinosis cutis? This is usually diagnosed via a punch biopsy.

Let us know what the ACTH shows and how things are progressing for your sweet baby boy!

Hugs,
Leslie

It's now August 17. For the past few months I've been dealing with personal health issues and delayed Kobe's testing. This week he got his ACTH stim test and the results indicate his condition is stable, so he can remain on the 40mg dose for now (his weight is 33.6). Improvement seen in basic signs: drinking, eating OK. Pants in hot weather. Still has sensitive skin and scabby spots, interdigital infections are bad. Vet is giving a three-week regimen of antibiotic (previous episodes have been given two-weeks' worth), says it won't resolve the issue completely but can bring down the swelling and redness. Meanwhile, Kobe has a lump that appears to be a hematoma on lower abdomen about the size of a quarter. Doctor suspects some type of cancer, proposed removal and biopsy. Kobe is middle-aged (ten). No signs of problems right now from the lump; smaller lumps have formed and broken open, healed over. Vet discussed risks of cancer spreading, etc. etc.

So, there are more things to consider. Having decided to treat the Cushings, I'm presented with another problem, to treat or not to treat possible cancer. Kobe's age is middling. (I have the same situation with my health issues, being neither too old nor too young to sway me one way or another.) Now, does having Cushings make cancer treatment more problematic? For example, is his immune system compromised? I've heard Cushings can cause problems with regard to vaccinations. Overloading a dog's system can be fatal. An otherwise healthy dog might be treatable for cancer, but a dog with a serious condition??? And again there's the money factor. Just testing and screening with lump removal and biopsy is in the many hundreds, let's not even discuss treatment like chemo.

That's about where I'm at. Kobe's a good dog. Be well.

[labblab]

Welcome back to us. I’m so sorry you’ve had health issues of your own to deal with. I know that makes it so much harder to try to resolve other issues. But turning to Kobe, as long as his elevated cortisol is under reasonably good control, I don’t think that the disease itself would be a physical contraindication to cancer treatment that otherwise carries a good prognosis. The cost of treatment is another issue entirely, and I do understand that.

I do have one question for you, though. Is the vet unable to first perform a simple needle biopsy in order to gain a better sense as to the nature of the lump? I’m not a vet myself, and seemingly there must be some reason why a needle biopsy hasn’t been suggested. But that’s always been the first step in assessing lumps on my dogs. Most have turned out to be benign fatty tumors, but one was a cancerous mast cell tumor which fortunately was removed pretty easily with clean margins. So that was the end of the issue. The initial needle biopsies have always been relatively inexpensive and delivered important information. And in Kobe’s case, I’d think that first determining the nature of the lump would play a major role in deciding how, and even whether, to move forward. So I’m just wondering if a needle biopsy is an option.

Marianne

[inheriteddog]

Vet offered two options. Fine needle aspiration and cytology (approx. $100 total) "has disadvantages with poor exfoliation of cells or blood-filled lesions" (wording per vet's post-visit notes). Second option was "mass removal with histopatholgy", deemed the better choice to confirm diagnosis. Kobe would first need blood workup and x-rays (close to $400) to determine if he's healthy enough for total anesthesia. Cost of actual surgery, anesthesia and biopsy will be provided to me later by the surgery team. Based on the look of the lump Vet strongly suspects cancer. If confirmed, of course, followup treatment will depend on what actually is discovered. Kobe' had smaller bumps, some of which have opened up and bled, then healed over.

I'm not a techie and don't know if I can attach pictures to these posts, but visuals might be helpful. Thank you for your concern.

[labblab]

Well dang, that’s certainly an enormous price difference between the needle aspiration and the tumor removal/biopsy. What a difficult position you’re in as far as making a decision :-(((((. Would the needle aspiration pose any danger of possibly spreading some tumor cells? If not, and if the only drawback is a higher likelihood of inconclusive results, I still think I might start there, myself. If you gain some useful information, great. If not, I realize you’re still faced with that original hard decision about removing the mass. And I think I do understand why that’s a hard call for you under the circumstances.

You say the vet does believe it’s likely cancer. If so, does he have any guesses as to the type? I know I’m kind of grasping at straws here, but any shred of info or even just conjecture about the tumor type might help you with a decision about advancing further.

As far as photos, even though I’m a staffer, I’m pretty helpless about that myself. My best advice would be for you to go ahead and create a personal photo album. That would definitely give you the ability to upload pictures to your album that we can see. Here are instructions on how to create an album:

https://www.k9cushings.com/forum/faq...faq_vb3_albums

Good luck if you want to give that a try!

[inheriteddog]

Yesterday I received a cost estimate for surgery and biopsy. $2000. That's in addition to the $400 for labs and x-rays before anesthesia. I don't need to make any decision right now. In any case, I have to figure out my own health situation before I can take care of Kobe. We'll see.

[labblab]

I totally understand. It sounds as though you’ve got an awful lot to deal with right now, and I surely hope there will be a positive path forward for both you and Kobe. Just let us know if and when we can help in any way.

Sending many healing wishes across the miles,
Marianne

[inheriteddog]

I totally understand. It sounds as though you’ve got an awful lot to deal with right now, and I surely hope there will be a positive path forward for both you and Kobe. Just let us know if and when we can help in any way.

Sending many healing wishes across the miles,
Marianne

I've been off line for a while and not sure if I am checking back in correctly. This setup confuses me.

A lot has been going on over the past few months. As far as Kobe is concerned, his Cushings seems to be stable at the dosage 20mg twice daily. Water intake is good, eats well although he can be picky. He walks less than before and occasionally has trouble jumping into the car or going up steps, though generally he manages. Weakness in legs is apparent. Main problems are skin rashes and sores between the toes which are only relieved by antibiotics, and I don't want to overdo that, so am using a lot of neosporin, sometimes hydrocortizone, and anti-itch cream, all of which help somewhat. Also still using the DouxoS3 shampoo, but not sure if that makes a difference. Have not seen fleas lately, presumably due to the weather. The vet wanted me to use a heavy-duty flea medicine, which I declined because Kobe has had seizures and these meds are wicked. I keep him bathed and combed, and as I say, no fleas lately.

The lump he had on his underside that the vet wanted to get biopsied resolved itself, there's only a blood blister left, no lump anymore. He has a few of these blister things, which he sometimes rubs open with blood coming out. Nothing serious. Oh, and he just turned 11.

I'd say he's doing pretty well given his age. I welcome any suggestions on skin sores and fleas for the summer. Otherwise, thinks for your support.

[labblab]

Welcome back to you and Kobe, and thanks so much for your update! I’m really sorry it took me so long to see your post, but I’ve been having some internet issues lately that are hopefully now resolved. Anyway, I’m really glad to hear that Kobe is holding his own. I wish I had some good alternative suggestions re: flea control and the skin sores, but it sounds as though you’re doing the very best you can under the circumstances. I do understand your worry about possible neurological risks to the flea meds, so as long as you’re not seeing any of the pests when you comb him, I think you’re good right now.

So even though I don’t have any great suggestions, I’m surely glad you’ve made it back to us for your report. Please give Kobe a big hug for me, and tak3 good care of yourself, as well!

Marianne