Rocky, 6 y/o Boxer, dx Cushing's

[Rocky]

Hi everyone,

I'm glad I found this forum, got a lot of questions. My name is V, and I have Rocky, a 6 yr old Boxer, who diagnosed with Cushing's about a month ago.

He weighed 58.5 lbs at diagnosis. Cortisol level was 6.4 mcg/dL, dexamethasone test at 4 hours was 6.0 mcg/dL and at 8 hours was 3.5 mcg/dL.

Vet thinks he has a pituitary tumor. Vet put him on 120mg/day of Vetoryl-given once a day in the morning at breakfast. He improved for the first 2 weeks, and then I noticed him getting the shakes/muscle tremors, but only in the evening. He began to get lethargic, not wanting to eat (very unusual for him), hind legs shaking, back arching.

Took him to the vet and they did a follow up test-corisol baseline was 2.3 mcg/dL, his weight has dropped to 54.5lbs, but we have not changed his feeding schedule. Vet said we need to change his dose to 60mg/day.

We are now waiting for his 60mg pills. In the meantime, vet suggested trying 120mg every other day. We tried it for 1 day and stopped - shakes and lethargy came back. 2 other vets suggested halfing the capsules and putting the powder in peanut butter - tried that today and he is back to shaking, lethargic, excessive panting, but only in the evening. We decided to stop Vetoryl completely until his meds come in, should be around next Thursday.

My questions - Why is he only shaking in the evening? Will the shaking stop when he is on the right dose? He looks so pitiful in the evenings; during the day he seems more normal – not his usual self, yet, but much better than this shaking, panting and lethargy. I am at a loss of what to do...

Thanks for your advice, I appreciate it!

V

[Simba's Mom]

Hi and welcome to this get site, you have found a place where everyone knows what you are going though and we are all here to help. You will get lots of info and encouragement too...So again welcome to you and Rocky!!

[Budsters Mom]

Welcome V and Rocky:)
I am sorry for the reason that brought you here, but so glad you found us.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. We will do all we can to help. Others will be popping in to welcome you also.
So again welcome to you and Rocky.:)

Hugs,
Kathy and Buddy:cool:

[Roxee's Dad]

Hi V and welcome to you and Rocky,

Maybe you can tell us of the circumstances that led to the cushings diagnosis. It is a tough disease to diagnose.

The newer recommendation for Trilosatane (Vetoryl) dosing is about 1 mg per pound, so it sounds like Rocky was getting a higher dose than recommended. I see a baseline of 2.3 but did the vet give you a post stim result? It sounds like Rocky's cortisol has gone too low and yes he is probably feeling really lousy, kind of like having the flu. This can be a very dangerous condition. He should also have his electrolytes checked.

Trilostane only remains in the system for up to about 12 hours so every other day dosing dosing isn't going to be of much help. I would definitely hold off on giving Rocky any more Trilostane until he feels much better, an ACTH test is performed.

Oh and by the way, Vetoryl recommends against the breaking up the capsules and handling of trilostane. I was just wondering if your vet gave you any information on what to watch for when Rocky started the trilostane? Did the vet give you any predisone? Pred is like a rescue remedy when the cortisol goes too low.

We look forward to hearing more about Rocky and how he is doing.

[Rocky]

Thanks for the welcome, guys!

Rocky has a short health history. He has been healthy until now. When he was 2 he had acute pancreatitis. It resolved with meds and a change in diet - he is on EN food and tolerates it well. One thing we noticed after he was 2 were bumps on his skin. He has them all over and the vet never could figure out what they were. They never seem to bother him, but they have increased over the years. He has a small patch of hair loss at his nape. He has had that since he was 2.

A month and a half ago we noticed he was drinking a lot of water. He started having accidents in the house after being left for only a few hours (he used to be able to hold his urine at least 8 hours). He was always hungry and ate like he was starving. He weighed 70 lbs and was stocky, especially through the middle.

Vet did the dexamethasone test and a CBC. Based on Rocky's dexamethasone test and related symptoms he concluded it was Cushing's. CBC was normal this last time. No, didn't get much info on what to watch for with Vetoryl. Did some research on it and found that tremors can be a side-effect. But it is also a side-effect with Addison's. Vet didn't give us any predisone. What is a post-stim result? What should his cortisol levels be at?

Yeah, saw that about the capsules - won't be doing that again.

[mytil]

Hi and welcome from me too!

I am incredibly surprised the vets "recommended" you to open the capsules. This is pretty powerful medicine and to be exposed to the powder like that is not good for you.

How many cushpups have they diagnosed and treated successfully over the years?

The results from the LDDS can be consistent with Cushing's as well as the clinical signs (symptoms), but Cushing's can be a devil of a disease to diagnose properly. False positives can happen so there are several tests that are used (LDDS, ACTH and an ultrasound typically).

I would stop giving my dog the Trilo and I would have an ACTH test performed to confirm the cortisol levels as everyone has mentioned, it sounds like it has fallen tooo low.

Please keep us posted
Terry

PS - I am sorry, but I just noticed that the CBC was normal ------ can you post the ALT and ALP results from the recent draw.

[labblab]

Welcome from me, too!

I absolutely agree that you need to withhold the trilostane altogether until you have the chance to figure out what is going on with Rocky. As you have already found out yourself, he may be overdosed on the drug. Approximately two weeks into treatment, Rocky should have been given a monitoring ACTH test and also a test of his basic blood chemistries (which is different from a CBC). The ACTH involves two blood draws, one which measures the resting cortisol and a second draw 1-2 hours after the injection of a stimulating agent. The second draw measures the cortisol that is held in reserve and is actually the more important of the two numbers in assessing the action of the trilostane. On the face of it, a resting cortisol that exceeds 2.0 would typically be associated with a dose that is not necessarily too high. But you cannot know for certain without the second part of the test.

Since trilostane lowers aldosterone as well as cortisol, another danger of overdosing is that the balance of potassium and sodium can be thrown off. Even when cortisol has seemingly not dropped too low, an Addisonian crisis can still occur when these blood chemistries are out of whack, and that's why they must also be tested for monitoring purposes. And perhaps they were -- but not if only a CBC was performed (that test only measures the number of different types of blood cells).

I also want to tell you that your vet cannot know for certain that Rocky has the pituitary form of Cushing's based solely on those LDDS results. In order to draw that conclusion, either the 4-hour or 8-hour result would have needed to be less that 50% of the baseline, and neither one was. Pituitary Cushing's is by far the most common form of the disease, so perhaps your vet is going by the odds. But the testing results so far do not confirm that.

All in all, I do feel worried about your vets' experience level in treating Cushing's. Please don't give him any more trilostane for the time being. And here's a link to a publication that will tell you a lot more about testing and the dangers of overdosing. If Rocky continues to have the tremors and lethargy, even while off the trilostane, he may need some additional testing and supplemental rescue medication ASAP.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[Rocky]

Thanks for all the info, everyone. I've been reading over all the information. It looks like my vet did a HDDS last week instead of the ACTH test. On my records I only have the baseline cortisol level of 2.3 mcg/dL; not the actual test results.

Rocky has looked better today. He is more alert and responsive, but he is still having periods of lethargy. His shaking/tremors have reduced quite a bit, but he is still having them this evening, though not for as long. I haven't given him any Vetoryl today; it's been 36 hours since his last dose. His urine is still very diluted, but he seems to be able to hold it better. No accidents in the house today. :)

His ALT level in April was 69, and his ALKP (maybe that is the ALP?) is 78. I don't have the results from last week yet. Also his GGT (don't know what that is) is 16, which is twice as high as it should be. Tomorrow, I will go by the vet's and see if I can get some more information.

[mytil]

Your vet should have performed an ACTH test, not a HDDS (high dose dexamethasone suppression test). I would certainly inquire why was this done? And I would certainly bring in the documentation from Dechra to back you up. The HDDS is one diagnostic test to determine if it is pituitary or adrenal dependent Cushing's.

Successful diagnostics, treatment and proper monitoring are the keys here. Cushing's can be a difficult disease to diagnose as the symptoms and numbers mimic other conditions as well.

I surely am glad to hear Rocky is doing better. IMO I would continue to hold off giving the Trilostane until a proper ACTH test is given.

Sorry, but can you let us know the letters that come after the 69 and 78 numbers?

This is what I found out about GGT ---
Although GGT is found in many tissues, the main source is the liver (primarily biliary epithelium), thus GGT is used mainly as a sensitive indicator of cholestasis (interpretation, in general, is similar to ALP). Increases can be contributed to medicines as well. GGT can be shed into the urine and not into blood as a result of cell injury or inflammation.

Keep us posted
Terry

[Rocky]

There are no numbers or letter after the 69 and 78. That is why I wasn't sure what to compare it to.

[goldengirl88]

Hi V and Rocky:
Welcome to the forum. I am sorry Rocky is having problems, but this is the best place for help and support on Cushings. I have to agree with the others. I cannot believe a vet would tell you to open capsules. These are powerful drugs and I have been told first hand by the Vet at Dechra to never ever open the capsules. The dogs are not even supposed to puncture them with their teeth. They are to be given with food, and you must wash you hands thoroughly after handling them. Here is the number for Dechra 866-933-2472. When you call they will make a file on your dog. Anytime you have questions you can call them, they have Vets on staff there too. Good luck to you and to Rocky Blessings
Patti

[addy]

An ACTH test needs to be done within 14 days from starting Vetoryl along with testing Rocky's electolytes. Vetoryl can peak in a few hours of giving the dose and can leave the body within 12 -18 hours or less. Sometimes dogs will have their cortisol drop like a ton of bricks and feel yucky until they get used to the lower cortisol, like cortisol withdrawal symptoms. Some dogs have rebound symptoms later in the day as the drug wears off and cortisol again rises.

It is hard to guess what is going on unless the proper monitoring tests are done. If you are comfortable that the diagnosis of Cushings is correct, perahps an acth test should be done to see where Rocky's cortisol is and then possibly restart Vetoryl at a lower dose depending on the results.

[molly muffin]

Hello and welcome from me too. If you find out that the cortisol has gone too low, then typically you do not restart vetoryl until symptoms return and then at a lower dose. Vetoryl should be given typically in the morning, unless the dosage is split to am and pm, and given with a bit of food, since the ACTH test must be done within 4 - 6 hours of the dose for accurate results.
It doesn't really sound like your vet is very experienced with either cushings or the medication and it's protocols. Hopefully he is willing to be educated though. :) Many of the members on here have gone through the same thing, unfortunately sometimes it's more than the norm than not. :(
I hope that Rocky starts to show improvement soon.

Sharlene and Molly Muffin

[mytil]

How is Rocky today?

I would bet the number following GGT is u/l (units per litre). That numbers you gave are pretty high. It is a liver enzyme and can indicate some liver problems.

Terry

[labblab]

Hello again from me, too. I am glad that Rocky seems to be doing better, and will be anxious to see his actual test results once your vet reopens and you can get copies.

Just wanted to also mention that Terry is absolutely right that the GGT is a liver enzyme marker, as is the ALT and ALP (or ALKP). As it turns out, all three of these markers can be moderately elevated by the excessive cortisol production associated with Cushing's. So hopefully, these levels will plateau and perhaps even improve once the trilostane dosing can be stabilized. It is important to continue to monitor them, though, for ongoing changes.

Marianne

[Rocky]

Hi everyone! Thanks for your replies! Rocky was off the Vetoryl for a week. His symptoms quickly returned - tons of peeing and excessive drinking all week long. He still had slight tremors throughout the week, but overall was looking and acting more like his normal self. He was much more alert and wanting to cuddle. :) So much so, he jumped up on the Fed Ex man today, something he never does! lol

I looked through Rocky's records and saw that they did a partial profile which lists electrolyte balances. I don't have the numbers, but when I talked to the vet he said his labs were normal, so I have no reason to think his electrolytes are out of balance. I am wondering if he is going through cortisol withdrawal syndrome as opposed to Addison's? His stools are normal, not showing any weakness, no vomiting, but he is lethargic. His appetite has decreased, so I've split up his food - half in the morning and half in the evening - and as long as I do that he eats all of it. Not with his usual gusto, but I am glad he is eating it. He has lost a lot of weight and is now skinny. He used to be a stocky 70 lbs and at our last visit he was down to 54.5 lbs.

I started him on 60mg of Vetoryl this morning. Wasn't able to do an ACTH before due to financial constraints, but I hope to get an ACTH done 10 days after starting Vetoryl at this new dose. Been watching him today and he seems ok - the Vetoryl gives him tremors and right after I gave it he started twitching. It went on throughout the day off and on. It is evening now and the tremors are back, and he is really panting each time he shakes. :( Is this normal for Vetoryl or is he not tolerating it well?

[goldengirl88]

V:
Welcome to the forum. Sorry about your Rocky having problems. First of all I think you need another vet. To start a dog off on 120mg and then drop to 60 is ridiculous. They should be started off on a lower dose and if more is needed after testing then increase. These are powerful drugs and you have to err on the side of caution always. You will save heartache and money if you find a vet or IMS that knows what they are doing with Cushings. You can even call the manufacturer of Vetoryl, they will start a file on your Rocky and help you. The number is 866-933-2472. Was Rocky even tested for Cushings? You need to find someone to do the diagnostic testing to confirm a diagnosis. Testing above all is first to determine if your dog has Cushings, then treatment starting at a low dose will eventually follow if the diagnosis is correct. please do not open the capsules as stated by the Vet at Dechra, and always wash your hands thoroughly after handling them. I hope you can get Rocky to a good vet or IMS. Blessings
Patti

[Rocky]

Ok, here's an update on Rocky. After reading everyone's comments and then repeatedly calling our vet with concerns (who never returned our calls), we decided to change vets. We have stopped his Vetoryl for now because he seemed so much worse on it, and we felt Rocky was not being properly monitored. It has been 4 days and he is definitely back to peeing and drinking like crazy, but he is more alert and not as lethargic. He is also very skinny and is still having tremors daily.

We met with our new vet today, who was very helpful and much more knowledgable about Cushing's. She confirmed the Cushing's diagnosis after reviewing Rocky's records and examining him. She is very concerned (as we are) about his 15 lbs. weight loss in the past 2 months along with his lack of appetite. She is referring us to an IMV for an ultrasound of Rocky's adrenal glands. She suspects an adrenal tumor based on Rocky's HDDS results, which had a baseline of 2.3 mcg/dL and a 4 hour result of 2.4 mcg/dL. I also obtained a copy of Rocky's most recent lab results, here are the abnormals:

ALT is high: 167 U/L (10-100)
RBCs are low: 5M/microliter (5.65-8.87)
HCT is low: 32.4% (37.3-61.7)
HGB is low: 11.9 g/dL (13.1-20.5)
EOS is low: 0.01 (0.06-1.23)

So we are concerned because he is a Boxer (and only 6), and they tend toward tumors. :( We will call tomorrow about the ultrasound and hopefully, it will give us more information on how to proceed.

Thanks for everyone's input so far!

V

[frijole]

I'm just reading your whole thread and I am so glad you are having an ultrasound done. A couple things hit home with me - the weight loss, the lack of appetite and the tremors that come on at night.

I'm going to share some info on my Annie in the event it is helpful - it might not be but she had a very rare adrenal tumor called a pheochromocytoma. She was misdiagnosed with cushings and had many tests that indicated it but they were false positives.

She lost weight - became skeletal. She was starving but would not eat - it was if the food made her nauseous. She had full body tremors at night mostly. The episodes lasted a minute or two then went away. I paid close attention and noticed she got hot, feverish/sweaty, her skin actually turned pink. She panted and breathed faster than I could replicate.

What I later learned is these 'pheo' tumors basically emit adrenaline - the blood rushes from the heart to the head. During this time their blood pressure spikes high. This type of tumor is NOT the kind that causes adrenal cushings.

So if you notice anything like what I have described be sure to tell the specialist because what happened to me is that the episodes were all at night and never at the vets or hospital. Please video them so you can show them to the vet - it helps a great deal.

Your dog is young and that tumor can be removed. You would need to find a highly skilled specialist/surgeon to do the surgery but it can be done. But for now the next step is to go to the IMS and I am so glad you are doing that. Great work. Keep us posted! Kim

[Rocky]

Thanks, Kim! Funny, I just read your thread about Annie...I will definitely keep your experience in mind!

Rocky's tremors come and go during the day, but are worse at night; it seems they are mostly in his shoulders, but his whole body will twitch. On your thread several people described their dog's tremors and they sound exactly like Rocky's. The vet thinks the tremors are not related to the Vetoryl, but I really wonder cause he didn't have them before we started the Vetoryl. At the vet's today, he had them worse than usual, so she got to observe them.

He eats his food over the whole day. He'll eat half in the morning and then pick at it the rest of the day until it's gone. This is really strange for him. He used to inhale his food and was always ready to eat.

Really appreciate your comments! It is hard to know what to do! He is still such a young dog.

V

[frijole]

You read Annie's thread? That thing is a monster! It took us over a year to figure out what was going on with her and we were all over the map.. but then I guess you figured that out. :)

Here's a video I took of Annie during an episode. This was early on as she still had weight on her but looking back her hair was SOOOO thin you can see all her age spots. Anyway you'll see what her episodes looked like.

http://www.youtube.com/watch?v=PLNTmf9AbJ4

Hoping you get answers once you visit the IMS! Kim

[Rocky]

Rocky's adrenal ultrasound and IMS consult is scheduled for June 17; hoping someone will cancel and we can take him sooner. Seems like a long way away! :P

V

[Rocky]

We received some great news about Rocky today!! :)

Here's a recap about what has been going on this past week. Starting on Sunday Rocky began having diarrhea, by Monday there was some blood and mucus in it. We hoped that it was due to the change from dry to wet food, but by Monday we thought not (he is not on any meds for Cushing's right now). He started being incontinent with bowel movements in the house, and he lost more weight, now down to 46 lbs. We took him to the vet and she was really concerned, but the ultrasound was still almost a week away. She was great and called around the area and got us an ultrasound (abdominal and adrenal) for today. She gave us Flagyl and probiotics to give to him, and told us that it wasn't looking really good (which we already knew).

So fast forward to today at the ultrasound. Rocky's adrenal glands were both enlarged to 0.9 cm, so this points to pituitary Cushing's. His duodenum wall was thicker than it should it be at 0.6cm. There were no tumors or enlarged lymph nodes. They also checked his heart, which looked great. Based on the ultrasound, the vet thinks that Rocky has some sort of inflammatory bowel disease that is messing up his nutrient absorption, along with pituitary Cushing's. My thinking is that the Cushing's has masked this and he was self-medicating until we started the Vetoryl. Since being on the Flagyl and probiotics Rocky has gained 2lbs in the past 2 days! Now up to 48 lbs, formed stools, looking much more alert, and eating most of his wet food in one sitting. :) We are still waiting for our vet to call us and discuss treatment options. We know he will have to be on something for the Cushing's and IBD, but we are really relieved that there are no tumors. Yay!

V

[addy]

I'm at work so this is a quick pop in- make sure you are giving the Flaygl at least 4 hours apart from the probiotic.

My Zoe has inflammatory bowel disease diagnosed through endescopy and biopsy as well as Cushings.

I'll be back later :)

[Boriss McCall]

yay for NO tumors. That is great news. Hopefully everything gets sorted out soon & you start seeing major improvement. ;)

[Roxee's Dad]

No Tumors !!!! That is good news,:)

Formed stools and gaining weight :D:D:D YAY !!!!

Please let us know what your vet plans to recommend.

[Budsters Mom]

Thanks so much for letting us know! We love good news!:D:D;)
Please keep us posted.

Hugs,
Kathy

[molly muffin]

Whew, from a very scary situation to good news. Wow, that post had it all. I'm so glad that there weren't any tumors found and that it looks like IBD and cushings instead. Both of which are treatable. Addy has a lot of experience with IBD and the key is finding what they tolerate okay, and make changes, Very Tiny changes, nothing big. You always try each thing out in little increments to see what will work best.

It does sound you'll be working out a game plan for Rocky and that is very good news. :)

Sharlene and Molly Muffin

[Rocky]

Thanks for everyone's posts and good thoughts! Rocky continues to improve. He is eating half to three-quarters of his food at one sitting, but we've noticed he tends to eat more of his food in the evening. No BMs in the house since Wednesday, but he has occasional peeing accidents due to Cushing's at night. Last night he played with his squeaky ball for the first time in weeks. He also hopped up on the couch with me for the first time in a long while. :)

Addy, can you tell me more about the Flagyl and probiotics being given 4 hours apart? Our vet didn't mention this. We've been giving Flagyl and the probiotic with his morning meal and another dose of Flagyl at his evening meal.

V

[addy]

Hi,

If you give them together they cancel each other out. Antibiotics kill off bacteria in the gut and probiotics replace beneficial bacteria in the gut so you would not want to administer them to a dog at the same time, same with humans. Two hours would be the minimum I would do four is better. I have found the vets dont really know so they dont tell us unless they are holistic vets. I picked up Azodyl for Zoe (various probiotics) and the tech said oh yes, fine to give with her metronidazole. I just smiled.;)

I am so pleased Rocky is feeling better. I love that he played with his squeaky toy.:):):):)

If you call a pharmacist- they will know.

[Rocky]

Thanks for the info, addy! That makes a lot of sense. My sis looked it up in her drug book and saw the 2 hour recommendation. The difficulty we are having right now is getting him to eat apart from his morning and evening meal. He doesn't seem to want anything in between. He has been having some room clearing gas for the past few days, too! The vet only wants him on the EN food for now, otherwise we would usually use peanut butter to entice him.

We have powder packets for the probiotics; I wonder if the packet could be dissolved in water? He would drink that for sure!

[Rocky]

Hey everyone!

I'm Rachel, Rocky's auntie, V is busy with school so I'll give y'all an update! Talked to the vet on Wednesday and Rocky has started the Vetoryl again, this time 20mg twice a day. He seems to be doing better on it now. The tremors are still there but no change like before so we are happy about that! He finished his antibiotic and is now just on the probiotic and Vetoryl. He's not drinking or peeing as much now either. We've noticed that he wanders aimlessly around the house and he circles at least 3-6 times before he sits or lays down now. He still isn't eating like he used to either. We have to coax him to eat most of his food and he usually will eventually eat it. He weighs 47lbs now and that's eating 3 cans of wet food a day for over a week now. Do you all have any suggestions how to get him to gain weight? We are only doing EN wet dog food bc of his tummy but not sure if we need to add something to help him gain weight. Our vet thinks his tummy is upset from the Cushing's and maybe some IBS, she's hoping the Vetoryl will help! Thanks a lot!

Rachel

[molly muffin]

Oh poor Rocky. It's very hard with IBD to get them to put on weight it seems. Everything just upsets the gastro tract.
Slipper Elm Bark might help to settle the tummy. Others on here have used it. You do have to give it 2 hours before or after food. You use the powder and brew it up with water. Then you can use a syringe to give it to him. If his tummy is feeling better, maybe he would eat better too.
It's a thought anyhow.

Sharlene and Molly Muffin

[Budsters Mom]

Slippery Elm Bark can be given with food. In fact, it is tastier if you mix it in with a little wet food. If they don't feel like lapping it up, you can us a syringe. The two hour window is for meds. It is to be given two hours before or after any medication. SEB Provides a protective coating for the stomach. It acts kind of like a Band-Aid. However, it can also slow down the absorption of medications. That's the reason for the two hour window.
Hugs,
Kathy

[molly muffin]

Oh there you go, I knew that Kathy or someone who has used it would know the protocols for how to give it!
Thanks Kathy. :)

Sharlene and Molly Muffin

[Harley PoMMom]

The SEB is great stuff for upset tummies. Carbs can help with weight gain, carbs such as pasta, rice, oatmeal, potatoes, etc...Hope Rocky's appetite picks up soon, and if Rocky does not eat than, IMO, I wouldn't give the Vetoryl because the Vetoryl is a fat-soluble drug which needs food to be absorbed properly.

[Rocky]

Hi everyone!

Thanks so much for your replies! We took him to the vet last Monday since he wasn't eating very well. She put him on a small dose appetite stimulant and a little bit of prednisone. Both seem to be helping him eat better and improving his appetite! We are slowly tapering him off the prednisone, and then we will see how his appetite is faring without it. We are also thinking of trying chicken and rice to see how he handles that.

The Vetoryl seems to be working really well for him; his Cushing's symptoms are pretty much gone, except for the hind leg weakness. His nose, which became really dry and cracked, is looking almost normal. Thanks for the advice about slippery elm bark. We may try it later, but he is on so many meds right now we are going to wait. We also put him on glucosamine for his joints because he has been arching his back a lot. Overall, we feel he is definitely becoming more of the dog he was before. :) Yay!

V

[Budsters Mom]

So glad to hear that Rocky doing so well. :)Rear leg weakness is one of the symptoms that often takes the longest to improve. Keep it up Rocky! Great job Rachel. Love to hear good news! Hugs,
Kathy

[Rocky]

Hi everyone!

Here is an update on Rocky! We started him out on 40mg of Vetoryl (20 in the morning and 20 in the evening). We did an ACTH stim test this past week and his post stim was 6.2 which is still a little high. My vet said we want him between 3 and 5 with symptoms controlled. His symptoms weren't controlled, so I was sure we would have to go up to 60mg. So we started him on 30 and 30 of Vetoryl on Monday. It seems that he is slowly improving. He has stopped drinking as much water and peeing. :) But he has definitely had an increase in tremors with the new dose.

My concern now is his diet and getting him to gain weight. In the past three to four weeks he only gained 4 lbs. He is now up to 50lbs. I was totally shocked because I swore he had gained at least 10. His appetite had really improved and he was cleaning his bowl every time. Overall, he is not as bony and has filled out more. We changed him over to a new food that my vet recommended over a week ago and since upping the Vetoryl I have noticed he is not eating all his food again. He is getting 4 cups a day (2 in the morning, 2 at night with his meds), but it looks like he is slowly starting to back off on how much he is eating. The good thing is he is still eating all of his food, just not in one sitting like he was (He'll eat most of it, and then go back an hour or two to finish). I've definitely noticed an increase in gas and belly noises. I am wondering if IBD is affecting him again? His stools are quite large, formed and soft, but no diarrhea or vomiting. Every once in awhile he becomes fecal incontinent and makes a mess in my living room (like this morning :(). Has anyone else had problems like this with IBD? We had him on Flagyl, probiotics and an appetite stimulant, but have finished all of those.

Thanks for your input!

V

[Rocky]

Rocky has been having some difficulties lately. I thought once his Cushing's was better controlled he would be more like his normal, happy self, but he hasn't really perked up.

I've been doing more reading and I really think that Rocky is having a lot of adverse effects from the Vetoryl. He pants alot, shivers/shakes, has inappropriate elimination (defecating in the living room), elevated potassium with normal sodium, has new skin problems (really dry spots where he is losing hair), his nose looks all crusty; he hasn't been his happy self in months - he seems zoned most of the time, lays there and stares, and very rarely wags his tail. A lot of this has started in past two months while he's been on Vetoryl with the new vet at a low dose twice a day. On July 22nd we changed his dose to 30mg twice a day. We had his cortisol level checked on July 26th and it was at a normal level, but his potassium was elevated.

For those of you using Vetoryl, did your dog come back to his usual self after getting Cushing's controlled? How long did it take? Did anyone change from Vetoryl to Lysodren and if so how did your dog respond? What made you switch?

I am seriously thinking that we might need to do the switch to see if Rocky responds better....it looks like his cortisol levels are getting under control, but he is nowhere near where he used be personality-wise.

Thanks for your help!

Vanessa

[Rocky]

In the past few days we've noticed some neurological problems cropping up. Rushed him to the vet yesterday, after the left side of his face was droopy and his head wouldn't stop bobbing. He stumbled a bit as he was walking (looked almost drunk) and seemed to be batting at something, and then he would stop and stare for a minute and then go about his business like nothing happened. It lasted maybe 10 minutes. Once I got to the vet he was fine. They kept him for 5 1/2 hours to monitor him and he had no issues. Discussed this with the vet, she thinks it is a reaction to the Vetoryl, so we decreased his dose back to 20mg, plus he is getting 5mg of pred. He just had an ACTH test a week and a half ago and his post stim was 6.2, so she doesn't think he is in Addison's. She sent a case file on Rocky to our local IMS, so we are waiting to hear about that.

Last night, 3 hours after I gave 20mg Vetoryl he had another episode. He started weaving and stumbling as he walked, then he started batting the air like he was playing with his ball, then he would stand very still, stare and his back would start vibrating up and down. His tongue sticks out at this point. He came out of that and was walking around the living when he just fell over. He jumped right back up and then was fine. It probably lasted 15 minutes. He has been very restless lately at night. He walks the hallway constantly.

This morning he tripped up going outside to potty and weaved a little bit, but it was much shorter and he recovered quickly. I don't quite know what to think. I suppose it could be the Vetoryl or his tumor could be growing and causing these symptoms?

I decided to stop the Vetoryl today and see how he fares. So far, he hasn't really eaten his food and he had a good stool. No diarrhea, but it is soft and formed. As of now, he has stumbled and fallen over twice, lays there, twitches and gets up a few minutes later... :( I am calling the vet to see what to do.

V

[frijole]

Glad you shared the update. You are doing the right thing with phoning the vet. We see alot of boxers on this board and we have noticed that dogs in that family (square faces for lack of a better word) have a higher than normal occurences of macro tumors. It could be that the tiny pituitary tumor is growing. When it does the symptoms are as you described with the walking issues and seizures. Praying it is nothing but wanting you to know... Kim

[Trixie]

I'm so sorry to read about what Rocky is going through...and you too. I hope the vet will be helpful and that Rocky will be feeling better soon.

Barbara

[Rocky]

Of course my vet was out today. :P I kept Rocky at home and have been monitoring him as well as keeping a diary of the episodes he has been having. They are coming and going throughout the day with mostly the same features I described in an earlier post. I've also noticed he has started walking into things. In between episodes he has no trouble walking and even trotted a bit outside today.

Thanks, Kim. I was reading about that possibility. As of now, it is looking like the most likely explanation. :( Though we were really hoping it was Vetoryl side effects; I suppose it's not looking so likely since he has been off the Vetoryl for 23 hours. Today the episodes have increased in number, and I've noticed a definite increase in his peeing and drinking today.

We are going to stay positive! I am looking forward to what the IMS thinks. Hopefully we will hear from him tomorrow. :)

Thanks for everyone's kind thoughts!

Vanessa

[Rocky]

Sad news today about my Rocky. The IMS is sure he has a pituitary macroadenoma; he also thought the Cushing's was likely secondary all along. It's progressed very rapidly and Rocky's quality of life has decreased so much, especially in the last few days. It has been heartbreaking to watch and realize my best furry bud is not coming back. We're going to spend the weekend with him doing fun doggy things and loving on him until it's time for him to go home.

Thanks for everyone's support and advice throughout this ordeal. It really helped to guide us and know we were doing the right things for Rocky!

Vanessa and Rachel

[doxiesrock912]

Oh ladies,

I'm so sorry! This news is heartbreaking!

[Trixie]

I'm so sorry to hear your news. It's heartbreaking. Wishing Rocky a special weekend with you.

Barbara

[Harley PoMMom]

Dear Vanessa and Rachel,

I am so sorry to hear this news about sweet Rocky, and we are here for you both.

Sending much love, hugs, and strength, Lori

[Trish]

Oh no, so so sorry you have had this news about Rocky. Big hugs for all of you right now xx

[labblab]

Dear Vanessa,

I am so deeply sorry to hear the IMS's assessment. My heart goes out to you. Especially so, since I lost my own Cushpup many years ago this week to exactly the same issue. I know how heartbreaking it must be for you to watch your boy slipping away from you. And I can imagine how bittersweet this weekend will feel. Hold him close and hold him dearly, and may your love for him give you the courage you will need and also the comfort that you all deserve in these coming hours.

Sending you huge hugs,
Marianne

[addy]

I have been following along and am so sad to hear this news.
My heart goes out to you, I am so sorry about the turn of events.

Hugs and prayers to you and Rocky.

[Squirt's Mom]

Hi Vanessa,

I am so sorry to hear about Rocky's diagnosis and I know your heart is slowly shattering. This past Dec. I found myself in similar shoes. Tasha, my little Boston, had breast cancer that metastasized and had spread to her brain, causing seizures. For several months we had known how sick she was and I prayed for a sign to let me know when she had had enough - the start of the seizures was that sign for me. That fine line had been crossed. :(

We took a couple of days to spend doing the things that had been denied to her due to her illness - the things that gave her immense joy, like gobs of peanut butter. Tash got to eat any and everything she wanted; we spent hours talking and touching; every moment of those few days were devoted to her. I wouldn't trade those few days for much of anything today.

We had been working with an animal communicator and "that day" after Tash had Flown, the communicator told me that Tasha was surprised at how good she felt as she ran across The Bridge, that she hadn't realized just how debilitated she had become on this old Earth. That has brought me a great deal of comfort to know that she really was freed from her pain, fear and confusion, that she was once again whole; that after we had done all we could for her, her Creator gave her what we could not.

Please know we are here for you any time you need to talk. So many of us understand where you are and want to help if we can.
Hugs and belly rubs,
Leslie and the gang

[frijole]

ah Vanessa I am so sorry. Go to your little boy and love him, hug him, give him whatever he wants to eat, cherish every moment. We are here for you. Kim

[molly muffin]

I am so sorry that this is the diagnosis. Just spend time together for as long as possible. We'll be here anytime you need us to be.

Hugs
Sharlene

[scoora]

I am so very sorry to hear about what is going on with your Rocky.
Hugs

[kaibosmom]

I'm sorry to hear of this diagnosis. Enjoy every moment with Rocky this weekend. My thoughts are with you.

Nikki

[spdd]

This is heartbreaking news. We will all be thinking of you. I'm so sorry.

[Tina]

Dear Vanessa,
I am so sad to read this news about Rocky. You are both in my thoughts and prayers. Hold your boy close this weekend.

Big hugs,
Tina and Jasper

[Squirt's Mom]

My thoughts are with you today. I know the bittersweetness of each moment you will share this day and the tears that threaten with every breath. You will not face "that day" alone, Vanessa. We will be with you, wrapping you in our arms, our tears mingling with yours.

Hugs and belly rubs,
Leslie and the gang

[molly muffin]

Just checking in to see how you and Rocky and family are doing.

hugs,
Sharlene and Molly Muffin