Diagnosed with Cushings yesterday - Beautiful Bella has crossed

[Bellabeauty]

Hi everyone! My 11 yo collie mix was diagnosed yesterday with pituitary dependent cushings.. Her symptoms started only excessive drinking and urinating about 4 weeks ago.. But as looking back other symptoms were there but chalked it up to her age. Such as occasional shaky back legs when she stood or when she urinated. Or panting which I atributed to her being a fur bomb!!
What is worrisome to me is that in a matter of a day she went from walking around and getting up when called to not wanting to move and an awful time walking and standing. She wobbles really bad and has taken some spills. She's very unsteady. During the time when we were trying to figure out a diagnosis; the vet discovered she has spinal arthritis and RT hip osteoarthritis (basically bone on bone).. Would the cushings symptom of muscle weakness added to the arthritis cause this drastic change in her mobility? I'm so scared that she will always be this way... We have to carry her down the stairs and assist her when she uses the potty otherwise she may topple over! Anyone else have or had this problem?
The vet has prescribed her Vetoryl which we are waiting for it to arrive Tuesday.. Pins and needles over here! How long was it when you started to see some minor improvements in the musculature?
So scared... Not sure how long she can stay positive since she can no longer go on those long walks she loves so much!
Thanks for any info!

[addy]

Hi and Welcome,

We all know the worry and fear of the unknown as we see our beloved dogs have symptoms that are new and worrisome. We have quite a few questions for our new members; we only ask them so we can provide meaningful feedback. Don't be worried at my list;)

Since the drinking and urinating seem to have just started 4 weeks ago, we would want to make sure that other diseases or problems have been ruled out.

Could you please let us know what tests were done to diagnose Cushings? Could you post the results? Was a urinary tract infection ruled out? Diabetes ruled out?

Have you had any blood panels done? If so could you post the abnormal results with the normal reference range?

How is the vet addressing the issues below?


During the time when we were trying to figure out a diagnosis; the vet discovered she has spinal arthritis and RT hip osteoarthritis (basically bone on bone)

What dose of Vetoryl has been prescribed? What does your dog weigh?

I am glad you found us!!!

[Bellabeauty]

Sooo glad I found you too!!! Felt alone in this and have shed so many tears!!

Urinalysis was dilute.. Gravity was 1.007 (1.015-1.050).. Diabetes, thyroid, UTI and kidney infection were all ruled out from testing. CBC #1 showed high Alk phosphate 643 (5-131) GGT 25 (1-12) cholesterol 737 (92-324) Tryglyceride 1060 (29-291) Since these results the vet did another CBC on 11/20 her numbers have improved quite a bit, but I don't have the current levels yet.
The Cushings test was a Low-dose Dexamethazone
She had an abdominal ultrasound from a specialist and all her organs looked beautiful.. No enlarged adrenals. All was perfect on that end.
The vet has prescribed Carprofen 75mg for the arthritis.. She has been on that for 3 days so far with no changes.
Miss Bella weighs 46 lbs. He prescribed the Vetoryl once a day at
60 mg.
what do you make of this? Sound right?

[addy]

I'l bump this up this am- I am off to work so hoping others will chime in as I only have a few minutes right now.

We usually suggest per Dechra to start at 1mg per pound so you are a bit over the starting dose but it should be ok. Did the vet tell you that with high cortisol your pup is self medicating the arthritis and as we drop the cortisol, the pain may worsen?

Do you have the results of the LDDS test? Could you post them?

I understand the tears and feeling of being all alone. Just know you don't have to feel that way anymore, ok?

[Squirt's Mom]

Sweetheart, you are no longer alone. We may not post every time but you can believe we are keeping up and watching carefully. Anytime you need to talk, you just holler and someone will be along to listen.

Welcome to k9c!
Hugs,
Leslie and the gang

[lulusmom]

Hi and welcome to the forum.

I am a bit concerned with the diagnosis and have a number of questions that might help alleviate some of that concern so here they are in no particular order:

1. Was your dog fasted for the blood chemistry.
2. Was a complete blood count done (CBC) and if so, were there any abnormalities?
3. Was a urine culture done?
4. Collies are a breed that are predisposed to primary hypertriglyceridemia. Did your vet diagnose your dog with this condition and has he instructed you to put the dog on a low fat diet? Your dog's triglyerides are severely elevated and you need to get those down to no higher than 500. Hypertriglyceridemia can cause mild to moderate elevations in ALKP.
6. Was there any mention on the labs of hemolysis or lipemic sample? When fat lipids are very, and I believe your dog has high lipids, it can affect the results.
5. Has your dog had an increase in appetite?
6. Any loss of coat or skin issues?
7. The sudden and profound weakness your dog has experienced is not typical of cushing's but it is with degenerative joint disease, especially if it the joints are bone on bone. That certainly would explain the dog's inability to ambulate as well as the panting.
8. Was your dog on any medication before the diagnosis and if so, please name them.
9. Was your dog housebroken and is she now unable to hold her bladder and having accidents in the house?
10. If your vet has not prescribed Tramadol for pain, I would recommend that you ask him to do so asap.

I am a senior and special needs rescuer and have had two cushingoid dogs of my own and one foster cushdog. I have also had lots of rescues with advanced arthritis so yes, I have experienced what you are going through. I currently have a very senior girl with degenerative disc disease (spinal stenosis). NSAIDS like carprofen are often not enough to alleviate the pain so that may be why you haven't seen much improvement in your girl. My old gal has been in hospice care with me for over a year and I never expected her to be with me this long. Evaluating her quality of life and making the right decision to let her go is paramount and not an easy thing for me, no matter how many times I've had to make the decision. She lives in diapers and I have to carry her up and down stairs but as long as she can still get up on her own, continues to have a good appetite, responds to my love and scritches with excitement, she'll continue to be with me. I'm not suggesting that you are in the same position but just wanted you to know how much experience I do have with both conditions that your vet has diagnosed.

I apologize for grilling you but your answers will help me and others follow your vet's rationale and ask the questions that you may not know to ask. I feel for you because I believe you are dealing with a quality of life issue and I'm not convinced that cushing's is the reason for her discomfort.

I'm so very sorry for the reasons that brought you here but I'm very glad you found us. We're here to help you and your baby any way we can and the more information you can give us, the better we can provide meaningful feedback.

Glynda

[judymaggie]

Kelly -- I wanted to welcome you also. Glynda is much, much more of an expert in Cushing's than I am but I wanted to add one more thing -- would it be possible for you to post exactly what the ultrasound says? I noted that you said that there were no enlarged adrenals which is good but seems an odd finding with a Cushing's diagnosis.

Hugs to Miss Bella!

[doxiesrock912]

Hi Kelly, I have a Bella too :)

I agree that is it odd that the adrenals or at least one of them is not enlarged. Have they ruled out other causes?

High cortisol masks pain as well as causing weakness as Cushings is treated and progresses. It's a catch 22, the vet must treat the cushings and at the same time do something for the pain of arthritis that is now becoming apparent. In my mind, this shouldn't be happening at this stage though.


Something about the quickness of Bella's decline is bothering me.

I am concerned that the weakness might be due to the dosage being too high. Seriously concerned.

Is Bella eating normally? Lethargic? Vomiting? If any of these things occur, get her to an ER vet immediately.

Important to note that Dechra's insert for the drug is outdated and as far as I know, they have not updated it (we are NOT happy about this, but they say it's not cost effective to redo it all).

Dechra (the manufacturer of Vetoryl) advises to start very low with the medication and work your way up. There is no rush to get the right dose and it is best to take it SLOW. Every dog responds differently and it does sound like Bella is at the beginning stages being that her organs are healthy. You can't go by the test numbers alone. Treatment is truly on an individual basis. 60mg for a 46lb dog might just be too high for her.

I would ask the vet to do an ACTH test right away and suggest lowering the Vetoryl to 1mg per 1lb, especially since her organs all look healthy. Many dogs also do better when the dosage is split in half with one dose given with breakfast and the remainder 12 hours later with a meal.

ACTH test are done between 4 - 6 hours after the dog has their medication with breakfast. Each time the test is performed, it has to be done exactly at the same timeframe. So if Bella ate with meds 5 hours before the ACTH was first done, then every ACTH test must be done 5 hours after she has breakfast and morning meds.

If your vet resists, please have them call Dechra right away to discuss Bella's case.

Over time, Cushings will affect the organs and as Glynda said, I would change to Tramadol now and forgo any NSAIDS.

The most important thing that you can do it to educate yourself. Many of us have learned that too many vets don't know enough about Cushings. If you have any doubt, please find an IMS specialist in your area. Do NOT worry about making your vet feel bad etc. Cushings is definitely treatable and many dogs live out their full life expectancy when treatment is done correctly.

[molly muffin]

I want to welcome you to the forum.
Glynda knows the most of any of us when it comes to the senior issues that you are dealing with.
I wouldn't actually start the vetroyl until some of the questions that Glynda through out can be answered.

The other thing is that I wouldn't start at 60mg. The reason why and this is saying that this Is cushings, which I don't think we are really all that sure of yet, is your baby is already experiencing pain from the degenerative disease, and bone on bone is very painful, higher cortisol would probably cover and help with some of that pain. Lower that cortisol too much and you'll have more pain.

I agree that it is important to get those trig levels down and the very things that you mentioned in your original post, could cause the cortisol to be higher in response.

So, lets think and evaluate what we have going on here and best course of action long term. You have no one better to pick the brains of than Glynda. :)

Welcome to the forum!

[Bellabeauty]

Hey everyone.. Thank you so much for your kind words and wisdom! Unfortunately Bella took a terrible turn today and stopped eating and drinking.. She also was not getting up or standing her up without falling down :(
Her spinal arthritis/pituitary tumor (could be either) is now causing involuntary tremors in her head and legs/paws.. She is not well at all.. This came on so damn quickly that it's shocking and heartbreaking :(((. There is definitely more than just the Cushings going on with my girl.. Her arthritis is very advanced now that cushings started weakening her muscles and ligaments This is a twisted difficult disease :(
She is staying the evening at the vet tonight for observation and a few tests. We will have to make some difficult decisions tomorrow morning.
She is a shell of what she used to be just a few weeks ago... I hate seeing her like this and I know my baby is unhappy and depressed with how this has all come on and taken her down. Her quality of life has deminished to basically "bed ridden"
I wish I would have found this group weeks ago... In the ONE day I've been on has been such a breath of fresh air to know you have a team that knows what you're feeling and going through!! Everyone who is on this Cushings warrior site is lucky lucky to have all of you amazing people!!!
I'll let you know how it goes tomorrow morning!!! Thanks again for all the care and comfort!!!
Kelly & Bella

[molly muffin]

Oh No! I'm so sorry to hear this. :( I do hope she'll be better in the morning.

Big hugs, Kelly and Bella too.

[doxiesrock912]

Kelly,
Whenever a dog stops eating it is important to stop the Vetoryl.
Please keep us posted.

We'll be praying. Hugs.

[Squirt's Mom]

Hey Kelly,

Please let us know how Bella is when you can. We are right by your side, sweetie, holding your hand. Prayers and healing white light flying your way,

Hugs,
Leslie and the gang

[Dixie'sMom]

Hey Kelly. I'm waiting here with the others to see how Miss Bella is doing. I'm praying she is better today. Sending prayers and big hugs to you both. We're here for you.

[Bellabeauty]

Hello everyone... My beautiful Bella crossed the rainbow bridge this morning at 1025. We had not started the Vetoryl.. It was delivered after her passing today
Bella stayed overnight at the er to receive some fluids/electrolytes to hopefully perk her up since she stopped eating, drinking, standing and her stumbling and falling worsened.. :(
Either her spinal arthritis or the location of the pituitary tumor was causing neurological mayhem. Bella definitely had more than just the Cushings taking ahold of her... She developed tremors/twitches in her legs/paws and also her poor head. When we arrive back to her this morning her eyes were open, but zero response to us being there.. No trying to lift her hear or a tail wag. It was like she was paralyzed.. It was awful. We stayed with her and gave her love and kisses for about an hour, then it was time to let her be happy again.
It was the hardest thing to do since one month ago she was good. I'm so happy I layed next to her and snuggled her while she took her final breath... I miss my baby so much already and it feels like I'll never stop crying.

I want to thank each one of you for your kind words, information and concern!! What a wonder support group this is! I hope to never need you all again.. But glad to know you're out there!!! <3
Kelly & Bella~RIP

[lulusmom]

I am so terribly sorry for your loss. My thoughts and prayers are with you.

Godspeed, sweet Bella.

Glynda

[My sweet Ginger]

I'm so very sorry sweet Bella crossed the rainbow bridge today.
I'm sending you my very sincere condolences.
I'm glad she took her last breath in your loving arms.
I'm so sorry. Hugs.

[addy]

Oh dear, I am so very sorry to read this about Bella. My heart goes out to you. Please know you can stay here and talk to us whenever you want. We understand the heartache.

I am so sorry Kelly.

[labblab]

Dear Kelly,

I am so sorry that this is my first opportunity to post to you, on such a sad day. Even though I so wish that the outcome of your membership here had been different, we are grateful to have the opportunity to honor Bella amongst our family of Cushpups who await us at Rainbow Bridge. Bella has now been entered on our special memorial thread:

http://www.k9cushings.com/forum/showthread.php?t=5973

And just as Addy has said, we will welcome you back at any time. It would be our privilege to hear more about Bella's better days and your loving life together.

Sending you many hugs in loving memory of your beautiful girl,
Marianne

[judymaggie]

Kelly -- I am so sorry to learn of Bella's passing. It was very obvious to all of us here that you loved her dearly. Please take care of yourself during this difficult time.

[Bellabeauty]

Thank you all so much!!! I'll definitely take you up on that.. My husband and I know THE day would come for Bella. It came so sudden and unexpected; we really thought we would have another few years before she would start heading to the end. And we knew it would be so difficult, but this is gutwrenching.

She's been with us for 10 1/2 of her 11 1/2 years... Every one amazing. She was perfect from day one... Never chewed or destroyed anything. Never got on the couch. She trained so easily.. She was such a smart smart girl. She was with us everywhere we could take her.. She was our child. Although we live in Chicago and have to leash her.. Anytime we didn't have to; she stayed right with us... She was always by our side.. We were so lucky to have found her at the Anti Cruelty Society! I wish I could personally thank whomever decided to surrender her because we had the privilege to be her mommy and daddy!
I know it gets better... But not having her with us tonight is terrible. UGH!!
Sorry for the sob sob! ;)
You guys are amazing.. Thank you <3

[spdd]

I had to sign in here to tell you how sorry I am to read about your experience with your beloved pet. I too just lost my best friend Keesh and know exactly how you are feeling right now. 24 hours after he was gone I actually thought I was going to have to take myself to hospital I was so grief stricken. It's only been 11 days for me and I think about him everyday as he too was with me almost 24-7. Please take care of yourself, and if you want to private message me with any of your thoughts or feelings, by all means please do so. There are a few of us on here that just recently are in the same position as you and will be willing to help you if need be, through this.

[Dixie'sMom]

Oh honey, I am so sorry. I was so hoping that things would turn out differently. I can tell that Bella meant the world to you and your husband and that loss is devastating. Please know that I'm keeping you in my thoughts and prayers and close to my heart in the coming days. And don't EVER be sorry for sharing your grief with us. We understand and you can sob sob all you want to. We are sob sobbing with you.

[scoora]

Kelly, I'm so sorry to hear of the loss of your sweet girl Bella.
My thoughts and prayers are with you.
Hugs

[molly muffin]

Oh Kelly :( I am so very sorry. I hoped I would log in tonight and find that Bella had made a turn around over night.
I know your heart is just broken and you miss her something awful. :(

My sincerest condolences. Together you made many wonderful memories.

HUGS

[Robert]

Prayers for you and Bella. So so sorry.

[doxiesrock912]

Awww Kelly :(
I'm so very sorry! It does sound like much more than Cushings was going on.
Bella clearly had an amazing life with you and thank you for rescuing her!

All of our babies are rescues and Bella sounds so much like out Daisy Mae who passed in June.

I am glad that this wasn't a long, drawn out thing for her though. I imagine that losing control of your body for any reason would be scary.

Hugs to you and hubby!!! Bella has many others to meet over the Rainbow Bridge. All of them are healthy again and we will see them when our time comes.

[mytil]

I am so incredibly sorry for your sweet girl's passing. My heart is with you and your husband.

We will always remember Bella and please do stay with us.
((((hugs))))
Terry

[Squirt's Mom]

Oh Kelley, I am just so sorry to hear this. :( And I know just how you are feeling right now - many of us do so we understand and are here anytime you wish to talk. We would be honored to get to know your sweet girl thru your memories.

Please know you are not alone.
Our deepest condolences,
Leslie, Trinket, Brick, Sophie, Fox and all our Angels


FRIEND
I lost a treasured friend today
The little dog who used to lay
Her gentle head upon my knee
And shared her silent thoughts with me.

She’ll come no longer to my call
Retrieve no more her favourite ball
A voice far greater than my own
Has called her to his golden throne.

Although my eyes are filled with tears
I am thankful for the happy years
She spent down here with me
And for her love and loyalty.

When it is time for me to go
And join her there, this much I know
I shall not fear the transient dark
For she will greet me with a bark.

~Author Unknown

[Bellabeauty]

You guys are AMAZING!! You have no idea how comforting you all are to me during this time! I will definitely stay in contact..
Big love and hugs to you all <3 :)

[My sweet Ginger]

What a beautiful girl Bella is! Thank you so much for the pictures.
You can tell that she was a good girl just by looking at her eyes.
Hugs, Song.

[molly muffin]

What wonderful pictures. She really is something. Beautiful and wise eyes.

Hugs

[doxiesrock912]

We're not amazing. We've come together out of a mutual need to help our furbabies and make sure that we all have the right information since so many vets don't. We have and do feel your pain that you feel now and along with all of this comes a special bond borne out of love. Hugs.

[Bellabeauty]

Oh my Bella.. I miss her worse than the day we knew we had to let her go. It's been a week and a day now and the grief gets worse every day. We know she told us it was time with her halting all eating and drinking.. The toughest part is the time lapse of her illness!! One week... Seriously?!?! It's not fair and I want my baby back with us. To go from walking and standing like normal; to falling down and not being able to stand or walk without being held up in a weeks time is unreal!! What the hell happened that quick? We didn't even have enough time for the meds to arrive!
My husband and I are just a mess wondering what was wrong.. Did she have a stroke that we didn't witness? What did we miss..what else should we have done?
It went too fast.. We're in complete utter shoke still and to be honest pissed off! She should still be here...
Ugh... Needed to vent and cry :((

[Robert]

Vent and vent some more. Sometimes life just sucks. I lost my little man tommy last year and he went from healthy and beaming after his walk on Sunday to me holding his little head as he left on the next friday. I have many good thoughts about him now so it does get easier but still miss him a lot.

[doxiesrock912]

It's best to let it all out. Part of the healing process. Eventually, the good memories will surpass the bad. I promise <3

[Dixie'sMom]

She's beautiful and such a sweet face. Yes, it rips your guts out. You will get thru it, but it takes time, so vent all you need to vent. Scream, stomp your feet,throw rocks at something, vomit... whatever it takes. It hurts and it sux and its not fair. And most of us have been there and understand exactly what you are going thru. And it will get easier but probably not any time soon. So vent away. We are here to prop you up if you need propping or just let you cry if you need to cry.

Bella was lucky to have someone who loved her so dearly. And I know you can count a million reasons why you were lucky to have her. You've shared a very special bond with a very special little spirit and one day you will be able to think of her without so much pain and the memories will make you smile and thank the creator that you had this experience.
Gentle hugs for you today and days to come.

[jas77450]

I am sooo sorry for your loss. I too have recently lost my little boy and know what you are going thru, many others here too...Bella is with good company, free from suffering and pain...prayers for you during this most difficult time.

[pansywags]

I'm so sorry to hear about the loss of your Bella. So many of us here know your pain. I hope that in time, memories of your happy healthy times together will make you smile again.

[Trish]

Still so new, no wonder you still feel like this, I too hope the nice memories start to outweigh the bad, unfortunately with grief no telling how long that will take but I hope some of the happy things can bring a fleeting smile to your face... so sorry for your loss xx

[Bellabeauty]

Thank you all so much for the support and hugs! We now have Bella home with us as of Thursday. Lots and lots of tears have streamed down her urn.. I think I held it for 45 minutes hugging her and apoligizing to her when she came home! I do feel better now that we have her and her precious paw print.. My husband thought I was a kook because I was smelling the paw print hoping I would smell that good ol frito feet!! ;)
Just waiting for her memory box to arrive so I can put her, all her prized possessions and fur clippings in..

I want to thank you all for being so wonderful during this very short amount of time we've known each other!! What a great support you have been to me!! So very thankful to have found this forum.. I really think I would have been in a much worse state had I not had all of you right next to me during this
Love and major hugs to you all!!!!
Xoxox
Kelly

[addy]

Im glad Bella is home with you , I hope her memory chest arrives and it brings you comfort to go through the ritual of lovingly placing her toys and belongings in it.

Missing their smell, it is hard some days.

Zoe's memory chest is a trunk. I don't know if I will ever be able to make it smaller.

I hope the good memories will soon bring some smiles through your tears