nmcrawf
01-17-2013, 12:02 AM
I have read the forums on this site for the past several months, ever since my wacky beagle, Roxy, was diagnosed with Cushing’s. We are now at a point where I would love your advice and opinions about the path of care that she is receiving.
Roxy is an 11-year-old beagle who weighs approximately 24 pounds. She developed what appeared to be anxiety a couple of years ago. The symptoms began gradually after the passing of our 15-year-old black lab, Jamie; the gradual “escape” of our three kids as they left for college; then our pilgrimage into becoming foster parents to many shelter dogs; finally adopting a 7-month-old mixed breed dog into our family. We felt like Roxy had lost a lot of the people/animals that she loved, so we assumed that this caused her anxiety. She began to have difficulty sleeping at night, and she kept us awake nightly for at least two years. We were completely exhausted and frustrated. She panted non-stop and howled and cried all night long. She couldn’t sleep in our room because her snoring became terrible. Our vet treated her for anxiety with Clomipramine, but it didn’t work. They also tried Valium 10 mg twice a day, but the symptoms escalated. We tried a Thundershirt, DAP spray, and lavender candles, but nothing worked. Eventually, she developed an extreme food drive, increased thirst, increased urination, and constant panting. The vet did blood work in August of 2012 which showed a high amylase (2397), high CK (287), slightly high cholesterol (363), elevated B/C ratio (32.5), and elevated bicarb (28) which the doctor thinks is related to the constant panting. He then performed a dexamethasone challenge which showed her baseline cortisol = 183 (15-110), cortisol low dose dex 4h = 85 (0-30), cortisol low dose dex 8h = 235 (0-30). The results suggested pituitary-dependent hyperadrenocorticism. She was started on Vetoryl 60 mg daily.
ACTH stimulation test after four weeks showed pre-ACTH = 4.1, post-ACTH = 4.9. Her symptoms were under control at that point. She was sleeping through the night, and her increased urination and thirst were better. The food obsession was a little bit better. Six weeks later, the symptoms returned, although she was still able to sleep through the night without trouble. A repeat ACTH stimulation test showed pre-ACTH = 10.2, post was 8.9. Her Vetoryl was increased to 90 mg daily. That was two months ago, and her symptoms have not improved. Any time she is awake, she forages for food, even when there is no food available. She snorts like a pig and covers the entire kitchen, bathrooms, family room, etc., searching for something to eat. She is able to open the door where we keep our kitchen trash, even with a baby-proof lock in place. We feed her twice a day, and she cries frantically if she hears me approach the food storage container. When she sleeps, she snores so loud that we have to turn up the TV to hear. She wants to go outside every 15 minutes. I don’t know if she truly has to urinate, or if she wants to be outside so she can eat her own “poop”. I swear she’s that hungry. She also has a strange symptom that started when we increased her dosage. If she gets excited (if someone rings the doorbell or one of my kids comes home to visit), she rushes towards them, stops, then draws up her right leg and lays down on the ground. She lays there and gives that typical beagle greeting--the howling/barking/crying sound that a lot of beagles have. It doesn't seem like she is in pain at that time, but that right leg contracts up and she immediately lays down.
Repeat blood work done last week (seven weeks after the dosage change) was within normal limits. I forgot to ask the vet to give me the numbers, but I will get them. He consulted with an internal medicine vet, and she suggested I give the Vetoryl twice a day (60 mg in the a.m., 30 mg in the p.m.). I have started the Valium again, 10 mg once a day. Today was her first day of the split dosage, and she appeared anxious the entire day (until now—she is snoring next to me). She had one episode of vomiting tonight. The emesis had a bit of bright red blood in it.
Our plan is to continue this dosage for the next two weeks, then we’ll talk with the vet and decide whether to change medications. I wondered if anyone has any suggestions of what else we can try. We never established why Roxy had the high amylase, although I searched online and read that Cushing’s dogs have an increased incidence of pancreatitis. We haven’t rechecked the amylase since we started treatment, so it may have resolved by now. I read online tonight that if you decide to give the Vetoryl twice daily, the dosage should be increased by 33-50%, then split into two doses. Has anyone else heard that? I thought I would call the vet tomorrow to ask him. Thank you all so much for any advice you have!
Roxy is an 11-year-old beagle who weighs approximately 24 pounds. She developed what appeared to be anxiety a couple of years ago. The symptoms began gradually after the passing of our 15-year-old black lab, Jamie; the gradual “escape” of our three kids as they left for college; then our pilgrimage into becoming foster parents to many shelter dogs; finally adopting a 7-month-old mixed breed dog into our family. We felt like Roxy had lost a lot of the people/animals that she loved, so we assumed that this caused her anxiety. She began to have difficulty sleeping at night, and she kept us awake nightly for at least two years. We were completely exhausted and frustrated. She panted non-stop and howled and cried all night long. She couldn’t sleep in our room because her snoring became terrible. Our vet treated her for anxiety with Clomipramine, but it didn’t work. They also tried Valium 10 mg twice a day, but the symptoms escalated. We tried a Thundershirt, DAP spray, and lavender candles, but nothing worked. Eventually, she developed an extreme food drive, increased thirst, increased urination, and constant panting. The vet did blood work in August of 2012 which showed a high amylase (2397), high CK (287), slightly high cholesterol (363), elevated B/C ratio (32.5), and elevated bicarb (28) which the doctor thinks is related to the constant panting. He then performed a dexamethasone challenge which showed her baseline cortisol = 183 (15-110), cortisol low dose dex 4h = 85 (0-30), cortisol low dose dex 8h = 235 (0-30). The results suggested pituitary-dependent hyperadrenocorticism. She was started on Vetoryl 60 mg daily.
ACTH stimulation test after four weeks showed pre-ACTH = 4.1, post-ACTH = 4.9. Her symptoms were under control at that point. She was sleeping through the night, and her increased urination and thirst were better. The food obsession was a little bit better. Six weeks later, the symptoms returned, although she was still able to sleep through the night without trouble. A repeat ACTH stimulation test showed pre-ACTH = 10.2, post was 8.9. Her Vetoryl was increased to 90 mg daily. That was two months ago, and her symptoms have not improved. Any time she is awake, she forages for food, even when there is no food available. She snorts like a pig and covers the entire kitchen, bathrooms, family room, etc., searching for something to eat. She is able to open the door where we keep our kitchen trash, even with a baby-proof lock in place. We feed her twice a day, and she cries frantically if she hears me approach the food storage container. When she sleeps, she snores so loud that we have to turn up the TV to hear. She wants to go outside every 15 minutes. I don’t know if she truly has to urinate, or if she wants to be outside so she can eat her own “poop”. I swear she’s that hungry. She also has a strange symptom that started when we increased her dosage. If she gets excited (if someone rings the doorbell or one of my kids comes home to visit), she rushes towards them, stops, then draws up her right leg and lays down on the ground. She lays there and gives that typical beagle greeting--the howling/barking/crying sound that a lot of beagles have. It doesn't seem like she is in pain at that time, but that right leg contracts up and she immediately lays down.
Repeat blood work done last week (seven weeks after the dosage change) was within normal limits. I forgot to ask the vet to give me the numbers, but I will get them. He consulted with an internal medicine vet, and she suggested I give the Vetoryl twice a day (60 mg in the a.m., 30 mg in the p.m.). I have started the Valium again, 10 mg once a day. Today was her first day of the split dosage, and she appeared anxious the entire day (until now—she is snoring next to me). She had one episode of vomiting tonight. The emesis had a bit of bright red blood in it.
Our plan is to continue this dosage for the next two weeks, then we’ll talk with the vet and decide whether to change medications. I wondered if anyone has any suggestions of what else we can try. We never established why Roxy had the high amylase, although I searched online and read that Cushing’s dogs have an increased incidence of pancreatitis. We haven’t rechecked the amylase since we started treatment, so it may have resolved by now. I read online tonight that if you decide to give the Vetoryl twice daily, the dosage should be increased by 33-50%, then split into two doses. Has anyone else heard that? I thought I would call the vet tomorrow to ask him. Thank you all so much for any advice you have!