Meet Oscar, my boxer

[Lolabirdie]

Hi all,
Oscar, one of our boxers, was diagnosed with Cushing's in early December 2012, and we got his dose of vetoryl regulated pretty quickly. However, apart from his hair starting to grow back from where it had been shaved for tests, he hasn't really shown any improvement. Oh, just this last week he's able to actually leave food in his bowl...
He's bloated, overweight, drinking loads, but the biggest problem is the peeing. He's probably peeing in the house 3 or 4 times a day, which is pretty grim for all of us, him included I'm sure.
When we took him back to the vet with the the continued symptoms, he was diagnosed with borderline hypothyroidism and on medication for that too, again the dose has been stabilized.
I am interested in members' experiences with the peeing - how long did it take to get that under control, as I'm sure we should have seen an improvement...and whether any of you with dogs who've made little progress have had further illnesses diagnosed?
He is due back at the vet later this week, I wonder what direction they'll go in this time...

[Squirt's Mom]

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[Harley PoMMom]

Hi and welcome to you and Oscar,

So sorry for the circumstances that brought you to us but glad you found your way here.

It would help us a great deal if you could round up copies of all tests that were done on Oscar and post any abnormalities that are listed along with the reference ranges and units of measurments...e.g.ALT 150U/L (5-100)....Thanks! We are specially interested in the results of all ACTH stim tests with their timelines.

What dose of Vetoryl is Oscar on and is it given once or twice a day? How much does Oscar weigh? Were other non-adrenal issues; such as diabetes, UTI, or kidney problems, ruled out?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[Lolabirdie]

Hi Lori
Thanks so much for getting back to me so quickly, I can give you some info but not about his test results I'm afraid, not right now anyway. He has only had one ACTH test, I know that much.
He's on 130 mg of vetoryl, once a day, and 375 mcg of thyrofin, twice a day for his hypothyroidism, prescribed as he was borderline and I think probably just to see if it made a difference.
He's 8.5 years old and weighs a hefty 39kg at the moment, he's put on about 7 kg in the last 6 months.
He was originally treated for a UTI as they tried to find out what was wrong, although that was before any tests and I think just a place to start. I think - think- diabetes was tested for, and I don't know about kidney problems, I will ask later this week when he goes in.
Hope this is enough for now!
Thanks again
Lolabi

[lulusmom]

Hi Lolabi and welcome to the forum.

I realize you don't have copies of Oscar's acth stimualtion tests but without seeing those results, there is no way for those of us who have dealt with excessive peeing to know if our dog's circumstance parallel Oscar's. Therefore, it would be great if you would please get copies of those results and post them here.

I will tell you that the goal of treatment is to resolve symptoms and if your dog is still peeing and drinking excessively, I don't understand how your vet can claim that Oscar is well controlled. Vetoryl has a very short half life, meaning its effects is short lived, waning any time after 8 hours. Some dogs, therefore, never see a complete resolution of symptoms on once daily dosing. If Oscar is on once daily dosing, this could be what is happening with him.

Dogs with cushing's usually do have a mildly low T4 (thryoid hormone) and before giving thyroxine, most experienced vets will want to get the cushing's under control as most of the time the T4 normalizes. It could very well be that Oscar is getting too much thyroid supplementation and he is now hyperthyroid. Excessive drinking and peeing is the hallmark symptom of hyperthyroidism. When is the last time your vet checked the thryoid levels?

[Lolabirdie]

Hi lulusmom, good to hear from you, I will get on the case about the test results!
Oscar was put on thyrofin about a month after his cushings diagnosis, which, although certainly wasn't any better, was registering that he on the right vetoryl dose. I do hope the vet hasn't prescribed thyroid meds in haste. He was last tested for his thyroid about 3 weeks ago.
It's interesting what you say about the once a day dosing, I wasn't aware of this.
So already i have ideas about questions to ask the vet later this week and I thank you for getting back to me so quickly.

[lulusmom]

Hi again,

If your vet ran a full thyroid panel and determined that Oscar had primary hypothyroidism, then I would say he probably needed supplmentation but if your vet was going by the T4 value only, I'd have to say that he probably jumped the gun and should have waited until Oscar's cushing's was completely controlled, meaning acth stimulation test results within the therapeutic range of 1.5 ug/dl to a max of 9.1 ug/dl and all symptoms have resolved. Was thyrofin prescribed at the same time Vetoryl was prescribed? If you saw a definite increase in drinking and peeing after you started Oscar on the Thyrofin, then that's pretty good evidence that it may not be the cushing's but rather the Thyrofin.

[Lolabirdie]

Hi
No, the thyrofin was prescribed about a month later, after full thyroid tests. The vet did make us aware that the various drugs can affect the conditions and that Oscar needs to be monitored closely.
It seems to be trial and error and best guesses, but all we want is a quick cure and to get Oscar back to full health....oh, and a clean, dry kitchen floor of course ...!

[gabelle1995]

Dudley has both Cushings and hypothyroidism. He's been on thyroid medication for 12 of his 14 years (hypothyroid). When our vet diagnosed the Cushings a little over a year ago, he stopped the treatment for thyroid while getting Dudley's Cushing's stabilized. When he retested Dudley for the Cushing's he saw that his thyroid was still low but not as low as before he started Vetoryl. So maybe your vet just tested too soon after the Cushing's treatment was started. Some of the continuing symptoms you describe are hyperthyroid symptoms. Make sure he's not just checking TSH concentration or just Total T4. You want to see Total T4, Total T3, Free T4 and TSH concentration. But that's just my 2 cents....

[Lolabirdie]

Just a quick one to update you guys that since visiting the vet last week, Oscar has been referred to a specialist as they felt his case is too complex to deal with in a general practice.
The vet was as concerned as we are over his lack of progress, and referred him straight away, to a renowned teaching hospital about a hour away. My husband took him in this morning, and after listening to a thorough history and studying his notes, they have kept him in. They are re-doing all his tests from scratch including an ultrasound to check out his liver, so I will keep you posted about what they say.
It's reassuring to know he is now in the best place, but scary wondering what they'll find...

[lulusmom]

That is awesome news and I'm so glad that your vet realized that Oscar's complex case was too much for him to deal with. Yes, he is in the best place possible now. We'll be anxiously awaiting your updates.

Glynda

[molly muffin]

Positive thoughts! He's in a great place to find out exactly what is going on and hopefully get him on track and a happy guy again.

hugs,
Sharlene and Molly Muffin

[Lolabirdie]

Hi folks, an update on today's visit to the specialist... Oscar is back home, shaved from top to toe (ok not quite but enough to think about a coat, especially with the thinning hair!)
He was tested for diabetes which came back negative, and all other blood tests came back either normal, or as expected with a cushings diagnosis. His ultrasound showed his liver has an appearance consistent with cushings, and enlarged adrenal glands indicating pituritry-based cushings. Everything else is normal - he has a heart murmour score of 3 but we knew that anyway.
So, as one of you clever guys suggested, the vet is not convinced the single dose a day is working, and he had put him on a higher total dose, but twice a day - 90mg of vetoryl twice a day. He has also stopped the thyrofin, which again one of you mentioned (I wasn't convinced about that either so I'm glad they've stopped it) - once the cushings is being controlled we'll look again at the thyroid issue, if there is one...
So, a positive day that has confirmed the cushings and given us hope that this might be a simple case of drug management. I do hope we'll see some improvement soon, and I will keep you posted!
Thanks again for your expert help x
Lolabi

[molly muffin]

Hi Lolabi, just thought I'd check in and see if you have noticed any changes in Oscar since starting the higher dose?

Sharlene and Molly Muffin

[lulusmom]

Hi Lolabi,

Sorry that I missed your last post. I'm so glad that your visit to the specialist went well and hopefully things will fall into place for Oscar. Please keep us posted on his progress.

Glynda

[Lolabirdie]

Hi guys,
Oscar has been on the higher dose for 5 days, and yes, we've noticed a change. He has only peed in the house a couple of times, although he is still drinking and peeing a lot. He does seem a bit more able to hold it. Today he looked as though the shape of his pot belly has changed a little, so we popped across the road to the vet (we live literally opposite :)) got him on the scales, and he's lost a kilo! He had put on at least another kilo in the time it took us to get to the specialist, so we are very glad we got him in there when we did....
One thing he is doing occasionally now is shiver a little, not all the time, but something to note. My husband also thinks he gets sleepy after the vetoryl but I'm not sure, as it coincides with just having had a belly full of food.
He's definitely not as ravenous for food as he was in the early stages, that was frightening as he's never been motivated by food and he had started raiding the bin and scoffing anything. One morning we found him eating egg shells out of the rubbish...hopefully that's sorted.
Obviously now we are aware of the chance that he'll go the other way, so whilst we are pleased about the slight weight loss and the food thing, we are keeping a very close eye on things. He is due back at our regular vet in a week to check his levels. I read on one website about the need to have prednisone at the ready in case it's needed, have any of you any thoughts on whether it's worth asking the vet? Remember we live 30 seconds from him, so i may have just answered my own query!!
My other concern is about the vetoryl dose, it seems a huge jump from 130mg once a day to 90mg twice a day, and whilst i understand the double dosing theory, he's clearly on a much bigger total dose. In the past the vet only tweaked it from 120 to 130. He was 41.5kg when the specialist prescribed this new regime. Perhaps they'll reduce it if his weight continues to drop.
So much to think about hey! But great to know you lovely people are interested, and even better that Oscar is comfortable at least for now, fast asleep and contented in front of the fire.
Thanks again guys

[lulusmom]

Hi Lolabi,

It's hard to determine if 130mg is too big of a dose for Oscar without the benefit of seeing his last acth stimulation test. Did you post the results and if not, can you do that for us? If you saw a specialist, I have to believe his/her assessment took all factors into consideration. I'd be more concerned if your gp vet prescribed the increase in dose. Looking forward to seeing those results.

Glynda

[labblab]

Just to reconfirm -- Oscar's dose has been increased from 130 mg. once daily to 90 mg. twice daily (or 180 mg. total)? And for those of us who go by pounds, I think his weight is about 90 pounds. As Glynda says, though, as far as assessing the increase, it'll help us a lot if you can first tell us the results of his last ACTH test.

Thanks in advance,
Marianne

[Lolabirdie]

Hi
Yes, Oscar was on 130mg once a day (tweaked from 120mg) but since seeing the specialist is now on 180mg, split in to two doses.
I have been reading the treatment guidance for vetoryl, and am relieved to see the recommendation of increasing the original dose by a third or half when changing to twice a day dosing. So, today's little panic over. ;)
He is due back at the local vet on Friday for an ACTH test, so I will get hold of the results for past tests if I can.
Meanwhile, he's not peed in the house, but has been in the bin! Mind you, i think that might have had more to do with there being homemade nutella muffin wrappers in it than his Cushing's...he is still just a naughty boxer boy sometimes!
Talking of food, I'd appreciate anyone's thoughts on diet. Oscar currently gets dry complete food, and i wondered if increasing his protein by adding some meat might help him rebuild some of his wasted muscle.
Thanks for listening, what a great forum
Karen x