My Pug Scoop (Precious Scoop has passed... )

[Trish]

Hi Vicki and Scoop

How's it going with you guys, hope you have some news for us soon as very worried for you, you sounded so upset. Let us know if we can help in any way sweet.

Trish xxxxxxxxxxxxxxxxxxxxx

[SoggyDoggy]

We're all here with you. Just so you know. Take care sweetie.

[scoora]

Hey everyone, Thanks for all the concerns and love. I'm sorry I haven't come back on sooner. I didn't mean to make you worry. I'm so stressed lately and I've been tired. The other night I tried to post and I dozed off and couldn't stay awake. Scoop has me worried. Saturday after he ate his supper I took him out to do his business, like usual. When we came in he started shaking so, so much. I never saw him shake like that before. When he would exhale it was so loud and you could hear how shakey he was. I covered him with a blanket and rubbed him and kissed him and talked to him for about 10-15 minutes. He finally started to calm down then another 15 minutes till he settled. Then Monday(I think it was) after he ate Raleigh was near him and he put his front legs on Raleigh's back like he wanted to hump him. He wouldn't leave Raleigh alone. So I took him out. I thought maybe when we came back in he would settle down. Nope, he sensed Raleigh was there and went on his back again. So we made Raleigh get out of the way and Scoop just started wondering around. He wouldn't settle down. Usually after supper he goes out and then comes in and lays aside of my husband on the recliner and sleeps. So this was very strange. He was walking all over and with him not being able to see I had to make sure he didn't walk into anything. The one time he stopped and my husband said it looks like he is going to poop. I said no, he's doing that "gagging" thing he does. Did that a few times. I sat with him and tried to settle him but he just wanted down off the sofa. I little more wondering around then went towards the recliner and stopped. He wanted to go on the recliner. Settled some but wouldn't sleep. My husband said Scoop kept leaving stinkies. I noticed later, too, that he was. Took him into my daughter's room. Still wouldn't sleep. I put him on my bed and I was laying there with him and he finally went to sleep. The other week the vet wanted to know his water intake for 3 days. It was 14-16 oz. Which was good.I kept measuring it. A couple days later he had 25 oz., then down to 18 oz. Yesterday it was 20 oz. During the night after the 25 oz. he had an accident in the kitchen. Last night after he ate his supper he had an accident in the kitchen before I could get him out. In the mornings he usually is sleepy but this morning he seems extra sleepy. He started giving me a hard time with his not wanting to eat his dog food. When I mix baby food(meat) or some of Raleigh's food he eats it. Guess he's had enough of the W/D crap. He eats so much of it I'm not surprised he doesn't want it. It worries me, what if he doesn't want to eat anymore. I am just so upset, worried and scared I don't know what to think or do.

[scoora]

Again, I am sorry for the worries. One small bright spot. Scoop saw his Opthamologist yesterday. She said he has no active ulcer. What I still see is scar tissue. It has gotten smaller but don't know if it will go away. Too bad that horrible tumor won't go away.

Anyone who's dog is on Vetoryl. Do they seem to sleep a lot? What makes Scoop sleep so much? Wish I knew.

[scoora]

I was just reading a link to 360dvm June 2010, where Dr. Feldman says his first choice for PDH is Mitotane. Does anyone know why? He says Trilostane is second given twice a day. I knows there's a report saying Trilo can cause the tumor to grow faster. Has there been any findings that Mitotane does that too? Scoop's vet never gave the option.

[addy]

Hi Vicki,

We are so glad to hear from you. from what I have read there is thought that Lysosdren (Mitotane) may also cause a pituitary tumor to grow but I'm sure one of the Administrators will come by and confirm that. Sometimes a vet will select the drug based on his experience with it or what other health issues may be going on with the pup. The drugs work differently, lysodren actual erodes the adrenal glands.Trilostane is an enyzme blocker and does not erode the adrenal glands and could make them larger.

With my pup's IBD issues we went with Trilostane because it is not as hard on the gastro system as Lysodren and I can start it and stop it whenever I need to. If you stop Lysodren, you would probably need to reload.

I think every endocrinologist has a different opinion and it is hard sometimes to keep it all straight.

((((((((((((((((hugs)))))))))))))

[lulusmom]

Hi Vicki,

Dr. Feldman prefers Mitotane (Lysodren) because he's prescribed it for 40 years and knows it like the back of his hand. He thinks it's great that there are two choices for cushing's but he'll probably always be partial to Mitotane. I think another reason why he is not a trilostane convert is because based on his own experience at UC Davis, trilostane is not as side effect free as it was tauted to be. My cushdogs were treated with both Lysodren and Trilostane and were well controlled with absolutely no side effects.

It is documented in veterinary text books that Mitotane can facilitate growth of a macrotumor so yes, both drugs can have this effect. If I knew for a fact that my dog had an expanding macrotumor, I'd definitely have to reconsider treatment with either drug. For me, resolving overt symptoms like excessive drinking and peeing take a back seat to slowing the rate of tumor growth and maintaining my dog's quality of life for as long as possible.

Glynda

[scoora]

Addy, Glynda-Thanks
Do they think treatment can cause the tumor to grow that much faster? I read the link about the Trilostane but didn't quite understand it all. I'd thought about what would happen if I didn't give him Vetoryl. I wonder if he would feel better. Like I said he sleeps a lot. If he didn't get Vetoryl I wonder if his Calcinosis Cutis would get bad again and would he get some kind of infection again? Also would Scoop's diabetes be less under control without Vetoryl? He also had quite a bit of muscle loss in the beginning. Would he lose more? Can Vetoryl be stopped and restarted again right at the same dosage if need be? Maybe I should talk to my husband about it and see if he could handle the excessive peeing. Then talk to the vet. Funny thing though, I asked the vet a few weeks ago about it causing the tumor to grow faster and she said, no. I sent her an email Tuesday and today and haven't heard from her. One thing I asked her about was Chinese herbs. Jessica said Doc was on them. Has anyone else used them?

[labblab]

Vicki, since Scoop seems to be feeling so poorly and acting strangely right now, I surely understand why you are trying to weigh all options. But what makes things especially hard is that you are trying to weigh an unknown (does Scoop have an enlarging tumor?) vs. a known (he is diabetic with erratic blood sugars and he has suffered from some very serious complications of Cushing's such as calcinosis cutis and vulnerability to infection).

The majority of dogs being treated for Cushing's do not develop tumors large enough to cause neurological problems. On the other side of the coin, because of the shape of their skulls, breeds like pugs may be more vulnerable. But the only way you can find out the size of Scoop's pituitary tumor for certain is to perform expensive imaging of his head. So short of that, you can only guess.

If Scoop's only issues associated with Cushing's were outward symptoms that are manageable for you, then I'd be more likely to say, "Sure, go ahead and stop the trilostane for a while and see what happens." But you are in the midst of struggling to gain control of his diabetes, and his history of calcinosis cutis is scary to me. Sadly, we have seen dogs on the forum here who lost all quality of life due to the effects of calcinosis cutis. Those skin lesions can expand and grow in severity very quickly. So in Scoop's case, I think a decision to stop his trilostane would need to be carefully considered.

My opinion is colored by my experience with my own Cushpup. We started trilostane treatment with him and initially he did well. But he started exhibiting neurological problems that we assume were caused by an enlarging tumor (don't know for sure because we never had the imaging done). We did consider stopping his trilostane, and even briefly did. But when we did so, not only did he still act abnormally from a neurological standpoint, but he also resumed his non-stop panting and did nothing but lie down like a lump on our cool hardwood foyer. So we started back with the trilostane and did not discontinue it again.

Quality of life means different things for different dogs. My boy was a Lab and came down with Cushing's at age eight. Prior to that, he loved to chase balls, jump in our car for a drive anywhere, swim in the lake, go up-and-down stairs a zillion times each day to be near us wherever we went, nap on the couch alongside me each evening. His Cushing's caused muscle wasting such that he could no longer climb stairs or jump in the car or jump on the couch, he panted 24/7, he no longer ran after a ball, he couldn't swim, in fact he could barely walk about the block. All that in addition to excessive drinking/peeing/appetite. So I may be repeating things that I may have written to you earlier in your thread , but even had I known that trilostane may have caused his tumor to grow more quickly, I would still have continued treatment, regardless. But that is me, and him, and the specifics of our situation.

Coming back to Scoop, one thing that still puzzles me enormously is why your vet has never tried shifting him to twice daily trilostane dosing. If you do opt to continue with the trilo, I'd want to revisit that question with her. I finally found one of the quotes I've been looking for in that regard. This was written by Dr. Mark Peterson:

In diabetic dogs with concurrent Cushing’s disease, twice-daily administration is essential in avoiding large fluctuations in serum cortisol concentrations during the day. With once-daily trilostane administration, adequate diabetic control will be next to impossible in many dogs with concurrent Cushing's syndrome.

http://endocrinevet.blogspot.com/201...rilostane.html

Marianne

[scoora]

Hi Marianne-Thanks, it helps to hear your experience. I really appreciate you telling me about your Cushpup. When he was on the trilo, did he have any energy at all? I don't feel Scoop did well since he started on the Vetoryl. When he started taking it he was tired and mopey and it seemed the higher the dose the more tired he became. I wish I knew why he's like that. I just wonder in my head if stopping it would change that. Then as his vision got worse he also stopped being interested in his toys. I wish I could see my old Scoop back again. He loved walking around our back yard, sniffing, and peeing everywhere. He just loved that and when you called him to come, he would look at you as if to say, I'm not ready yet, and he would just keep doing what he was doing. We would call him Mr. Independent. Or he would sit on the couch and just look out the window. Oh how I wish he could enjoy simple things like that again. If we knew for sure the tumor wouldn't press on his optic nerve, we would consider cataract surgery on his one eye. As far as I know right now Scoop is infection free and his calcinosis cutis has really improved and if he wasn't on Vetoryl I guess that could all change. I did mention to the vet about twice daily dosing because of his diabetes and I even mentioned the article by Dr. Peterson. She just kind of brushed it off and said something about Vetoryl doesn't come in 20mg. I guess because Scoop's dose is 40mg, a 10 and a 30. I thought well isn't that when you would check into compounding or is compounding as expensive as Vetoryl?Also the IMS Scoop saw in Nov, along with the neurologist, told me she believes if you split the dose you also increase it. I know Dr. Peterson doesn't do that. Scoop hasn't seen the IMS since then but his vet emails her and gets her opinion. I would hate to split his dose then have to increase it. Since I'm worried about it allowing the tumor to grow faster would more make it grow even faster? If you don't increase it could the cortisol go up? He is having a fructosomine test done Mon so we'll see what that shows then maybe talk about splitting dose.

In mid Nov Scoop had the MRI done that showed his ear infection that lead to the surgery and it showed his pituitary tumor. It wasn't on the radiologist report but I asked the neurologist if he could give me the measurements of it. He told me to the best of his ability with the equipment they had he said it was approx. 8mmx3mm. To me that's pretty large for a dog with a head like Scoop's.
The radiologist report said:There are no masses or other structural abnormalities seen in the brain, but the pituitary gland is enlarged and protrudes dorsally from the sella turcica into the hypothalamic region. Mild ventricular enlargement and enlarged sulci are most likely due to age-related brain atrophy.
Then down further on the report he says:The appearance of the pituitary gland is most compatible with a pituitary macroadenoma. The mass is not causing any significant mass effect or compression of adjacent tissues at this time, but if it continues to grow then it may affect the optic nerve, hypothalamus, or thalamus. So this is why I contantly worry about the tumor.
Thanks again Marianne