6 Year old Boston diagnosed in June 14' - Wylin has passed

[wylin]

hello,
our Boston was diagnosed with Cushings in June. We suspected it with some frequent urination/excessive drinking/panting. We thought we were ahead of the diagnoses and we started Veteroyl 10mg for 30 days July 1, up to 20mg August 10, and two weeks ago 9/15/14 up to 30mg.
Her last ACH level was 14.6.
she was 20 pounds back in June and is appearing to be losing weight.
the last few weeks she still continues to drink water, urinate frequently, shows hair loss, calcium under her elbows, and now shakes while laying on her side.

Our vet is recommending we see a specialist at this point. Does anyone have any advice on our next course of action? would going higher in dosage be possible? What would a 20lb Boston top out w/ regards to Veteryol MGs? If Veteryol isnt the answer, what would be the next drug? Do we want Addisons? Any thoughts would be greatly appreciated as we are at a loss.

Thanks in advance

[Spencersmom]

Hi and welcom to the forum! More experienced members will be jumping in with lots of questions, links for info and very good advice!

I'm still learning, but will say that you definitly don't want addison's!! The dose your pup is up to seems a little high for the weight, but you will need additional tests to determine if you are getting control.

With the vet suggesting a specialist, it seems they may not be as experienced with this disease as you may need! Definitely find one that knows what to do!

You've come to the right place! Everyone here is like family!

[labblab]

Welcome from me, too! Can you tell us when the ACTH was performed that showed the level of 14.6? If that measurement is in units of ug/dl, it indicates that the cortisol level was not being sufficiently controlled at that time. Desired therapeutic range for a dog being treated with trilostane tops out no higher than around 9, and that is only if all symptoms are being adequately controlled.

If your dog weighs 20 pounds, a daily dose of 30 mg. represents a ratio of 1.5 mg. per pound, which is not excessively high in light of an ACTH no lower than 14.6. In that situation, a further dosage increase may indeed be warranted. Individual dogs can metabolize the drug quite differently, resulting in a wide range of doses for dogs of the same weight. But I will never argue with the recommendation to consult with a specialist, especially if you are not seeing any symptom resolution whatsoever and your regular vet is wanting another opinion. In the long run, consulting with a specialist can bring you peace of mind and also save you money since it can facilitate appropriate diagnotics in the event that something else is also at play here.

Marianne

[wylin]

thanks for the responses. i will get the full details of the results from the vet tomorrow and post them on Monday. actually the last ACTH test was a 12.6 . is there anything we should be doing to help her absorb the drug better? we are switching to a wetfood / dry foo d blend as we have heard it will reduce her need for water a little bit if she has dry food.

[labblab]

You will want to make sure the Vetoryl is given along with breakfast. It is not metabolized efficiently on an empty stomach.

How long ago was the last ACTH performed?

Marianne

[molly muffin]

I too would agree with seeing a specialist. They will probably want to do an adominal ultrasound if one hasn't been done.

Are you giving once a day or twice a day? Sometimes it helps to do 10mg am and 10mg pm, rather than 20mg in the morning.

Sharlene and molly muffin

[wylin]

sorry i have not updated. we increased veteryol to 30 mg 6 weeks ago. she was tested two weeks ago and her levels went into all of the good ranges per our vet on her last test 2 weeks ago. we now have some new problems. her skin is falling off in patches from her rubbing against it. she has had a history of allergies and was on Atopica, but stopped taking back in July. He skin is raw and she wants to rip it off. we have been using betadine and a white powder to clean the wounds but it is getting worse with her trying to scratch and is starting to smell. she also is very lethargic clearly not herself. she shakes while she lays down and is only getting worse. in addition she is having trouble standing on her hindlegs and fell back this morning. is there a point that you have to consider putting her down or do you keep fighting? i am afraid to see what is next if means she will be in pain. any suggestions? she is only 6 and half years old.

[labblab]

Can you please find out the exact numbers for the ACTH test two weeks ago? Sometimes when vets say that the test results are "good," we find out that they fall in a range that would be normal for a dog without Cushing's but they are not low enough to be therapeutic for a dog being treated with Vetoryl. Since you gave us the numbers for the earlier ACTH tests, it will be a huge help if we have these new ones to compare.

There are certain skin disorders that can flare when cortisol levels are not being controlled at a low enough level. But on the other hand, I am worried to hear your description of her lethargy and difficulty standing because that could be caused by a cortisol level that has dropped too low. So actual numbers for that ACTH test and any abnormal results on other recent blood/urine panels will be super helpful.

Marianne

[wylin]

4.5 pre and 6.4 post

[wylin]

i will get the full lab results tonight when she goes to the vet to discuss further. thanks for your input

[molly muffin]

She shouldn't be too low on cortisol with those numbers from two weeks ago.

The smell indicates a yeast infection likely on her skin. As the vet to do a skin scraping. But guessing she'll need antibiotics.

Sometimes with severe allergies or arthristis, you actually want the cortisol levels to be a tad bit higher. You are looking at doing a delicate balancing act, of enough to help with the allergies or arthristis, but not high enough to cause bad cushing symptoms. You can be up to say 9.0ug post with symptoms control, but in all honesty, it depends on the dog and what they are comfortable at. What post was her skin better at and her cushing symptoms better at?
That is the key, her comfort and quality of life.

[labblab]

I agree with Sharlene that the ACTH is not too low and that it is within the broad therapeutic range. So given that info, I remain quite worried about the lethargy, trembling, and difficulty walking. You had spoken earlier about the possibility of seeing a specialist. I strongly encourage you to move forward with a consultation at this point. There are enough "conflicting" symptoms to really be a puzzle. And if your girl is doing poorly enough that you are seriously considering her quality of life, I would really want to get some feedback from a specialist with additional expertise in complicated disease situations like this.

Please keep us updated, OK?
Marianne

[wylin]

with sorrow, our trip to the vet last night was our last.
her skin lesions were rapidly expanding and new ones were forming. 3 in total with each reaching the size of your hand and another one begining to bleed on her neck. she had lost another 2 pounds in 14 days and was visibly wasting away and was having trouble standing w/ the shaking.

with regards to the skin, the doctor was concerned that all of the exposed skin and remaining skin with hair was in fact already dead and wanted to do blood testing to rule out cancer. she was also concerned that any new aggressive treatment to battle the skin problem and the cushings might not even work and if it did, she would need further dermatology surgurys to repair the dead skin. we painfully decided it was in her best interest to be let go and be at peace. i am not sure what else we could have done differently, we did see another vet back in September that further indicated to increase the veteryol and not use lysodren. we're at a loss. is it possible the cushings was just too much on her little body, even at a young age?

[labblab]

Oh, I am so very sorry to hear this news, but thank you so much for returning to tell us. Whether it was the Cushing's itself or instead some additional complications, your baby was suffering and I do understand why you made this decision. There is a specific skin condition called calcinosis cutis that can be associated with Cushing's, and sadly we have seen a few other cases so severe that the symptoms and outcome were the same as for your girl. And with the additional problems, as well, it was not only a question of treatment for you but also the question of time. How long would she be suffering in the hope of finding an answer?

So I do understand your decision and my heart goes out to you and your family. Your little girl will always remain an honored member of our family, as will you.

With my deepest sympathy,
Marianne

[Squirt's Mom]

I am so sorry to hear about your sweet girl. :( We have to put ourselves and our wants last, especially when our babies are suffering so. I know she is grateful to you for all you did on her behalf.

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

[spdd]

I am so very sorry to read this update. You are on my heart and mind right now. It's not easy and I'll be thinking of you.

[wylin]

here is a picture of her in her prime a few years ago. thank you all for your help and sympathies.

http://wylinterrier.files.wordpress.com/2008/10/8.jpg?w=1000&h=

[molly muffin]

oh no, I am so sorry. I don't know what the answer was, if it was cushings or if it was another problem but whatever it was, her little body was tired and she was weak. There are no easy ways to make these decisions, other than to do the best you can for your little girl and that is what you did. Now she doesn't hurt and isn't weak, and in your heart she will always be the sweet baby, playing gleefully with you.

My sincerest condolences
hugs

[Budsters Mom]

I am so sorry to read of you sweet girl's passing. What a beautiful little one. Thank you so much for sharing her adorable photo.

Fly free little one, fly free!

[Jenny & Judi in MN]

she was a doll. I am so sorry

[doxiesrock912]

I am so sorry that your furbaby has passed.
CC (the skin lesions) is very difficult to get ahead of and with the affect of Cushings on their immune systems, many dogs can't overcome it and those lesions are painful.

It sounds like it was too much for your sweetie and there is no doubt that you made the best choice for her.

She's pain free and running with many others.
Hugs

[mcdavis]

I'm very sorry to hear of the loss of the beautiful girl. It takes great courage to take the decision to say goodbye to someone who means so much.

[Dixie'sMom]

I'm so terribly to sorry to hear about your little girl. She is so beautiful in this picture and now she is beautiful and healthy again. When we accept responsibility for these little spirits, it's also up to us to use good judgement in freeing them from suffering and pain when there is no convincing evidence that they can get well. And you did that despite your own pain at losing her. I think you made the right choice at the right time and I know your sweet Wylin thanks you for releasing her. You are a great Mom and you will be together again one day. She will be waiting just over the bridge for you. I'll be keeping you in my prayers in the coming days.

[judymaggie]

My thoughts and prayers are with during this difficult time. Hopefully, you can find some comfort in knowing that Wylin is pain free and meeting lots of new friends over the rainbow bridge

[jas77450]

I am so sorry for your loss. You did all you could do, now she is free from her pain, but that doesn't take away yours, sending prayers and hugs for you. She is such a cutie.

[apollo6]

I am so sorry for your lose. No words can comfort you at this time. With sincere sympathy.
Sonja and Angel Apollo