New member confused and worried (14 y/o Boston Terrier)

[tonysdad]

Hello to everyone in the group. This is my first post. I have a Boston terrier, Toby, who is almost 14. Toby has numerous health issues, and at this point has not had a diagnosis of Cushings. I am really starting to wonder if he does indeed have it though. Toby has been on hypothyroid meds for about 2 years, but at this point, he takes no medication for anything. Toby is losing the use of his hind legs, and general xrays show several places in his lower spine that have arthritis, and our vet says that he thinks this is where the leg issues are coming from. His back feet knuckle pretty badly, so there seems to be some neuro too, not just weakness. This has been progressively getting worse over the last year and a half. Toby is about 23 pounds, but ideally should be 18 or 19. He has trouble doing anything aside from basic walking, so exercise is out of the question. Toby loves food...and is never full. He also drinks a good bit and urination is more frequent, with accidents becoming more common, although not due to incontinence...he knows he's going. Over the last month, he has really started panting a lot more, he pants if he is walking or sitting. Once he lies down, the panting almost always stops. His heart is a 'little large', and his liver is a little large as well. I am unsure what 'a little large' really means at this point. His blood work looks very, very good except for his alkp levels. His last 3 alkp levels over the last 2 years were as follows... 1500, 700, and back to 1500. He is shedding like crazy, but has no noticeable hair loss areas. He follows me everywhere through the house when I am home, but otherwise does very little...no playing anymore, as his back legs can't keep up. Our vet is very 'up to date', and there was even a very brief discussion of Cushing type symptoms a while back, but it doesn't seem to be concerning to him at this time. So I don't know what to do exactly. I know that because of Toby's age and his supposed spinal arthritis, even if he has Cushing's, it might be best not to treat it because the extra cortisol may be masking a lot of pain in his back. Do any of you have any suggestions? He's an old boy, and I don't want to put him through anything that will be even harder on him. What would you guys/ladies do at this point? The excess panting could be from weight, enlarged heart, arthritis discomfort, or Cushing's....I just don't know. I thank you all in advance for any input. I love this little boy more than I could ever begin to express, and it is so hard to see him getting old.

[mytil]

Hi and welcome to our site - I am sorry your boy is having these problems. It is so very hard when they just seem to feel rotten and trying to find out what is the best for them, especially anything neurological and arthritic related.

Have you and your vet discussed the possibility of having to make any adjustments in his thyroid medication?

I know Bostons are food hounds but is he completely obsessed about it? Meaning knocking over trash cans to find food, food guarding etc. Does he have a pot belly appearance?

This heavy panting is a pretty recent symptom and is pretty consistent whether standing, walking or laying down, right? It could very well be connected with any heart troubles or being slightly overweight but it also could be pain related. I know you mentioned he is not on any medication other than thyroid right now, but has he been on any in the past?

I would consider doing testing for Cushing's just to "cross it off the list" if you will, and the least invasive is the UC:CR test.


Urine Cortisol/Creatinine Ratio Test: Considered a screening test, this cannot diagnose Cushing's, but it can rule it out. A urine sample is examined for the relative amounts of cortisol versus a normally excreted protein metabolite, creatinine (the latter is used to control for the degree of dilution of the urine). The greater the ratio, the higher the cortisol level. High cortisol in urine is suggestive of high cortisol in the bloodstream. Many conditions other than Cushing's disease can cause false positives, so this test is not considered diagnostic. Nonetheless, if the cortisol/creatinine ratio is okay, the dog is not likely to be Cushingoid, so this is a good screening test.

Keep us posted
Terry

PS - sorry for all the questions, but the more we know the better we can all help.

[labblab]

Given Toby's symptoms, I agree with Terry and I believe I would test him for Cushing's. Normally, with senior dogs I do urge parents to weigh the risks and benefits of treatment in the event that Cushing's is diagnosed. If the symptoms are not causing the dog much discomfort, then it may indeed be best to just forego treatment. But in Toby's case, it sounds as though his quality of life is highly compromised. Even though you are exactly right that there are trade-offs in terms of arthritic pain, etc., you may be able to find a happy "compromise" with treatment whereby cortisol levels are only moderately lowered.

If Toby were my dog, I do think I would proceed with some diagnostic testing so that I would know my options. Also, has Toby's thyroid function normalized so that you are no longing treating it? Low thyroid readings can be secondary to Cushing's or they can result from primary thyroid issues. If it is the latter, the need for supplementation is ongoing and the absence of treatment could account for at least a few of Toby's problems.

Marianne

[Squirt's Mom]

Welcome to you and Toby! :)

I need clarification on something -


Toby has been on hypothyroid meds for about 2 years, but at this point, he takes no medication for anything.

Does this mean Toby is no longer taking his thyroid med? If so, that could be the problem instead of Cushing's. Hypothyroidism and Cushing's share all those signs you listed. ;)

[tonysdad]

Hello again, and thank you for the responses. Upon rereading my first post, I realized that some of my wording was clear only to me...haha...sorry. Let me correct myself. Toby has been on Soloxine for close to two years for his hypothyroid. After making adjustments to dosages in the beginning, Toby has been and is still taking the Soloxine, and is rechecked at least every 6 months. His thyroid levels have been around 1.7 since on the meds, and I believe that this is not bad. I'm sorry for the mix up. He was only diagnosed hypothyroid after having repeat skin issues that would go away for a few weeks if given a steroid injection, but would come back each time. At that point, he was not panting, that has become a gradual issue over the last year. We have only been with this vet for 2.5 years. On our first visit, Toby was xrayed, and the vet pointed out that he had arthritis in his spine(no outward symptoms at that point, so I was shocked), and that his heart was maybe a little large, but not a concern then. He has had two or three xrays since then, and the vet told me last time that his heart has grown a little each time. He has no murmurs, and the vet has never gone so far as to say "We have a real problem here with his heart", although I know that a slightly enlarged heart is not ideal by any means. Oh, also last year he was diagnosed with mega-esophagus. He has been a life long regurgitator, so maybe this explains why. Over the last 8 or 10 months he has had several bouts where he will regurgitate after getting up in the middle of the night to go out to potty. He does regurgitate other times too, but what makes these specific times unique is that he will get it in his airway, and stop breathing for at least 30 seconds. He will fall over if I am not there to hold him up. This gave me concern that the recent panting increase could be from aspiration pneumonia...along with the coughing, but the vet said his lungs sound good, and look good on the xrays with only minor irritation. There was some test given for his oxidation rate or something, and it was nearly 100%, which is great according to the vet. Sorry I can't remember what it is called. I'm pretty sure that Toby has not had a Cushing's test...at least not the lengthy test because I've never had to leave him there for any length of time. I don't know if they performed the urine check on him or not...I'll call and ask.

Toby sleeps silently, with no noises at all. He is restless at night in the beginning, but since he has not done anything all day, maybe he is just not ready to sleep...I'm not sure. If he is lying down, either on his side, or on his stomach, there is no panting. If he gets up from either position and walks 6 feet, he starts to pant. He never acts like he's in distress, and is actually quite alert. Even though he only has one good eye, he sees everything that's going on, and often spies things out the front door over 75 yards away. He does whine sometimes, but it reminds me of his 'anxious' whine...it usually seems like he thinks there is something going on that he is missing out on somewhere.

He does love food, but does not make any attempt to get it on his own. He often checks his bowl...just to see if there's something new there, and never leaves any of his food. He will often try to lead me to the kitchen and he will look up at the counter... as if saying he wants food, and if I open the refrigerator, he comes and sticks his head in there to see what's available. We don't have any trash can that he could get into, but he ignores them all anyway. He does make a b-line for the cherry tomato plants when I take him to potty...he loves tomatoes. He doesn't food guard, or growl or snap, but then again, no one bothers him when he eats, and he is our only dog. I don't know how he would react otherwise. He really only likes me, and somewhat tolerates other people. He lets me near his food, but I don't know if that would hold true for anyone else. I don't think he's food obsessed to the extent that I hear some Cush dogs can be, but he certainly does want to eat. He also gets mainly home cooked now, and I'm sure he has really learned to like it more than dry kibble, so he looks forward to it. He is a few pounds overweight, and considering his small stature, his tummy is pretty solid. I think this is part of the problem, but getting the weight off of him has been so hard. He can't get around good to burn any of it off, but he still wants to eat. I have substituted green beans for some of his food, and we snack on carrots and broccoli and celery, but he's not losing. It's probably harder for me because I feel so sorry for him since he can't play anymore...food is his love now. I'm struggling with that.

I hope this clarifies some of my previous post. Thank you so much for your replies. I hope to hear from you all again soon.