BuckyBoy (10 y/o Boston Terrier) Diabetic - New issue w/ clots

[Robin Verhose]

I really don't know where to begin so I'll just start...In January 2011 Bucky started losing hair gradually but it was enough to alarm me to get him to Garden State Vet. Specialists...to make a long story short he was FINALLY & officially diagnosed in January of this year...Bucky is now a 10 year old Boston Terrier and he had an awful summer...sluggish, HOT all the time, panting, peeing, drinking water...it was pathetic to see him so run down.
2)In the meantime, he has had a few teeth out, came down with a severe case of Pancreatitis in December and now is a Diabetic...I am overwhelmed...my biggest challenge is that dang needle twice a day, but we press on...
3)Here's a question: my vet put Bucky on 30mg Vetoryl...at first once a day...big fat capsule...then she upped it to 1 additional dose every other night...my problem is this...he has either diarrhea all the time or a very, very loose stool...squishy they call it...i attribute it to the Vetoryl...we have tried the pumpkin, rice, clavamox, Rx Biotic and still this 'crap'...i've had enough...poor little guy is losing weight.
With this and the diabetes going on the Vet said 'you're going to have to make a decision'...what the heck does that mean? which disease to treat?...Yes, i'm between a rock and a hard place.
He has a good appetite...and of course he is thirsty.
Vet finally relinquished to 1 capsule every other day and tylosin powder thinking he may have IBS.
If its not one thing its another and i'm just besides myself...its absolutely breaking my heart.
Vet keeps researching her manual and has concluded switching to the other Cushings med will/may produce the same problem=diarrhea.
Trouble is he isn't supposed to have prolonged diarrhea...its supposed to go away...
4)Bucky is not a panter BUT we just went out in the car for a ride...its 49 degrees out but the sun is strong=he's panting again...its one of the Cushing symptoms for him...
thanks for reading...if anyone has any insights/ideas/comments good or bad, i'll be glad to read them...sorry this is long....just pent up stuff...:(

[Robin Verhose]

I forgot to add his heart murmur diagnosed that fateful January 2011.

[frijole]

Hello and I'm glad you found us. It is hard to comment too much as we don't know the results of the testing done to diagnose cushings. I will say this - trilostane/vetoryl does not cause diarrhea. Having too much of it does. And if you keep giving too much then your dog could be in really bad shape. The other drug works differently but diarrhea is a sign of overdose as well. So if your vet is sitting there and saying these drugs cause diarrhea I will say without a doubt that your vet does not have a clue how to treat cushing's.

First off - is the diabetes under control? That is way more important than cushings at this point.

Please try to give us a greater amount of detail of when each disease was diagnosed. Also please provide the tests that were done for cushings (and blood panel info as well) We need dates and results. Has your vet been doing the acth test each time you switch dosing amounts? (you're supposed to) More evidence that your vet is clueless is that you don't give trilostane/vetoryl every other day. That'd be as effective as taking an aspirin every other day for a headache. The drug doesn't stay in the system long and therefore you can't wait days.

Finally please know that you can't just switch to the other cushings med because they interact badly and you need 45 days of washout.

Frankly I am wondering if your dog even has cushings. So please go to the vet and get copies of all testing and post it for us to take a look at.

How much does your dog weigh? You can tell us before and after losing weight so we have a feel of how much weight has been lost.

Hang in there - frankly I'd focus on the diabetes and make sure it is under control. Giving meds for cushings every other day is a total waste of your money. Please get the info asap so we can help determine if your dog was properly diagnosed. Are there other vets in your area you can go to? Note get all records first.

Thanks Kim

[Harley PoMMom]

Hi and welcome to you and Bucky,

I see that you mentioned that Bucky has had a pancreatitis attack, has a spec cPL test been done to evaluate Bucky's pancreatitis? Also, any non-adrenal illness, like pancreatitis and/or diabetes, can create false positive results on all tests for Cushing's, so I am very suspicious of his diagnosis of Cushing's.

We have a sister site that deals with canine diabetes and I do stongly urge you to join there too, here is a link: http://www.k9diabetes.com/forum/

Getting copies of all tests that were done on Bucky and posting any abnormalities that are listed would be a great help to us.

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

Love and hugs,
Lori

[goldengirl88]

Robin:
I just wanted to welcome you to the site. I am so sorry your poor baby is having all these problems. You came to the right place. The people on here will help you so much. It is like one big family. I feel your pain about your poor dogs situation, I hope it all gets better.God Bless You and your Baby.

[Robin Verhose]

good morning...my comments are below and i'm not done yet because i have to rush off to Mass...
Hello and I'm glad you found us. It is hard to comment too much as we don't know the results of the testing done to diagnose cushings. I will say this - trilostane/vetoryl does not cause diarrhea. Having too much of it does. And if you keep giving too much then your dog could be in really bad shape. The other drug works differently but diarrhea is a sign of overdose as well. So if your vet is sitting there and saying these drugs cause diarrhea I will say without a doubt that your vet does not have a clue how to treat cushing's.I have to stick up for her just a bit...perhaps something got lost in my story...she kind of insists Vetoryl does not cause prolonged diarrhea but is a side effect at the start of treatment...she is puzzled why it still continues...ME TOO.

First off - is the diabetes under control? That is way more important than cushings at this point.
i am not sure if it is under control as it was just diagnosed February 21. so we are working on it and its tough.

Please try to give us a greater amount of detail of when each disease was diagnosed. Also please provide the tests that were done for cushings (and blood panel info as well) We need dates and results. Has your vet been doing the acth test each time you switch dosing amounts? (you're supposed to) More evidence that your vet is clueless is that you don't give trilostane/vetoryl every other day. That'd be as effective as taking an aspirin every other day for a headache. The drug doesn't stay in the system long and therefore you can't wait days.
will go over this later on today.

Finally please know that you can't just switch to the other cushings med because they interact badly and you need 45 days of washout.
ok

Frankly I am wondering if your dog even has cushings. So please go to the vet and get copies of all testing and post it for us to take a look at.

How much does your dog weigh?
Bucky has lost a lot of weight, especially for a little dog...as of Friday 16.7 lbs...it is alarming me.You can tell us before and after losing weight so we have a feel of how much weight has been lost.

Hang in there - frankly I'd focus on the diabetes and make sure it is under control. Giving meds for cushings every other day is a total waste of your money. Please get the info asap so we can help determine if your dog was properly diagnosed. Are there other vets in your area you can go to? Note get all records first.

Thanks Kim

Thanks Kim...as i said, i will collect what i have and get it over to you...just wanted you to know i have made an appt. to take him to the Specialists in our area called Garden State Vet Specialists...maybe my Vet is puzzled...and one one of the boards or Facebook is where i got the idea...to me its Time's a Wasting and so is Bucky...wasting away.

[frijole]

Thanks for giving us a bit more info. As you know we need the full picture to truly help.

Please note that a dosage of 60 mgs a day (twice daily as you were told to do) is way to high to start. At 16.7 lbs the starting dose should have been closer to 20 mgs a day.

I continue to be very very concerned about the cushings diagnosis. It appears (I don't have all the facts) that your dog was diagnosed with both cushings and diabetes around the same time. We often see this because the symptoms are the same. Understand that dogs often test FALSE POSITIVE for cushings when something else is going on such as diabetes. This might explain why your dog has diarrhea - because he doesn't need it and if you keep giving it (if he does not have cushings) it could harm him.

So this is why we need to know what tests were done and when. Meanwhile if he were my dog I'd hold off on treating cushings for now because that dose is high, he's losing weight, he has diarreah and I'd really want to make sure the diagnosis is right. There is NO rush to treat cushings as it isn't life threatening, however getting the diabetes under control is.

Here's info on trilostane which might help and a link to what cushings is. Please know we tend to see alot of cases just like yours and that is why I am concerned. Thanks, Kim

http://www.k9cushings.com/forum/showthread.php?t=185
http://www.k9cushings.com/forum/showthread.php?t=180

Kim

PS WE have a sister site that might help you with the diabetes: www.k9diabetes.com

[molly muffin]

Hello and welcome from me too. Definitely join up with our sister diabetes site that Kim gave you a link to. You'll have immediate feedback on any questions and that is the main thing to get under control at this point I'd think. Then perhaps you can see if the cushings symptoms are still there.
60mg at that weight is not a good place to start with vetroyl treatment. 1mg-1lb is the basic starting place that the experts are at right now. Every other day anything with vetroyl doesn't work. You want once a day or twice a day dosing, if you do end up with cushings and diabetes, then you are most of the experts now agree that twice a day dosing is the way to go so as to keep a steady cortisol level throughout the day. That is very important when trying to control both diseases.

Looking forward to seeing the test results and narrowing this down a bit.

Sharlene and Molly Muffin

[Robin Verhose]

I have both sites open simultaneously!

How do i get the information to you? I have reports.

Once again thanks for the support, Robin & Bucky




Thanks for giving us a bit more info. As you know we need the full picture to truly help.

Please note that a dosage of 60 mgs a day (twice daily as you were told to do) is way to high to start. At 16.7 lbs the starting dose should have been closer to 20 mgs a day.

I continue to be very very concerned about the cushings diagnosis. It appears (I don't have all the facts) that your dog was diagnosed with both cushings and diabetes around the same time. We often see this because the symptoms are the same. Understand that dogs often test FALSE POSITIVE for cushings when something else is going on such as diabetes. This might explain why your dog has diarrhea - because he doesn't need it and if you keep giving it (if he does not have cushings) it could harm him.

So this is why we need to know what tests were done and when. Meanwhile if he were my dog I'd hold off on treating cushings for now because that dose is high, he's losing weight, he has diarreah and I'd really want to make sure the diagnosis is right. There is NO rush to treat cushings as it isn't life threatening, however getting the diabetes under control is.

Here's info on trilostane which might help and a link to what cushings is. Please know we tend to see alot of cases just like yours and that is why I am concerned. Thanks, Kim

http://www.k9cushings.com/forum/showthread.php?t=185
http://www.k9cushings.com/forum/showthread.php?t=180

Kim

PS WE have a sister site that might help you with the diabetes: www.k9diabetes.com

[Jenny & Judi in MN]

Hi, My Jenny had cushings and diabetes too. we overtreated he cushings so her cortisol is very low and she is off the cushings meds right now.

I understand how overwhelming this is and how frustrated you are.

We had a hard time getting Jenny's diabetes controlled till we started treating her cushings. She went from 7 units twice a day of insulin, down to 3 units twice a day of insulin once things were better.

What kind of Insulin are you giving Bucky Boy? Walmart has the best deal, Novolin N for $25 per bottle.

I'm the opposite of you. Being home every 12 hours for the insulin can be a challenge but at least with blood sugar you can check their blood and know, with Cushings you are flying by the seat of your pants till you get them to the doctor and have a test run there.

My Jenny did get to a point where she is her rowdy diva playful girl again. So I do NOT think any "decisions" are necessary at this time.

hang in there. Judi

[Jenny & Judi in MN]

I just wanted to add that Jenny had loose stools for awhile before we had her official cushings diagnosis. She is all better now but I always wondered if her liver being wonky from all her medical conditions had anything to do with it?

I know over on the diabetes forum a few people have had their vets prescribe flagyl to get their dog's intestinal systems on track again

[frijole]

You can simply type results and dates. Most tests just have a couple numbers (see below examples). For blood panel only need to type items that are above or below normal:

low dose dex supp test (LDDS) 2/1/13
baseline = 1.5
4 hrs = 0.4
8 hrs = 5.9

acth test 2/1/13
pre = 2.4
post = 30

blood panel done on 1/25/13
alk phos 2000 (5-150) (Note in brackets put the range for normal)


Be sure we know testing done before and testing done AFTER taking the trilostane ok?

Thanks so much. Kim

[Robin Verhose]

Ok, let me study this and get back to you. just a little note...we went out for a poo and it was softer now than it was this morning...its got to be that Vetoryl...i can't wait for Wednesday...

You can simply type results and dates. Most tests just have a couple numbers (see below examples). For blood panel only need to type items that are above or below normal:

low dose dex supp test (LDDS) 2/1/13
baseline = 1.5
4 hrs = 0.4
8 hrs = 5.9

acth test 2/1/13
pre = 2.4
post = 30

blood panel done on 1/25/13
alk phos 2000 (5-150) (Note in brackets put the range for normal)


Be sure we know testing done before and testing done AFTER taking the trilostane ok?

Thanks so much. Kim

[frijole]

If you read the instructions for vetoryl you will see that should you have diarrhea you should CEASE giving it as it is a sign of overdose. If the purpose of the Wednesday appointment is to do an acth test (to check cortisol levels) I would try to get in tomorrow instead. The objective of vetoryl is to reduce cortisol levels. You test cortisol levels by doing the acth test. The problem is that vetoryl has a very short life in the body so if you cease giving it due to diarrhea (as per the instructions) then you need to have a test tomorrow because cortisol will increase by Wednesday and the test will be worthless.

The reason you have to be sure of the diagnosis is that dogs need cortisol to live. If a non-cushings dog removes too much cortisol it can harm the dog - even cause death.

Type up the results and we'll see what we got. Oh also did they do an ultrasound? Thanks, Kim

[molly muffin]

How are things going today? How is the poo? (we call this poo patrol btw and many, Many of our members are currently involved in it with their furbabies). :)

Sharlene and Molly Muffin

[Robin Verhose]

Just wanted to say i'm going to get Bucky's reports today or tomorrow and will have info for you then...my reports are incomplete...the most i have are the BILLS!

[Robin Verhose]

Thanks Molly...I have to say Bucky's poos are much better as of yesterday morning...i was so relieved to see a little whole log coming out of his butt i almost cried! Its not perfect...far from it, but at least i can pick it up...so
my Vet was correct, we should see results Monday (this was after Vet visit
Friday night)...he also has 1/16th of a tsp of Tylosin powder sprinkled on his
dog food...so is it the powder, the cutting down of Vetoryl or the combination?
I swear that Vetoryl is either too strong (30mg) or not for him...i hate that stuff...he still hasn't grown ANY hair back...was even taking melatonin for the longest time...no change at all...well, maybe the one changed is that he isn't losing any more hair...
Thanks for asking...silly talking about poo first thing in the morning! LOL
Have a great day everyone and thanks so much for the board and the wonderful supportive people on it...i'll be back!

[molly muffin]

poo and pee, morning, noon and night it seems. :) Hey, solid logs are a good thing!!! Just what we like to hear.

Now remember, hair and muscle weakness are two of the last things to clear up usually. When you see your ACTH results you'll know if it is in the golden zone or not and if so, then things hopefully will go smoothly. It's tricky getting there but it's worth it in the end I think.
Don't let the vetroyl scare you. Many members have had their pups on it for years and are having a healthy life. It's the initial hurdles that you have to get over.

You're doing great, jut hang in there!

Sharlene and Molly Muffin

[Robin Verhose]

Hi everybody, i'm back...here's the story...I kind of let go of Forums and web sites because it was just too much...i was hearing one way to do things from the vet and another from the boards...so i spent some time listening only to the vet and doing things his way...besides, i will admit to being extra sensitive and emotional so if the wrong thing was said or the tone lecturous(?), then that was it...
The latest is: we are on a third kind of insulin: 1 unit of Levemir twic e daily (oh we've mastered the shot--piece o cake now)...his numbers are still rather high but they do curve...i've charted him many saturdays...the vet now wants to start Bucky back on the Vetoryl...10mg twice daily...poor thing is just so skinny its frightening, yet he is ravenous...almost desperate for food (ate a banana peel the other day)...is his diabetes under control? Maybe for Bucky it is...just seems to be something else going on here...his accidents are no more, his water drinking is average to above average...his poops are wonderful...he is now on Hills W/D wet and dry & chicken ...which reminds me, i have to print out a coupon as i need to reload...let me look up those reports and see what i can report here, as you did ask for information...thanks for listening, Robin & Bucky
he gets NO treats; life for him is really rather boring lately...we're just waiting...waiting for him to get well...

[Robin Verhose]

12/22/12 Ultrasound Report
Left Adrenal: Abnormal--Bilateral adrenomegaly, 8 mm caudal pole
Right adrenal: Abnormal--15mm cranial pole
Liver: Abnormal -- mildly diffusely hyperechoic
Gall bladder: Abnormal there is severe dilation of the cystic and common bile duct (up to 8mm). the duct tapers at the duodenal papilla where it is surrounded by hyperechoic tissue (presumptive fibrosis).
Pancreas: abnormal -- the left and right limbs of the pancreas are irregular and mottled suggesting pancreatitis (acute or chronic)

[Robin Verhose]

Lab work IDEXX endocrinology MAY 17, 2012
PRE-DEX 3.4 ug/dL 1.0-6.0 Normal
4 POST-DEX 1.6ug/dL
8 POST-DEX 1.2 ug/dL
Lab comments: Ascn: Jo201493
3SS PRE/4HPOST/8HPOST Canine

weighed 21.7

[Robin Verhose]

IDEXX Reference Laboratory
10/8/2012
T4 0.6ug/dL reference range 1.0-4.0 LOW


i think this is his thyroid report.

[labblab]

Lab work IDEXX endocrinology MAY 17, 2012
PRE-DEX 3.4 ug/dL 1.0-6.0 Normal
4 POST-DEX 1.6ug/dL
8 POST-DEX 1.2 ug/dL
Lab comments: Ascn: Jo201493
3SS PRE/4HPOST/8HPOST Canine

weighed 21.7
Hi again, Robin, and welcome back!

Is this the only LDDS test that was done, and is this the basis for the Cushing's diagnosis? If so, can you look back on the lab report and see what "normal" range or interpretation was given for the 8-hour Post-Dex result? In some other IDEXX reports that I've seen, an 8-hour result between 1.0 and 1.4 /1.5 is not considered a definitive diagnosis for Cushing's, and the recommendation is to wait and retest again at a later date in order to see whether the 8-hour result elevates further over time.

Marianne

[Robin Verhose]

Marianne...it is this Ultrasound report in which the Specialist Vet said 'he is definitely Cushionoid'.
This is when i brought Bucky into the 24/7 vet for the pancreatitis attack...there's another report in Dec/Jan i need to look for, so i will be back :) i remember it well because we ran into the Christmas Holiday and had to wait for the results from Tennessee.


12/22/12 Ultrasound Report
Left Adrenal: Abnormal--Bilateral adrenomegaly, 8 mm caudal pole
Right adrenal: Abnormal--15mm cranial pole
Liver: Abnormal -- mildly diffusely hyperechoic
Gall bladder: Abnormal there is severe dilation of the cystic and common bile duct (up to 8mm). the duct tapers at the duodenal papilla where it is surrounded by hyperechoic tissue (presumptive fibrosis).
Pancreas: abnormal -- the left and right limbs of the pancreas are irregular and mottled suggesting pancreatitis (acute or chronic)

[Robin Verhose]

found it...its a 2 1/2 page report...how can i get it to you...can i attach it here? if so how...
but its off to work i go, so i'll do this over the weekend...report is from 12/17/12...this is when he was put on Vetoryl..
Have a good day everybody.

[Robin Verhose]

I'm back with an update...Bucky seems to be much better although his weight still is an issue he is slowly putting on a few ounces...here's the information from his latest lab report for ACTH done on Sat. May 12
Cortisol Serial2(ACTH) Antech Diagnostic
Time 1 Pre
Time 2 Post
Cortisol Sample 1 1.7 1.0-5.0
Cortisol sample 2 3.5 (LOW) 8-17

On a whole, the vet thinks we have him at a very good level and now we will conquer/maintain his diabetes.
He seems to be much happier and more like his old self...i know we have a long way to go, but i think we've hit bottom...

[Jenny & Judi in MN]

hi Robin: welcome back. I'm glad you are seeing some improvement with the Levemir and hope it continues now that Bucky's cushings is under control.

Quite a few dogs on the K9Diabetes forum had luck with Levemir when the NPH just wasn't cutting it.

hope he continues to get better and better.

Are you watching for low blood sugar? When Jenny's cortisol went too low, it also meant her insulin was too high. That was when I had to learn how to test her blood sugar!

Judi

[molly muffin]

3.5 post is a very good controlled number. In the right range. It's just sometimes harder with diabetes on the plate too, so as Judi mentioned, keep an eye for low BG, just like you do for high.

hugs,
Sharlene and Molly Muffin

[Robin Verhose]

Well, we got a good report from the Vet today...Bucky went up for yet another ACTH test (seems to be monthly lately!) and Electrolytes Out whatever that means...we will have the results this week sometime.
Vet walked Bucky out himself into the waiting room very pleased with the little guy who now weighs 19 pounds!!!! Which is right about where he should be...the reason why an ACTH test is because Bucky suddenly stopped eating his ALL of his dog food...he was telling me "I'm full Mom"...so right away I emailed the vet...he told me to cut out the Chicken and just continue with the dog food...worked like a charm...Vet said Bucky seems not to need the additional protein at this time.
ALL OF HIS HAIR HAS GROWN BACK IN...I should post some before and after pictures...his hair is silky smooth now...all of the white is silky white and his brown coarse hair is now black as it should be!!!!!
Of course he has diabetes which seems to be very manageable for the moment...he is on 4.5 units of Levemir.
Bucky plays a bit now, barks and just seems happy...why? He feels better...
Its been a long and expensive haul but he's worth it!
Just wanted to share the happy news :)
Oh, he takes 10mg Vetoryl twice daily...that's the right dose for him.
I was so amazed when he fur started growing back in.
I'm so happy I switched Vets and stuck with him...sure was worth it.

[Roxee's Dad]

Yay !!!!:D Great news, Glad Bucky is doing well :D:D:D


Thank you for coming back and giving us such a great update.:)

[Trixie]

So great that Bucky is doing so well and feeling much better. I'm sure you're relieved. I was looking at your old posts and it looks like you did eventually decrease the vetoryl dose from 30mg to 20mg...once you did that did the loose poop issue get resolved?
Sounds like Bucky is doing great now..happy and look good with beautiful fur back! Great news! :)

Barbara

[molly muffin]

This is Fabulous news!!! What a difference. I'm so glad to hear this.

hugs,
Sharlene and Molly Muffin

[Robin Verhose]

Bucky's mom here...we have a bit of a problem and the vet believes it has been caused by his cushings disease...he has been at the vets since last Saturday with breathing issues...yes, he has a huge heart murmur but the vet says 'he's trying to throw clots'...his breathing rate in the oxygen room was up to 108, now its down to 48...this is the most scariest thing...I'm between a rock and a hard place...everything was under control until last Friday night...you could just see his labored breathing...our plan is to bring him home on Sunday God willing...he is now on Plavix, baby aspirin and heprin (which will stop when he gets home)in addition to benazepril (heart), pimbodan (heart), soloxine (thyroid), vetoryl (cushings) & insulin...he's a walking little pharmacy.
Has anyone had this kind of issue before?
Bucky is 11. A beautiful Boston Terrier. I am besides myself with worry. Thanks.

[labblab]

Hi Robin, you'll see that I've moved your reply so as to add it to your original thread about Bucky (and I've also edited the thread title to reflect this new problem :(). Keeping all fingers crossed that he stabilizes quickly!

Marianne

[molly muffin]

Oh I am very sorry to hear that Bucky is having these problems. I know that there have been mention of clots associated with some cushings dogs here on the forum. It seems to be very rare instances though. How horrid that it has happened with Bucky.
I too hope that he can be stabilized soon and be okay.
sending you huge hugs and strength,
Sharlene and Molly Muffin

[goldengirl88]

I have read on here before of someone else having this issue. I am so sorry your Bucky is having this happen. I know I did read a lot about these clots can form because of the Cushings when I was researching one day. I pray that they go away and Bucky gets over this quickly. He is on an awful lot of meds as you said. Was he on the heart meds before he got the Cushings? I hope it works out quickly for both of you. Blessings
Patti