Our 9 year old mutt, Penny, in the dx process - sweet Penny has passed

[trk_koa]

Our female dog, Penny, is around 9 years old, 44 lbs and a rescue. Speculation is Shepard, Sharpei and Heeler and probably some other things mixed in. She has had some small, hard bumps under her skin and several have been removed and biopsied as benign over the last two years.

Over the past 6-8 months she has begun showing vague symptoms including panting and lack of energy. More recently, she drinks and urinates excessively and has the beginnings of a potbelly although her weight has fluctuated a bit. Right now she is down a couple pounds. She had a complete blood work up a couple months ago and all was normal except extremely high triglycerides. Blood sugar was normal. So the vet changed her to a higher fiber diet. Recent six weeks or so, she is always hungry. Unless we limit her, she will drink until she throws up.

So I took her back to the vet and they did a urine test to screen for Cushings. A week later the results came back as normal (???) so after more discussion we decided last week to do the ACTH stim test anyway. The results came back yesterday as positive for Cushings.

The vet wants to do an abdominal ultrasound tomorrow morning and has mentioned the drug trilostane over the phone.

So right now I am researching and researching and want to be prepared for the vet appointment in the morning.

Thanks to the knowledgable folks I found here earlier today, one thing I know I should do is get copies of all her test results.

Sorry about the late-in-the-day posting. We are in Hawaii. There aren't many veterinary specialists here as the Big Island is very rural. I think we are seeing the most knowledgable (and only accredited) vet here.

I would appreciate any and all advice on questions to be sure to ask, other tests, etc.
Mahalo,
Nancy

[molly muffin]

Hello and welcome to the forum. You said the UC:CR came back as normal but the ACTH was high?
So, her liver enzymes were fine, not high? ALKP, ALT, etc.

If you do go with trilostane, don't go over 1mg/1lb maxium to start with. Just safer.

Don't limit water. I know you don't want her to make herself sick, but if this is cushings, then their bodies can't regulate temperature, their kidneys work over time and it is very hard on them and they have to drink the water to stay hydrated. It isn't that they drink and then pee, it's that they pee and then they have to drink.

Usually, and its by no means an always, the drinking and urinating will be one of the first things to clear up.

Did they ever mention if the hard bumps were calicinosis cutis? It's small hard calcium deposits which cushings dogs are prone to. (a skin scraping should tell you for sure if that is what it is)

So glad you found us. Some of the others will be around soon to check in.

Sharlene and molly muffin

[trk_koa]

Thanks for the reply.

Yes, that is correct. Her liver enzymes are all normal and her uc:cr test was normal. But the symptoms match so much, we did the ACTH test anyway and it was high. I'm not sure of the exact numbers since test results were told to me over the phone. We will see the vet in the morning for the first time since the results came back and I will get copies of everything, including her biopsy results on the skin bumps.

Not to worry. We don't really limit her water, we just have to tell her to take a break and she will stop. It's almost like she gets to drinking and doesn't think to stop. She always has access to water.

[Harley PoMMom]

Hi Nancy,

Welcome to you and Penny! Glad you found us and we will help in any way we can.

Cushing's can be difficult to diagnose and is frequently misdiagnosed. Severe stress and other non-adrenal illnesses can create false positive results on all tests for Cushing's which is why, for the Urine Cortisol/Creatinine Ratio (UC:CR), the urine sample is collected at home and taken to the vet's office.

With the ACTH stimulation test a percentage, although low, of dogs will have a false positive result for Cushing's. When the (UC:CR) results are normal the consensus among the top canine endocrinologists is that it is very unlikely the dog has Cushing’s.

Increases in drinking/urinating can be attributed to other non-adrenal illnesses such as an UTI or even diabetes insipidus. Diabetes insipidus, which should not be confused with Diabetes mellitus, is a rare disease, but we have had a couple of dogs on the forum who have indeed been treated for the disorder. The usual treatment for DI is with desmopressin. If Penny's urine is diluted a regular urinalysis may not be sensitive enough to pick up any bacteria so an urine culture and sensitivity test should be done.

Getting copies of all test results and posting any abnormal values with their reference ranges and units of measurement may help us to provide you with more meaningful feedback. Is Penny on any other herbs/supplements/medications?

Again, welcome to the forum and please do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[goldengirl88]

Welcome the forum. What a great place to live.Sorry your baby is having troubles. Were there any other issues going on with Penny when she was first tested for Cushings? If so this can skew her numbers by giving a false positive. She certainly is showing some symptoms of Cushings, but as stated earlier it is the one of the hardest diseases to diagnose. Has you dog been tested for diabetes or thyroid problems? They have some of these symptoms also. I see you are having an ultra sound done. Is that a high definition machine being used? You will want to be asking if the adrenal glands are enlarged, what the liver, spleen, and gallbladder look like and any problems in the abdominal cavity they can see. If your dog has Cushings and is treated with trilostane like Sharlene mentioned please start low at only 1mg per pound as we have had several dogs on the forum lately have problems because they were started too high. Unfortunately a lot of vets are unfamiliar with this disease and it's management on these drugs so please come on here before doing anything you are not sure of and ask questions. Also if your dog is put on trilostane do not under any circumstances let the vet talk you into raising the dose before thirty days is up as the cortisol continues to fall for that time and sometimes more. You want to start low so your dog can adjust to the falling cortisol and to this new drug she has never had in her system. Starting low minimizes risks of your dog having problems. Blessings
patti

[trk_koa]

Penny's ultrasound shows nothing abnormal. Everything is actually extremely normal. No enlargement of her liver, no tumors, spleen and kidneys all look great.

The vet is going to consult with a couple of internists on the mainland to get another couple of opinions.

I will be receiving copies of her test results via email later today. He wants to write up the ultrasound report and include that.

Bottom line is she has the symptoms, but her blood work, thyroid, liver enzymes, blood sugar, etc are all normal with the exception of very high triglycerides. She is not diabetic. Urine test was normal, ACTH stim test slightly high.

If it isn't Cushing's, what might it be?

[goldengirl88]

I know Tipper had high triglycerides and with the Cushing's dogs they have an awful lot of fat mobilized in their systems. Her fish oil worked well, but you have to be careful with it too as it is adding more fat even though it is a good fatty acid. I am conservative on how much I give her and it really helped but took a while to bring them down. Penny's report sounds good and it sound like nothing seen to worry about right now. Hope your Dr.'s find out what is going on with her. How did she do for the US? Blessings
Patti

[goldengirl88]

Hi:
Just checking in to see how Penny is doing? Have you gotten her written reports
from her tests yet? I am curious to see her numbers. Blessings
Patti

[trk_koa]

Update. Discussions with two different internists suggest we wait before trying the medication. We will keep an eye on her symptoms and try the LDDS test in about six months.

I am disappointed in the vet and staff that I still have not been given copies of her test results.

[goldengirl88]

That is extremely disappointing that you have not gotten those reports. What are
they saying is the reason they have not gotten them to you? I would be talking to
someone in charge to get this expedited. Blessings
Patti

[trk_koa]

Aloha,
Finally got copies of her test results but they didn't send me the blood work from April.

UC:CR 44.2 range 13.6 - 49.2
Cortisol PRE 2.6 range 1.0 - 6.5
Cortisol POST 22.7 range 6.5 - 18.0

Her energy level seems better lately.

So the watch-and-see approach makes sense to me.

[jxeno13]

Hi Nancy and welcome! I'm glad you found the forum, and sorry your baby is having problems. Thank you for saving Penny! "Mutts" are the best! I wish the Vet had done the LDDS, before he had done an ACTH Stim on your Penny. It would have been a little easier to tell as well what is going on. Maybe they were just busy at the office with the weekend coming up? Just a guess. Anyway, I'm hoping it's not Cushing's at all. But with a watchful eye.....and more test results it should be easier to tell. Just post them when you can. My Eli who was pretty full blown Cushing's had a pretty normal Ultrasound as well. The only thing a little abnormal was a small cyst on one kidney, but his IMS said it was nothing to worry about.

Anyway....nice to meet you. Sorry for the circumstances and so happy you found us!

[jxeno13]

Aloha,
Finally got copies of her test results but they didn't send me the blood work from April.

UC:CR 44.2 range 13.6 - 49.2
Cortisol PRE 2.6 range 1.0 - 6.5
Cortisol POST 22.7 range 6.5 - 18.0

Her energy level seems better lately.

So the watch-and-see approach makes sense to me.

Watch and see sounds good as well to me. Cushing's is a slow progressing disease. Although, in some cases, such as Eli's, it can come on kind of all at once, just showing some subtle signs, that in the end, I put together like a puzzle. A surgery he had to remove a benign tumor, along with a tooth cleaning (at the same time) brought on the initial Cushing's full blown symptoms. ....My Eli was one of the dogs on here that almost died from an overdose on the Vetoryl. He is OK now...thanks to the great people on this forum...and is now back on a small dose to start again.

[goldengirl88]

There is nothing wrong with watching and seeing what goes on. Cushings is a very slow progressing disease so you have time to observe and see what if anything Penny is showing in the form of new symptoms. Blessings
Patti

[trk_koa]

Penny had follow-up LDDS test and blood work and the signs are there now along with more pronounced symptoms. Her excessive drinking has increased, now voracious appetite, pot belly and some signs of muscle deterioration.

Our local vet again consulted with the veterinary internist. We will be starting her on Vetoryl tomorrow and rechecking her blood work December 3.

Will keep you posted on her progress.

Aloha,
Nancy

[labblab]

Thanks so much for this update, and we will definitely be walking alongside you and Penny as you launch into treatment. You already know about our fascination with test results ;), so if you can post the actual numbers for the LDDS and any abnormals on the other panels, that would be great.

How much does Penny weigh, and what dose of trilostane will she be starting out on? I am hoping it won't be more than 1 mg. per pound since that is the initial dosing formula that is now recommended by many specialists as well as Dechra, the manufacturer of brandnane Vetoryl.

Welcome back, and good luck to sweet Penny!
Marianne

[trk_koa]

Penny weighs about 46 pounds and is starting with 30 mg Vetoryl. Had her first dose this morning with her breakfast.

I am watching her, probably too closely. She got into the garbage today. She is always so hungry that she is constantly hunting for things to eat.

She seems a bit off her usual self and a little bloated, so I'm not sure if she ate something from the trash or if it is the Vetoryl.

I got Penny's update via phone so I didn't get a copy of her lab work yet. I will post her numbers as soon as I can get a copy.

Nancy

[trk_koa]

Penny has beenn stable on 40 mg vetoryl for a year now. She is mostly asymptomatic except for hunger and dry skin.

Over the last few months she has developed a hematoma on her side. It was suspected to be a lipoma as she already has several of them. This lump got to be almost the size of a golf ball. We had it sampled last week and the cytology shows only blood and erythrocytes. No sign of any abnormal cells nor is it fat.

Our vet tried aspirating it yesterday afternoon and removed 7 cc of blood. By 10 pm it had refilled. Penny has also got another small apparent hematoma on her belly.

I have read that Cushings can weaken blood vessel walls. So I am concerned about her.

Anyone else have a dog with hematoma issues and if so, what if anything, did you do?
Thanks,
Nancy

[trk_koa]

Well. We had the hematoma removed and inside was a membrane encased mass. Turned out to be hemangio sarcoma. Ultrasound today shows an additional probable tumor on her spleen. The liver, adrenals, kidneys, heart and chest x-ray all look normal for a dog with Cushings.

So we are now waiting for confirmation of the diagnosis from a radiologist. We will most likely surgically remove her spleen some time next week.

Our vet said this is unusual but lucky in many ways. Hemangio sarcomas aren't often found until they rupture (spleen or liver) and the dog is bleeding out.

Penny wasn't happy about missing breakfast so we just fed her and gave her vetoryl. But she is a trooper - happy and energetic.

Time for a nap by the fire.
Nancy

[molly muffin]

We have one member, whos dog has a mass on it's spleen. Once the spleen was removed the cortisol went down on it's own and no need for cushing meds.

Something to keep in mind after the spleen is removed. It could be contributing to the higher cortisol levels. Or may not but food for thought.

Glad she is doing well and this mass was removed.

[trk_koa]

Penny has had a rough time. She had her spleen removed Friday (5 days ago) and just wasn't bouncing back. She was painful and couldn't keep her oral medications down. She spent two nights at the vet hospital, finally got her to eat and she came home Sunday evening. She had a urine accident in the middle of the night but was eating okay, tolerating ice packs, etc. but her pain meds only seemed to work for about three hours. By Monday evening she was shaking and panting so we ended up at the vet ER. It took a lot of tests and several consultations with specialists to figure out that she had fat necrosis going on and her Cushings belly was inflamed.

So late Tuesday she had additional abdominal surgery to remove the dead and dying belly fat. Tough times. She spent the night in the hospital and we were able to bring her home Wednesday evening. She is eating baby food and very thirsty. She has only had one dose of vetoryl in a week. She's on pain medication, lots of antibiotics and drugs to get and keep her digestive tract moving. The vet said she thinks Penny has turned the corner. Right now she is sleeping heavily next to me.

The big news: her spleen lesions were benign (!) scar tissue and fibrocysts, probably from some past trauma. Good news, bad news. If we had known that, she would not have had the splenectomy. We are focusing on the good part. That she doesn't have an aggressive form of hemangio sarcoma. The hemangio sarcoma that was removed from under her skin was not a manifestation of splenic cancer.

So for now we will be spending our Christmas holiday babying her beyond all reason, hoping she stays stable and continues to heal. If we can get her over this set back, her prognosis is pretty good. Right now, we're grateful she's here.

[labblab]

Omigoodness, I am so sorry to hear about Penny's surgical issues! But thanks so much for updating us. I will certainly be holding you all in my thoughts and hoping that she continues to improve. Please do let us know!

Marianne

[molly muffin]

Oh my gosh. I hope to hear that Penny is doing better.
Really glad the spleen lesions where benign though but wow, what a lot to go through in such a short time.

Keeping you and Penny in our thoughts and hearts.

[trk_koa]

Penny is doing very well. It was pretty scary there for a while, but she is a trooper. Her staples/stitches will come out tomorrow. One more day of antibiotics. She was on some pretty heavy doses of pain medication but she is competely off one of them and tapering the other. We hope to have her off that one in a day or two.

She is only now starting to show some Cushings symptoms. We have just been giving her adrenal harmony gold in her food for the last week. When we see the vet for the staple removal, we will find out how to best restart her vetoryl. She had been on 40 mg per day so I'm not sure if we go straight back to that dose or ramp to it. The vet doesn't want to do a stim test until later. She's been through a lot.

[molly muffin]

I can see not wanting to test right now, but I do think I'd want a test before starting (ACTH) to see where her levels are. The thing is that you want her to be recovered from these other issues prior to doing the test as it is likely her cortisol has increased with all this going on.

I'm glad to hear that she is continuing to get better. What a strong girl she is.

[trk_koa]

Update on Penny. She continues to be happy and have lots of energy. However, the hematoma that was at the site of her tumor has recurred. The suspicion is that the hemangio sarcoma is back and affecting her blood vessels again.

At this point we have decided not to put her through any more procedures. Her Cushings is controlled on 40 mg of Vetoryl per day. She doesn't seem bothered by the hematoma at all.

We are just watching her and spoiling her and will just see how it goes.

Nancy

[molly muffin]

Oh gosh, I hope it isn't the sarcoma.
I know that one of our members, whose dog Flynn had a lypoma removed, kept having that area fill up with fluid within hours of it draining. They finally went in again (they were doing needle aspirations to drain it) and found that a bit hadn't come out completely. They removed that and it hasn't refilled. They didn't use a general anethesia this time either as she didn't want him put to sleep, but just a local and a light anethesia which doesn't bother them the same as a full does. He was in and out and it wasn't too bad, but another option is to drain it of fluid if needed with just a needle, like if it gets big enough to really be bothering her.

I'm so glad to hear that she continues to have lots of energy and be happy. That is what is really important in the long run isn't it. :)

[trk_koa]

Thanks for the kind words.

We are going to watch and see for a little while. Then discuss going in again with the vet. Penny definitely bounced back from just the sedation and local much better than general anesthesia.

Nancy

[trk_koa]

Penny continues to do well after her Holiday ordeal over Christmas and New Years. Her weight is up slightly. She is starting to show some minor loss of hearing and eyesight, but that seems to go away as soon as she spots a squirrel :-)

The area where the hemangio sarcoma was removed filled up with blood again but subsided about a month ago and no signs of it now. We are agreeing with our vet about watching and waiting. She's been through so much but seems to be thriving right now.

Her teeth need a cleaning but we are reluctant to put her under anesthesia again. So I am now brushing her teeth daily and we are seeing improvement there.

She has developed a couple sebaceous cysts and really flaky skin. I am looking for a better shampoo than oatmeal-based if anyone has a recommendation.
Thanks all for your help.

[molly muffin]

Glad penny is doing well.

Maybe look into one of these shampoos.

http://bestdogshampoos.com/

[trk_koa]

Penny is our miracle dog. It's been several years now since her Cushings dx and over a year ago that she had hemangiosarcoma cancer.

She's getting very lumpy with numerous cysts and lipomas. We took her to the vet for a check up in December. They sampled 5 or 6 of her lumps and bumps. All are benign. She got a good report for an old dog.

Her hearing is nearly completely gone, eye sight is dimming and she sleeps a lot more.

But every once in a while she gets lively and runs around in the yard. She had quite a romp in the snow yesterday. She loves her food and treats. We lift her onto our bed at night. She seems to like being allowed to sleep at the foot of the bed.

So she is happy and we are glad she's still here.

[molly muffin]

Awww, Penny. What a love. Heck yea she loves sleeping on the bed with you. :) Nice comfy and with her peeps.
So good to hear a positive report on Penny. Glad she is doing well for an older dog. Sounds like everything is natural progression of aging. :)

[trk_koa]

Still amazed that our Penny is still with us. She gives us a scare once in a while. This last June she had severe bloody diarrhea and two different vets thought she had a perforated bowel or cancer and it might be her time. Ultrasound and additional testing showed an e-coli infection. Antibiotics, bland diet and TLC and she bounced right back.

In late July she had an adenoma (benign) rupture just above her anus. She bounced right back.

This week, it’s vestibular syndrome. Vet said she might have had a seizure but she has the darting back and forth eye movements, stumbling, nausea, circling that are typical of vestibular. They gave her a shot of anti-nausea meds. She refused to eat for two days but yesterday and today she is enthusiastic about home-cooked chicken and rice. I think she has had prescription diets so many times, just the smell puts her off. However, she has diarrhea again. She is drinking water just fine and had her favorite dental treat a little while ago.

The first two days she was obviously very stressed out, poor baby. It’s got to be freaky to have your world not behave.

We have another appointment with the vet tomorrow afternoon.

She’s walking a little better today. I bought a sling harness to help keep her from falling over. She’s resting in her favorite spot right now

[Squirt's Mom]

It's good to hear from you and Penny again! I am glad she is doing as well as she is! Especially considering all she has had to deal with in just a few short years! I think that TLC she gets at home has a lot to do with that. ;)

Vestibular can be so very scary but most pups recover with little to no lasting effects. My old guy, Brick, developed Vestibular and he circled for weeks, at first so badly he couldn't get anywhere which frustrated him no end. But slowly the circling became less frantic and he was able to navigate from one place to the other albeit not normally for a while. He also required some help remaining on his feet for a while. He was blind so we didn't have the nystagmus to help diagnose, we went solely on his behavior. He had hydrocephalus so it was a waiting game to see if it was Vestibular, a stroke, or the hydrocephalus worsening. Thankfully it was only Vestibular. He returned to his normal goofy self and never had problems with Vestibular again. I hope your sweet Penny is soon more her old self, too. Stay in touch and let us know how she is doing!

Hugs,
Leslie

[trk_koa]

Penny’s vestibular is improving slowly. Nystagmus is pretty much gone but she is wobbly and still circling. Diarrhea is gone also. I’m getting better at walking on her “head tilt” side. If she bumps into me, it seems to keep her from falling on slopes or stairs.

Right now the issue is her refusal to eat anything but the home cooked chicken stew. All canned prescription diets are just yuck. She’s had them too many times, I guess. I tried her regular food mixed with the stew and she refused that too.

I’m getting her vetoryl and other meds into her by making homemade chicken pill pockets. So she has had her vetoryl three days in a row now.

Thanks for the encouragement and kind words.

[Harley PoMMom]

You're doing a wonderful job taking care of your sweet girl. All we can do is love them and try to make them as happy and comfortable as we can.

[trk_koa]

Penny continues to amaze. She is recovering from the vestibular quite well. Moving better each day and today she finally ate her normal diet from her normal bowl in the normal place. She’s back to following me around the house and wanting love. She still has a slight head tilt and uncertain gait. But her back end is wasted from Cushings so that isn’t far off her normal. We have a recheck with the vet tomorrow.

[Joan2517]

What a great update...she sure is amazing!

[Harley PoMMom]

Good luck with the vet visit today. And I agree with Joan, Penny sure is an amazing girl!

[Squirt's Mom]

So glad to hear Penny is coming back to herself and pray the visit today brings more good news! Thanks for sharing your wonderful update!

[FoxFire]

Wow. Go Penny!

I love hopeful stories like this. She has been through so much and yet she still keeps plugging along.

The cruel tragedy of these amazing animals, friends, furry family members, is that they have such short lives. :-(

I know I'll need to deal with that some day down the road with my Kobe, he's only six (and boxers aren't the longest lived dogs), but in the mean time I intend to help him make it as long as he can, while also making sure he's as content as possible.

That TLC goes a long way toward that.

[trk_koa]

Just made an appointment to take Penny for ACTH stim testing. Our rural vet doesn’t have it so it will need to be ordered. Our appointment is next week.

Penny is now 14 and she keeps on tickin. Her Cushings symptoms have progressed recently, with more panting, thirst and having to potty a lot more often. So we think she might need her meds adjusted. She is currently on 40 mg vetoryl per day.

My concern right now is the minimal Cushings experience of her current vet in our rural community. I’m trying to decide if we would be better off trying to find an internist in Reno which is about an hour drive.

Penny is dong amazingly well considering she has had Cushings for five years(!) and survived hemangiosarcoma as well. The only remaining symptom from the vestibular syndrome is head bobbing, especially when she eats. She bobs her head like she can’t find the bowl. She has lost a little weight, down to 39 pounds, so we are feeding her more and more often.

[Squirt's Mom]

Hi, good to hear from you again!

So Penny has been on the same dose of Vetoryl since 2016, correct? When was her last ACTH? Would you mind posting the results from the latest ACTH?

If you aren't comfortable with the knowledge level of the local vet I would certainly say go to Reno for the IMS. Considering all she has had to deal with over the last 3 years that might be the best bet regardless. It is important that the vet our babies use be cush savvy so the trip may be well worth it.

I am so glad she seems to be doing well even with the increase in cush signs! She is a trooper for sure!
Hugs,
Leslie

[trk_koa]

Hi, good to hear from you again!

So Penny has been on the same dose of Vetoryl since 2016, correct? When was her last ACTH? Would you mind posting the results from the latest ACTH?

.....


2014 actually. She started at 30 mg and then up to 40 mg about 6 months later.

This vet doesn’t recommend ACTH testing much since Penny gets so upset, he felt it wasn’t going to be all that accurate. We have been monitoring her symptoms and they have been very well controlled until recently.

Honestly, with all her other issues and almost losing her to those other things, we weren’t expecting her to even still be here.

[Squirt's Mom]

He is right - dogs who get upset just going to the vet can and do cause elevated numbers on the ACTH. Have you tried having them come outside to do the test? Someone who had a dog like this found that worked much better for her baby but I can't remember if they were from this group or one of the many others I have been part of over the years. If I remember correctly they spent some time making several trips before trying this just letting her dog walk around the vet lot and yard with members from the care team coming out to say hi and bring a treat. Then when the day came to take the test her baby wasn't as nervous about being in the yard there or having the vet and techs around. One of our members here simply had them come out to her vehicle and do the testing there, taking her baby out for a ride to get a special treat from a drive thru between draws. In both cases it was understood the ACTH might well be elevated more than expected and that was taken in to consideration when adjusting meds. Just food for thought. ;)

Indeed! Penny is definitely a fighter and I too would be so thrilled she was by my side after all she has been thru and very hesitant to upset the apple cart. You are doing a great job of monitoring her!

Hugs,
Leslie

[trk_koa]

Well, I finally obtained a copy of Penny’s test results. The vet’s staff told us the wrong pre test instructions so that delayed it a week, then the vet ended up in the hospital from a bee sting (single vet practice). Anyway.

Her ACTH result did not indicate a change of vetoryl dose.
Cortisol Pre 2.2 (2-6)
Cortisol Post 4.4 (1.5-6)


Here’s what is abnormal:
Platelets 579 (143-448) K/uL
SDMA 18 (0-14) ug/ dL
Creatinine 1.7 (0.5-1.5) mg/dL
BUN 41 (9-31) mg/dL
Potassium 5.6 (4.0-5.4) mmol/L
Na:K ratio 27 (28-37)

Her kidneys are showing signs of failure. She also has a grade 2 heart murmur (0-6). These things might explain her increased panting, fatigue and increased urination.

The big problem is right now her appetite has waned considerably. Unfortunately, the food she has eaten for years recently changed from chicken based to turkey and lamb. She won’t eat it. Spitting out her usual kibble too, even if I hand feed her. The vet wants her on Rx kidney diet and at first she ate the stew kind willingly. Now she eats only a few bites, even if I warm it up.

We are resorting to grocery store gravy-based canned food. This has upset her digestion a little bit. She eats more of it but certainly doesn’t even eat that well. I will make her some chicken and rice today to see if she will eat that.

Her teeth and gums are in bad shape even though she just had a cleaning a few months ago. We are reluctant to do it again because of the anesthesia required.

She’s sleeping a lot more but is still a trooper and seems happy and interested in the world. Loves going outside to sniff and explore. We are just taking each day as it comes.

[Squirt's Mom]

I am so sorry to see those results for the kidney function. If I were you, I would stop the Vetoryl with no plans to start it back. Vetoryl is contraindicated for dogs with kidney disease. From the Vetoryl brochure:


CONTRAINDICATIONS: Do not use VETORYL Capsules in animals with primary hepatic disease or renal insufficiency (See WARNINGS and PRECAUTIONS)...

Since her appetite is already falling off I would be very hard pressed to continue the Vetoryl period. I would find foods she could and would eat and enjoy every minute of every day with her and not worry about making her take a pill she really shouldn't take any more. Hydration is even more crucial for her now so a wet food or home cooked food may be better than a kibble.

Let us know how your sweet girl is doing!
Hugs,
Leslie

[trk_koa]

Thank you, Leslie. I just placed a call to the vet about stopping the Vetoryl. I had not remembered seeing that on the prescribing info.

Penny’s last blood work six months ago did not have the kidney values she has now. The numbers were high normal then. So the kidney disease is a new development.

I’m so glad I posted here. Thank you.

I can’t seem to find any information about stopping Vetoryl. Does it need to be tapered off or cold turkey?

[fkhan]

Subcutaneous fluid could help as well. My vet showed me how to do it at home.

[labblab]

Sorry I have only a moment to write, but you don’t have to taper off of Vetoryl — you can just stop it entirely at any time it seems advisable.

Marianne

[trk_koa]

My vet discussed Penny's situation with an internist and they decided it would be better for Penny to remain on the Vetoryl since she is so well controlled. The internist said the issues with Vetoryl and the kidneys is in the case of an overdose.

So we have been feeding Penny homemade chicken and rice for two days, then yesterday we started mixing it with chicken stew k/d. She ate pretty well so far. Every few days we will decrease the chicken and rice and increase the k/d. We also have been given a couple doses of an appetite stimulant called Entyce.

Day by day. Smooches and walks and love.

[Squirt's Mom]

Hi,

I'm glad you discussed this with Penny's vet but this statement:


The internist said the issues with Vetoryl and the kidneys is in the case of an overdose.

is absolutely incorrect. The manufacturer of the drug, the one who MADE the drug, says in no uncertain terms that their drug should not be given to a dog with renal insufficiency and that certainly includes kidney failure. They make no mention of overdose with this warning. You are of course free to continue the drug in spite of the manufacturer's clear statement to the contrary but I want you to be fully aware of the choice you are making. Sadly, we have seen many dogs made sick(er) even to the point of death due to vets who refuse to follow the directives for this very powerful drug. Vets are not infallible so it is up to us to be our baby's advocate since they cannot read nor speak for themselves. Part of what we do here is educate the parents so they can make decision for their babies with eyes fully open. I hope I have achieved that with Penny.

We will of course be with you every step of the way regardless but I couldn't stay silent in the face of this statement from Penny's misguided vets.

Hugs,
Leslie

[Bobo09]

It may have been mentioned earlier (sorry if it has) but i just wanted to add that dechra who make the drug are happy to speak to vets re dogs taking vetoryl. My previous vet and current one have both spoken to them about Bo.

It would be worth asking them to get in touch if they do not believe you when you get back in touch with them after Leslies informative post.

[trk_koa]

Sorry, I haven’t been back here in a while. Penny had repeat blood work and her CRE was back down to 1.2 so the vet now does not think her kidneys are failing. We have kept her on her regular dose of vetoryl.

We have been dealing with Penny not eating ever since the vet tried to switch her to kidney diet. She has an appetite but turns her nose up at her (non-Rx) dog food. We got her eating a different brand. She refused that after a few weeks. We got her eating again by adding Stella and Chewys dehydrated chicken patties to her dog food. But over time she stopped eating that. She will no longer eat kibble. Appetite stimulants aren’t helping at all; they last for a day but it doesn’t kick start her into eating beyond that day.

So now we are cooking for her and trying to keep her from getting diarrhea.

She had blood work and everything is within normal ranges. A chest x-ray was clear.

This dog amazes me every day. She is sweet and happy other than the eating and recurring diarrhea. She even took my on a half mile walk a couple weeks ago and ran all the way home.

[labblab]

It’s so good to hear back from you, and especially to learn that Penny is doing as well as she is. What a relief to know that her kidney values have rebounded! I’m sorry about the lack of appetite and diarrhea, though. My biggest concern is that both of those problems can be caused by a cortisol level that’s dropping too low. Is Penny still taking her Vetoryl? If so, has her cortisol level been checking lately? You had written earlier that’s it difficult for you to have an ACTH stimulation test run in the area where you live. But barring that, another option would be to test her resting cortisol level one hour prior to receiving her morning dose of medication. Here’s a link to that can explain this testing method to your vet:

https://www.dechra.co.uk/therapy-areas/companion-animal/endocrinology/canine-hyperadrenocorticism/vetoryl-monitoring-1

Either way, given her symptoms, I do think it’s very important to have her cortisol checked if she’s still taking the Vetoryl. If she worsens even more before the testing can be done, I’d stop the Vetoryl altogether, even if only temporarily. It’s much safer for her to have a break from the medication than it is to risk overdosing and triggering an Addisonian crisis. Please do let us know how things develop for you guys, OK?

Marianne

[trk_koa]

Thank you, Marianne. That is good information and I will talk to the vet.

[trk_koa]

Penny has had diarrhea for a month. Every time we think it’s resolving, she decides not to eat that food (whatever it was this week) anymore.

So we are doing more extensive GI testing and sending that and fecal samples out (instead of in house). She had fasting blood draw this morning and depending on the results, we might take her to Reno for an ultra sound with a vet that our vet says is fantastic at it. Another $500+ today, but our girl is worth it since she is still bright and happy in spite of her issues.

We did decrease her vetoryl to 30mg from 40mg.

[labblab]

Has Penny’s cortisol level been checked yet? For all the reasons we discussed above, I do believe this is critically important if you are going to continue the Vetoryl at any dosage at all. For safety’s sake, I do believe that you need to make sure her adrenal function is not being oversuppressed. For a dog with diarrhea and lethargy, this really should take precedence over all other testing. Please, please let us know whether or not it’s been done.

Marianne

[trk_koa]

Don’t worry. Appropriate testing is being done. She is not overdosed and is in no way lethargic. Just recurring diarrhea.

[labblab]

Sorry, I mistakenly wrote “lethargy” instead of “inappetence.” It’s the combination of inappetence and diarrhea that has me concerned about Penny’s cortisol level. I know her ACTH results back in August were within the ideal therapeutic range, even while she was already exhibiting loss of appetite. So the two issues may well be unconnected.

But cortisol levels often change over time, even when the Vetoryl dose is unchanged. That’s why the manufacturer recommends testing every 90 days, even when a dog shows no visible symptoms of oversuppression. Given Penny’s persistent issues with appetite and diarrhea, it seems as though cortisol testing is even more important. Simply checking blood chemistries is not enough. The blood chemistries (including electrolytes) may remain within normal range even when cortisol has dropped too low. Here are the specific monitoring guidelines given by the maker of Vetoryl:


Long term monitoring:
Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days and every 3 months thereafter. At a minimum, this monitoring should include:
• A thorough history and physical examination.
• An ACTH stimulation test (conducted 4-6 hours after VETORYL Capsule administration) - a post-ACTH stimulation test resulting in a cortisol of < 1.45 μg/dL (< 40 nmol/L), with or without electrolyte abnormalities, may precede the development of clinical signs of hypoadrenocorticism.
• Serum biochemical tests (with particular attention to electrolytes, and renal and hepatic function).
Good control is indicated by favorable clinical signs as well as post-ACTH serum cortisol of 1.45-9.1 μg/dL (40-250 nmol/L).

If Penny’s cortisol has been retested and remains within therapeutic range, then you can ignore everything I’ve just written. But if your vet is relying on blood chemistries alone to monitor the Vetoryl dosage, that is not enough. As I wrote earlier, even a resting cortisol level taken right before Vetoryl dosing would be better than no cortisol monitoring at all. If this testing has already been done or was included in yesterday’s blood draw, of course we’ll breathe easier if you’ll tell us the actual numerical result. But either way, I do indeed hope that the testing has been done.

Marianne

[Joan2517]

If Penny were my dog, even if her cortisol is within range, I would stop the vetoryl and see if it makes a difference. Stopping it for a while won't hurt her. Constant diarrhea puts such a strain on them. If the diarrhea gets resolved then start her back up.

[trk_koa]

Update on Penny. At the end if December we did a great battery of tests ($$) and absolutely everything came back normal. We switched her food to Hill’s I/D and her diarrhea resolved. She ate that regularly along with her meds (reduced her dose of Vetoryl) and her Stim test showed therapeutic.

However. A few weeks later she refused her food again. So we gradually switched her back to her old food. Good news no diarrhea. But night pacing and agitation was driving her and us nuts. This has resolved by lots of nightlights and a baby gate to keep her in our bedroom at night. The vet thinks her diminished hearing and eyesight plus the possibility of minor dementia is the reason for the pacing.

She has recently stopped eating well again although she still eats some. No diarrhea. She won’t take her pills regularly either. But pill pockets loosen her stools. She is losing weight. At this point we are just keeping her happy and can’t quite figure out where she gets her energy. She likes to go outside and sniff the world. In a few months she will be 15. Our goal is her happiness and to make the right decision before she has a crisis. I don’t want her to go through any pain or suffering.

[Squirt's Mom]

I'm glad the testing all came back normal! That is always a relief even in the face of changes like those you mention. My Squirt developed dementia and started pacing in the late afternoons. She walked for hours on end...just like humans with Alzheimer's will when they have sundowners. It is hard to watch but as long as she was enjoying her food and being outside and able to interact we kept on fighting. The day came when she refused to eat or drink even when I put food or water in her mouth and I knew she was telling me she had had enough. I think your sweet Penny will let you know when she is ready to move on as well...tho we never are ready for that day. Just love her and make as many memories to cherish as you can now and know she loves you and trusts you completely.

Hugs,
Leslie

[trk_koa]

Thank you, Leslie

[trk_koa]

RIP sweet Penny.

Penny had a seizure this morning and we decided it was time for us to let her rest in peace.

Thank you to everyone here for the years of support you have given.

Mahalo nui loa,
Nancy

[Joan2517]

I'm so sorry, Nancy. Rest in peace, sweet Penny...

[Harley PoMMom]

Oh Nancy,

I am so terribly sorry for the loss of your beloved girl, Penny, and my heart goes out to you and your family. Please know we are here for you and always will be.

With Heartfelt Sympathy, Lori

[Squirt's Mom]

Dear Nancy,

I am so sorry to hear about sweet Penny's passing. It is very hard to make that decision but I have no doubt it was made from a place of deepest love...and Penny knows that as well. Now she is watching over you with the same devotion you watched over her all those years. One day when your job here is done it is my firm belief you will hold her in your arms again, never to be parted.

Please know we are here anytime you wish to talk.
My deepest sympathies,
Leslie



Rainbow Bridge

Just this side of heaven is a place called Rainbow Bridge.

When an animal dies who has been especially close to someone here, that pet goes to Rainbow Bridge. There are meadows and hills for all of our special friends so they can run and play together. There is plenty of food, water and sunshine, and our friends are warm and comfortable.

All the animals who had been ill and old are restored to health and vigor; those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by. The animals are happy and content, except for one small thing; they each miss someone very special to them, who had to be left behind.

They all run and play together, but the day comes when one suddenly stops and looks into the distance. His bright eyes are intent; his eager body quivers. Suddenly he begins to run from the group, flying over the green grass, his legs carrying him faster and faster.

You have been spotted, and when you and your special friend finally meet, you cling together in joyous reunion, never to be parted again. The happy kisses rain upon your face; your hands again caress the beloved head, and you look once more into the trusting eyes of your pet, so long gone from your life but never absent from your heart.

Then you cross Rainbow Bridge together….

Unknown

[labblab]

Dear Nancy,

I join the others in telling you how sorry I am about your loss of sweet Penny. You have always done your best to make sure she was as healthy and happy as possible. And now, as painful as it must be for you, you’ve given her spirit the final gift of release from a body that has reached its end. Thank you so much for returning to let us know, and for allowing us to join you in honoring Penny as well as your lives together. You rescued her the day she came to her forever home with you. And now she’ll forever remain safely tucked in your heart, as well.

Please do return to us at any time to tell us how you’re doing, OK?

Sending many hugs to you from across the miles,
Marianne