Pokey, 14 yr old dachshund - Cushing's/trilostane/bladder stones

[barry]

Pokey our 14 year old dachand has had cushing for three years he now is incontinent and can not walk far My last visit to the vet he stated kidney problems and not much else can be done.I have not been able to bring myself to have him euthanize My concern is he in pain ? what are the signs in a dog.He still drinks lots of water and eats

[frijole]

It sounds like your dog's cushings just isn't regulated. Those are all very common signs. With proper dosing and followup testing perhaps it is as simple as increasing the dosage. Sometimes dogs are regulated for years and then all of a sudden their dosage needs tweeking.

My dog was treated for 4 yrs with lysodren.

Tell us more about your dog, the weight, drug type, daily/weekly dosage amount and testing done recently to measure cortisol.

Glad you found us and hope we can get your dog back to feeling perky. You aren't alone - we have been there too. Kim

[frijole]

PS my gal was 16 1/2 when she passed away a couple mos ago. So there is hope for old dogs!

[lulusmom]

Hi and welcome to the forum.

I am so terribly sorry that your doggie is having such a hard time of things. I am familiar with kidney failure and excessive drinking and urinating are definitely a symptoms, as is weakness in late stages. The kidneys completely lose their ability to concentrate the urine and a dog has drink constantly or become dehydrated. The fact that your dog is still eating okay and holding it down does make me wonder if you are at a point where you have to make the tough decision.

The excessive drinking, urinating and weakness are also returning symptoms seen in cushingoid dogs that are no longer controlled. What medication are you giving to treat cushings and when was the last time you had an acth stimulation test done? Do you have copies of your dog's bloodwork and urinalysis that your vet did to diagnose kidney failure. If so, can you please post the abnormal values, including the reference range and reporting units, i.e. nmol, ng/dl, ug/dl. I am really sorry for answering your question with questions but the fact that your baby is still eating well is a really good sign. Dogs in final stages of kidney failure are unable to filter the toxins in the body and the pain and discomfort comes from the gut. I could get my dogs to eat but they couldn't keep anything down and then they just gave up and would no longer eat anything and could no longer walk without great effort. This is usually when you know that you need to start thinking about quality of life issues.

I am truly sorry for the reasons that brought you to us but I am glad that you found us. We will help in any way we can and it will help us give you more meaningful feedback if you will provide us with more information. Many of us have had to make the most difficult of all decisions so I am certain that others will be checking in with you to share their feelings.

((((Great big comforting hugs))))
Glynda

P.S. I see that Kim posted while I was typing so please excuse any duplication.

P.S.S. I forgot to mention that if a cushingoid dog is no longer controlled with treatment, it is not unusual to see abnormalities in kidney values, specifically the BUN:Creatinine ratio, as well as increased protein in the urine (proteinuria). These abnormalities can be secondary to cushing's and usually normalize once the cortisol levels are reduced. I am really hoping that this is what is going on with your baby.

[BestBuddy]

Hi and welcome.

I have recently been through the decision making on the Quality of life of an older dog. She didn't have cushings but the following link gave me a place to start.

http://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/quality-of-life-scale.aspx

I am not suggesting it is that time but it can give you something to think about.

As the others have asked, do you know how well the cushings is controlled at the moment?

Jenny

[barry]

pokey is on trilostane 60 mg two times a day The xray showed stones and enlargement his urine he puts out with no control has very little yellow

[frijole]

Good to hear from you. How much does Pokey weigh and when was the last time you had his cortisol levels checked? The test is the acth stimulation test. Thanks!

[Squirt's Mom]

Hi Barry,

Welcome to you and Pokey!

I am sorry you are in a place to need to ask this question. :( This is something none of us want to think about. If possible, we would like to help you get Pokey feeling better so you can have a few more good years with him by your side. Fourteen is a great age which says you have done a good job of caring for him all this time.

If I understand you correctly, Pokey has bladder stones? If that is right, then that might explain everything you are seeing. Has your vet mentioned surgery to remove them? I know anesthesia is scary for a pup of that age but my Squirt just had surgery and she will be 13 in Feb., and another member's geriatric baby just went under and both did just fine.

I can well imagine that your emotions are fairly high right now given what you are considering, but I hope you will take some time to talk with us and let's see if we can't find another path for you. One day at a time, ok? ;)

Keep your chin up!
Hugs,
Leslie and the girls - always

[barry]

his weight is 14lbs vet said test are a waste of money at this point.my concern is suffering at this stage not prolonging the inevitable

[frijole]

I say you go with your gut because mom and dads always know. I lost my gal 2 mos ago and my 14 yr old quit eating. Did all kinds of tests and my vet gave up. I didn't. I had to make sure I didn't let her go due to misdiagnosis. I ended up driving 5 hrs each way to a teaching university and they figured it out. My vet was dead wrong. My dog is doing well.

Those stones are painful - my oldest dog had them years ago and we surgically removed them.

I think what you do next is dependent upon if you think the vet is right or not. My hunch is that mine was wrong. If I'd have stuck with him she'd have starved to death. But sometimes vets are right. You know your vet and your dog best.

I wanted my oldest to die in her sleep so I didn't have to make that tough call. I wasn't so lucky. Woke up one day and she was doing circles (had had a stroke). She was blind, nearly deaf but had still managed to run around the house with a smile on her face. After the stroke I knew it was too much and her quality of life was not there. So I had to make that dreadful decision. Hardest thing I ever had to do.

I think you will know when it is time. I really do. And I am really sorry you are going thru this. It is so tough. Kim

[acushdogsmom]

Pokey our 14 year old dachandhas had cushing for three years he now is incontinent and can not walk far My last visit to the vet he stated kidney problems and not much else can be done.I have not been able to bring myself to have him euthanize My concern is he in pain ? what are the signs in a dog.He still drinks lots of water and eats


pokey is on trilostane 60 mg two times a day The xray showed stones and enlargement his urine he puts out with no control has very little yellow


his weight is 14lbs vet said test are a waste of money at this point.my concern is suffering at this stage not prolonging the inevitableHi Barry,

I am trying to understand what is really happening with your dog. I'm not so sure that you've reached "the end". It may just be that the Cushing's is not very well controlled.
(And maybe also that the stones may need to be removed.)

If you are treating with trilostane, your vet is supposed to be doing ACTH stimulation tests periodically, to find out how well the meds are working to control the cortisol production. And especially if the dog starts having symptoms of Cushing's (drinking a lot of water, pee accidents, leg weakness etc) the test should be done to see if a dose adjustment is needed.

If the trilostane dose is not right, that could be why your dog is drinking alot of water, and is incontinent and not wanting to walk very far.

Has your Vet been doing any ACTH stimulation testing at all since you started Pokey on Trilostane to check on the cortisol production and to see if the trilostane dose is correct?

And how did the vet arrive at the conclusion that there's nothing more that can be done for Pokey? Were there any tests done that specifically pointed to kidney failure? Or is the Vet just guessing that it must be the kidneys because your dog is no longer wanting to walk much and is drinking a lot of water and is incontinent and has clear urine (urine that is not yellow)? Because those things can all just be signs that the Cushing's is not well enough controlled or may be symptoms associated with the bladder stones.

If it's the Cushing's that's not well enough controlled, that can be fixed by adjusting the dose of trilostane. And if the symptoms are being caused by the stones, that could be fixed too. The "treatment" for bladder stones is different depending on the type of bladder stones that they are. Struvite stones can be dissolved with a special diet and calcium oxalate stones can be removed surgically, unless there's some special reason why that can't be done in this case?

Can you please tell us more? I really don't understand why your Vet is giving up on your dog.

I'm not against letting a dog go when it's their time, and I certainly would not want a dog to suffer if there's really nothing more that can be done to help them recover. But I'm not convinced that it's Pokey's time and maybe we can help you to figure out something that can be done to get Pokey feeling much better.

Would you consider getting a second opinion from an Internal Medicine Specialist Vet? They are the ones who are the real experts when it comes to managing a Cushing's dog, and can often get a good outcome when a regular "GP" Vet has run out of ideas.

Many of us have had our dogs seen and evaluated by an Internal Medicine Specialist Vet. I'm one of them. My Vet recommended euthanizing my dog when he was only 10. We decided to have my dog seen by an IM Specialist, to get a second opinion. And she was able to get him back on the road to good health and then she kept him well for another 6+ years! Honest. He went from being one of the saddest looking little dogs I've ever seen (who also drank tons of water and had pee accidents in the house and couldn't walk very far) to being a playful, happy little boy again (who could run and who drank normally again and who had no more pee accidents) after we got him into the care of the Specialist, who was an expert at treating Cushing's and getting the very best possible results.

[barry]

Thanks Kim I am sitting hear with tears in my eyes.reading and knowing what you have gone threw and having to make the same decision

[frijole]

:(

Just know that this group of cush dog owners have saved alot of lives and also consoled alot of people. We know the owner is always right and your case is no different. We're here if you want to talk. We also have a Memorial Section and would be happy to include your dog on it should you go that route. We would just need the photo of your choice.

Take care and know we are sending you strength and wisdom.

Kim

[lulusmom]

Kim's journey with her own two seniors is heartbreaking but her Annie is doing much better because she didn't feel comfortable that her vet knew what was going on with Annie and sought help from specialists. Based on the little information you've given us, it sounds like the decision you are wrestling with is premature and perhaps you're vet could be wrong. Is there any way you can have an acth stim test done? Stones can be surgically removed and there are entities that can help with financing. I have to run right now but will come back later and give you more information on that. Please don't give up on your dog just because your vet said there's nothing to be done. Call me crazy but unless your dog's kidney values are off the chart, then I don't believe it. Since your dog is eating just fine, I don't believe the kidney values are off the chart. Do you have any of the labwork that you can post for us. If the problem is cushing's, there are the usual abnormalities that will show up in bloodwork and we can tell you if we're seeing those. That would certainly be more evidence that your dog may need something as simple as an adjustment in trilostane dose. Please tell us more.

Glynda

P.S. Here's a link for financial assistance: http://k9cushings.com/forum/showthread.php?t=212&highlight=financial

[labblab]

Hello and welcome from me, too!

I know you have been peppered with questions, but here's one more for you...:o

Can you please tell us what Pokey's trilostane dosing history has been? (And I know you've already been asked if you could share any ACTH testing results along the way). I am really curious about the dosing, because a total of 120 mg. of trilostane (60 mg. twice dailsy) is a HUGE amount for a 14 pound dog. Has he always been on such a high dose, and was there ever a time when his hunger, drinking and urination were not as excessive?

Thanks so much for any additional info that you can tell us.
Marianne

[barry]

I am not at a place where I can give you his report I know he was increased over a year and seem to be without any problems except drinking lots of water

[frijole]

Barry, If the main issue is the drinking water thing I wouldn't give up either. I know it is tough but cushings is treatable. My first vet was clueless and I had to find another one to treat my girl Haley. It was this group of people who taught me what to do, what to ask, everything I needed to know to save Haleys life. Yes, I had to let her go but I treated her for 4 yrs and she made it to 16 1/2!

When you get to a place where you have time to fill us in a bit more - we'll help you I promise. You found a real compassionate group. Take care and give Pokey a hug for me. Kim

[Franklin'sMum]

Hi Barry

Welcome to you and Pokey. As others have said, there are many options to try to get Pokey feeling better, and the folks here are the best at explaining things, and hand-holding :). The combined knowledge here is truly astounding, and is not only limited to Cushing's.

You said your vet said kidney failure- was this statement based on any tests? My little boy Franklin is losing protein in his urine, and his IMS thinks it's glomerular disease. He doesn't have elevated kidney values, though, as quite often these only show up on test results when a lot of the kidney function is impaired. Even when kidney values are high, there are still lots of things that can be done to help a pup feel better - not just prolong the inevitable.

Has your vet mentioned 'phosphorus binders' or sub q fluids? The fact that Pokey is still eating well would suggest the kidney failure is not as far along as your vet said - if it is kidney failure at all.
When the kidney disease progresses, one of the things suggested is a phosphorus binder (usually aluminium hydroxide) which prevents most of the phosphorus (in food) from being absorbed. When phosphorus isn't properly filtered/eliminated, it builds up, causing the pup to feel sick, and not want to eat.
Sub q fluids are fluids given subcutaneously. If this is recommended for the pup, the pup-parent usually learns how to do this at the vets, and when they're comfortable, continues at home. This can make a HUGE difference in how the pup feels, as the fluids flush the toxins from the system. Diet also plays a big part in how kid. failure is treated, as the main aim is to reduce the phosphorus.

A recommended supplement is Co-Enzyme Q10, which has shown to be very helpful in reducing creatinine. Omega 3 fish oil has also been shown to be renal protective (slowing down the progression of kidney disease), while omega 6 is not recommended.

As others have said, there are numerous reasons that Pokey might be having issues, ranging from the trilo dose needing tweaking, to the bladder stones, and more.

I do hope I haven't confused the issue, Barry. Keep in mind that if Pokey is still eating well, that is a very good sign.

PS- When my vet said 'that test is a waste of money', I told him that it might be true, but it's my money to waste :p:D

Jane, Franklin and Bailey xxx

[barry]

Thank you for taking the time to wright My last visit to the vet only a xray was done based on Pokey enlarged stomach lethargic and constant urinating vet felt testing was a waste the xray showed many stones.his urine is very pale.Based on your expertise I will find another vet op ion

[Franklin'sMum]

Hi Barry,

You probably already know this, but sometimes when I feel overwhelmed my mind shuts down and I need someone to remind me of things :o. When Pokey was tested originally, did the vet test for thyroid issues or diabetes? Both these conditions can also cause excess drinking and urinating.
Now, if Pokey was tested, and the testing of thyroid and diabetes came back negative, that's not to say that something hasn't cropped up over the last few months to cause the changes you're seeing now.

We have a number of members who have dealt with stones, and you have received replies from a couple already. One thing I have found through the experience of others is that a urinary tract infection can cause symptoms of kidney failure, but after anti biotic treatment that clears up the infection, the symptoms (and /or lab test results) go back to normal.

Pokey may be more lethargic than he used to be, but he is 14 :). You've been a great parent to help him get to this age :).

Barry, the wonderful folk on this forum helped me to save my little boys life, and they have sooooo much knowledge and expereince. Ask questions, read up on threads, and ask more questions. I promise- we won't bite :p. We're here for you and Pokey, alright.

Jane, Franklin and Bailey xxx

[Harley PoMMom]

Hi Barry,

A belated welcome from me and my boy Harley! I am glad to see you are seeking a second opinion for Pokey. Bladder stones can be painful to our pups. A few months ago my other furbaby, Bear, had stones surgically removed from his bladder. The stones were too big for my little guy to pass so surgery was the only option. He has since recovered beautifully from this operation .

Many different factors can influence the development of stones and one factor being the presence of bacterial infections. Urinary tract infections(UTI) are very common in our cush-pups and excessive peeing and drinking are some symptoms of an UTI in a pup. Has Pokey been tested for an UTI?

We are definitely here for you and Pokey.

Love and hugs,
Lori

[barry]

thanks for feedback thyroid and diabetes have been checked with negative results.

[barry]

He has been checked and falsely treated buy another vet.

[Squirt's Mom]

Hi Barry,

I am soooo thrilled and relieved to read that you are going to seek another opinion! Way to go, dad! :cool: I know Pokey is happy as well.

When you see your vet, ask for copies of Pokey's blood work and testing - the actual results, not the invoice they give out. This will help us a great deal to see what may be going on with Pokey. One of our members is a lab tech and can help interpret those things for us. Your vet should be happy to give you copies.

Keep in touch and again, I am so happy to read that you are gonna fight for Pokey!

Hugs,
Leslie and the girls - always

[acushdogsmom]

Thank you for taking the time to wright My last visit to the vet only a xray was done based on Pokey enlarged stomach lethargic and constant urinating vet felt testing was a waste the xray showed many stones.his urine is very pale.Based on your expertise I will find another vet op ionBarry,

If you are going to get a second opinion, I think your best bet would be an Internal Medicine Specialist Vet, not just another "GP" Vet.

Here's a link to a topic in our Resources forum that will help explain about Internal Med Specialists - what they are, where to find one etc:

click here --> Finding an Internal Medicine Specialist Vet (ACVIM) (N. America and other countries) (http://www.k9cushings.com/forum/showthread.php?t=182)

If you have any trouble finding an Internal Med Specialist where you live, let us know and we'll be glad to help you with finding one.

If your Pokey is as lucky as my little Bichon was, then getting an Internal Med Specialist (IMS) on the case may be the best decision you've ever made.

Please keep us informed. We worry when we don't hear any news.

[barry]

Thanks for the help its nice to know there are so many dog lovers who understand and willing to share their knowledge