Fighting A Losing Battle

[Guest PhillyPups]

Oh Heather,

 

This is the part that sukks. to you both. You are all in my thoughts.

[Guest KennelMom]

I'm going to pick up some mirtazipine tomorrow at the vet. We can give it right away, even though she got her weekly dose of lysodren for Cushings today. Fingers crossed that this gets something going. We half of our crew at noon and half around 5pm...I offered her a second meal today and she ate a a bit more...a good sized leg quarter, but that's not enough.

 

I was also going to suggest to try mirtazipine. It works better in cats than dogs but, it sure can't hurt.

Have you contacted Dr Couto to get his thoughts??

 

I haven't contacted Dr. C since this is so far outside what he primarily deals with...though I guess this could be secondary to cancer.

 

It's just hard to know if the inappetance is due to her Cushings (though according to the ACTH stim test it's well controlled) or cancer that may be somewhere in her body (though we can't see any sign of mets or other swollen lymph nodes at this point).

Dr Couto is not only an oncologist he's also a boarded Internist too---give him a call.

 

You have a good point. Can't hurt to try at this point.

 

 

The strange thing is that she actually seems a little interested in food...she'll lick it, sometimes chew it up and then spit it out. She'll mouth it, take it out of her bowl and drop it on the ground. We've tried ground versions of lots of different meats and she is less interested in that than whole pieces of meat. Had the vet really check out her teeth and mouth and there's nothing that we can see. When she does eat, she crunches through bones with no problems at all.

[CaliforniaGreys]

Things may have changed over the last year, but when I spoke to Dr C's staff about donating Misty's Lysodren, they had never dealt with a GH with Cushings.

[GeorgeofNE]

Oh, that's sad. My parent's dog was given something to stimulate his appetite, but I think it was steroids of some sort. She must feel pretty darned awful to refuse food entirely. I'm so sorry.

[Guest BiancasMom]

I was going to say try Mirtazapine as well. Also, try a few days of Cerenia. Maybe she is nauseous? Cerenia and Mirtazapine wouldn't hurt either way. You could try one at a time to see if one works. I gave Mirtazapine to my old Aussie long term with no ill effects. (He also had Cushings but is was from the Pred I had to give him for his immune disease :-) )

[Guest goofydog]

Heather, I hate seeing this about your girl. I have no personal experience with this but wonder about syringe feeding her at least some Ensure to get calories in while other possibilities are being pursued. Hugs for all of you during this challenge.

[FiveRoooooers]

Heather, has Stella's mouth been checked? Really checked? She could have a bad tooth or abscess forming? It's one of the first things I think of when a horse starts acting not like himself and so many times it has turned out that a thorough dental can turn it around. I hope it can be something as simple as that for your Stella. Sending hugs.

[Guest Lovey_Hounds]

No healthy dogs don't starve them selves. I'm so sorry you are having to fight with her to get her to eat i have been there with D.C before i sent her to the bridge and it was hard so hard. the best advice i can give is do what your heart feels is right my momma dog made it easier i could see that it was time she told me in her own way.

 

honestly at this point let her eat what ever she wants, be it pancakes, peanut butter, bread anything she wants i even tried cat food at the end and sandwich meat.

[KF_in_Georgia]

If Stella isn't actually nauseated but is just food-resistant, you might see if some nutritional yeast will stimulate her appetite.

 

I went through this with Jacey. The ER was force feeding her, but she started to "erp" and nearly vomit, so they had to back off. At one point Jacey ate a fair amount of vanilla yogurt for me, but she wouldn't touch any more a few hours later (and was drooling heavily with nausea). I could put food in her mouth and she'd let it sit there and not swallow it.

 

And I think the only reason she ate the vanilla yogurt was to please me.

 

It broke my heart. But that--and the unceasingly rotten lab reports after nearly four days in the ER--were what made me decide to let her go.

[GreyPoopon]

I don't have any advice to add. Just and

[MerlinsMum]

I'd second Jan's suggestion about her teeth, but I bet you've already thought of it. I am so very sorry you're going through this. It sounds heartbreaking and so dreadfully worrying.

[fourofem]

I was going to say something about checking her teeth but that's already been mentioned. I don't know too much about appetite stimulants but that, along with a call to Dr. C sure can't hurt. I hope something works for her....it's never easy when things start going the wrong way. She'll let you know.

[JJNg]

Sorry you're having to deal with this, Heather. I agree that healthy dogs (or those with well-controlled medical issues) do not starve themselves, so I'm suspicious that there's something else going on with Stella. I'm not familiar her history and what testing she's already had, but here are a couple thoughts.

 

I'm assuming her Cushing's was determined to be pituitary-dependent since you mentioned MRIs to rule out adrenal tumors? PDH is usually caused by a microscopic, benign tumor in the pituitary gland. However, in a small percentage of dogs, it can be caused by a larger pituitary tumor (macroadenoma) that causes neurologic problems simply due to the space they take up in the brain. Lack of appetite can be considered a neurologic sign since the 'hunger center' is in the brain (hypothalamus), and it is right next to the pituitary gland. I remember a case when I was in vet school where the dog's only sign was a loss of appetite. An MRI of the brain would be able to diagnose this. Here's a good article on pituitary macroadenomas.

 

Next thought...has she had GI endoscopy performed? I think a pituitary macroadenoma would be the more likely possibility since it would be related to one of her existing problems. But another possibility (less likely as it would be completely unrelated to her other problems) would be primary GI disease, such as a stomach or intestinal ulcer, IBD, or GI cancer (like lymphoma). While most of these usually have other signs (like vomiting/diarrhea), there are some cases that present with no other signs besides inappetance, and labwork is often completely normal.

 

Pred isn't necessarily contraindicated with well-controlled Cushing's, but starting pred without a diagnosis would just be symptomatic and may also mask signs and make a diagnosis more difficult. IMO, trying pred may be a last resort, but I would hold off if you're wanting to pursue more diagnostics. Sending good thoughts that you're able to find some answers for Stella.

[nmontgomery48]

Sorry you are going through this, it's very heartbreaking when you try everything, and your dog is just too sick to eat. I hope she perks up and starts eating

[4greyhounds]

:grouphug

[galgrey]

[Walliered]

Da Vid had an abscessed tooth that was found with an X-ray. He had to be put to sleep to do the X-ray. They extracted the tooth.

[Guest KennelMom]

Thanks for all the support, everyone. It's difficult. We force fed Annie a few years ago during her last week and it was pretty traumatic for us...I think we both look back on it as a time when we made Annie hang on past the time she was ready to go. But, Annie was also much older at 14. I'm willing to hand feed Stella (doesn't work), but I don't think either of us want to go the force-feeding route...after our experience with Annie, eating is one of those criteria for basic quality of life. We're going on almost a year of inappetance and chasing various diagnoses/treatments, though the not eating definitely got really got bad starting around June of this year.

 

Sorry you're having to deal with this, Heather. I agree that healthy dogs (or those with well-controlled medical issues) do not starve themselves, so I'm suspicious that there's something else going on with Stella. I'm not familiar her history and what testing she's already had, but here are a couple thoughts.

 

I'm assuming her Cushing's was determined to be pituitary-dependent since you mentioned MRIs to rule out adrenal tumors? PDH is usually caused by a microscopic, benign tumor in the pituitary gland. However, in a small percentage of dogs, it can be caused by a larger pituitary tumor (macroadenoma) that causes neurologic problems simply due to the space they take up in the brain. Lack of appetite can be considered a neurologic sign since the 'hunger center' is in the brain (hypothalamus), and it is right next to the pituitary gland. I remember a case when I was in vet school where the dog's only sign was a loss of appetite. An MRI of the brain would be able to diagnose this. Here's a good article on pituitary macroadenomas.

 

Next thought...has she had GI endoscopy performed? I think a pituitary macroadenoma would be the more likely possibility since it would be related to one of her existing problems. But another possibility (less likely as it would be completely unrelated to her other problems) would be primary GI disease, such as a stomach or intestinal ulcer, IBD, or GI cancer (like lymphoma). While most of these usually have other signs (like vomiting/diarrhea), there are some cases that present with no other signs besides inappetance, and labwork is often completely normal.

 

Pred isn't necessarily contraindicated with well-controlled Cushing's, but starting pred without a diagnosis would just be symptomatic and may also mask signs and make a diagnosis more difficult. IMO, trying pred may be a last resort, but I would hold off if you're wanting to pursue more diagnostics. Sending good thoughts that you're able to find some answers for Stella.

 

Thanks for the info Jennifer...You're correct that we didn't do an MRI of her head, just her abdomen/adrenals with the 'if it's not one, it's the other' approach, leading to a pituitary-dependent cushings dx. Adrenals were normal in two MRIs done a couple months apart. I'll read through the info on macroadenomas this morning. We've done the endoscopy and everything is normal...I was worried about lymphoma as well. Between our regular vet and UVS trying to get a dx on the cushings and her cancer dx and tx, I think we've done just about everything you can do to a dog. I'm not sure how many more rabbit holes we can go down with her

 

I do agree that *something* is wrong, we just don't know what it is. What makes all of this harder is that Stella has really bad white-coat hypertension. She stresses out so much at the vet (and pretty much anywhere but home) that her blood pressure has reached dangerous levels. She's always been our spooky girl...she's gotten better over the years, but I think hers has a strong genetic component as her grand-sire is known for throwing spooky females. So, taking her to the vet for just about anything gets a lot more complicated.

Edited November 1, 2011 by KennelMom

[greyhead]

Not all neuro problems can be visualized. Something like B-vitamin deficiency seems likely after a year of inappetance and leads to loss of appetite and, as others have mentioned, defective communication between parts of the brain. Just a thought.

[Guest FullMetalFrank]

I don't have anything new to offer; just sending lots of prayers.

[Guest KennelMom]

We started the mirtazipine yesterday so we'll see how that goes. She ate 1.5 leg quarters and some offal, which is great! But, it's not unusual for her to have a day or two of eating decently followed by a day or two of hunger strike. I'll see how the mirtazipine does and then maybe add in some B12 as suggested by some GTrs.

[Guest greyers]

We started the mirtazipine yesterday so we'll see how that goes. She ate 1.5 leg quarters and some offal, which is great! But, it's not unusual for her to have a day or two of eating decently followed by a day or two of hunger strike. I'll see how the mirtazipine does and then maybe add in some B12 as suggested by some GTrs.

 

Fingers and paws crossed she will retain some of the interest in food she is showing and that it will only improve on meds!

[Pepsi2004]

Our furkids know when it is time and I believe that not eating is a signal. I am so sorry.

[Guest KennelMom]

she did not eat well yesterday. Ken and I, after talking with our vet again and reviewing her past year's medical history from all the medical teams that have treated her, have decided to give her a week to start eating with these new meds. If she doesn't, we will say goodbye

 

Despite eating well Monday, yesterday she only ate one drumstick. We'll see how she does the rest of the week.

Edited November 3, 2011 by KennelMom

[tbhounds]

Maybe you should have her re-evalutated to see if she's truly a cushings dog by another internist??