Joined Today (Orlando has passed)

[lalosmom]

Orlando is my 8 year old GSD/spitz/collie mix. My vet and I have been anticipating a possible dx of Cushings and at this point will do the low dose dex test in the near future. If Orlando has Cushings, he will be my second dog with this condition, the first being an aussie who passed on 13 years ago. Very glad to have found this site as I felt like the first experience with Cushings was like swimming in molasses.....I never felt as if I had a clear overview of the condition and consequences despite treating Franco for 2 years with Lysodren.

[Harley PoMMom]

Hi and welcome to you and Orlando!

Sorry for the reasons that brought you here but sure glad you found us.

Could you share more information about dear Orlando such as: what symptoms she is displaying; is she taking any other herbs/supplements/medications; how much does she weigh,; could you get copies of all tests that were done on Orlando and post those values that are marked abnormal? Thanks!

Gosh I am really sorry that you are having to go through the Cushing's journey again, but remember we are here and will help in any way we can, ok?

Hugs, Lori

[Dixie'sMom]

Welcome to you and Orlando. What a cute name! I'm glad you found us because it would be horrible to go thru having a pup with Cushing's alone like you did with Franco. My hat is off to you. This time you don't have to do it alone. We are here and will be here every step of the way.

The guru's on this site are amazing and have so much first hand experience. They stay up to date on current information and will be a great blessing for you.

I know they will ask you to please post the results of any of Orlando's recent blood work, urinalysis, ultrasound, ACTH, LDDS, etc. with the reference ranges. You only need to post the abnormal results, but they would like to see the actual values with ranges for any ACTH OR LDDS if Orlando has had any of those done. If you do not have a copy of these, can you request them from your vet?

Again, welcome and I look forward to getting to know you and Orlando. :D

[lalosmom]

Thanks so much for the welcoming words! I do not have a lot of info yet. Over the summer, Orlando had his usual bloodwork and the ALP reading was in the mid 200s. Last week, it has gone up to the mid 600s. He does take thyroid medication for hypothyroidism, weighs 75 lbs, has become more lethargic over the last few months, pot-bellied tummy, not necessarily hair loss, intermittent panting. He hates taking anything and so we are not on any supplements. He will not use pill pockets or eat anything in his food, and he takes his thyroid meds with a little bit of Nurtical. About 10 days ago he had to have a minor procedure on an anal gland that would not empty and while nothing went wrong, he completely stressed out, refused to eat, became greatly agitated and all this prompted the new blood test as the dr suspected that the procedure had caused stress which had affected his liver.At that time he was on tram**** ( I don't know if your boards allow for the accurate spelling of narcotic drugs as some don't), rimadyl, amoxicillin, and finally Flagyl. Now he is off of everything but the Flagyl. I have postponed the low dose test as he is just now relaxing a little bit and the 9 hours at the vet's will put him into another tailspin. My vet told me that there are better drugs now than Lysodren, and I assume that means Vetoryl. Is that the opinion of the boards? I will get the other results as they come in and post them.

[Harley PoMMom]

When a dog has Cushing's their body is producing excessive amounts of cortisol. There are two forms of spontaneous Cushing’s, pituitary dependent hyperadrenocorticism (PDH) and adrenal-dependent hyperadrenocorticism (ADH).

The Cushing's is caused by a tumor that is located on the pituitary or the adrenal gland. Most dogs, 85% of them, have the pituitary type (PDH) while 15% have the adrenal form (ADH), and rarely some dogs do have both.

Now, Cushing's can also be caused by a overuse of a steroid, such as prednsione which is known as Iatrogenic Cushing's. With this type of Cushing's a dog can display the same symptoms as the naturally-occurring Cushing's while the only treatment for Iatrogenic that is needed is to slowly taper the steroid use.

The two medications generally prescribed for canine Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane. They are strong drugs and one drug is no safer than the other, adverse effects are usually not seen unless the proper treatment protocols are not followed. Also, as you probably already know, the medications do not cure Cushing's they are given to help abate the symptoms from Cushing's and to lower that elevated cortisol to within the therapeutic ranges. Either drug can be used to treat the pituitary or adrenal type of Cushing's.

The clinical symptoms commonly seen in dogs with Cushing's are a ravenous appetite, drinking buckets of water and peeing rivers, skin/hair issues, and a pot-bellied appearance. Has Orlando's drinking and urinating increased? How about his appetite?

I hope my overview about Cushing's was helpful and didn't confuse you. I am providing some links from our Resource Forum where we have a wealth of information regarding Cushing's. If you have any questions please do not hesitate to ask them, ok? ;)

Oh, and yes, it is allowed to post all medications that one's dog is/was taking, whether they are narcotics or not. :)

Hugs, Lori

Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Links to Cushings Websites (especially helpful for new members!) (http://www.k9cushings.com/forum/showthread.php?t=180)

Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

[lalosmom]

Thank you for that very clear and concise overview and it did answer many of my questions, especially about the meds. I will study this community and read all the information you have recommended. Orlando does drink quite a bit of water, and does pee a lot, but his appetite is the one area on question. He loves Trader Joe's chicken jerky (for dogs, not made in China) for a treat, but usually eats his dinner several hours after it is put on the floor, sometimes in the middle of the night. After his recent procedure he stopped eating entirely for several days, necessitating another vet visit, but his appetite seems to be returning.

[molly muffin]

Hello and welcome from me too.

You mentioned his ALP, but was there any other abnormalities in his blood work?

There are a couple of compouding pharmacies who make trilostane into treat form, I think chicken flavor(?) which might be an option if this is cushings.

[lalosmom]

I don't have a copy of the bloodwork yet, the vet told me that there were no other abnormalities. I appreciate the info about the med as I am starting to research prices/options. The only "non-Cushings" symptom which is still troubling us is his disinterest in food. Thanks so much for the reply.

[Harley PoMMom]

The only "non-Cushings" symptom which is still troubling us is his disinterest in food. Thanks so much for the reply.

There is a small percentage of dogs with Cushing's that do lose their appetite instead of it becoming ravenous. I'm pretty sure one of our Administrators, Marianne (labbab), her sweet boy Barkis did lose his appetite when he had Cushing's.

[lalosmom]

I appreciate you mentioning that, and I had been reading some older posts by labbab, as it then might make Orlando consistent with a Cushing's dx. I am going to try to schedule the test in the near future; it will be stressful for him to stay at the vet for so long, but it has to be done.

[lalosmom]

Orlando's tests came back today indicative of a pituitary tumor which is the cause of the Cushings. I did expect this. In a conversation with my vet yesterday, she said that I had a choice of Vetoryl or herbals to start. We ruled out Lysodren because, as she said, "it wiped out your other dog" which was completely true. She was the junior vet in 2000 when Frankie was dxed and treated and remembered his case. While I have not spoken to her in depth yet, it seemed that she felt I should use either Vetoryl or an herbal. When I did some research, it seemed as if the use of both simultaneously could administer too much of the medication. I wondered if you had this same opinion. I also found a few herbal products online and wondered if anyone had used them. They were Adrenal Harmony Gold, Primalix CortiQuel, and a few separately mentioned herbs like si miao san and ginkgo.

[molly muffin]

We haven't seem any real lowering of cortisol progress with the things like Adrenal Gold, cushex etc.
Some people do say that symptoms improve for awhile, but eventually go onto regular medication.

If the cortisol is high, and cushing confirmed then getting on a good dose of trilostane that would keep the cortisol at just under 9.0ug post (if no symtoms) would be ideal. We've had members who have been successful with long term use of medication and longevity.

I was a definite wait and see if symptoms start, but before cushings symptoms started, my dog developed hypertension and protein loss kidney disease, all of which cause some blindness and she is now on trilostane.

If you do Not start medication to lower the cortisol, then I would still advocate that you get blood pressure checked regularly to make sure everything is still good. My dog went from no problem blood pressure fine to 3 months later loss of significant sight and BP over 200. So, just something to be aware of. It's not a problem for all dogs, some never develop that issue, but now I know more about it, it's worth keeping track of.

[lalosmom]

Thanks so much for the response. I do not have a problem with using the medication vs the herbals. My experience has been that in severe cases of illness, medication is required rather than alternative therapies, although those may have some use in some cases.

I did not realize that serious side effects could occur that quickly; my vet did not want to start Cushings treatment before it was necessary, so we have been discussing this for some time...which makes me think even more that I should get Orlando on the medication.

Several years ago I had a cat who went blind after a spike in blood pressure not related to Cushings, even while he was being treated for his initial condition.....it was very sad to have to watch that happen and I know that Orlando would be miserable.

[molly muffin]

It did take a long time before the problem arose. Her cortisol had been high but we hadn't been able to confirm why it was, her LDDS kept coming back negative for cushings and she didn't have the symptoms, then it seemed to be very sudden, the high BP and the resulting problems.

It might Never become a problem for Orlando, just it is now something that I advocate keeping an eye on so that if it is going to be a problem, you catch it early.

[lalosmom]

Your story certainly brings up another case with another of my dogs. Orlando's big sister was a rescued cavalier mix. As she aged, about 9, she had some irregular liver numbers, a definite low thyroid which we treated, but after my experiences with my first Cushing's dog, I also felt that she had that. Just as you describe, the LDDS kept coming back negative despite the fact that I felt that I observed other symptoms. So....it was never treated and about a month before I had to let her go, she was suddenly mostly blind. Your answer seems to give me another piece of the Mikki story.

[lalosmom]

As I am about to purchase Vetoryl for Orlando, I wanted to clarify two things which I have seen discussed on the board, but want to make sure I am not misinterpreting.

What is the usual dose of Vetoryl, mgs to lbs of weight? Or is it not always calculated that way?

Have board members reported problems with using meds from a compounding pharmacy because the dose is not as certain or standard as it would be from a non-compounding source?

[pansywags]

The only "non-Cushings" symptom which is still troubling us is his disinterest in food.

I also had a Cushing's dog with low appetite (this was not a new thing, she had always been a dainty eater). Pansy had a pituitary macroadenoma (a larger pituitary tumor), confirmed by brain imaging. The vets at UC Davis think her appetite was further suppressed due to pressure being put in her brain by the macro. One important thing to know about macros is that medical treatment can cause them to grow.

I sincerely hope that is not the case for Orlando, and I don't mean to frighten you away from medical treatment. Macros are unusual (the number I've read is that only 10-20% of canine pdh cases are due to macros) so the odds are in his favor.

[lalosmom]

Thank you so much for posting this information. I feel that I need to know as much as possible, and would rather be informed than in the dark, as I was with my first Cushing's dog....and possibly the second who continually tested negative, but.......

Orlando's appetite has returned, but it is not like it was before...meaning he seems to want less, and eats a little more irregularly.

[Harley PoMMom]

What is the usual dose of Vetoryl, mgs to lbs of weight? Or is it not always calculated that way?

The starting dose of Vetoryl is based on the dog's weight and Dechra now advises a starting dose of 1 mg per pound of a dog's weight. Dechra's newly published literature can be found here: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Also if using brand-name Vetoryl and Dechra does not manufacture the capsule/s needed it is recommended to round down the dosage instead of up, as an example...if a dog weighs 37 lbs, 30 mg would be an adequate starting dose instead of 40 mg.


Have board members reported problems with using meds from a compounding pharmacy because the dose is not as certain or standard as it would be from a non-compounding source?

Many of our members have been very satisfied using compounded products, and sometimes there is no alternative if a dog needs a custom dose that is not available in Vetoryl. However, a recent research study has determined that some compounded products are not as consistent or effective as brandname Vetoryl. I would discuss this with your vet, but either way (using compounded or brand-name) you will probably find cheaper prices for the drug on the internet.

Hugs, Lori

[lalosmom]

Thanks so much for the response. You are completely correct that the internet prices are much better and thanks to this site I feel as if I have a few options.

[lalosmom]

I read the link about Dechra's new dosing guidelines, but suspect that my vet is going to start Orlando on a higher dose, probably the 120 mgs. He weighs 75 lbs. When I went to the Dechra website, which is very informative as well, they still had dosing guidelines which indicated that 1-3 mg per lb were okay. Should I be concerned about a higher dose? She also wants him to take some powdered form of herbals, which will never work as he is difficult to pill as it is...and they will cost another $100 per month. I am resolved to give him the Vetoryl and will order from one of your sources this week.

[Harley PoMMom]

I would be very concerned that the vet wants to start out at 120 mg of Vetoryl for a 75 lb dog. The 1-3 mg per pound is outdated and in that article in black-and-white it states
The new, lower recommended starting dose is 2 mg/kg once daily because
lower starting doses are efficacious and may reduce the risk of side effects.
I would ask your vet to please contact Dechra directly in order to discuss their new revised starting dose recommendation.

Dechra's U.S. office: http://www.dechra-us.com/Default.aspx?ID=365

Also, I would hold off starting something new when Orlando's Vetoryl treatment begins, if Orlando would have any adverse effects it would be difficult to determine if it's the Vetoryl or something else that is the cause of the side effect/s.

Hugs, Lori

[lalosmom]

I will talk to her about that dosage. If she stands completely firm on that dose, I do have the option of going to the vet who treated my GSD when he had degenerative myelopathy....now deceased. If both agree on the higher dose, would you recommend giving him the pill every other day?

I have all but ruled out the herbals from the point of view of expense and difficulty of administering.....and I know that you can buy empty capsules and fill them, but you raise a very good point about not mixing meds in case of side effects and I agree completely.

[pansywags]

If you're open to seeking a second opinion, you might consider consulting with Dr. Bruyette. If I have your location right, you're close to him and he's one of the leading US Cushing's experts.

http://www.vcahospitals.com/west-los-angeles/our-team/veterinarians/david-bruyette-dvm-dacvim/28374

[lalosmom]

Thank you so much for that link; I have written down the information and given that this is probably my third Cushing's dog, I should have the name of a local specialist.

I have emailed Dechra's support site as well and called them. Their phones are set up so you have to leave a message.

[Harley PoMMom]

If both agree on the higher dose, would you recommend giving him the pill every other day?



Every-other-day dosing is generally not a good option, at any dose. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a rollercoaster of higher cortisol one day, lower cortisol the next.

This is especially troublesome in terms of trying to interpret the results of an ACTH stimulation test. If the test is performed on an "off" day, the results will be higher; if the test is done on a day with the med, the cortisol level might even be lower.

Ideally you want to keep the cortisol controlled more consistently during each day.

Hugs, Lori

[lalosmom]

Thanks....that is very good to know. Nothing has been resolved yet as I am waiting to hear from Dechra as I want to have some information for the vet when I talk to her.

[lalosmom]

Lori
I appreciate your PM and will be happy to post.

I emailed Dechra two days ago and this morning at work found a very polite email asking that I call them. I did so immediately and was very surprised when the person who wrote the email answered and was able to respond. They certainly get kudos for customer service, especially for a non-medical professional.
I told them that I expected that my vet was going to prescribe the 120 mg dose for my 75 lb dog and that on their website I had found dosing instructions which said that between 1-3 mgs/lb was acceptable. I was told that Dechra stands by that information and that they recommend that a dog owner follow the vet's instructions on dosing. They did acknowledge that starting with the lowest possible dose is recommended, but not necessarily insisted upon at the vet's discretion. Very polite and helpful all the way through.
The irony of all this, as I was going to place my order with CPP is that my vet wants Orlando to take 100mg/day. Given that his weight has been higher than it is now, I am willing to consider that dose and take responsibility for authorizing it for his treatment. I do understand the position of the boards on dosing.
So as this saga continues, I did call CPP, also very polite and helpful, but they do not supply that dose and told me to contact a compounding pharmacy. I did email Diamondback and am waiting for a reply....only sent the email a few minutes ago so will not expect pricing from them yet. I also have contacts with WestLabs in Gainesville FL from when I treated my GSD for degenerative myelopathy and have contacted them a well.
The vet wants $149 for the Vetoryl, and while I can afford it, I would like to have a little better price if possible as this could go on for a while....hopefully for Orlando and I.

[labblab]

Hello and here is a very belated "welcome" from me, too!

Thanks so much for relaying the content of your conversation with Dechra's U.S. office. They have been very polite and helpful to many of our members (including myself!), and I am so glad you had a similar experience. However, their response to you regarding the 1-3 mg/lb initial dosing range highlights an emerging "incompatibility" between the published guidelines issued by Dechra U.K. vs. those published here in the U.S.

Just to bore you with a little bit of history :o, back when I first joined this group in 2003, Vetoryl was a medication manufactured by a British company named Arnolds. Arnolds was subsequently bought by Dechra, and Dechra now has a worldwide presence, including a U.S. headquarters. However, Vetoryl is still made in the U.K. To be legally sold there, Vetoryl must be properly registered with their "VMD" (Veterinary Medicines Directorate). To be legally sold in the U.S., Vetoryl is regulated by the FDA. Both regulatory bodies require their own specific filings and published literature re: medication. Until recently, the published initial dosing recommendations for Vetoryl were similar in both countries. However, last year, the official "Summary of Product Characteristics" for Vetoryl filed in the U.K. was revised to reflect this new initial dosing recommendation:


The starting dose for treatment is approximately 2 mg/kg, [or approx. 1 mg/lb] based on available combinations of capsule sizes.

This is an official recommendation, and can be found here (just enter "Vetoryl" in the "Search" window, then click on the SPC for any dosage strength):

http://www.vmd.defra.gov.uk/ProductInformationDatabase/Default.aspx

Likewise, it is this revised recommedation that is discussed in the U.K. publication, "Vetsonline," that we often highlight for our members:

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

This revised recommendation is based on accumulated worldwide research and experience during the past decade, and reflects the current thinking of the majority of the specialists treating Cushing's here in the U.S. as well as elsewhere. It also reflects experiences we have seen here on our forum during this past decade. Put simply, dogs seem to experience fewer unwanted side effects when they are started at lower doses and adjusted upwards if need be, rather than vice versa.

However, the U.S. Product Insert does not reflect language identical to Dechra's revised "SPC" in the U.K. So the folks in Dechra's U.S. office are obligated to verbally relay the original 1-3 mg/lb dosage range that remains published on the FDA-approved insert. However, as they did with you, I believe they usually make a special point in most conversations to also reinforce a newer sentence that immediately follows the stated range, "Start with the lowest possible dose based on body weight and available combinations of capsule sizes." So in truth, this is the same recommendation as that of the new U.K. revisions: start as closely as possible to the 1mg/lb formula.

I know that the U.S. Dechra office will be very happy to talk about the dosing guidelines and the accompanying research experience in great detail with any vet -- probably in even greater detail than they will normally discuss with an owner. So for any U.S. vet who has questions about the appropriateness of starting with a lower rather than a higher dose, I'd encourage the vet to call Dechra directly in order to discuss whether there are individual factors at play that make a higher dose more desirable for any given dog.

Kudos to you for calling Dechra yourself, though, and I hope that the 100 mg. dose will turn out to be just right for Orlando. But I hope that what I've written above will give you and our other members a better understanding of our reasoning when we advocate for lower starting doses. My personal opinion is that the simplified U.K. literature more accurately represents the current dosing trends followed by most Cushing's experts, and I hope the U.S. literature follows suit before long.

Marianne

[lalosmom]

Marianne
Thank you so much for taking the time to explain and for including the link. I did go to it and read the 6 page document carefully. There is a lot of good information there, really an encapsulation of what vetoryl does and what to be aware of. I will certainly refer to it if needed.
I am going to have my vet place an order with Diamondback tomorrow. I spoke to two different representatives today at two different times and their price is definitely the lowest I have found and I would not have known about them if I had not joined this group.
As I was reading the literature it cautioned against handling the pills. Orlando is extremely difficult to pill, does not eat anything in his food, does not like pill pockets, etc. He has only used Nutrical to take pills, which means using my hands. Is that small amount of contact okay or should I use gloves? He will not take anything from a spoon either. All my other dogs were trained to use silverware.
I have referred the information to my vet and asked her to review the amount and contact Dechra.

[molly muffin]

I know there are caution for if you are pregnant that sort of thing. I have never had any qualms about handling the capsules. I form wet can food around it to get Molly to take it. I wash my hands afterwards. Well they do have dog food on them too so rather need to be washed. Lol.

[labblab]

If it's not too late, here's a quick suggestion before ordering your trilostane...

Even if your vet decides to stick with the 100 mg. daily dose, you may want to place your order in a smaller dosage size, like 50 mg. This means you'd be stuck with giving two capsules, but it may save you money if you end up needing to decrease the dose in the future. You can always order a second batch of a different strength to combine with the 50's in the event the dose is lowered a bit, but you cannot split the original capsules to achieve the same goal. Just a thought to give you more dosing flexibility in the future.

And no, I did not wear gloves, either. I just washed my hands thoroughly after dosing.

Marianne

[lalosmom]

It would be such a shock if I got pregnant at my age that it might actually take my mind off the Cushings. Thanks for the info....I have been administering felimazole to my cat and just washing my hands. Great suggestion about the 50/50 and I had thought that along the way the dose might be lowered.

[molly muffin]

It would be such a shock if I got pregnant at my age that it might actually take my mind off the Cushings.

ROFL! I sympathize completely! LOL

[flynnandian]

a forum baby...................

[lalosmom]

Orlando has been on the trilostane for a week; I am not observing anything that I could consider a side effect, but it is early days. However, he is mildly arthritic, mostly seeming to affect his right shoulder area. This was noted before the Cushings dx.

If the Cushings treatment does aggravate the arthritis, is a drug like Rimadyl conpatible with the trilostane?

[flynnandian]

i use norocarp/carprodyl together with trilostane for my 14 year old. no problems.

[Harley PoMMom]

Rimadyl is an amazing anti-inflammatory that does bring much needed relief to severely arthritic dogs, however, it is tough on the stomach and the liver and any dog taking it should have their liver enzymes tested routinely.

Hugs, Lori

[lalosmom]

Thanks so much. I will look into what you suggested and am cautious with Rimadyl after having a lab in the mid 90s, the old formulation from what my vet assures me, who had a severe reaction to it. Does the norocarp/carprodyl have a brand name?

[Harley PoMMom]

Carprofen is the active ingredient in Norocarp, carprodyl, and rimadyl. ;)

[flynnandian]

norocarp/carprodyl is very cheap too. [ tasty pills]
i buy 20x 50 mg pills for 8.50 euro[=10$]
i have smaller dogs but it is cheaper this way. i break them in 4 equal pieces.
that is very easy to do.
no side effects after using them 1 year together with vetoryl.

[lalosmom]

Orlando had his ACTH test and the numbers were greatly improved. He is now on 50 mg of trilostane per day and I am happy with his current state. He is peeing much less, eating normally, less lethargic, and less arthritic. We are still walking less than we did in the past, but the distance is increasing each day. My vet is going to a meeting this week with other medical professionals regarding Cushings and has told me that she will contact me when she gets back with any further information or changes in dosage. Over the years she has expressed an interest in alternative medicines and therapies and actually trained to become a professional veterinary acupuncturist. When the whole Cushings dx first came up, she mentioned that there were new alternative therapies, but I assumed she meant products like Adrenal Gold and Cushex which do not interest me. If she wants to try melatonin and lignans, where do you stand on that? Have people had success? I did read the abstract from the U of T about it;parts were confusing to me, some were not. In your opinion, it is given with trilostane or does it replace it?

[Squirt's Mom]

Melatonin and lignans work on the intermediate hormones - Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone - which are involved in Atypical Cushing's. Atypical pups have NORMAL cortisol but elevations in one or more of these five hormones.

Melatonin does have the ability to have a mild effect on cortisol but it cannot cope with the massive amounts in our cush babies bodies. It works on temporary elevations from stressful situations or things like jet lag. Lignans, spruce (HRM) or flax (SDG), do nothing for the cortisol that I know of. They will not replace Trilo. ;)

Complimentary and integrated medicines use things like herbs (both western and from other approaches like TCM - Traditional Chinese Medicine), diet, supplements, acupuncture, and so on ALONG WITH pharmaceutical medications like the Trilostane or Lysodren. This is more than likely the approach your vet is talking about.

The most important thing about using any of these approaches for our cush babies is keeping up the testing to see what the cortisol levels are (the ACTH). Herbs, diet, etc. CAN make the signs better, but they can also mask the underlying issue so it is vital that the cortisol continue to be monitored if a pup is taken off the traditional meds for another approach to be sure that approach is working as well as the drugs. ;)

[lalosmom]

Thanks so much. I am not inclined to take him off of the trilostane at all and appreciate the clarification of what the other two treatments can and cannot do.

[LtlBtyRam]

I have my fur kid on Trilostane. She also gets supportive therapy from a Chinese medical vet who also practices western vet medicine. My personal belief is this is what has her here with me today. Like it has been said this is only to support the western stuff, not replace it. She gets regular testing too.

Angela & Shasta & Family

[lalosmom]

Orlando is still on trilostane, 50 mgs, after the last ACTH test. He should be up for another one in mid July. I have not used any other supplements and noticed that with the lowered dose of trilo that the arthritis was less noticeable. We continue to be very happy with Diamondback and their service; they are very easy to communicate with and are very professional.

[molly muffin]

Great to hear that Orlando is doing well on trilostane.
Yes. Very one has good things to say about diamondback. Glad to hear that is working out well for you.

[lalosmom]

Orlando is holding his own and will go back in for the next stim test in a couple of weeks. I wanted to double check the time frame between giving the last dose of the trilostane and the administration of the test. How many hours should the med be given before the test?

The only issue we seem to be having is a lot of panting. Admittedly, it is hot out here in LA, and it has been humid, a condition to which we are not accustomed. However, I do have fans running all day, and central AC which comes on periodically. Is the panting indicative of anything related to Cushings? Orlando has not lost any weight with the treatment, and our exercise is lessened quite a bit, especially due to the heat. He just does not want to go very far, even in the cooler parts of the day.

[lulusmom]

You need to have Orlando to the vet's office 3 to 4 hours after his morning dose of Trilostane. Make sure his dose is given with food.

Panting is definitely a symptom of cushing's that does improve with treatment but it can take a while. My little Pom, Lulu, sounded like a freight train most of the time but it was especially worse on warmer days. Dogs with cushing's have various stages of muscle wasting which contributes greatly to the exercise intolerance. That can take a while to improve as well so just like everything else you've experienced so far in this cushing's journey, you can expect your patience to be challenged for a bit more. Coming here and talking about it helps so keep checking in with us.

Glynda

[lalosmom]

What a cutie Lulu is! Thanks for the answer. I will definitely watch the time frame of the trilostane before the test. O is a GSD grazer and absolutely will not eat much except on his own time frame. That has been an issue with the meds, but he will take his favorite chicken jerky with them. It is reassuring about the panting as he does sound like a freight train at times.

[lalosmom]

Orlando had his last ACTH on Wednesday, along with the geriatric blood panel. He will remain on the 50 mgs of trilostane once a day, which is fine with me. He does not seem to have any serious issues with it and I was glad to see that it has remained the correct dose. It was funny as the receptionist in the vet's office, who is probably in her 20s and not that experienced, made a point of telling me to fast him before the test. When I got in, I told her what I had done, which was to give him the trilostane within 4 hours of when I felt they would do the testing and to give him a light breakfast....as I have said he is never one to rush over to food in the first place, so it was not a huge amount. I told her that I did not want some high false reading which would put him back on a higher dose and then here we go again. She told me that apparently she should have been asking me the questions, with which I agreed completely. So thanks to all of you for keeping the info updated on all of this.
I believe that O is still somewhat arthritic. He is no where near as bas as he was with the high dose of the trilostane, not even reacting as if he is in pain, but still slow to walk and disinclined to go very far. The vet has ruled out the NSAIDs due to his high Alk Phos numbers which are now down to 430 which is a drop of almost 200 points since the last test. I am fine with that as I have always had issues with them from years ago with another dog. What do you recommend in terms of natural arthritis supplements, or even meds like Adequan? Currently he takes no supplements for this.

[Squirt's Mom]

A good supplement is Glyco Flex. It comes in 3 strengths and my dogs love them like treats. Adequan is good. Also look into Dasuquin and Cosequin. Hydro therapy,cold laser therapy, and acupuncture can also do wonders.

Glad Orlando is doing well on the Trilo!

[molly muffin]

I use the glyco flex III for my dog. It does help her.

Good job on following proper protocol for the testing even when told wrong by the vets office. :)

[lalosmom]

After some thinking, I remembered that I had purchased some Phycox a while back for Orlando, but he did not like the taste and would not take it. This time around, I decided to break it into little pieces and give it like a pill, which was reasonably successful. Just in case anyone would be interested, the results were amazing. After two days he willingly went on his old walk, played tug of war after his bath, and remained much more up and alert....right up until his mommy figured out that the COX part of the name means that it is a COX2 inhibitor. I am going to look into the Glyco Flex, and in the mean time found another formula at a privately owned pet store which has most of the desireable ingredients without any NSAIDs. But I do have to say that the results were shocking for anyone whose dog can take NSAIDs.

[lalosmom]

Orlando has continued to do well on the 50 mg dose of trilostane. The cold weather has helped him to feel more energized and we are walking a little more, which he seems to enjoy. However, a new issues has arisen. The vet who has treated him as moved to another veterinary hospital a few miles away.While I am on very good terms with the remaining vets at the old place, I would like her to keep treating his Cushings. Orlando is very much afraid of other dogs, probably stemming from the fact that he was taken away from his mom at 3 weeks old and never had that learning time with her. He ironically loves to go to the old vet, loves everyone there and has not had any trouble being left there for the time that the Cushings testing takes place. I think that this is because as a little sick puppy he was taken there early on and bonded with them However, it is out of the question for him to go to a dog park, Petsmart, etc without complete panic setting in. I intend to take him to the new hospital for a trial run in the near future, probably about a month or so. If he completely panics, would it be a good idea to leave him for the stim test? Can the cortisol level be raised or can a false reading result if he becomes hysterical? I can try to insist that they let me stay with him, but I don't know what their policy might be about that. I do basically trust the vets at the old hospital, but would prefer that he see the same vet if possible....but I don't want to mess with the level of trilostane that he is taking if it is not completely necessary.

[molly muffin]

Panic can cause cortisol to raise, whether it would be enough to completely skewer the ACTH test or not I don't know.
I definitely would not have his first trip to the new vet hospital be for the ACTH though.
It might be getting the ACTH done by the regular vet hospital he is comfortable at would be the better option, while slowing introducing him to the new hospital. You can get the results and then decide what you want to do after you know the results and even call your regular vet or have the results faxed to your regular vet. I do think you need to do a gradual transition though if panic is an issue.

[lalosmom]

Thanks so much.....I do plan to bring him to the new place for a trial run before I would even schedule the test. That might answer some questions, but you have a good point about having the test done at the old hospital and then taking the results to the previous vet. I am trying to recall....are test results legally mine or could they give me a run around? I don't think that the parting of the old vet was on good terms, although I am not suggesting anything like malpractice.

[molly muffin]

Did you or do you have a plan for Orlando getting his ACTH test yet?

[lalosmom]

Sorry to be away for so long. Orlando and I made the trip to the new hospital last month and while he was uncomfortable to some degree, he did not react as much as I expected. The vet agreed that he could stay in the waiting room with me for the duration of the ACTH test, not be put in the back or in a cage, and I think that is probably a decent compromise. He continues to be stable and for that I am thankful.

Now I have another question. Do you advise not giving vaccinations to Cushings dogs? This was something that I was told by a coworker who had a Cushings dog at one time. I am not an anti-vaxxer, having had a puppy years ago who barely survived parvo, and an acquaintance whose dog died of distemper after she had run titres and believed he was safe.

[labblab]

Welcome back, and I'm so glad Orlando is doing well!

As far as vaccinations, as I'm sure you're aware, many people have strong opinions. What I can offer you is simply my own opinion. I don't believe vaccinations should be given to anybody, human nor dog, during a time period of acute illness. However, dogs with Cushing's cover a broad spectrum, from those who are newly diagnosed with highly elevated cortisol and concurrent infections or vulnerabilities, to dogs who have been stabilized with treatment and enjoy controlled cortisol and are otherwise doing well. In the former situation, I would want to withhold vaccination. In the latter case, I would opt to vaccinate based upon the advice of my vet and the individual risk factors that are pertinent for my dog (prior vaccination history, age, lifestyle, geographics, liklihood of exposure, etc.).

For vaccines that seem appropriate for my dog, I would definitely try to obtain the longest-acting version that is available and that is allowed where you live -- for instance, 3-year rabies and 3-year distemper/parvo combos. And finally, humans and animals with compromised immune systems may be advised not to be injected with any "live" virus vaccines. Since the elevated cortisol of Cushing's does suppress the immune system, this can be another issue or consideration to discuss with your vet.

As I say, this is only my personal opinion based on my own reading and conversations with my vets, and you may hear from others here who feel differently. But whatever you decide, I'm really glad that Orlando is doing well!

Marianne

[molly muffin]

Great to hear that Orlando is doing well! Good news.

Molly gets what is absolutely needed in our area, and the longest possible, so as not to have to repeat too often. We get kennel cough (yearly), rabies/parvo, for example, usually every 3 years as Marianne mentioned.

[lalosmom]

Thank you both so much. I will look into the three year parvo/distemper shot, but will probably continue to vaccinate at this time since he appears to be very stable.....fortunately...and we do go out every day for walks. I live in an area with good animal care and control, so we are not encountering animals on the streets; however, with the CA drought, coyotes are prevalent in the neighborhood and I am going to ask my vet if they can be a vector for dog related diseases.

[molly muffin]

I live in an area with racoons and coyotes, so I do get vaccines to protect molly from anything she might catch.

[lalosmom]

This is the latest on Orlando. We did go to the new hospital so that he could be with the same vet, and they have been very nice to us. When we did the last ACTH stim test, I waited in the room with him between the blood draws. However, right before that he went into what I would call a crash...no appetite, lethargic, no desire for activity. I called the vet and she said to stop the vetoryl and bring him in as soon as possible. We were able to make it until Monday as opposed to going to the ER and he remained stable, but in the same condition. She did a full blood panel including the T4 and the stim test, even though he had not been on vetoryl for two days. His pre test reading was 6.8 and his post test reading was 5.1. His T4 was 4.2 and his ALP had gone back up almost 200 points....almost 600. I have kept him off the vetoryl now for 2 weeks...his appetite came back and I initially thought that the cortisol was rising again, but now he is less inclined to eat, although eating enough to get by, not necessarily urinating excessively, or drinking excessively, and it has been hot here. I can tell if he is urinating because he stays inside when I am gone and he uses the blue backed pads. The vet wants to perform an ultrasound as she thinks that something is going on with his liver and I can see her point, just need to get the money together for it. He looks very good, great coat, no skin issues, not pot bellied, but something is going on and I do believe that he still need to be treated on some level for the Cushings. Can you think of any other tests that I should be considering when we go back to the vet next week?

[Harley PoMMom]

Hi and welcome back! I went back and reread your thread and saw that Orlando has had a few ACTH stimulating tests, however the results of those tests were not posted. Could you please post those stim test results for us and is he still on the 50 mg dose of Vetoryl? Having these answers will give us a more complete picture of Orlando's health history....thanks

Lori!

[molly muffin]

I think an ultrasound is a good idea, it can give you a lot of bang for the buck.

[lalosmom]

The previous stim test was 7.9 and I will get the readings of the others from the vet when I see her next week. He was on 50 mgs until the latest dip and has not been taking any vetoryl since, nor has a recommended new dose been suggested. I have had ultrasounds before on my dogs and know that they can give a lot of information, so I will go ahead with this hopefully within the next couple of weeks.

[lalosmom]

I have not been here for awhile due to various circumstances, but Orlando is doing well. His Cushings has responded to the Vetoryl and he is suffering no side effect related to Cushings, except to be very sensitive to the SoCal heat. However, something else has arisen. About two weeks ago I noticed him licking his paw, suspected a granuloma, and took him to the vet within the week. He does not like his paws touched, but on closer examination by her it appeared to be a cancerous growth. Needle aspiration and biopsy have been done and it is melanoma. It was not possible to get clean margins and it appears that a stalk is extending further into the leg. I will get conclusive results of the biopsy in about 5 days. At this point, the idea of toe amputation and radiation are on the table. Not only do I have concerns about those, but also about the use of anesthesia which is what caused me to lose my first Cushings dog about 15 years ago. A local was used for the biopsy because my vet was sensitive to my fear of anesthesia which might not be completely necessary. Do you have any advice going forward about Cushings dogs and oncology surgeries and treatments? The vet was not happy about the biopsy and what she is seemingly worried will be the result and held my hand while she was talking to me, so maybe this is worse than I even know at this point.

[Joan2517]

Jeez, I'm so sorry...poor Orlando.

[Carole Alexander]

You have done an extraordinary job of caring for Orlando over the years, in spite of the Cushing's and arthritis. Is your vet recommending that you see an oncologist? Perhaps I read too fast but I'm unclear about next steps. Obviously, surgery to remove what they believe to be a melanoma is very serious in light of Orlando's age. Please let us know how you both are doing and whether his vets are recommending treatment. Best to you.

Carole

[lalosmom]

Thanks so much for the replies. I was waiting to see the oncologist which I did yesterday. She recommends amputation of the 3rd phalanx, radiation at least 4 time, the melanoma vaccine Oncept, but not chemo as it is not effective with melanoma in dogs. Because of Orlando's age and because I lost my first Cushings dog to anesthesia years ago for another type of tumor removal, I am not comfortable with radiation since it requires general anesthesia. At this point I am seriously considering amputation as recommended to be done at a special surgery center with 24 hour doctors on duty and hopefully the would weather the anesthesia well under those circumstances. The pathology on the biopsy came back as low mitotic rate on the cells that were found and staining showed what they called low grade melanoma. I am unsure about the use of the vaccine. The oncologist says that with treatment given his age and Cushings and melanoma that he probably has a year to a year and a half. Cost is up to about $5000 or so without radiation included at this point. Today another question came up when I spoke to his regular vet. She does not want to give him his next rabies shot because of everything going on. Has anyone gotten a waiver on rabies shots, should I just lay low and let it ride? Any advice or questions about the course of action is greatly appreciated.

[Carole Alexander]

My dog, Skippy, was due for Rabies vaccination in early June. I am lying low on the issue but will secure a waiver if need be. Sick dogs should not vaccinated period. This is a tough diagnosis and I wish you both the very best. Please let us know how it goes.

[Carole Alexander]

One more thing regarding Oncept: I didn't do an exhaustive search regarding this vaccine but I did make my way through three articles; I must confess one was way too dense. The research is mixed with some researchers reporting that it extends the life of dogs with melanoma, other say not. Here's what I looked at:

http://www.petcancervaccine.com/vaccine/Pages/default.aspx
http://onlinelibrary.wiley.com/wol1/doi/10.1111/vco.12057/full
https://www.researchgate.net/profile/Ilene_Kurzman/publication/51839513_Safety_and_efficacy_of_a_xenogeneic_DNA_v accine_encoding_for_human_tyrosinase_as_adjunctive _treatment_for_oral_malignant_melanoma_in_dogs_fol lowing_surgical_excision_of_the_primary_tumor/links/552d2e960cf2e089a3ad4199.pdf

Hope it helps as you consider your options.

[molly muffin]

I'm sorry that Orlando is having these problems. :(

We have had people who have had waivers for vaccines due to age and medical issues.

[lalosmom]

Thank you so much. I did find that LA County has a waiver for the rabies vaccine and about 50% receive it, so that gives me something to fall back on. Immunotherapy is one reason that they give a waiver.

I had been trying to research the vaccine as well and, as you say, a couple of those articles are dense, but I did get the gist I think. Not a hugely great survival rate and I also found one article elsewhere which questioned how the studies were done...not that they were dishonest but that they were not normed correctly and the care of the various dogs depended on how much the owner could spend and other factors which really could not be documented with 100% certainty.

[molly muffin]

I'd get the waiver for sure then. If they accept waivers, then I'm sure orlando qualifies. How is he doing?

[lalosmom]

We are going to see the surgeon on Tuesday for a consultation only. Orlando is comfortable but quite lethargic which I think is partly due to the heat we are having. I have not decided on a course of action yet and hopefully the surgeon will be able to answer a few more questions.

[Carole Alexander]

Heat everywhere right now it seems. Wishing you and Orlando the best in your decision about next steps.

[lalosmom]

Thank you all again for your help. I am going ahead with toe amputation on Thursday at a special facility with a very reputable surgeon. On the hopeful side, we may get clean margins which will allow me to make a decision about further treatment. On the other hand, I have observed Orlando licking at the toe despite stitches being removed two weeks ago and a very clean job done by his vet. If the lesion returns and infiltrates the bone we will be looking at a palliative amputation at the least and one done with he is further down the road.

[molly muffin]

Hi. Know that our hearts will be with you and Orlando on Thursday and we are all hoping for clean margins and a successful recovery for Orlando.

Let us know how things go! I hope there is no spreading and you can move on from this specific issue.

[lalosmom]

I will definitely keep you posted.

[lalosmom]

Orlando came through the surgery successfully and without the need for CPR to save him. He is recuperating at home and being seen by his regular vet who handles the Cushings and the surgical team at the specialty group. We had a rough time with the Duragesic patch which had to come off one day early and the tramadol has made him constipated and lacking in appetite, but we are trying to decrease the does and wean him off of it in a few days. Since I can't determine if he is in pain as he is so stoic, I don't want to deprive him of pain meds if he needs them. No biopsy results yet and I have not made a decision on the vaccine.

[Joan2517]

Hoping for the best!

[molly muffin]

When are the biopsy results expected to come in?

so glad he came through surgery like a trooper. How is he doing?

[lalosmom]

There was a delay with the results and they just came a couple of days ago. Orlando is doing well, all bandaging is off, and has a strange looking peacock type foot now, but is happy and back to normal We do a stim test on Thursday as I certainly can't drop the ball on the Cushings after he has been treated so successfully so far.

The biopsy showed that the melanoma was contained in the toe and the resections were also clear. However, it was in the nail bed as opposed to the digit itself and so the doctors are recommending the Oncept vaccine because melanoma is so agressive. I have done a lot of research and can find no serious side effects to it and have joined a couple of support groups for amputee animals for advice as well. At this point I am inclined to do the vaccine despite the high cost.

Orlando is in a little bit of a gray area with a low mitotic rate and clear margins, but most dogs with subungual melanoma who are stage 2 only survive about 5 months after surgery without the vaccine it seems.

[Squirt's Mom]

I'm glad to hear Orlando is doing as well as he is. Whatever you decide about the vaccine will be the right decision because you make it from a place of love and hope for him. And whatever you decide, we are behind you all the way. ;)

Keep in touch and let us know how your sweet baby boy is progressing.
Hugs,
Leslie

[lalosmom]

Thanks so much and I will keep you posted.

[molly muffin]

I can see why you are leaning towards getting the vaccine, that 5 month rate isn't great to read.
What is the longevity of dogs who have the vaccine with stage 2?

[lalosmom]

First, to answer your question.....one year is the time usually attained with the use of the vaccine. They say that some dogs do better than that.

We just received the new stim test results today. A creatine level was 26...a couple extra readings were requested by the vet. The stim test was 1.6. Pre was .6 and post was 1.6. The meds were administered according to the way that you describe in the group before the test. The vet mentioned that this might show adrenal necrosis or a move into Addison's and wants to lower the vetoryl from 20 mg to 10. Orlando seems to feel well, recovering from the surgery, but seems hungry, seems to be drinking more water, and is peeing more than usual. His first immunotherapy vaccine is scheduled for September 2.

[Harley PoMMom]

I see why the vet is concerned with those ACTH test results, they are too low for my comfort too. Were the electrolytes checked also? I don't want to worry you needlessly but increased thirst and urination are symptoms seen with Addison's, if he would lose his appetite you may want to take him to get checked. Did the vet give you any Prednisone?

[molly muffin]

That stim result is too low for my comfort also. It needs to come up a bit.
Orlando seriously just needs to catch a break somewhere and have some good days with no worries

A year is better than 5 months for sure, and if possibly longer, that would be even better.

[lalosmom]

Thank you both so much for the replies. Orlando will have another stim test within 2 weeks or so if everything remains stable. The vet did tell me that the drinking and peeing are consistent with Addison's but his appetite is very good right now...in fact, he is eating more than he usually does and even sneaks some dry cat food at night which is something that he has not done in his entire life. I will call the vet and ask about keeping pred on hand; my first Cushings boy who definitely went into an Addison's crisis was on a regular dose of it and I don't think that Orlando is in that area yet. Do you have a link on the website to information about Addisons?

[molly muffin]

I found this site about dogs with Addisons: http://www.addisondogs.com/addisons/

I have also found 3 facebook groups for Addison dogs

https://www.facebook.com/groups/2347518387/?ref=br_rs
https://www.facebook.com/groups/addisonsdiseaseindogs/?ref=br_rs
https://www.facebook.com/groups/10322336355/?ref=br_rs

If he is eating well though, it doesn't sound like he is Addisions, as usually they don't tend to eat very well. Still it doesn't hurt to get up to speed on anything that might come up or what to watch for.

It sounds like he is doing pretty well, especially considering everything that he has been through recently.

[Harley PoMMom]

An UTI would cause a dog to drink and urinate more. Was an urinalysis done?

Lori

[lalosmom]

Thanks so much for the links. At this time, Orlando is still eating well, so that is something. He did have a urinalysis and everything was normal. His vet is careful to think of those outlying issues that might need checking, fortunately, as his mommy is not thinking that clearly anymore.

[molly muffin]

That's good that no UTI, so that can be eliminated. And yay for good eating!

[lalosmom]

Despite the concern about Addison's, Orlando is eating very well, seems hungry. With 110 degree heat he is of course lethargic despite the AC running for him. He had his first injection of Oncept today and the oncologist explained to me that it is not immunosuppressive so there is no reason not to give the rabies vaccine and in LA County he is not eligible for a waiver based on the use of that therapy. She recommended that he not take the rabies shot for the two months that the Oncept is being used however. I am going to lay low on this and see where it goes, as I am not anxious to give him the shot anyway.

[molly muffin]

I understand that. I wouldn't want to give him the shot either, especially while under treatment receiving the Oncept shots.

How is he doing? Yes it sure has been hot out there!

[lalosmom]

The heat has subsided a little, by LA standards, which means it is now just hot and will be for the rest of the month, and in a bad year, in October as well. But O is holding up, eating well, seems himself, still on the lower does of the Vetoryl. I can see no side effects to the Oncept at all. At this point I am not going to go looking for trouble and will just continue to lay low about the rabies. Even if local AC has the manpower to approach me, I am sure I can stall them until the vaccine series is over.

[Squirt's Mom]

Glad to hear Orlando is doing alright! I think many times just being in the moment with our babies is more important than anything else. ;) Most of my babies don't get vaccine due to health issues so we also lay low often. LOL

[lalosmom]

In many ways that is all our babies want is for us to be with them to be happy being in their company.

[lalosmom]

I am sorry that I have not updated for so long but did want to let you know that Orlando is still holding his own with good readings on his last stim test, in fact the best they have ever been. His liver numbers have risen a little bit, but we are watching that. I had my vet do the 6 month chest xray and send it to the oncologist...it was clear and he will be scheduled for his next Oncept injection in April. Last October I was dxed with breast cancer, caught early on a mammogram, and had a lumpectomy in December and a re excision in January. I am about to finish radiation in a couple of weeks, fortunately the medical oncologist did not feel that I would need chemo based on a clear sentinel node and a decent score on the Oncotype DX test. So Orlando and I have faced this all together and he has been there for me as much as I ever was for him with his melanoma.

[Squirt's Mom]

Hi! Good to hear from you again and especially good to hear that Orlando continues to so well! :cool: I am sorry to hear about your own cancer diagnosis but very glad it seems to have been caught early and pray radiation puts an end to it! Please drop by when you can and let us know how Orlando and YOU are doing.

Hugs,
Leslie

[labblab]

“Ditto” to everything Leslie just said!! Thanks so much for taking the time to stop by to update us. We’re all wishing you both the best in your recoveries!

Marianne

[molly muffin]

Great news about Orlando continuing to do well, but I'm very sorry to hear that you have had to go through cancer too. Two peas in a pod you and Oralando. It seems you are doing well and on the road to recovery. Keep it up!

[lalosmom]

Thank you all so much....I will stay in touch!

[lalosmom]

Orlando appears to have an arthritic shoulder, not rendering him immobile, but cutting down on our walks. I also suspect that the amputation site, while completely healed, has left him with an odd feeling in the foot. The toes must splay a little when he walks and it might be causing some discomfort. He is overly sensitive to any discomfort but I wanted to ask what a safe pain reliever is for Cushings dogs, any type. Thanks so much!

[Harley PoMMom]

Tramadol and Gabapentin are two that I can recommend. I take Gabapentin for my nerve pain and it does help. With both of those meds you need to watch out for loopiness, when I first started the Gabapentin it was a 300mg dose twice a day and it did cause me some uncoordination until I got used to it, I now take 600mg twice a day without any issues.

[lalosmom]

Thank you so much! I do have tramadol on hand from his amputation....lots of it, so that might be the answer.

[lalosmom]

Orlando's primary care vet has been very careful to maintain his foot with the missing toe, so he is doing okay in that department. We have not had to go to any regular medication for pain, thankfully. However, we are having, as are many of you, a miserable summer. I have central AC, 5 ceiling fans, and 6 tower fans in the house, but he continues to pant and seem generally uncomfortable. Cushings is under control, and this seems like a reaction to heat and not a new medical issue. I put him in the tub and keep him wet which seems to help, but wondered if you had found that one brand of cooling pad was better than another. When I went to Amazon, there were very mixed reviews. He may be "weird" and not lay on it, but what is another $50 at this point if it might help him.

[Joan2517]

I bought mine from Petco and Gable uses it all the time.

[Harley PoMMom]

If he doesn't like the cooling mat maybe a cooling vest/collar will work?

[lalosmom]

I have not posted for a while, and this is where we are right now. Since July 30, Orlando has had 5 stim tests, all fine by me. The situation became that his numbers moved into a very close to normal range and he appeared to be possibly showing signs of Addisons. His vet consulted with a specialist in Cushings and they decided that, while it is not done normally, we should give the meds every other day, 20 mgs total in a day 10 AM and 10 PM. Next stim test was similar to the one which prompted that decision but I remained uncomfortable with his outward appearance, especially remembering my last Cushings dog going into Addisons and then needing cortisone to even get up in the morning. Next thing we did was to run stim tests two days apart, the first one without having administered the vetoryl and the second after administering it. He was at 8 without the meds and 5.7 with them. The specialist brought up questions of adrenal necrosis, etc and it was decided to stop the meds completely and retest in about 2 weeks. This test showed pre stim at 6 and post at 11.2, both of which are in the normal range. However, to me Orlando is showing signs of Cushings....excessive panting ( we are still having warm weather out here), thirst, hunger, and lethargy. We are now back on the meds twice a week until the next stim which will probably be next week. His vet said that possibly this reading will show that the levels are back into the Cushings range, or at least equivocal range. I have no issue with keeping him on the meds, but am more or less seeing negative outcomes either way.

I have delayed his next Oncept injection AND the vet has referred him to an optomological specialist because she is afraid that there is a mass behind one eye.

[lalosmom]

Orlando's issues with the medication were resolved and he has done well for the past few months. He has been on Vetoryl for over 4 years now which is double the life span of my first Cushings dog. However, there is no doubt that he is slowing down and I cannot say that this might all be down to Cushings. His most recent problem has been with arthritis and pain in the shoulder opposite from the foot on which the toe was amputated. I think that he has probably overcompensated or adjusted and thrown the shoulder off. Subsequently he has been on Cosequin, Dasuquin, human glucosamine and MSM, and CBD oil not all at the same time or even in the same time span. I have also used some Tramadol but infrequently. About 2 days ago something happened with his rear legs, left more than the right. The leg seems unstable and he is not willing to put weight on it or senses that it will not hold him. Nothing in the foot and he does not react to it being touched. His mobility is entirely limited and I am using a sling to help him as needed but mostly he is just asleep for hours on end. Is the leg issue, muscle wasting or atrophy, connected to the Cushings? Is this an end stage sign or can it be treatable or reversible?

[labblab]

Boy, I sure wish I could give you a definitive answer as to what’s causing the leg problem, but there’s a number of things that could be wrong. Without a physical exam and possibly some x-rays or other imaging, there’s just no way to know. It could be his hip, his knee, a ligament issue, a muscle bruise, an arthritic worsening, even maybe a back issue. Some of these things could be complicated by Cushing’s, but others could be totally unrelated. My own nearly 11-year-old nonCush Lab has suddenly started favoring her left rear leg, too. She’s stumbling at times, limping at times, and definitely favoring it. This all started for no apparent reason yesterday. She doesn’t react to me manipulating the leg, but something is definitely “off.” So if misery loves company, you and I are both suffering together tonight :-(((.

If it keeps up beyond the holiday weekend, I’ll need to take her in to the vet for assessment. And I’m afraid that’s what you’ll need to do with Orlando, too. For both of us, it may just be a temporary issue that could be relieved with a limited course of an anti inflammatory, for instance. Regardless, please keep us updated, OK?

Marianne

[lalosmom]

Thanks so much. I have arbitrarily returned to giving him loading doses of Dasuquin and he is somewhat more mobile but the leg is still not right. You are correct in that he has to see the vet about this and that is my next step. Prior to returning to the Dasuquin I had been trying the CBD oil for the arthritis, not Cushings, and I am not sure that it did anything, but that is not a discussion that I need to bring up. I hope that your baby will be okay as well.

[lalosmom]

I have not been here for a while and Orlando has held his own. He has been on Vetoryl for 6 years now and his readings have been encouraging....but he will be 14 if he is still here on December 10. A few weeks ago his personal vet found a lump in one anal gland. We were referred to the Animal Specialty Group on LA where they did his melanoma treatment. We went and ran all preliminary testing which showed no metastases in any imaging or other testing but did reveal that the mass is very small and cannot be biopsied, so removal was suggested. As time has gone on, he has aged, certainly, and has been challenged with mobility. We added Tramadol and Rimadyl to his regimen and he seemed to feel so much better and was able to move a little easier, relatively to the fact that he is an old, heavy dog who has been affected by the missing toe.

I hesitated on the surgery, but never made a decision. Today I planned to decide what to do but last night he suddenly could not get up. One front leg is affected by the loss of the toe and the stress that has put on his shoulder, but suddenly he could not get his back legs to work. Since then, I have been lifting him with a harness and supporting him when he walks. He is very stiff, cannot squat, cries for me when he needs to get up if I have not gotten him up before that, can stand on the legs but will only walk a few feet. He could not step up on a curb this morning when I took him out. Is rear end limb failure or involvement a sign that the Cushings is running its course? We used Dasuquin and Cosequin for a long time until it seemed as if it had done nothing but failed to relieve the pain he was in. I have used Adequan on other dogs; is that a possibility. I hate to say it, but my GSD before him had degenerative myelopathy and despite having no use of his rear legs he was easier to manage and struggling less than Orlando is now. At this point I am not going to proceed with the surgery. He is very sensitive to pain and between that and the new mobility issue along with 2 hours of anesthesia I just don't think that he will be able to run the gauntlet.

[labblab]

Hello again to you and Orlando. I’m so sorry that you’re both having such a rough time right now. Unfortunately, it’s really hard for us to know exactly what’s causing these new mobility problems for him. It could be hind-end muscle wasting from Cushing’s, but it could also be caused by a different type of orthopedic problem such as arthritis, or hip degeneration, or ligament/tendon damage, etc. For those of us with big dogs, mobility issues such as these can be so very difficult to deal with. Unlike with the little ones, we can’t just pick them up and carry them to where they need to be. So it becomes a huge quality of life issue when they cannot move freely on their own.

Last year I spoke about my elderly non-Cushing’s Lab girl who is still experiencing an overall general decline in her mobility. Before that, we had to make the heartbreaking decision to release her non-Cushing’s Lab sister when her arthritic hips grew so painful that she could no longer walk on her own, even with the help of a harness to try to hold her up. From these experiences, my heart goes out to you as you try to settle on the best path forward for Orlando.

I do understand your reluctance to put him through surgery under these circumstances. I’d probably feel the same way. And as far as the rest of things, I’m sorry I can’t give you a definite answer. But I really can’t guess as to exactly what’s wrong. I’m afraid you’ll need to rely once again on the opinion and advice of a vet who can actually physically examine him and obtain any imaging or other testing that can give you a better idea about things.

We’ll surely remain anxious to find out any news, and we’ll definitely be here to act as a sounding-board if you want to talk over any options that are presented to you. And we’re also always here just to listen. Please give Orlando a gentle hug for all of us here, and we surely hope a solution can be found that may grant you still more good days together.

Sending healing wishes to you both,
Marianne

[lalosmom]

Thank you so much for your reply. I remember your previous comments on your baby and am sorry that you had to make that hard decision. Orlando is able to boost his upper body up, which is a help, and then wait for me to use the harness to lift him in the rear. Once he is up, he can walk a few steps and with a harness he can be assisted to walk a little further. He made one valiant attempt to stand up when I was in the shower and when I came out he was up, but too exhausted to move. At this point, we have reached a management "agreement" where he knows that he needs help and I am ready to help him, so it is somewhat like my first GSD. I will call the vet on Monday and let you know what I find out.

[lalosmom]

Miraculously, Orlando is still here a year later. His right rear leg is weak and he struggles to get up and walk, but if he is alive on December 10 he will be 15 years old which is remarkable. I am with him all the time and we have a routine where I help him up and keep him clean as needed. His appetite is great and he had his last stim test a couple of weeks ago. I don't think that he has lot of time left, but he still has quality of life. This is the latest issue. His stomach is very black, the skin very thin and it is starting to split open. These are not exactly pressure sores but almost more like very thin skin as you see in the very elderly which snags easily and splits. However, they are from contact with the floor as he lays down most of the time. I bought pressure sore pads which did not stick, bandages don't stick, so I proceeded to home made wraps which also did not work as these are very low on his distended belly. I have belly bands coming from Amazon today and am cleaning the sore with Hibiclens and using Neosporin ointment. I called his vet and she suggested I try shorts, under pants, or diapers which are in the works. However, I am worried that this is not going to stop with one lesion. Do you have any suggestions for treating this or managing it?

[labblab]

Oh my goodness, it’s so good to hear back from you! Orlando is such a good brave boy, and congratulations to you for taking such good care of him. I wish I had some suggestions to offer about the sore, but I’m afraid I can’t think of anything else in addition to what you’re already doing. Skincare can be such a challenge for dogs and humans alike, as we all age. Hopefully some other members may have some thoughts to add, though, that could be a help.

In the meantime, we’re very grateful for this update. And I’ll surely hope that December 10 will be a day of birthday celebration! Please do keep us updated.

Marianne

[lalosmom]

Thank you so much! Orlando has been a wonderful boy and it has been a pleasure to be here for him in his long battle. I am concerned about the skin's fragility. So far altered underpants and Depends have only been marginally helpful as the sores are in an odd place.

[lalosmom]

I wanted to let you know that Orlando passed away yesterday. He fought the good fight, was still be treated for Cushings, and, in the end, I cannot say that Cushings is what caused his passing. The anal tumor I wrote about never got larger, but of course any tumor can send out cells. Additionally, he was dxed with a hemangiosarcoma and kidney decline, including a possible mass. It was always possible that the previous melanoma had come back. We did not investigate further as there was no procedure that he could have sustained. He lost a tremendous amount of weight over the last 6 months and stopped eating despite all attempts to give him an appetite. It was time for him to be allowed to rest. With the help of his great doctor, he survived Cushings for 7 years comfortably and with great quality of life. I want to thank you for all your support, especially about the stim test as I felt that we always had correct readings as opposed to my first Cushings dog.

[Joan2517]

I'm so sorry for your loss of dear, sweet Orlando. It hurts terribly.

I lost my second cushpup in November and even though I know I did better this time around and gave him a few more years than with my Lena, it still seems unfair that Gable left too early from an acute and sudden onset of Pancreatitis.

We love them with all our heart and do what we can for them....

[mytil]

I am so very sorry to hear of your boy, Orlando's, passing.
Our hearts are with you.
Terry

[gingerbread]

I am so very sorry for your loss of Orlando. It hurts no matter how much we know it is their time. Please know it's ok to not be ok at times. All the emotions will come, they are normal. Your experience is yours alone and will be different from anyone else's. That said, do not hesitate to reach out, share, vent, whatever you need. The support here is amazing and a great comfort.

[Squirt's Mom]

I am so sorry to hear about the passing of our precious Orlando. :( He has been such a trooper it seemed he would be here with us always, overcoming one thing and then another. I know your heart is shattered but I hope you know just what a wonderful mom you have been to him....there is no doubt Orlando knows this deep in his heart. Today this handsome boy is running free in the Rainbow Fields, whole and strong once again, a whole host of new friends from here running along with him. Now it is he who will be watching over you just as you did him for so long. It is my firm belief that we will see our babies again when our time here on Earth is done and I know Orlando will be at the end of that Bridge, his tail flying so fast it's a blur and grinning from ear to ear waiting to jump into your arms once again. Til then, cherish the memories you hold so dear, knowing your sweet boy cherishes them just as much.

My deepest sympathies,
Leslie



Dogs Never Die
by Ernest Montague

“Some of you, particularly those who think they have recently lost a dog to “death”, don’t really understand this. I’ve had no desire to explain, but I won’t be around forever and must for those out there to finally understand.

Dogs never die. They don’t know how too. They get tired, very old and their bones hurt. Of course they don’t die. If they did they would not want to always go for a walk, even long after their old bones say “No, no not a good idea. Let’s not go for a walk.” Nope, dogs always want to go for a walk. They might get one step before their aging tendons collapse them into a heap on the floor but that’s what dogs do. They walk.

You see, a walk with you is all there is. A walk with their best friend and the symphony of odor that the world is. Cat poop, another dog’s mark, a rotting chicken bone and you. That is what makes their world perfect and in a perfect world death as no place.

Dogs just get very, very sleepy. That is the thing you see. The don’t teach you that at the fancy university where they explain about quarks and economics. They know so much there that they forget that dogs never die. It is a shame really. Dogs have so much to offer and people just talk too much.

When you think your dog has died, it has really just fallen asleep in the world and now lives in your heart. And by the way, it is wagging its tail madly, you see, and that is why your chest hurts so much and you cry all the time. Who would not cry with a happy dog wagging its tail in their chest? Ouch! Wap, wap, wap, wap, wap, that hurts. But they only wag because they are so happy to be so close to you.

Whenever they wake up in your heart they wag their tail. After a few dog years, they sleep for longer periods of time and you will too. They were a GOOD DOG all their life and you both know it. It gets tiring being a good dog all the time, particularly when you get old and your bones hurt and you fall on your face and don’t want to go outside to pee when it is raining but they do because they are a good dog. So understand that after they have been sleeping in your heart, they will sleep longer and longer.

But don’t get fooled. They are not “dead”. There is no such thing, really. They are sleeping in your heart and when they wake up, usually when you are not expecting it. It is just who they are.

I feel sorry for people who don’t have dogs sleeping in their heart. They miss so much. Excuse me, I have to go cry now.”

[labblab]

I join the rest of our family in grieving your loss of dear brave Orlando. You two had been through so much together, hard times as well as good. But throughout it all, you’ve been a wonderful caretaker, advocate, and loving parent. We’ve very much appreciated all your updates throughout Orlando’s journey, and especially your letting us know now what has happened. This way, we can all share in honoring his memory and his shining spirit alongside you.

Do take good care of yourself, and please continue to return if it would ever be a comfort to talk with us or to share more stories about your lives together. I send you my sympathy now and my best wishes always.

Many hugs,
Marianne

[lalosmom]

Thank you all so much for your lovely thoughts. It is all very raw now, although I knew that his time had come, but I do feel him with me again as I try to make it through the day without him. Your support over the years was greatly appreciated.