Newly diagnosed 9 y/o Cavalier, Charlie (Charlie has crossed The Bridge)

[DebsW]

Hello everyone, my name is Debbie and I found this forum while doing some research after our 9yr old Cavalier Charlie was diagnosed with Cushing's last Friday. I have had a little look around and so far have yet to come across anyone else from the UK and I'm not sure if that's because I just haven't seen anyone yet or if it's because treatment is different in the UK and therefore not relevant to this forum? If that makes sense!
So about Charlie, I'm afraid it may be rather long! As I said he was 9 in Jan and is the oldest of our 4 Cavaliers. At the beginning of last year he had an op to have a pin taken out of his back left kneecap as it was causing problems and things have not been right since. We were told to rest him and just let him do as much exercise as he wanted, this turned out to be none! (He's never been the biggest fan of walks) After a while we asked again and got the same reply, we were also told the turning in of his front right wrist was because he wasn't putting weight on his back leg but not to worry about it. A little while later another vet said gentle walks would help with the loss of muscle mass he was experiencing in his hind quarters but Charlie didn't want to so we didn't force him, next visit told again, let him do as much/little as he wants. (We've seen I think 3 different vets over the past few months) By now his wrist was getting worse and we were told he had arthritis in it, a course of Cartrophen seem to make it worse. More of the let him walk when he wants followed along with his muscle loss in his entire body is due to not walking and hair loss is old age. Next came the pot belly and we're told it's just 'where he stores his fat'. A few weeks ago I noticed his belly skin looked very dry and thin, mentioned this to the vet who really didn't take any notice and then the final visit we were told that some of his symptoms looked like Cushing's but the vet didn't really think it was but we could try a urine sample anyway. After this we decided to take him to another practice to the vet who treats our budgies and is very good - he diagnosed the reasons Charlie was deaf within a couple of minutes when other vets had scratched their heads! He gave Charlie a proper examination and straight away said he wanted to do a ACTH test for Cushing's, this was done the following week and as I said we had the positive results back last Friday. So in short, Charlie has hair loss, mainly on his tummy region though it is thin elsewhere, he has a pot belly, he's drinking more than normal though doesn't seem to be weeing more but has always had exceptional bladder control, he has always been food orientated but these days has a ravenous appetite and nearly takes your fingers off, he has weak back legs and you can feel every bone in his body.
He started Vetoryl on Sun morning and up until today it didn't seem to have any side effects but this morning when I came down he didn't get up to greet me and when he eventually did he was very slow and tentative. I have been calling him my stalker as he is usually just one step behind me everywhere I go but today he hasn't been following me at all, he has been very lethargic and seems to find it difficult to stand. I'm sure his belly has become bigger and earlier on he was laid on his side and struggled to right himself when he wanted to get up. He started heaving about an hour or so after supper but didn't bring anything up and whereas he usually is a heavy sleeper he seems to be finding it difficult to settle and I don't know if this is because he is uncomfortable or in pain. We have been told he has arthritis in his front legs but it seems to be his back legs that are causing problems.
So I guess what I'd like to know firstly is are the things Charlie seems to be experiencing today normal side effects or should I be concerned, if they're normal will they go away. Also, do you know if it's ok to give pain relief with the Vetoryl, he was on Metacam for over a year but we started some new glucosamine and chondroitin tablets a couple of months ago so weaned him off it. Are there any foods I can feed him to help build up his muscles.
Up until today I haven't been too concerned as I've read in numerous places that dogs with Cushing's can live out their natural lives with meds like Vetoryl and we haven't seen any negative change but seeing how Charlie is today has been upsetting, especially when he looks up at me and I can tell he is either in pain or very uncomfortable. It doesn't help that last year we had to have our 7yr old Cavalier pts because she had a tumour but in her last weeks she was very thin, had a pot belly, had difficulty walking and seemed depressed. I know it's a different disease but it's hard not to draw parallels and get upset. We have another appointment on Sat morning to discuss things with the vet as we have only spoken to him on the phone since the diagnosis.
Oh and also, Charlie has a heart murmur though he doesn't need medication for it and has a problem with his breathing sometimes when he's asleep, it gets very laboured and then suddenly stops, we've been told it's a soft palate problem but it can be quite scary to watch him. Because of this it's difficult to know for sure but I'm sure Charlie is breathing a bit heavier today too.
Phew, that was quite an essay! I'm now off to have another look around and see what information I can pick up but will be very grateful for any advice or tips you can give. :)

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[labblab]

Hello and welcome! Just wanted to tell you that your membership has now been approved so you will have no more problems with your posts appearing immediately on the forum. Also, I've taken the liberty of adding some info to your thread title. We do have a number of members in the U.K., and I'm hoping that the new title will bring Charlie to their attention. ;)

Marianne

[DebsW]

Thank you Marianne, I was beginning to think my e-mail account was playing up again and yours wasn't coming through! Also thank you for adding more info to the title, makes sense really. I have been sat here telling myself I should go to bed but it's difficult to leave Charlie when he's not completely settled - that and the fact it is pouring with rain and they all need to go out before bedtime! But I really must so I'll catch up again in the morning and hopefully Charlie will be feeling a little better.:)

[lulusmom]

Hi and welcome to you and Charlie.

If Charlie is acting sick, DO NOT give him any Vetoryl. Not eating, extreme weakness, vomiting and diarrhea are all signs that cortisol may be too low. How much does Charlie weigh and what dose of Vetoryl are you giving him and is it once a day or twice a day? Did you vet instruct you to call him if you see signs of low cortisol. Did he also instruct you to bring Charlie in no later than 14 days from starting treatment for an acth stimulation test. Did he also instruct you to make sure you give the Vetoryl with food for optimum absorption. On the day of the ACTH stim test, you need to make sure he is at your vet's office within 3 to 5 hours of dosing as the test must be completed within 6 hours of dosing. Your vet should also check Charlie electrolytes with every stim test.

Charlie has really had his share of problems for a while and I'm glad that you found a vet that may have more experience with cushing's; however, we like to look over the vets' shoulders just to make sure all the i's are dotted and t's are crossed. General practitioners are more likely to be inexperienced and not follow proper diagnostic and/or treatment protocol so our comfort level is rock bottom until members can provide us with enough information for us to relax. We are worry warts around here and for good reason. You can help us greatly by gathering up the test results that were done to diagnose Charlie and post the results here. Here in the states, that's never a problem; however, I seem to recall that vet's in the UK don't feel it is important nor necessary to provide a pet owner for tests they have paid for. I'll never understand that mentality and I hope your vet will be more cooperative. With respect to the bloodwork, you need only post the abnormal values and please include the normal reference ranges.

Was an abdominal ultrasound done to validate the ACTH stimulation test and determine whether Charlie has pituitary or adrenal dependent cushing's? If not, I am concerned as a lot of the symptoms you mention overlap with hypothyroidism. Was hypothyroidism ruled out.

The most common symptoms associated with cushing's are excessive drinking and peeing and a voracious appetite. You mention that Charlie drinks more than normal but he doesn't pee more than usual. That is a concern because dogs with cushing's lose their ability to concentrate the urine and drink to keep up with the huge amounts of urine in order to stay hydrated. Was a urine analysis done, including a culture, on Charlie? Is his urine dilute? Does he have a huge appetite?

I'm sorry for the reasons that brought you to us but I'm really glad that you found us. We do have members in the the UK but I'm certain that are posting regularly. The good news is that cushing's is the same in every country and members from every country are part of our family. We can help you and Charlie get through this. Cushing's isn't an easy disease to wrap your head around so please ask any questions you might have and whenever you find some quiet time, please check our Helpful Resources section. There is a wealth of information, including lots of reference material for Vetoryl.

Glynda

[Spiceysmum]

Hi Debbie,
I am in the UK and have found great help from the site for a few years. My Spicey started with Cushings when she was 11, then went into remission after being on Vetoryl for 18 months then we had to restart her on it after another 18 months. She passed away aged 14 nearly 2 years ago and is still greatly missed.
Lethargy is one of the signs of low cortisol so if this is still the case I would contact your vet to discuss this. Vets in the UK don't usually pass on test results but mine did cooperate when I asked them. They would be very useful here for people to help you. You said that you can feel every bone in Charlie's body but usually a dog with Cushings puts on weight especially as you say he has a ravenous appetite. Spicey had a slight heart murmur too which disappeared once she started on Vetoryl as did the really heaving panting.
Let us know if Charlie is any better this morning.
Linda

[DebsW]

Hi Glynda and thank you for the welcome and info. I have decided not to give Charlie his Vetoryl this morning as I was concerned his symptoms may be because his cortisol was too low and I shall be phoning the vets when they open in 5mins. Charlie is on 30mg once a day which he has with breakfast. I can't tell you precisely but Charlie weighs around 10kg, he is a large Cavalier and we have often been told in the past he was overweight purely on what he weighs and not how he looks which annoys me somewhat! At one point he did weigh just over 13kg but at that point he was a little overweight but not vastly and it was probably 3-4yrs ago. The vet did say to call if we were worried. He was going to check as to when we are to take Charlie back in for more tests but as yet we haven't heard back. The vet we have is very good not only in diagnosis but also in other aspects and takes the time to talk to us as owners and I'm sure he won't mind us having copies of Charlie's tests, we have in the past asked one of our vets for test results and have been given them but I can't remember which practice though I think it was our regular one. When we took Charlie in for his ACTH test we also took a urine sample but I'm not sure if other tests were done on that and bloods but Charlie didn't have an ultrasound and as far as I know wasn't tested for hypothyroidism, I have read about it before and although Charlie does have a lot of the symptoms he certainly isn't gaining weight so I ruled it out, I will mention it tomorrow when we see Martin.
Charlie doesn't go out to pee often but can stand there and have a long pee, the sample we took in to the vet was taken first thing in the morning and did seem diluted. Up until supper yesterday I would have said yes, Charlie has a huge appetite but he firstly refused to eat and then did but quite slowly, usually he hoovers food up like there's no tomorrow. This morning I offered him wet food with his biscuits which they don't usually get for breakfast and he turned his nose up, I then made scrambled egg and again he refused, I put it back down 5mins later and he ate about 3 teaspoon fulls before turning away, 5 mins later he ate some off a fork and then tucked in like he was hungry, ate half of it then suddenly stopped, turned away and laid down, he didn't move for over an hour even though I was out of sight, both of these things as so totally opposite to how Charlie usually behaves.
I have just spoken to the vet who has agreed Charlie shouldn't have his Vetoryl this morning and he'll see what he's like when we go in tomorrow. He says it could be the meds but didn't think the dose Charlie is on was high enough for it to be a problem and he is also concerned it may be something to do with his heart, I'm not sure if the Vetoryl can effect the heart or whether he thinks it's unrelated.
I hope all that makes sense, I'm afraid I'm not really all here this morning as I'm so worried about Charlie and have been laid on the floor with him crying, it doesn't help that my husband is away at the moment but is luckily back tonight.
I shall be writing down a lot of things to ask our vet tomorrow and will let you know what is said.
Thank you again and I am also very glad that I found you!

[DebsW]

Hi Linda, you posted while I was typing!
I'm sorry you lost your Spicey but it's good to know the Vetoryl helped her. Is that her in your avatar? If so she is gorgeous. We lost one of our Cavaliers last September so I know how much they are missed when they are gone.
I think I covered most things you said in my above reply but with regards to how thin Charlie is, I think it is more down to muscle loss which as I understand it is a Cushing's sign.
Although Charlie has had a huge appetite he doesn't get any more food than he normally would so hasn't been able to put weight on, he rarely goes out for walks so can't scavenge and our bin is pretty impossible for any of them to get into so he can't pick up 'extras' anywhere.
Charlie has always had a murmur, and a regular irregular heart beat apparently! When we do take Charlie out he does seem to pant very quickly, we assumed it was because he had weak muscle and was therefore finding it hard work to walk.
Having just spoken to the vet he does sound a little unsure of what exactly is causing Charlie's current problems because he has a few different issues going on, hopefully tomorrows visit will help to clear things up a bit.

[lulusmom]

I'm glad your vet agrees with withholding the Vetoryl. Every dog responds differently to Vetoryl and we've seen some dogs on very light doses have cortisol drop too low, so you just never know. I hope Charlie is feeling better today.

[BreeandDaisy]

Hey Debs:
Welcome. I am reasonably new myself but have TWO dogs with Cushings. One dx in Dec and the second a couple of months ago. The second one (11 year old havanese) had an elevated enzyme for 8 years that my vet said was a precursor to Cushings so it was a long slow onset. The older one went from zero to full blown in a month. Both dogs are on vetoryl but it did take three months for the get Daisy's (older one) dosage right. She was in getting tested and retested every few weeks.

I definitely echo the other postings. Contact your vet (the second one) and give the symptoms you are seeing. Hairloss is normal. Eating more is normal. Pot belly is normal. Not sure of the lethargic behaviour - I just can't remember if my vet mentioned it or not and I did not see it in my two.

This is a great board and I have found much support here.

Cheers and good luck
Shari

[DebsW]

Hello Shari
Charlie has been much the same today as he was yesterday, lethargic, slight difficulty in getting up, not interested in anything and off his food. His eating is a little odd though as he acts like he's interested, takes a couple of mouthfuls and then refuses any more, this evening he's done that and then had a drink as though he doesn't like the taste. I've spent the best part of an hour trying to tempt him, his wet food he had a couple of small pieces and then a drink, I tried mashing his biscuits with some warm water and he licked some of the 'gravy' then stopped so I blended it but again, although he got up to see what it was he left it. I then tried some fish and rice but not interested. There's something about the way he is acting that makes me wonder if he has a problem in his mouth, I offered him some of a low fat chicken strip and he ate it but kept turning his lip up as though it didn't taste nice or he couldn't chew it properly, it's very difficult to explain! He also has a strange smell coming from his mouth, not a usual doggy breath smell but something else and it's not pleasant! He has also burped a few times today which is something he doesn't usually do.
He has been in the garden 3 times today and each time I've had to carry him out and he's stood there for a minute and then wandered a little before going but doesn't produce much, although he drank very little this morning this afternoon he's had more so I was expecting more out the other end. Just now he also stood like he was weeing but nothing was coming out so I wonder if he may also have a urinary infection?
The lethargic behaviour has only been since yesterday so I'm assuming it's to do with the Vetoryl.
I've been wishing the day away so tomorrow comes around and we can see what the vet thinks, I've not been able to concentrate on much else today and the other 3 dogs are very confused as to why I'm trying to feed Charlie lots of different foods he doesn't want when they would gladly eat it! I have written a little list of things to ask, let's hope I don't forget!

[BreeandDaisy]

Sounds like he might have some bad teeth. Definitely contact the vet. Do you have an emergency vet you can call? Where in the UK are you?

[DebsW]

They aren't too bad and it's odd he's only been like this the past 2 days when he's been feeling so off colour, but we will definitely ask the vet tomorrow to have a look. He also seems to have become more 'jowly' inside his mouth, getting a toothbrush down the sides is difficult! I have to admit to not knowing his normal colour but his gums seem a little pale to me.
If we phone the vet practice out of hours it goes to an emergency number, with our local practice it goes first to a nurse who then phones the vet who phones us, I think Charlie's practice uses an emergency helpline.
We are in North Herefordshire, just south of Shropshire.
Charlie was sick earlier on and I thought he'd brought up all of today's food but he was then sick again half an hour later, twice in succession and seemed to bring up a lot more than he appears to have eaten today. I'm hoping that he now feels a little more comfortable. Did I mention he's burped a few times today that he doesn't usually do? He has been toilet the 3 times he's been outside so something is going through. He has had slightly soft stools for a couple of weeks but nothing too soft and although when I've seen him go I've though they seem small my husband has said he's seen him do normal sized stools.
I'm not going to give him anything else to eat until we see the vet in the morning but I would prefer him to drink a bit more.

[DebsW]

Well Charlie has been sick again and while I was holding him up I noticed he has some loose skin on one of his sides, just where the side goes under to his tummy, could this be because he was bloated for a while and him being sick has relieved that and so now the skin that was stretched is saggy? It's only on one side though. Any thoughts?

[lulusmom]

I'm very concerned with Charlie. Saggy skin can be a sign of dehydration and with him not eating, nor able to stand up, I think you really need to get him to a vet asap. If your vet can't see him, is there an emergency clinic you can get him to? His electrolytes should be checked at the very least and in all honesty, your vet should have had you come in today for that. Did your vet give you any prednisone to give Charlie in case of emergency? If so, I would recommend you give him a dose now.

[DebsW]

Thank you for your concern Lulusmum but I think maybe I've made Charlie sound worse than he is and he will be fine until the morning. His skin is only saggy in that one place and it seems to be saggier than you'd expect from dehydration, like someone who has lost weight and has excess skin. He is able to stand and walk around but he is just very slow and a little tentative, this could be partly because of him not feeling well but he also has mobility problems because of arthritis and his lack of muscle mass, I've read that the Vetoryl can cause arthritis to be more painful as the high cortisol levels beforehand mask the pain so it could just be he is feeling it more. He has been sick once more but that was after we tried syringing some water into his mouth so we are going to leave him to sleep now and take him along to the vet in the morning. We didn't get any prednisone but will again ask about it tomorrow. Thank you again and I'll let you know how we get on tomorrow.

[Squirt's Mom]

How is Charlie this morning? Hope he is feeling much better and that the vet will check his electrolytes as well as cortisol. ;)

Hugs,
Leslie and the gang

[DebsW]

We ended up phoning the vet around 12.30am as Charlie was sick again and seemed worse but he didn't think he was bad enough to take in. This morning when I came down Charlie didn't move and when I carried him outside for a wee he couldn't stand up, I brought him back in and he was just really floppy and couldn't even hold his head up. He had also been sick again and was sick as we were getting ready. We took him over to the vet which has to be one of the longest 30mins of my life, I had my hand on his chest the whole way as I was so worried he would stop breathing, he was also sick again in the car and I had to hold his head up as he was just completely limp. The vet immediately put him on a drip and said he would test his electrolytes and bloods but assumed it was his cortisol levels that had dropped too low. We had a phone call mid morning to say Charlie had improved and was holding his head up looking around but he is keeping him in until either tomorrow afternoon or Mon morning depending how he is. He also said his temp was low, 97F, so they were warming him up and had given him steroids. We are waiting for another call to let us know how he's been this afternoon.
The vet also said that Charlie was on the lowest dose of Vetoryl so I'm not sure where we go from here with treatment, can he be given a dose every other day for example?
Obviously because Charlie was so ill this morning we did actually talk to the vet about test results etc but will hopefully be able to when we go to pick him up.

[Squirt's Mom]

I am so glad you got Charlie in. I hope the damage is reversible and he is feeling better and back home soon. Do keep in touch and let us know how he is doing as well as what more you learn from the vet.

Hugs,
Leslie and the gang

[labblab]

I, too, am very relieved that Charlie is at the vet's and I will anxiously await further updates.

Right now, the most pressing issue will likely be giving him supportive therapy until he is able to rebound from this episode. It may be quite some time before he needs to resume Vetoryl. But just so you'll know, Vetoryl comes in 10 mg. capsules. So I don't know why your vet would have told you that his current 30 mg. capsules are the smallest dose available. Perhaps there was some misunderstanding.

Anyway, once again, the most important thing right now is that Charlie has the chance to recover from this episode.

Sending many healing wishes your way,
Marianne

[Spiceysmum]

Hi Debbie,

Hope Charlie is improving by now, will be looking for further updates. Just to let you know that Vetoryl is available in 10mg capsules in the UK too. I used them for Spicey to make the dose up to 40mg. And yes, that is Spicey in my avatar and I think she was gorgeous too.
Hoping to hear good news later.

Linda

[Squirt's Mom]

Morning, Debbie,

Just popping in to check on Charlie. Hope is has rebounded and is on his way back home soon, if he isn't already there.

Hugs,
Leslie and the gang

[DebsW]

Thank you for your thoughts and good wishes but it is with a heavy heart that I have to say that Charlie was put to sleep yesterday evening as it was discovered he had a tumour on his adrenal gland that had enlarge to the point it was encroaching on other organs and had caused either his intestine or stomach to rupture meaning there was fluid leaking into his abdomen. The vet had done some tests and there were things that were too high and things too low, I'm afraid I wasn't paying enough attention at that point to remember but I do know his temp was 104 and his blood pressure half what it should have been. The vet said even if they managed to stabilize Charlie he didn't think he'd survive an op to find out exactly what was wrong and also said he wouldn't be able to get Charlie to the point where he could come home again so we though the kindest thing was to let him go, he wasn't aware of what was going on and it was all very peaceful. It has been quite a shock and we are devastated to lose our special boy but know he is now at peace at Rainbow Bridge with our Rosie. He was our first dog and had been a big part of our lives for 9.5yrs and it is so difficult not having him around, but we have so many wonderful memories of our boy that he, like Rosie, will live on in our hearts.
Debbie x

[Squirt's Mom]

Dear Debbie,

It breaks my heart to hear this. I had so hoped it was a simple case of his cortisol dropping too low. So much more can be going on with our babies, tho, that we nor our vets are aware of and sometimes those are the things that rise up to shatter our world. It sounds as if Charlie had the worst case for adrenal tumors - one that makes surgery to remove it most risky.

I am sure you made the right, the only, decision in letting him go. That was the kindest thing to do, the greatest gift you could ever give Charlie. There is no doubt in my mind he and Rosie are running in the Rainbow Fields, happy together, strong and whole as they were meant to be. From there, they will watch over you with the same love and devotion you always showed them.

Charlie's name has been added to the In Loving Memory list for 2012. When you are ready, please know that you are more than welcome to post a tribute or memorial to Charlie in the In Loving Memory section. We would love to share in honoring and celebrating his life through your stories and memories.

Our deepest condolences,
Leslie, Squirt, Trinket, Brick, Tasha, and our Angels, Ruby and Crystal


************************************************** ***
Weep not for me though I am gone, into that gentle night.
Grieve if you will, but not for long, upon my soul's sweet flight.

I am at peace, my soul's at rest; There is no need for tears.
For with your love I was so blessed for all those many years.

There is no pain, I suffer not, the fear now all is gone.
Put now these things out of your thoughts, in your memory I live on.

Remember not my fight for breath, remember not the strife...
Please do not dwell upon my death, but celebrate my life.
************************************************** **

[Spiceysmum]

Debbie,

I am so sad to hear about Charlie. I know you did everything you could for him and he knew that too. Thinking of you.

Linda

[k9diabetes]

I'm so very sorry that Charlie was found to have such a catastrophic illness... even when it's so obviously the right decision, it is a heartbreaking one to have to make. Godspeed to your boy and my deepest sympathy to you and your family.

Natalie

[Jenny & Judi in MN]

I'm so sorry for such a sudden loss of your Charlie. Thank goodness he was not in any pain. hugs, Judi

[Bo's Mom]

So sorry to hear about your Angel Charlie. Hugs are sent to hopefully comfort you and your family at this difficult time.

Belinda Rose

[mytil]

I am so very sorry your Charlie has passed on. My heart is with you.
((((((hugs))))))
Terry

[BreeandDaisy]

I am so sorry to read this. My thoughts are with you at this difficult time.

[Roxee's Dad]

Dear Debbie,
I am so sorry for your loss.
Rest in Peace Charlie, you are our newest and brightest star in the sky.

[Cyn719]

Debbie


So sorry for the loss of Charlie....you did all you could for him and loved him so much and he knew that......no words could help right now but hold your memories close to your heart..you will always have those forever.

Love, hugs, strength, support....xoxo

[DebsW]

Thank you all for your lovely comments, we are both touched by your kind words. It's still hard to believe our special boy will never be with us again but he was not in a good way on Sat and we know the decision we made was the right one for Charlie.
We have cried oceans of tears for him but have also managed to look at photos and talk about all the happy memories we have of him and these will keep him in our hearts. He was a very quiet and unassuming boy but through all the little things he did he still made a big impact on our lives, especially as he was our first dog and has been with us for 9.5yrs so has been through a lot with us. He was also very much 'our' dog, the others would happily have gone and lived with someone else but Charlie would only have wanted to live with us. I miss him so, so much, his clip clopping on the hard floors and plodding slowly up the stairs, him following me around like a little shadow so I fall over him when I turn around. I miss his head snuggling in for a cuddle and the twitch at the end if his tail before it started to wag fully because I was wagging my whole body at him. I miss doing sign language and waving my arms around like a windmill to get him to go somewhere and him laying flat dog in the sunshine. So many little things that made up our boy Charlie Farley, Mr Plod, Clip Clop, Twitchy Tail, Flat Dog, all nicknames we used that described him but most of all he was known as Our Special Boy as that's what he was. It's still incredibly difficult but I know that as time goes on the tears will be fewer and the heartache less as we went through it all with Rosie 9months ago. He will always have an extra special place in our hearts and live on in our memories. xxxx