Constant Vomitting

[trevron]

Can anyone let me know if they have had this problem with their Cushings dog. Holly is a 13 year old schnauzer (mini) who has been on Vetoryl 30mg per day for 3 1/2 years. About 6 weeks ago she started vomitting yellow bile on a regular basis throughout the day and night, visited the vet and he gave her stomach protector as beleived it was a form of gastritis. No diahrrea, no temperature. Tried chicked and rice diet small amounts during the day and evening, made no difference and she started shedding weight. Both the stomach proptector and Vetoryl were vomited up within half and hour and the same with the food. Went back to vet with a wee sample and high protein found in it, bloods showed no organ failure. Tried pureed rice and chicken still no luck and weight loss now bad. At present she is off Vetoryl,two weeks, at vets suggestion and is on jars of baby food, my idea, with no lumps in it.Skin getting bad and she is still being sick but not so often, about three or four times a day, but gets bouts of seeming very breathless after being sick. She a has also on two occasions collapsed sideways after being sick, very, very scary.
I am at my wits end what to do for her and wondered if this is due to long term use of the cushings drug.
I should also point out that I live in rural Spain and although my vet is very kind I feel his expertise in Cushings is lacking. I am up every night with her at least once as she is sick yet she seems ok afterwards apart from the rasping breathe for a while. Any help would be much appreciated she is my baby girl and I hate seeing her like this.

[Squirt's Mom]

Hi and welcome to you and your sweet girl! :)

Did the vet do an ACTH when Holly started vomiting? Did they check the electrolytes? If not, I would insist that be done asap.

Do you have any prednisone on hand? If so, I would give her a dose of that now.

Was her pancreas ok? On the labs there should be something like AMY and LYP - were those values alright? Also the liver enzymes - ALP (ALKP), ALT, AST, GGT - were those all alright?

Did they test her for diabetes? Was her GLU ok on the labs?

Other than the possibility of the cortisol being too low and diabetes, these are my next thoughts - something wrong with the pancreas, or something going on in the bile system - liver, gall bladder, ducts.

I think I would be asking for a referral to a specialist (IMS) or hospital where they can do more extensive testing, including an abdominal ultrasound. And I would be taking this action immediately. Something serious is apparently going on and it needs to be looked in to asap.

Please stay in touch and let us know how Holly is doing and what you decided to do and what you learn.
Hugs,
Leslie and the gang

[frijole]

Please stop giving the trilostane for now. It could be the cortisol is too low. Have the acth test done asap. If your dog has been vomiting bile for this long you also need to have the electrolytes checked and I agree I would test for diabetes since Schnauzers are known for diabetes as well as pancreatitis.

You might need to find a more experienced vet because your dog is likely very sick having vomited this much for this long. Kim

[frijole]

I want to add it is unlikely the vomiting is due to using the drug for so long. It is likely that over time your dog requires less of the drug. A sign of overdose (too low cortisol) is vomiting. That is why I mentioned STOPPING it asap. Regardless your dog needs an acth test, electrolytes check, diabetes check and the pancreas checked. Hang in there, Kim

[trevron]

The vet said that all her organs were ok on the blood test and that nothing else was abnormally high for dog of her age. He has not done another ATCH. It is very hard here to get anything out the ordinary done due to remote location and the seemingly lack of specialist small animal vets. I presumed that diabetes would show up on the urine test that I took?? He just said it was high in protein.

She normally weighs 7 kilos so is 30mg of Vetoryl a day too high? I don,t know wether to try giving her 15mg a day mixed into her baby food to get some down her. She has bouts in the evening of constantly asking for food but she just cannot keep large amounts down. She is also the last couple of days starting to have bouts of manic scrapping and nesting behaiviour.

I know this is going to sound awful but money is a real issue as I only have my pension to for us to live on and my vets bill outstanding is already several hundreds of euros.
I will be taking her again soon and want to know if there is anything I can suggest to the vet for his response, at present he is saying that quality of life is more important than treating the cushings hence stopping it as it was making her violently sick whenever she had it.

[labblab]

Welcome to you and to Holly. I am so sorry that she is doing so poorly and I surely understand why you are so worried.

Since she has been off the Vetoryl for two weeks now and you are not seeing a lot of improvement, I do think it is possible that something unrelated is causing her problems. Can you possibly give us the actual results for the bloodwork that has already been performed (all you have to list is anything that is outside the normal range)? When we speak about the electrolytes, these are levels that would be included on a standard test of blood chemistries. So perhaps this has already been checked. In terms of possible overdosing with Vetoryl, it would be the levels for potassium and sodium that would be really important to know. Even if all those levels were normal, though, I agree that it is important to check Holly's cortisol level. Even if your vet cannot perform a complete ACTH stimulation test right now, hopefully he can at least check the level of her resting cortisol. Even that information would be helpful as far as judging whether low cortisol is causing her current problems.

Is there any possibility of taking Holly somewhere for some imaging of her abdomen such as an ultrasound? If all her bloodwork truly is normal, that would be the next diagnostic step that I'd probably want to look into. An ultrasound can give you a lot of helpful information about any internal abnormalities.

Do keep us updated, OK? And if you can post the results for her testing, that would be great.

Marianne

[labblab]

We were typing at the same time, so I'm popping back again with a couple quick answers. Yes, the standard blood and urine testing should have been able to rule out diabetes.

As for the Vetoryl dosing, the only way in which to know whether or not that's the right dose for Holly is by performing tests of her cortisol. Given her weight, the amount she's been taking is twice the dose that would currently be recommended as an initial starting dose for a dog beginning treatment. But every dog metabolizes the drug differently, so dosing needs can vary tremendously as treatment progresses. That's why the individual monitoring blood testing is so important. Has Holly ever had an ACTH done since starting treatment? If so, can you tell us the results?

If not and if your vet cannot perform an ACTH, as I said above, a simple test of her resting cortisol would be better than nothing. I would definitely ask your vet to check that if he has not already done so. As long as her electrolytes are OK, the only treatment she would need in the event of low cortisol is some supplemental prednisone. And that is a very easy and inexpensive drug to obtain.

In the meantime, I do agree with your vet that I would not be giving her any more Vetoryl at all while she is doing so poorly.

Marianne

[Squirt's Mom]

That "quality of life" comment sounds to me as if your vet has given up on Holly and I would not let him do that. If he is willing to work with you on the bills, then get him to do some more testing and find out what is wrong with her. This is NOT normal aging - I have a 15 year old. ;)

Please, do not give any more of the Vetoryl - none. This could be the cause of the problem and since she hasn't had an ACTH, you are walking on very thin ice if you continue the med - that could be fatal. So no more Vetoryl. If you don't have prednisone, get some NOW and give it to her.

There is a drug called Cerenia that will help stop the vomiting. I would ask about this asap.

There are also a couple of herbs that may help - Slippery Elm Bark or Marshmallow. Both act as internal "Bandaids", coating irritated mucosal linings.

If you can get copies of the test results that have been done and post them here, that would help us help you a great deal.

If I were you, I would withhold all food for 24 hours, just let her have water only. Give her system a chance to balance out without the stress of digestion. Then start back very slowly starting with chicken broth only, small amounts 4-6 times a day. If that goes ok, add a tiny bit of chicken, again frequent small meals. As that works ok, add a bit more chicken; then a little bit of white rice cooked into a paste for easy digestion; gradually add more of the rice paste keeping with the frequent small meals throughout.

I soooo understand the financial aspect! I am also on a fixed income and it ain't near enough to cover all we need. We are also lucky that our vet will work with us - he even said I could clean cages, floors, etc if needed! :D I have three "special needs" babies and one that is just crazy so we see him often and he has been very good to all of us. My old gal recently had a seizure and we have spent a fortune for me the last month...but she is worth it. There are other tests I would love to do but simply cannot afford. Then there is the other side - even if we found something, at her age I can't ask much more of her. So I do understand where you are coming from with all the expenses. However, your sweet girl is very sick and I would be talking to her vet about what you could do to pay for testing, what ways he would be willing to work with you to find out what is wrong and treat it if possible.

For now, the Vetoryl must be stopped - this is critical. ;)
Let us know how things are going.
Hugs,
Leslie and the gang

[trevron]

I will ask for the details you mentioned. The ACTH test takes a week to come back but I will get that done as well. I understand that she has pituarity cushings and I asked the vet if the tumour could have grown and making her feel sicky but he said it was not that type of tumour. I must sound so ill informed but believe me it is not easy here, the nearest animal hospital is over 4 hours drive away, I just wish I was back in the UK where specialist help is readily available. The relationship between the rural Spanish and their pets is far removed from ours and they do not understand how important my baby girl is.We are having a good day today, only sick once this morning and been out for a couple of short walks up the lane and back for a good sniff round and poo and a pee, bless her heart she is so clean, no matter how lousy she may feel never an accident in the house

I have a Spanish rescue mini schnauzer, Lula, as well who is only three, I have had her a year and would you believe it has taken me that long to persuade her that not everyone is going to kick or beat her, although she still will not go near Spanish men at any price. Anyway I am drifting off the point.

Holly's skin is terribly dry, hair loss more than normal, although it has never fully recovered since diagnosis. Is there anything anyone can suggest to help this, I give her omega 3,6&9 but she feels a bit like a scouring pad now which must be uncomfortable.
Thanks so much for comments snd support, wish I had found you when this all began.

[Squirt's Mom]

awww...bless you for taking in Lula. It is so easy to destroy the trust these little souls have and can be a long road back to that trust once broken. But loving hands and tender words can do much to heal their wounds. Lula is a lucky girl she is now with you and Holly.

Is Holly taking any other medications?

[trevron]

No other medication at all now. Stomach protector just made her sick!! Tried three different types all the same result.Her bowels are ok, normal if less due to lack of food. No temperature etc no blood in vomit and sometimes she regurgitates rather than retches and then re comsumes it if I don,t see her, lovely, but dog like.
I am going to note down the suggestions you have all kindly given and speak to vet about them.
I have tried withholding food but she still vomitted up liquid.Her breath smells awful.
It is so sad to see a previously fit trained agility dog struck down although she still likes to chase the farm cats around here and jumps up on the couch ok.

[Budsters Mom]

Hello and welcome from me too!

I am sorry to hear that Holly is feeling so poorly, but I am glad you found us :) Yes, the vomiting thing can be scary:(

You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better.

So again welcome to you and Holly,

Kathy and Buddy:cool:

[Trixie]

I'm too new here to be much help with the issue at hand but wanted to say that I hope Holly is doing okay and will begin to feel better. I have a mini schnauzer too! We have had our share of gastro problems prior to our recent Cushing's diagnosis. Schnauzers are prone to Hyperlidemia and Pancreatitis but you probably already know this. I believe you would probably have diarrhea along with the vomiting in both those cases too. Those conditions also occur with Cushings quite often--again I'm probably telling you things you know. The times that we have had this same type of bile vomiting with Trixie they always mention these conditions...though she has never tested positive for either. I hope you get some answers and that Holly's system gets back to normal soon!
Barbara

[molly muffin]

Hello and welcome from me too. What a sweetheart you are to rescue Lulu and take such good care of Holly.
I am hoping that something in the results of the blood or urine tests could help us get some idea of what might be going on with her. We see a lot of blood and urine tests here.
I too have thought pancreatis, or something of that nature.

Again welcome to the forum.
hugs,
Sharlene and Molly Muffin

[trevron]

Pleased to say really good day yesterday, had six small meals with no sickness until 3am when I was up with her but she settled down afterwards next to me in bed and slept the rest of the night. Eaten this morning and so far so good, even wanted to chase a pidgeon on our short walk out.
Am hoping a friend will give Lula a good run today I am unable to leave Holly as she gets distressed so Lula not getting her normal amount of exercise at the moment. Anyone who has mini Schnauzers know that they are very lively little things and for a small dog need plenty of exercise and stimulas.Holly has always been clingy but worse now and of course not used to being left without Lula but a long walk is out of the question at the moment although we are going a bit further than we were a week ago.
We are soldiering on and keeping fingers crossed for today, what is it they say, one day at a time!!.

[Trish]

Hi there
Welcome from me too, glad to hear your girl has had a better day. Hope her tummy settles down soon and you can get some results of what her cortisol is doing with the acth test.
Trish and Flynny

[SoggyDoggy]

Hi and a big welcome from me too. I possibly can't give any more suggestions at this point either, I think grabbing hold of the blood test results will be the next step for you, and when you can post those up (along with the lab reference ranges too) folks will be able to give you some more suggestions.

One thing I would like to draw your attention to though is the diet of baby food. While the purée idea is fine, please be careful as a lot of baby food contains powdered onion which can cause all sorts of problems, including anemia. I am in the midst of doing some dietary related research myself at the moment (for different reasons though) and just saw that some of the symptoms of anaemic can be stomach upset, nausea, vomiting, lethargy etc. it may be an idea to look at the jars you have and check out the ingredients. If onion is listed, maybe try home purée to make your own version?

Just a suggestion, and while the issues probably started before the baby food, it's nice to be able to rule out one more thing.

Good luck with it and I hope both of your gorgeous girls get to run together soon.

[trevron]

Thanks for info on onion, will check that out and I am starting my own puree from tomorrow as she is still keeping food down most of the time!!!

[Trixie]

Love seeing the photo of your cute schnauzers!! Glad Holly is doing better. I give Trixie a half a Pepcid a/c every night. She has so much tummy gurgling in the evening and the Pepcid works like a charm. The noise that comes from her belly is really loud sometimes.
I'm told the Pepcid cannot hurt her and it certainly seems to help a great deal. Don't know what is available in Spain but the generic name is Famotidine. We the 10mg but give only half- 5mg she's about 15 pounds.(she's gained a little weight the last month or so)
So many schnauzer owners I know have these same gastro issues. We use a low fat diet and low fat treats. Also plain canned pureed pumpkin-nothing added (not pumpkin pie filling) is really good for their tummies...once Holly is back to normal you may want to try a little along with her food a few times a week. Trixie also takes a probiotic capsule and I give her plain no fat yogurt twice or three times a week.
You are right about these dogs and their activity level. Trixie is nine and can do a few miles a day. Not to mention the time she needs to sniff everything along the way! She was on a nice long walk with my husband all morning and is now flat out on the cool floor. Hope Holly continues to feel better and that all that vomiting is over! :rolleyes:
Barbara

[frijole]

Re the Pepcid - here in the states there are different types and you need to make sure it contains Famotidine. Here it is Pepcid AC, not the Pepcid... so caution - you might need to check with your vet. Kim

[Budsters Mom]

Yes, Famotidine 10mg. - comes under the name of Pepcid AC in California. Make sure you get the regular 10 mg, not extra strength!
It has done wonders settling Buddy's tummy!:)
hugs,
Kathy and Buddy:cool:

[molly muffin]

Love the pictures of your girls. Hope they and you are having a good weekend.

hugs,
Sharlene and Molly Muffin

[trevron]

Original query constant vomitting:
#
The more I read on this site the more I am wondering if Holly has ever had Cushings?? She has never had an accident of any kind in the house, she is weaker on her back legs but is now 13 and she can still jump up on the couch fine and from there onto the window ledge, her favourite vantage point.
I initially took her to the vet because her coat was sparse and skin dry and she was just not herself. They did the test were she had to stay all day and have blood tests before and after injections and cushings was diagnosed from that. Is there anything else it could have been?? The tests were sent away to a lab for anaylisis and results back to the vet. She has had normal bloods taken since, just blood taken and these sent away and the Vetoryl dose adjusted because of the results.
Her coat and skin have never recovered since diagnosis yet it would seem that on this med most have.
She is not spayed and I am wondering if her problem could be another hormonal problem. Anyone got any thoughts on this??

Update on her now is that she is stilloccasionally vomitting but this has got better and she is now eating a more normal diet, although pureed, off the baby food after advice on here about onion content.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about possible wrong diagnosis into Holly’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Squirt's Mom]

In looking back through Holly's thread, I don't see any test results posted from the diagnostic testing nor any monitoring testing since treatment was begun. For us to be able to offer any meaningful insight about her diagnosis, we need to see those test results. ;) So if you would get copies and post the results here, that would help us a great deal.

[SoggyDoggy]

Hi, I am just wondering if you have had or if it is possible for you to have done, an abdominal ultra sound on Holly? If you are questioning the cushing's diagnosis, it is one way to double check on that but also could give you a picture of whether there is anything else going on with her.

I know when my boy Fraser was first diagnosed, all the blood tests pointed to a pituitary based cushings, but after an ultra sound last week it turns out to be adrenal. Unfortunately in his case, there is also a lot more going on too, but it was the ultrasound that gave me this information. With either pituitary or adrenal based cushing's, you will be able to see changes in the adrenal glands with the ultrasound. As many have said here before, it really is a "best bang for buck" test. Incidentally, Fraser had never had any accidents in the house either, but his coat was definitely dry and he had a persistent skin infection along with increased thirst and hunger.

In addition to the question re an ultrasound, as Leslie mentioned, if you can get hold of the lab results of diagnostic and monitoring tests, folks will be able to give you some more accurate feedback on what might be going on with Holly. I am glad to hear at least that she is starting to eat a bit better and keeping most of it down. That is good news!