New Member Needs Help for Coco Joey

[coco joey's mom]

Intro
Hi, my name is Mary and I am Coco Joey's mom. While I am new to any type of forums, I have been reading your site for a few weeks ...( in between freaking out) trying to make sense of everything. Rather than ramble, I thought I would try to break this out into 3 parts History, Overview and Current to help get you up to speed. I do have copies of all of our test results, because I know you will ask ... I am just trying to figure out how to read them :).
SIDE NOTES:
The vet we use is a DVM DACVIM.
Unfortunately, I did not keep a log in the beginning, have started 9/1 ... so some dates /days are estimates.

HISTORY:
Coco Joey is an 8 year old 68 lb. female boxer, spayed . She is one of four Boxers in our household and acts as the "ears" for our other 3 deaf ones. Has really had an uneventful medical history over the last 8 years, until recently. A mild case of pancreatitis 5 or 6 years ago and a cancerous tumor removed from her back hip 3 years ago were it. Last October we noticed the right side of her face was drooping. Our vet said it was Bell's Palsy and to watch for any other neurological signs ... there were none. He said the drooping may never go away, but actually that side "shrunk" up and is now higher and tighter than her normal side. Other than
not being able to close her eye completely and having to take smaller bites, no other issues.

OVERVIEW
In March of this year Coco Joey started drinking and urinating a ton and then starting having accidents in the house. I thought it could be a urinary infection , so I did the cranberry and yogurt thing for a week with no success and than got her into the vet. They did tons of testing to rule things out, such as kidneys, diabetes and diabetes insipidus. They finally came back with a diagnosis of Cushings and prescribed 60mg of Vetoryl a day, which we started the first week in May. We did all the checks & rechecks. which were good. We had her on that dosage for 2 months and a few days. We actually had a couple of days where we saw signs of our old dog coming back, then her appetite started to decline, (it was never the best to begin with for the past few months) and she got more and more lethargic. The vet had us stop the Vetoryl and did another recheck to find she had been suppressed too much. She was taken off the Vetoryl and we were to do rechecks until her levels got high again and we would start her back on Vetoryl at half the dose which would be 30 mg. In between all of this she was found to have hip dysplasia and had pancreatitis.

CURRENT
• Her levels were high enough where we were able to start her back on Vetoryl as of Saturday 9/7/2013.
• We stopped the Rimadyl as of Monday9/2/2013
• She has had head tremors off and on for the last week or so. They are tremors and not seizures, but this leads our vet to believe it could be a brain tumor and wants us to go to a neurologist for a cat scan. I do know that head tremors can be common to boxers as we had one before that was prone to them and we had him for 7 years. For me, the neurologist is last call. If they don't find anything I am back to square one, if they do ..... I can't see putting her through surgery or chemo if those were even options.
• She has lost 10 lbs and is unbelievably lethargic.
• The vet is at a loss, says he has tested for everything but the brain scan. Suggests a second opinion with another internist or the neurologist .

So in a nutshell that's where we are at .... here a just a few of my questions.

The vet felt that she is way too lethargic for what normal Cushings would be, plus her lack of appetite and losing weight.

On 7/20 her SPECcPL was 842 ug/L. On her 8/26 retest her SPECcPL was 443 ug/L. I know under 200 is normal. So obviously she has pancreatitis, but she was not treated for anything. Could this be why she is barely eating and lethargic?

The vet did an ultrasound today and it came back normal, he was in surgery so I have not had a chance to speak with him, but I did leave him a voicemail. I want her on meds for pancreatitis to see if helps, but maybe I am in denial looking for a miracle?

How lethargic is TOO lethargic? If Cushings brings it on, and pancreatitis brings it on coupled with her lack of eating, couldn't that be the case?

I would really like to hold out hope for the lower dose of Vetoryl to kick in, I know it can take at least 2 weeks to see any slight improvement.

While I know we can not keep her forever, I would like to go out fighting and give her all the chances I can without making her suffer.

It has taken me a couple of days to write this, because I write it thru my tears. So if I ended up rambling anyway ... I apologize :)

[frijole]

Welcome. I am moving your thread into the cushing's thread (you are in the polling thread) so that more people will see it. Glad you found us and please know we all came here feeling the same way. Lots of loving helpful people here. And it's free! :)

I do think you should have a brain scan done. Your dog more than likely has pituitary cushings which is a teeny tumor that sits near the brain. 80% of dogs with cushings have this type. In some cases, particularly certain breeds and boxers are in that group dogs develop what are called 'macro tumors'. This is when that tiny little tumor grows and over time it can affect the brain. Symptoms and outcomes are dependent upon on the size and the location.

There are locations in the US that treat these tumors with radiation. We have had members do that successfully. I'm not sure where you are located and if that's even a possibility.... but first thing you need to do is to have that checked out. Other signs include stumbling, walking in circles or crooked.

I've linked you to some information that goes into greater detail. Again, don't worry as you are no longer alone on this journey. Kim

http://www.k9cushings.com/forum/showthread.php?t=229

[frijole]

Me again. The loss of weight and the lethargy have me concerned because they are both signs that the cortisol levels have gone too low. When was the last time you had an acth test? Please post the results from it and give us the date. I assume that is when you lowered the dose but am concerned that perhaps it is still too low.

An easy way to find out is to simply skip a days dose and see if you notice an improvement. Trilostane doesn't stay in the body long so you should notice changes.

If your dog has pancreatitis you really need to be on a special diet - we have some real experts here on that so I'll let them give you advice but if I recall correctly you withhold food and then you slowly introduce small amounts of rice and then some boiled chicken (white meat) - tiny amounts several times a day.

Just trying to cover all the bases. Sending you strength, Kim

[Trixie]

I'm so sorry to read about Coco Joey and what you're going through. I am no expert and there are many on this forum that know more than I, but pancreatitis can make a dog feel really terrible...and also very tired I think.
If Cushings is uncontrolled and cortisol is running high the dog is usually super hungry and also sometimes can seem a little hyper and restless along with the excessive drinking/peeing etc.

You wrote that her levels were back up high enough to start vetoryl 9/7/13-- when was an acth done to determine the most recent level? Do you know what the test results were?
It could be her level is low again...so she's getting 60mg of Vetoryl since Saturday and has she been lethargic with no appetite since you started back on th medication?
I think if it were my dog I would not be giving the Vetoryl right now, I would definitely stop and see if she rallies...it's sounds to me that the level is too low. I think the pancreatitis really needs to be addressed as well..probably before Cushings.
Did she have any other Cushing's symptoms other than excessive drinking/urinating? Did she ever have the ravenous appetite, panting, fur loss?
Hope you can figure out a plan with your vet so Coco Joey can begin to feel better.

Barbara

[Harley PoMMom]

Hi Mary,

Welcome to you and Coco Joey from me as well! So glad you decided to post and we will help in any way we can.

Pancreatitis can be very painful so pain medication is a must. The lack of appetite could be from pain and/or her cortisol being too low. As Kim has mentioned, if you could post the results of all ACTH stimulation tests with their timelines that would be great.

A diet very low in fat is recommended for a dog with pancreatitis, also feeding several small meals throughout the day is best. Keeping a dog hydrated is very important for the healing process of the pancreas.

Until Coco Joey is eating normally and acting more like herself, I believe, the Vetoryl should be stopped.

Hugs, Lori

[spdd]

Just want to welcome you to the forum. They've been a great source of information which you said you have seen. We have all shed tears over our babies, so we know exactly how you feel.

The best advice is here without a doubt, so hopefully you can get things resolved with Coco Joey.

[coco joey's mom]

Thank you all for your kind words and support. I will post lab results after work tonight. A special thanks to frijole for moving my post. After I did it ... I noticed it was wrong, by that time I was crying so hard I had to walk away!

[spdd]

Just a word of encouragement for you. Hope this helps. I never even heard of cushings and was absolutely beside myself when I found out, then came on here and was even more upset. Not because of what they said here, but because of the screw ups the vets did and I wouldn't have known until coming here. They didn't even do the testing at the right times, so hundreds of dollars later and even to a Veterinary college at that... it was all wrong. Because of this forum too, I had no idea about reverse cushings (Addison) so Keesh almost was put down, and certainly vets didn't tell me about prednisone for reversing his situation.
I have cried more in the last few months then I think in many, many years, and I still haven't resolved the issues with "mah boy" but now that I know what direction(s) to take, I've been so fixated on that, I don't cry anymore. It's a roller coaster for sure, but we cope.
Don't worry, it will work out. It's been over 4 months for me, but at least I know what isn't wrong with my pup, all because of this forum.
We love our furbabies absolutely whole heartedly and would go to the ends of the earth for them. We all know how you feel, so sit back, take a deep breath ( or a few ) and be ready for the best advice you could ever receive.

[frijole]

Thank you all for your kind words and support. I will post lab results after work tonight. A special thanks to frijole for moving my post. After I did it ... I noticed it was wrong, by that time I was crying so hard I had to walk away!

Don't cry - we'll help you thru this. Kim

[molly muffin]

Hello and welcome to the forum. We all basically arrive here scared to death.

What we do have is big hearts and wide shoulders. Hugs.

Sharlene and Molly Muffin

[coco joey's mom]

4/26/2013
DEXAMETHASONE SUPPRESION
Pre 3.3
Post 4 HR 0.7
Post 8 HR 3.5

[coco joey's mom]

6/7/2013 7/20/2013 8/26/2013
ACTH CORTISOL ACTH CORTISOL ACTH CORTISOL
Pre 5.3 Pre 2.9 Pre 5.4
Post 6.8 Post 1.3 Post 13.4

[coco joey's mom]

7/20/2013 8/26/2013
SPEC cPL SPEC cPL
842 443

[frijole]

4/26/2013
DEXAMETHASONE SUPPRESION
Pre 3.3
Post 4 HR 0.7
Post 8 HR 3.5

OK thanks. This is the low dose dex suppression test (LDDS). It is done to diagnose cushings. These 3 numbers are consistent with cushings and in particular pituitary type cushings.

We also need to see acth test results. That is a 2 hr test that is done sometimes before testing but ALWAYS after you have begun treatment. It measures the cortisol levels so you can see if the drug is working or not. YOu do it shortly after starting the drug and you do it if you think the cortisol has gone too low and you do it PRIOR to making any changes in dosing. You also do it periodically for life just to make sure the dose is still accurate.

Have you had these tests done? You mentioned a change in dose so I am assuming so. Thanks Kim

[frijole]

never mind... :D:D:D:D good girl.

[frijole]

6/7/2013 7/20/2013 8/26/2013
ACTH CORTISOL ACTH CORTISOL ACTH CORTISOL
Pre 5.3 Pre 2.9 Pre 5.4
Post 6.8 Post 1.3 Post 13.4


It looks to me like you made a dosage change between the 2nd and 3rd tests (July 20th and August 26th). You are right - the July results are very low - not what we call Addisonian but had you stayed at that dose you would probably have had trouble.

The problem is in August you are so high the symptoms are not controlled. What was the dosing at the time of the first test? Those results are actually the best. Thanks, Kim

[coco joey's mom]

Still trying to get the hang of posting on a forum. Did some handy dandy little spreadsheets to try and make it easy ... didn't paste in that way LOL!

• We started Vetoryl 60 mg around 5/5 or so
• We stopped Vetoryl around 7/20 after her test results
• She was off Vetoryl until 9/7
• We started Vetoryl 30 mg on Sat 9/7

Thanks!

[coco joey's mom]

never mind... :D:D:D:D good girl.

Your quick Kim:o ... I'm typing and your already asking questions

[coco joey's mom]

Your quick Kim:o ... I'm typing and your already asking questions

Hopefully I will get quicker with practice!LOL

[coco joey's mom]

So today, at my persistent insistence my vet started Coco on treatment for pancreatitis. I know it's a shot in the dark, but her numbers are high, she is barely eating and super lethargic. As long as it can't hurt her, I thought it was worth a chance. I would like to really get her eating waiting for the Vetoryl new dosage to kick in. We have her on Amoxi Tabs, Tramadol & Pepcid. Think I was silly for asking him?

[molly muffin]

No I don't think silly at all. Taking care of the pancrease takes precedence over the cushings. It's important to get that fixed, then can concentrate on the vetroyl dosage. I wouldn't even give it at all till the pancrease if fixed back up and that can take some time.

You'll be surprised at all quickly you'll get the hang of the forum. :) Scout around, ready, put your mouse over different symbols and they'll tell you what they do. :) Enjoy, it's a full immersion experience that gets easier as you use it. Any questions you have just ask and someone will pop in to answer. :)

Sharlene and Molly Muffin

[coco joey's mom]

Coco Joey actually spent a little time in the yard yesterday and even barked at the Com Ed guy working next door! It's funny how you now find joy in the little things that you took for granted before. All the times I told her to shhhh in the yard and now I want to grab the camera cause she's barking! Have a good day guys, I will post some this evening.

[coco joey's mom]

So the Vetoryl must be kicking in a little, today it is 1 week on her new lower dose. Yesterday she moved around more than she has in a long time, but she seemed restless.

There has been some back and forth about her pancreatitis. While her numbers were high from her 2 test at the end of July and the end of August the vet felt no medicine was needed. She had her abdomen ultra sound on Wed and it came back OK. I insisted we start her on meds anyway. She is on tramadol, Pepcid and amoxo tabs.

The problem is I can not get her to eat. She was off Vetoryl for almost 6 weeks and her eating was poor at best. She has lost 11 lbs. Yesterday she ate 1/4 of a can of food for breakfast, no dinner, no snacks, nothing. Today nothing so far. Getting her to take pills is awful. Using a pill gun but still a battle. ... I have a call in for the vet.

QUESTION:

To those who had pancreatitis and Cushing's , was eating a problem or am I dealing with something no else has had. If you had the same situation as me, what did you ?

[molly muffin]

Yes usually with pancreatitis, there is a period where getting them to eat is a real problem. You have to find what works best for them, sensitive tummys, and then slowly transition them to their regular food. You want moderate protein and fairly low in fat.

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

When was her glucose last checked?

[Harley PoMMom]

My boy, Harley, had chronic pancreatitis. We were never able to bring his spec cPL numbers within the normal ranges. His appetite would wax and wane, during the wane part I would try almost anything to get him to eat; baby food that contains no onions or onion powder, homemade chicken broth, and slippery elm bark which turned to be a God send. Also, feeding from my hand seemed to work better too.

I am glad you insisted on the pain meds for Coco Joey because pain can also cause inappetence.

Hugs, Lori

[coco joey's mom]

Did she have any other Cushing's symptoms other than excessive drinking/urinating? Did she ever have the ravenous appetite, panting, fur loss?
Hope you can figure out a plan with your vet so Coco Joey can begin to feel better.

Barbara

Hi Barbara,

Other than the drinking/urinating, being lethargic and test result, she had no other symptoms ...:confused:

[coco joey's mom]

[


When was her glucose last checked?

Looks like they checked glucose 03/07and it was at 96 and 08/26 it was 102.:)

[coco joey's mom]

My boy, Harley, had chronic pancreatitis. We were never able to bring his spec cPL numbers within the normal ranges. His appetite would wax and wane, during the wane part I would try almost anything to get him to eat; baby food that contains no onions or onion powder, homemade chicken broth, and slippery elm bark which turned to be a God send. Also, feeding from my hand seemed to work better too.

I am glad you insisted on the pain meds for Coco Joey because pain can also cause inappetence.

Hugs, Lori

Lori,

It's funny that you mentioned baby food. Yesterday when I was at Wal-Mart I bought baby food and unflavored Pedialyte. My family thought I was crazy ...then I showed them your post!

Can you tell me more about the slippery elm bark?

[coco joey's mom]

So the Vetoryl must be kicking in a little , yesterday was day 7. After Coco Joeys am Tramadol wore off (she was really groggy), she ate supper YEA! Then I noticed she started the pacing. This is the first time I had seen her do this the last few months. Then as I thought about it, I remember seeing her do it during her first Vetoryl attempt that was too high.

Is this a sign of things worsening? :(

[Harley PoMMom]

Slippery Elm (SEB) is used for many issues, it coats the stomach and helps to diminish the accumulation of acid in the stomach. SEB contains many nutrients (carbs, protein, fat, ascorbic acid, beta-carotene, calcium, and trace minerals) that can be beneficial for a dog that is not tolerating food at that time. One word of caution, though, is that it is recommended that you not give slippery elm within two hours of other medications because it may affect their absorption. Here's a link where you can find more info about SEB: http://www.littlebigcat.com/health/slippery-elm/

The pacing could be from pain and/or the Vetoryl not agreeing with her tummy.

[frijole]

Pacing could also be from the tramadol. A long time ago my Haley was given it and the dosage was the standard rx for her weight. OMG it was a nightmare - I was up all night - it made her bonkers. She would not quit walking, she walked into a wall/corner and just stood there like all doped up... I finally went to bed because the pacing drove me nuts but I got up at 2 am and there was diarrhea all over the living room.

Luckily our australian posters helped me keep my sanity that night. I knew it was the tramadol. Come to find out many of us found that the standard dose needed to be halved for our cush dogs.

My Annie however tolerated it fine and did not pace.

Just sharing... Kim

[coco joey's mom]

There are so many nuances to this ... it's just awful and heartbreaking. So much seems like trial and error.You guys are angels for what you do.

As an update, I started giving Coco some baby food (turkey & veg thinned down with Pedialyte) ... that way I could get it in a squirt bottle. She just laid on the bed and let me squirt it in her mouth. She must be that hungry.

Not only is she taking it, she is taking straight Pedialyte too and holding it all down. She looked really weak just lying there. I wanted her to go out potty, so I rang the door bell. She was up like a shot and went out potty, so she was moving OK.

In a little while I will try some infant oatmeal thinned with Pedialyte also. I will try a 4 hour schedule, just like a baby to see if I can get some strength and appetite back.

You are all in my thoughts and prayers ...

Mary

[frijole]

You are obviously a tremendous mom. Getting food in the system is important but don't overdo it. Small amounts throughout the day. Pedialyte should help as much as the food. Sending warm thoughts and prayers, Kim

[coco joey's mom]

Thank you for you vote of confidence. :o

Can I get some feedback about the dog being lethargic?

How extreme have you guys experienced?

Coco Joey just lays around. She will get up to go potty and sometimes get up to eat. (I think the eating is tied to the whole pancreatitis thing) But that is it. She never wags her tail or kisses anymore. If you ring the door bell 9 times out of 10 it will still trick her out to come running and barking, but it does not last long.

My vet feels she is too lethargic for Cushings, which is why he is pushing for the neurologist.

I wonder if it was just a "perfect storm" situation for her. The Cushings causes the lethargy, but she should be eating and drinking. The pancreatitis causes lethargy and makes you not want to eat or drink. The less she eats or drinks, the less energy she will have (she has lost 10 lbs). The less energy she has the less moves, less she moves the weaker she gets.

As I mentioned, she will be on her new dose of Vetoryl 2 weeks on 9/21. We are giving her baby food and pedilyte since Sunday all of which she is holding down. Last night I started my first dose of slipper elm. She actually came in the kitchen while supper was cooking and begged for some corned beef. We go for her next retest 9/19.

My family is starting to think it is time to let her go. I want to go out fighting but not make her suffer. If I am close to getting this thing under control, I don't want to give up ... but I don't want to fool myself and make her suffer.

Is the lethargy we are experiencing similar to others or extreme?

Thanks for your input...

With love
Mary & Coco Joey

[Squirt's Mom]

As I mentioned, she will be on her new dose of Vetoryl 2 weeks on 9/21.

I am reading this to mean that Coco Joey has been taking the Vetoryl this whole time while she is steady getting weaker? If that is the case, please, please, please stop the Vetoryl and give her some prednisone asap. Then have an ACTH and her electrolytes checked asap...as in today if at all possible.

I pray I am misunderstanding and that the med has been withheld while she has been ill.

[Squirt's Mom]

I see that it was stopped then restarted several times, dose changes, etc.. It makes me very nervous that she is taking the Vetoryl and acting worse. How are her stools? Any signs of nausea? any vomiting? When was the last ACTH?

I'm still wondering about diabetes - it can come on very rapidly and the lack of appetite and weight loss fit with diabetes better than Cushing's. They also fit with pancreas issues as well. If she were mine, I'd stop the Vetoryl for now and not restart it until she was eating well again and a bit stronger, more alert and interactive. And I'd definitely be calling her vet. Something doesn't seem right for such a drastic change in behavior and weight loss.

Listen to your gut and Coco Joey. They will guide you best of all in making decisions concerning her care and life. You know her best; she trusts you most. We will be by your side all the way - we trust you, too.

Hugs,
Leslie and the gang

[molly muffin]

I'm wondering if it isn't better to just not give vetoryl until you are positive that the pancrease is alright? Most people don't give the vetoryl when their dogs have pancreatic attacks. That might be causing much more lethargy.
I'd stop the vetoryl, concentrate on the pancrease and then resume when things are better. Vetroyl can cause effects to be worse I'd think if given during an illness and the recommendation from the manufacturer is to not give it.
Yes, you get some lethargy but it usually clears up and become more normal activity levels with controlled. However, over control, other illness going on, can all cause more lethargy and be not good for them.

Things to think seriously about.

Sharlene and Molly Muffin

[LtlBtyRam]

I don't have anything to add to conversation, but want to say I'm glad you found the forums and the folks around here are PAWSOME.
Angela