End Stage of Cushings??? When will I know?

[Camille]

Hello, Everyone ~

From what I've read, this seems to be a welcoming site with really warm, helpful people. I will tell you this is a long post, but I'm trying to answer some of the questions that seem to be asked of the new folks. :o)

Here is my situation: My dog, Bibsy, a 10.5 y/o Peke, was diagnosed right before she turned 9 with Cushings. We had her tested because her hair had not grown back after a clipping and she was panting terribly. After testing, my vet (whom I've used for over 20 years) confirmed Cushings. He suggested Vetoryl.

The Vetoryl has helped immensely with the panting, but that's about all I can see. She can no longer go up or down steps. Since she has always been tied to my side, I carry her up and down the stairs with me. When she tries to jump off the sofa (I put her on the sofa because she can't jump up), her back legs can't make it.

Bibsy drinks a lot of water, has lost even more fur, but doesn't pant while on the Vetoryl. She has doubled her body weight from 10 pounds to 20.1 pounds. Her skin is very dry with her elbows and heels being especially dry and cracking. I rub lotion on her hairless areas daily and her elbows and heels several times a day.

Last October, she developed bladder stones and had emergency surgery to remove them. As you know, dogs with Cushings can develop very thin skin. Her incision did heal, but in one place, it almost looked translucent. Seven months later, back in May of this year, a huge blob extended from this area of her body. It was blood red, but not bleeding. I got her to the vet asap and when I got there, it burst. The vet immediately took her and 'debrided' (proper word?) the area telling me that the muscle was fine, but the material between the skin and the muscle was like mush. He did something different with the stitches this time and it has healed nicely; HOWEVER, she has developed yet another bladder stone and we are giving her meds for that as well. I'm afraid if she has to have another surgery in the same place, the skin may not heal a third time.

For the last six months or so, she will still bark and 'go nuts (you know in a good way)' when someone she doesn't know comes to the door; however, more and more often she just lies around with her eyes open and not moving. It's not the "I'm relaxed and feeling good" kind of not moving, it's an "I don't feel good" kind of not moving. Also, her breathing has become labored at times and she will snore terribly.

What I'm asking is when will I know she is near the end? I don't want to wait until she's miserable, but I want to keep her for as long as I can. When she barks, it gives me hope, but when she lays there with her eyes open and not moving, it scares me.

What is your experience and what are your suggestions to help me with my baby?

Thank you,

Camille and Bibsy

[mytil]

Camille,

I wanted to welcome you and Bibsy to our site. I am so sorry you both are going through this.

Also, please let us know what tests were performed to come to the diagnosis of Cushing's.

I do have a couple of things going through my mind on what you had told us, especially the symptoms of still excessive drinking. Does she also have excessive appetite?

-Even though she is taking Vetoryl (please let us know how much you are giving) is there a possibility the Cushing's is not really under control (maybe too low of dosage maybe).
-There is another type of Cushing's called Atypical. This is where specific hormones are elevated and the treatment plan is much different. There is additional testing for this. Here is a great link from our Resources section that goes further into this http://www.k9cushings.com/forum/showthread.php?t=198.
-There is something else going on healthwise not associated with Cushing's.

I know others will be chiming in too soon.
Please keep us posted and I do not think your Bibsy is at the end stage. :)
Terry

[labblab]

Welcome from me, too!

Terry has already covered the important bases, but I just want to repeat one of her questions. How much Vetoryl is Bibsy taking, and has her treatment level been monitored through time via ACTH tests? If so, can you please find out the specific test results? The most likely explanation for Bibsy's ongoing problems would be that she is not taking a high enough dose of Vetoryl. And the only way to know that will be to find out where her cortisol level is through an ACTH test. So any more info that you can give us regarding her dosing and testing will be a great help.

Thanks in advance,
Marianne

[Squirt's Mom]

Hi Camille and welcome to you and Bibsy,

First, let's try to find a reason for Bibsy's behavior before we start thinking about "end stages", 'k? Hope is one of the strongest meds we know. ;)

I am also wondering about other health issues, especially hypothyroidism, since you mention the weight gain. Has she been tested recently for diabetes and thyroid issues? Diabetes in particular can come on very rapidly. Both these diseases mimic Cushing's in their presentation (signs) so it is vital to have them ruled out not only in the beginning but also to check them periodically. It not, that is something to pursue asap.

As Marianne mentioned, Atypical is another possibility. It presents with the same signs but is treated differently. If Atypical is involved, then the Trilostane (Vetoryl) has the potential to make the condition worse, not better. The only way to test for this form it via UTK, the University of Tennessee in Knoxville using a blood draw like the ACTH.

With the correct diagnosis, proper treatment, experienced, knowledgeable vets, and diligent parents, these babies can and do live out a normal life-span. We will play 20-Questions with you but that is so we can get as complete a story on Bibsy as possible to help you both. So the more you can tell us the better, especially concerning the Cushing's specific testing she has had and the actual results of those tests. Cushing's is one of the most difficult conditions to diagnose.

Hang in there!
Hugs,
Leslie and the girls - always

[Camille]

Hey, Everyone ~

I will have to check with the vet for the test results. I know she's been tested twice (several months apart). She was prescribed 30mg of Vetoryl last July. We have only given it to her sporadically because it does not seem to help her. (Perhaps more patience is needed on my end?) The only true difference we see is that she does not pant nearly as much. As of late when we have had to find a way to give her the bladder stone med, we have been putting everything in A/D which is more palatable to her.

Thank you all for jumping right in for me. I will check with my vet next week when he reopens. If you can think of any other information for me, I'm all ears! :)

Camille

[StarDeb55]

Camille, vetoryl is only active in the body for about 12 hours, so if you have only been giving it sporadically this may be part of the problem. The drug acts to block part of the enzymatic pathway in the adrenal glands that produce cortisol. Once the drug "wears off", cortisol can resume production in the adrenals. IMO, it would be a good idea to get your little one back on daily dosing & let's see what happens. Dechra strongly recommends that an ACTH be done between the 7-10 day mark to see how things are going. I, also, don't see where you have posted Bibsy's current weight. Dosage recommendations for vetoryl are 1 mg/lb.

I would, also, like to welcome both of you to our group.

Debbie

[frijole]

Camille, Getting those results will really help us help you better so thanks for that! Also - when you post the results, please let us know whether you were giving the drug daily or twice daily (whatever was prescribed at the time).

I have never used trilo but from having read here - my understanding is that it is designed to be used daily (once or twice) in order to reduce the cortisol. If you don't give it then the symptoms will surely reoccur. If you never really saw any sign of improvements then it is probably because the dose was too low. Alot of people have to tweak it to get it right and it can take some time. Better to start low though.

Glad you found us! Keep us posted. Kim

[littleone1]

Hi Camille,

Corky and I want to say hi and welcome you and Bibsy.

You have found a very wonderful group of very caring, supportive and knowledge people. I know you have gotten alot of information. There is so much to learn about Cushings as well as other diseases.

Corky is being treated with Trilostane. His IMS started him on a low dosage, which helped reduce his cortisol level for awhile. As time has gone on, and as I started to notice some of the clinical signs starting to return, along with the results from his stim tests, his dosage has had to be increased. Instead of the once a day dosing, Corky is now on twice a day dosing, which has helped to lower his cortisol. After his last stim, Corky is remaining on the twice a day dosing, and is doing well on it.

Some ofthe clinical signs can start disappearing in a very short period of time, while it takes alot longer for other clinical signs to disappear.

I hope that you will be able to get some good answers and results.

Terri

[Camille]

Hey, Debbie ~

She's right at 20 pounds right now which is double her usual 10 pounds. Since we've discovered the a/d, getting that vetoryl in her has been much better. We've been consistent for the past ten days now (I know that sounds horrible but when we put it in her other food, we'd inevitably we'd find it spit out somewhere, then trying to give it to her with peanut butter was almost traumatizing to her so until now, it's been difficult.)

Her vetoryl is 30 once a day. It comes in small capsules.

Camille

[Bichonluver3]

Hi Camille!
Welcome to the 2 of you from the 2 of us!
A couple of months ago, I was the new kid on the block - in tears and terrified. This group is amazing. The amount of knowledge and the willingness to share is the greatest gift ever!
My little Chloe was diagnosed by Tennessee as having Atypical Cushing's. If that is what Bibsy's diagnosis turns out to be, the treatment can be very simple. However, it is imperative that you get an accurate, correct diagnosis and look at what the values on the panel are.
I was so frightened at first. Chloe panted incessantly and constantly looked for a cool place to lay down (she kept us up all night, every night). She was constantly hunting for food and water. Subsequently, she was peeing all the time. She developed slight hair loss, a pot belly and 2 big lumps (fat?), one at the top of each hind leg. She looked and acted SICK.
When she was diagnosed, she was put on Melatonin and Lignans (both natural remedies) and I said to myself "oh, yeah, like this is really going to work :rolleyes:" and prepared myself for the worst (to the point where I was making MYSELF sick). But it did work! The constant panting, eating, drinking and peeing stopped. Her fur looks to be filling in. She still has the pot belly and fatty lumps but she runs and is, again, playing with her kibble at mealtime.
I listened to my vet and I took the advice given by the folks on this website. I am thankful every day for the direction and support I get here.
Post the info from the vet, get a definitive diagnosis and people here will help. We will be beside you and Bibsy all the way on your journey to better health. Hang in there..
Hugs,
Carrol & Chloe

[frijole]

Camille - I understand the pilling can be difficult but it really is important and the only way to bring her cortisol down. And it needs to be all the time. Cream cheese works great as it is malleable. Easier than peanut butter. When my dog finally caught onto that I switched to the pill pockets made by Greenies. So far so good. I usually didn't put it in food as that makes eating a negative experience. ;) I waited til afterward and made sure that darn thing was eaten. I'm sure others have some helpful hints as well. Hope this helps! Kim

[jrepac]

most of the cushings meds, aside from lysodren, require consistent daily dosing....giving them intermittently will make them less effective...

as others have suggested, having a fresh ACTH test done might be wise....suggest sending your samples to UTK and getting the full adrenal panel, which will also tell you if Atypical Cushings is present...that could be part of your problem..

if that's the culprit, they will likely take you off vetoryl and recommend something else...

and, thyroid and diabetes should be checked out as well..

Jeff

[O'Riley]

For everyone having difficulty with pilling, I highly recommend hiding the pill in braunschweiger (a liverwurst mixture found in the deli meat section). I have tried sneaking pills into everything under the sun and the moon, but the only thing to ever work consistently is braunschweiger.

It isn't something you would feed your dog in any quantity, but one pill hidden in 1/16-tsp of braunschweiger is foolproof. Because of its sticky consistency, I can cover the pill completely, and it sticks like glue and can't be separated from the pill.

All of my dogs go wild for it.

~Rose

[jrepac]

Ha-ha! I have used liverwurst, but its a tad messy! dogs usually LOVE it. Nowadays, I use thinly sliced turkey breast or ham (both lowfat)...I have to wrap the pill inside 1/2 a slice...that usually works!

[Rebelsmom]

I'm so glad I don't have problems with giving rebel pills. I open his mouth drop it in and he swallows. He doesn't fight me and wags his tail the whole time! Man one less thing for me I suppose. I couldn't imagine having one more issue with him.

Back when he was on some kind of liver med (really big pill) I wrapped it in chicken sanwhich meat. He loves chicken so much he never knew he was getting a pill.

[Lenore]

I have bought 3 sets of stairs, one for the bed, couch and car for Winnie that really help.
Lenore