Sweet Gabriel has passed - Intro (10 y/o Rottweiler)

[BarbaraLloyd]

Hi Cushing's Forum Members,

Thank you for organizing this group and sharing such valuable information, my name is Barbara Lloyd. My 10 year old Rottweiler Gabriel brought me to this forum. Last week he was diagnosed with Cushing's and 10 days before that he was diagnosed with hypothyroid.

Since last fall he has been slowly declining but it wasn't until recently a diagnosis was made. Last September Gabriel started to experience muscle atrophy on the left side of his head. It was very isolated so we had an MRI. CT, and x-Rays done and no masses were found, and all of his blood work was good and his electrolytes were good. His MRI & CT scan were sent to various Neurologists across North America and vets who treat Rottweiler's in South Africa & Germany were consulted as well, no anomalies were detected.

As a result we were given two options: 6 week run of antibiotics or 6 week run of prednisone, we chose the antibiotic after consulting with 3 vets.

Then this Spring I noticed Gabriel was squatting to urinate so we took him back to the vet and he had a prostate infection. He was given antibiotics.

A week later I noticed that he was walking like a drunk so we took him back to the vet and X-Rays were done and they showed that the two vertebra behind the ribcage were fused together and he had a bone spur on the vertebra just before his tail so he was given an anti inflammatory shot and we were instructed to continue with the antibiotics for another 5 days.

When we took him home he started drinking copious amounts of water, and I attributed it to the stress of the vet visit, then he started vomiting, so I phoned the vet the following day and he said to halt the antibiotics and bring him back for a re-check. At the re-check it showed that the antibiotics had worked and the prostate was good.

As this process was unfolding Gabriel started to turn away from food. So consequently he lost muscle mass because he was a lean dog to begin with.

Then about a week later I requested thyroid testing and the vet added a myasthenia gravies test. His thyroid came back very low and the myasthenia gravies test was negative. At this point Gabriel was started on Soloxine 2X/day.

About ten days after that I noticed that although Gabriel's coat looked better his abdomen was very distended, so we took him back to the vet and had him tested for Cushing's. The initial test pointed towards Cushing's and it was later confirmed with another test. At this point his electrolytes are super and his organ systems are operating optimally and his diabetes test was negative

Now Gabriel is on Vetroyl 60mg/day in the AM & Soloxine 2X/day.

We are now on day 8 of the Vetroyl treatment and Gabriel's abdomen has receded quite a bit and his water consumption is decreasing. He goes for a check-up on July 21, 2014.

Food wise he does not want to eat anything he has had before, so I am now purchasing meat from the butcher and his appetite has increased and he is finally eating 2lbs of meat/day.

I am feeding him land, elk, bison & beef, and he is happy to eat again, so after his check-up on July, 21, 2014 I will start to offer him some lamb tripe, and see how that goes.

[mytil]

Hi and welcome to our site. I am sorry you and your boy are having these troubles.

Firstly, when you get the chance can you post the actual results and names of the two tests performed to diagnose Cushing's. Just confirming also if he had a blood panel performed as well and if so post only the results that were elevated.

So his only symptoms at this point has been an increase in water consumption, pot belly and loss of muscle mass, right? He is not ravenous, panting a lot, accidents in the house?

Terry

[BarbaraLloyd]

Hi Terry

Thank you for the note. About ten weeks ago Gabriel was ravenous, then when his prostate was infected he started to lose his appetite a bit, then after the ant inflammatory shot for his spine, he was not so interested in food because he was feeling so rough. Every day since starting the Vetroyl his appetite is better.

Prior to the Vetroyl he was asking to go out a couple of times/night and he did have a couple of accidents in the house. After being on the Vetroyl for about a week he is more likely to have a good night. Also, if we feed him his supper early enough in the day he has a good night.

I take him back for a check-up and follow up tests regarding his thyroid and the Vetroyl on July 21st andI'll get all of his pertinent test results then.

One question I have is: Does the muscle mass return?

Have a Great Day!
Barbara

[mytil]

Thanks for the additional information on Gabriel. To answer your question, yes the muscle mass will get much better and often returns to the mass associated with his age. It will take time though and I am not sure how much is being affected by his thyroid.

Keep us posted after your Monday appointment.
Terry

PS - nice avatar of you two. Actually Rotties way back when were used as herding dogs for large livestock and are still being used today for this. :)

[BarbaraLloyd]

Hi Members,

What do you administer for nausea & loose stool?

Thank you!
Barbara & Gabriel

[labblab]

Barbara, welcome back although I'm so sorry Gabriel is unwell. You will see that I've merged your new question into your original thread. This way, all of Gabriel's history and info can be maintained in one place.

Can you give us more specifics as to what is going on with Gabriel? Vomiting and diarrhea are very worrisome symptoms in a dog being treated with trilostane. They can result from cortisol dropping too low and/or levels of sodium and potassium becoming unbalanced as a result of the medication. First, no more trilostane should be given until the cause of the illness is identified. Secondly, dogs who are overdosed may need supplemental prednisone, fluids, and other medication.

Did Gabriel have his check-up as planned at the end of July, along with monitoring blood testing? Can you give us more details about the onset of his illness now?

Thanks so much,
Marianne

[BarbaraLloyd]

Hi Marianne & Terry,

Thank you so much for the reply and the compliment on my avatar and yes, I knew Rottweilers were used for herding and drivin, Gabriel loves playing with his horse Jollyball :-) I'm sure a carryover from part of that heritage. When Gabriel was younger we did a lot of protection training, endurance training, nose work and obedience. In his day, he was an awesome athlete. He also did a lot of pet therapy with disabled children. He worked particularly well with autistic children.

Gabriel went for his check up yesterday and his cortisol levels were good, his liver enzymes were awesome and his kidneys are good.

For the next little while our vet recommended putting Gabriel on a bland diet of cooked meat/veg/rice, and to give him some Peptobismal. I gave him some Peptobismal last night and he had a good night, and a settled tummy.

My vet told me yesterday that there is a shortage of the test kit that is used to test the suppression test, he used his last one yesterday on Gabriel. Are your vets in other places running into the same problems?

I'll pick up my copy of his test results from yesterday and post them later today.

I really noticed a change in Gabriel when he was switched from Soloxinr to Thyro Tabs for his thyroid. I'm not sure if this was a coincidence, or if there is a slight difference in the composition of the tablets.

I also supplement Gabriel with Wobenzym, maybe that has caused the stomach upset? I give him this in lieu of Recovery, b/c getting anything into these days is difficult but he will eat the Wobenzym like a treat and it helps keep his arthritis in check.

For the next few days I'm only going to give him the bland diet, his Vetoryl & Thyro Tabs and I'll see if this gets his tummy and bowels straightened out, if they do straighten out then I'll start with 1 Wobenzyme/day and see how that goes.

The veg thinks that if we can get Gabriel's tummy happy then he will absorb more nutrition and feel better and get stronger.

Thank you again for the support, it helps very much.

Barbara & Gabriel.

[lulusmom]

Hi Barbara and a belated welcome to you and Gabriel.

Gabriel is certainly a complicated case, with multiple issues which raises questions about the validity of a cushing's diagnosis, especially given the absence of the more common symptoms associated with cushing's. I have lots of questions and comments which I have typed in blue text below:


Thank you for organizing this group and sharing such valuable information, my name is Barbara Lloyd. My 10 year old Rottweiler Gabriel brought me to this forum. Last week he was diagnosed with Cushing's and 10 days before that he was diagnosed with hypothyroid.

Many dogs with cushing's will test low on T-4 levels and it doesn't mean a dog has primary hypothyroidism. T-4 can be affected by any number of illnesses that transiently lowers T-4. This corrects itself when the underlying problem is addressed with treatment. This transient condition is called sick euthyroid syndrome. Did your vet put Gabriel on meds because he has had symptoms consistent with hypothyroidism or was it because T-4 was low on his blood chemistry?

Since last fall he has been slowly declining but it wasn't until recently a diagnosis was made. Last September Gabriel started to experience muscle atrophy on the left side of his head. It was very isolated so we had an MRI. CT, and x-Rays done and no masses were found, and all of his blood work was good and his electrolytes were good. His MRI & CT scan were sent to various Neurologists across North America and vets who treat Rottweiler's in South Africa & Germany were consulted as well, no anomalies were detected.

This is not a symptom of cushing's and since bloodwork was good, I don't believe cushing's would have even entered your vet's mind. Masticatory myositis is the first thing that came to my mind.

As a result we were given two options: 6 week run of antibiotics or 6 week run of prednisone, we chose the antibiotic after consulting with 3 vets.

Then this Spring I noticed Gabriel was squatting to urinate so we took him back to the vet and he had a prostate infection. He was given antibiotics.

This is not a problem commonly associated with cushing's.

A week later I noticed that he was walking like a drunk so we took him back to the vet and X-Rays were done and they showed that the two vertebra behind the ribcage were fused together and he had a bone spur on the vertebra just before his tail so he was given an anti inflammatory shot and we were instructed to continue with the antibiotics for another 5 days.

This is not anything we've seen related to cushing's.

When we took him home he started drinking copious amounts of water, and I attributed it to the stress of the vet visit, then he started vomiting, so I phoned the vet the following day and he said to halt the antibiotics and bring him back for a re-check. At the re-check it showed that the antibiotics had worked and the prostate was good.

Given the timing, I'd have to assume that the copious drinking and vomiting were probably related to the anti-inflammatory injection and the antibiotics.

As this process was unfolding Gabriel started to turn away from food. So consequently he lost muscle mass because he was a lean dog to begin with.

This is definitely not a symptom of cushing's.

Then about a week later I requested thyroid testing and the vet added a myasthenia gravies test. His thyroid came back very low and the myasthenia gravies test was negative. At this point Gabriel was started on Soloxine 2X/day.

What symptoms did Gabriel have that prompted you to have his thyroid checked? I assume that the myasthenia gravis test was done due to the skull atrophy. I believe the tests are different for masticatory myositis so you may want to ask if the test he ordered included the 2M antibody.


About ten days after that I noticed that although Gabriel's coat looked better his abdomen was very distended, so we took him back to the vet and had him tested for Cushing's. The initial test pointed towards Cushing's and it was later confirmed with another test. At this point his electrolytes are super and his organ systems are operating optimally and his diabetes test was negative.

So at this point, Gabriel was tested for cushing's based on a distended stomach? Was he voracious all the time, bugging you for food? Was he drinking buckets and peeing lakes? Did your vet do a urinalysis to check urine specific gravity? Did he do a culture to rule out a urinary tract infection? If Gabriel had cushing's at this point, I would not expect to see any improvement in coat and an extended abdomen is not exclusive to cushing's nor does it happen in a week's time. Dogs with cushing's also don't have organ system that are operating optimally. Can you tell us what test was done to determine that Gabriel's organ system was working fine? Can you please tell us what the initial test was that pointed towards cushing's and can you please post the results of those tests? Can you also tell us which test was done to confirm the diagnosis and please post those results as well?

Gabriel went for his check up yesterday and his cortisol levels were good, his liver enzymes were awesome and his kidneys are good.

I don't know what your vet considers as good cortisol levels so would appreciate it you could please post the results of Gabriel's acth stimulation test? I am assuming that the high liver enzymes were part of the initial tests that pointed to cushing's so just a reminder that we'd like to see those values and any other values that were abnormal on tests.

For the next little while our vet recommended putting Gabriel on a bland diet of cooked meat/veg/rice, and to give him some Peptobismal. I gave him some Peptobismal last night and he had a good night, and a settled tummy.

What was happening to Gabriel that your vet ordered a change in diet? Did he instruct you to stop dosing with Vetoryl at that time?

My vet told me yesterday that there is a shortage of the test kit that is used to test the suppression test, he used his last one yesterday on Gabriel. Are your vets in other places running into the same problems?

We became aware of a shortage of stimulating agent (Cortrosyn) in the UK a few months back but I was not aware that shortage was affecting our Canadian members. I don't believe there is a problem in the U.S.

I really noticed a change in Gabriel when he was switched from Soloxinr to Thyro Tabs for his thyroid. I'm not sure if this was a coincidence, or if there is a slight difference in the composition of the tablets.

Why was his medication switched and has his thyroid been checked since starting him on Soloxine? Was he diagnosed based strictly on T-4 or did your vet do a complete thyroid panel?

I also supplement Gabriel with Wobenzym, maybe that has caused the stomach upset? I give him this in lieu of Recovery, b/c getting anything into these days is difficult but he will eat the Wobenzym like a treat and it helps keep his arthritis in check.

For the next few days I'm only going to give him the bland diet, his Vetoryl & Thyro Tabs and I'll see if this gets his tummy and bowels straightened out, if they do straighten out then I'll start with 1 Wobenzyme/day and see how that goes.

I believe Marianne has already mentioned to you that it would be wise to stop Vetoryl until Gabriel's bowel issues and appetite are normal? The manufacturer is very clear in their packaging insert that a sick dog should not be given Vetoryl. For all intents and purposes Gabriel is sick.

The veg thinks that if we can get Gabriel's tummy happy then he will absorb more nutrition and feel better and get stronger.

What exactly did your vet tell you is wrong with Gabriel's tummy? Did he test for pancreatitis? Did he do blood labs that showed an active infection? Years ago my vet told me to give my dog Pepto bismol for his chronic colitis. Was Gabriel diagnosed with colitis?

Sorry for all the questions but Gabriel is a complicated case and his history is anything but classic cushing's. I find myself holding square pegs that are supposed to fit into a round hole and they just won't fit without additional information. I hope this isn't too overwhelming for you and if I've confused you about anything, please let me know and I'll try to clarify.

[BarbaraLloyd]

Thank you for the lengthy and thoughtful reply lulusmom.

I reviewed the discharge summary from last fall October 2013 from the Western College of Veterinary Medicine in Sask. Canada. The notes say:

"Gabriel's CK levels were in normal ranges but his ALT was elevated as was his GLGH as was his cholesterol"

This was the same visit that he had the MRI & CT and the internal medicine specialist he saw ruled out Masticatory miositis at that time via a 2M Titre. At this point in time Gabriel was voracious, and he had raided the garbage several times, which was very out of character for him.

In July of 2014 Gabriel was diagnosed with hypothyroid by Dr. Jean Dodds of Hemopet in the U.S. We ran the expanded thyroid panel with complete blood chemistry. His T3& T4 ratings were:

T4 0.50
Free T4 0.30
T3 <10
Free T3 0.45

And his cholesterol was high 414mg/dL

Dr. Jean Dodds wrote:

"there is a significant reduction in all thyroid analytes here, indicating an underlying systemic non-thyroid all problem, although primary hypothyroidism may be present."

She recommended treating with thyroxine 2X daily.

My vet also said that once the Cushing's is under control his thyroid may recover functionality.

As far as the excessive drinking post anti inflammatory shot goes, I agree, the anti inflammatory precipitated the polydipsea, but then he drinking never stopped drinking water and he became incontinant until he was diagnosed with Cushing's and treated with Vetoryl. He was also very restless at night, he could not get comfortable. As well as, he developed the pot bellied pig appearance.

On July 3, 2014
11:47AM CORT >276nmol/L baseline cortisol
3:04PM CORT 58nmol/L - 4 hour post low dose dex
7:30PM CORT 214nmol/L -8 hour post low dose dex

July 8, 2014
2:59PM CORT >828nmol/L ACTH stim (Cush selected)
1:39PM CORT 261nmol/L baseline cortisol

July 21, 2014
3:33PM CORT 83nmol/L baseline cortisol
3:42PM CORT 115nmol/L therapeutic monitoring

August 11, 2014
1:06PM 189nmol/L baseline cortisol
2:59 PM 193nmol/L therapeutic monitoring

What I do know is that Gabriel has received all the pertinent Cushing's tests outside of an ultrasound.

Doesn't Vetoryl cause loss of appetite & lethargy?

And isn't loss of muscle mass and hind end weakness characteristic of Cushing's?

Recently Gabriel's water intake has increased again, however not to the point of incontinance. This AM (August 16, 2014)he woke up and urinated.

Yesterday (August 15, 2014) I spoke with the vet and we compromised on splitting the dose of Vetoryl to 30mg 2x/day.

August 17, 2014- Gabriel did not respond well to this change in frequency of the Vetoryl, he is drinking uncontrollably and urinating whenever he stands up.

Over the last year I had noticed Gabriel's structure had changed, it was gradual, he started to look sway back, I attributed it to old age.

Also last fall he was shedding tons of fur, it came off in handfuls, and it was very coarse, this happened once before in 2011. He shed a lot though relatively speaking, but since being on the thyroid Meds the excessive shedding has stopped.

As this situation had been unfolding I have kept his breeder in Germany informed, and he agrees with the diagnosis and treatment.

I have also reached out to other Rottweiler people here in North America and they are shocked he lived this long, most North American bred Rottweilers are dead by 8 years old of cancer. That was one of the reasons I decided to go to Germany for a Rottweiler instead of getting one from North America.

Prior to the last 8 months Gabriel led a very active life, and he had had a few surgeries over the years, one for a cruciate and then 3 for porcupine quills. He definitely was not a lay around the house kind of dog, we hiked, swam, biked, his life was like an Iron Man for dogs. Even after his cruciate surgery when he was 7 he recovered completely and was able to resume our active lifestyle.

I worry about his quality of life now, but then I think, illness and injuries take time to heal, he has the mental attitude of an athlete still, he just doesn't have the strength right now. He is down to 88.8Lbs, in his prime he was 112lbs of lean muscle mass.

Thank you again for reviewing my notes, as the info rolls in, I'll post it.

Barbara & Gabriel

[BarbaraLloyd]

On Monday, August 25, 2014 we had Gabriel euthanized. He had dropped 9 more pounds and was declining rapidly, he was in an extremely emaciated state. In addition to the Cushing's there were other complications that we're causing his rapid decline.

On August 24th we had x-rays done and they showed enlarged lymph nodes around the prostate, in the chest and in the abdominal are. His symptoms were vomiting and diarre, he also had a UTI.

We have ordered an autopsy to get to the bottom of all that was going on in his system, the report will be available layer this week.

Barbara

[Squirt's Mom]

Dear Barbara,

I am so sorry to learn about the loss of precious Gabriel. It sounds as if there was a great deal more than Cushing's in play. :( Thanks to the gift you gave him, Gabriel is free of all his pain today, strong and whole once again, and I know he is grateful to you not only for this gift but for all the time you shared together, all the love you bestowed upon him.

Gabriel's name has been added to the In Loving Memory thread for 2014, where he will always be remembered as a cherished member of our family here.

Please feel free to start a memorial or tribute thread to Gabriel when and if you feel up to it. We would be honored to help celebrate his life through your memories.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox, and all our Angels

A Simple Message From Your Pet
by Ken D. Conover

To have loved and then said farewell is better than to have never loved at all.
For all of the times that you stooped and touched my head, fed me my favorite treat and
returned the love that I so unconditionally gave to you. For the care that you gave to me
so unselfishly. For all of these things I am grateful and thankful. I ask that you grieve
not for the loss but rejoice in the fact that we lived, loved and touched each other's lives.
My life was fuller because you were there, not as owner, but as my friend. Today, I am
as I was in my youth. The grass is always green, butterflies flit among the flowers and
the sun shines gently down upon all of God's creatures. I can run, jump and play
and do all of the things that I did in my youth. There is no sickness, no aching joints
and no regrets and no aging. We await the arrival of our lifelong companions and know
that togetherness is forever. You live in our hearts as we do in yours. Companions such
as you are very rare and unique. Don't hold the love that you have within yourself.
Give it to another like me and then I will live forever. For love never really dies,
and you are loved and missed as surely as we are.

Your pet in heaven.

[Harley PoMMom]

Dearest Barbara,

I am so sorry for the loss of your beloved Gabriel and my heart goes out to you at this difficult time. Please know we are here for you and always will be.

With Heartfelt Sympathy,
Lori

[Budsters Mom]

Fly free sweet Gabriel, fly free!

I'm so sorry for you loss Barbara.
Big hugs,
Kathy

[Dixie'sMom]

Gabriel sounds like an amazing dog. I have always thought the Rotties were so beautiful and majestic and your boy sure was a beauty. I am so sorry for your loss. I will keep you close to my heart and in my prayers in the coming days.

Hugs
Suzie

[Spencersmom]

What a beautiful life Gabriel shared with you! You are in my thoughts at this difficult time! I pray you find peace knowing you gave so much to not only to your furbaby but all those whos lives were touched during therapy!

Blessings at this time of loss and grief!

[molly muffin]

Barbara, I'm so sorry to hear that you have lost your beautiful Gabriel. I know it is heart breaking to have to make that final decision, even when it is the right one to make.

My sincerest condolences.
Sharlene and molly muffin

[Miae]

Dear Barbara...
I'm sorry about Gabriel. I don't know what to say. Stay strong.

[mytil]

I am so very sorry to read this! My deepest condolences!!!!

Always remembering your sweet Gabriel!
Terry

[Robert]

Prayers for you here and Gabriel on his new journey.

[pansywags]

Barbara, I am so sorry for your loss. I've known some amazing Rotties, they are fine dogs and I hope the memories of happier, healthier times will bring you some comfort.

Sweet dreams, Gabriel.

[Trish]

Sorry to read about Gabriel, RIP sweet boy, take care x

[celeste]

Dear Barbara
I was so sorry to read of the loss of your sweet Gabriel. He sounded like an amazing dog, and you sound like an amazing Mom as well. My beloved Frankie, my 11 year old Boxer passed 3 1/2 weeks ago. The grief is devastating. I still wander my house waiting to see him around the corner. I am lost without him. My heart goes out to you. I look forward to the time my grief turns to happy memories of my sweet boy, as I hope the same for you. It is so hard losing our beloved friends.
I wish you well.
Celeste