New here - hoping to gain some insight...and maybe a little support.

[BrookeB]

Hi everyone,
I'm Brooke. This will probably be long, but I am hoping to gain a little more insight into what I can expect for my dog, Max.
You might want to grab a coffee and a snack before you start reading...LOL

I'll preface this by saying that Max has not been "officially" diagnosed with Cushings, we are just waiting until his appointment with the vet to have the test....but she is 99% sure he has it. He has every single symptom.
So I don't have those test results just yet, but will post them when I get them. In the meantime, here's a little back story....

Max is a 15 year old yorkie. And up until about 2 years ago has been a healthy little guy. He was always very active and bouncy and alert. One night around 2 years ago, he suddenly started shaking and whining after running thru the house. The next day, he was limping on 3 legs, holding up a front leg and visibly leaning to one side. We thought is might have been a stroke, but after a vet trip, it was a pinched nerve/disc issue in his neck. At the time, our vet said that we'd need to be mindful of invertebral disc disease, which could be something that Max might be developing. After a little rehab period of about 8 weeks of limited activity, a course of prednisone and some anti inflammatory (Rimadyl) he got back to normal.

This past year, we began to notice that he was "forgetting" to go to the door to be let out to potty. He'd always been pretty good about going out. We also noticed a few other things that our vet said were likely caused by cognitive degeneration due to his age..dementia. He had also started to go blind.

Last July, he was being taken out for a walk, and as he stepped over the door threshold, he fell. The threshold was a step down of about 2 inches...when he fell he landed hard on his chin and didn't / couldn't get up. To the vet we went, fearing he had broken his back, but the vet said he just likely inflamed his disc/nerve issue again somewhere in his back...we got him up to walk at the vets office, and were sent home with predinsone for the inflammation and tramadol for pain.

After that time, he improved some, but we noticed that he was walking with a very stiff gait and having trouble standing...his front feet would slide apart and his back end would go down. We carry him in and out to the yard, so he won't have to go up.down steps, becuase that can make his back issue worse.

Over the last month, we have noticed that the weakness, especially in his rear end has gotten worse, in the last few weeks he has trouble getting up from laying down..he can still get up, but its a struggle. He can walk once he is up, but it's very stiff, and he goes back down pretty quickly. He can stand and walk to get food / water and go potty. All this was attributed to invertebral disc disease. Until...

He's always been a healthy eater...but now he's voracious.
Weight has held steady, but he has recently become very bony is his spine and back legs.
He's been peeing more (he's peed a lot since the demetia set in, but it's even more frequent now)
He drinks plenty...but not TONS...this has definitely increased over how it used to be.
Panting
And very restless, especially at night

So you get the picture.
We went to the vet last week because of the sudden muscle deterioration and panting/restlessness and the increased weakness. Something told me that wasn't likely due to the invertebral disc disease.
We moved, too....so we're seeing a new vet. Most of Max's previous treatment was with our old vet.
The (new) vet did a urinalysis to check for kidney issues and his creatinine test results (I think that's what she called them) were 4.5.
And said that he should be tested for Cushings because that could be causing the kidney problems and he has all the other symptoms. She wants to do the shorter blood test -- not the 8 hour one.

I've been reading thru the forums here...WOW...it's a lot of information to dig thru. But very helpful. And I'd love to just run some preliminary thoughts by all of you if I can.
I know that without knowing his complete test results, you may not be able to give me a ton of insight, but please bear with me and I'll get those as soon as I have them.

If he is put on one of the 2 treatments (Trilostan or Lysodren) what can I realistically expect for a dog of his age?
Will the treatments be too hard on him?
From what I've read the hunger and the peeing should be a little more normal, but what about the muscle weakness? Will he get any strength back? (even a little?)

My mom and my husband and I have had numerous conversations over the last week about what "should" be done. I've been told that he has a terrible quality of life, and that it seems like his body is shutting down.
However, the only poor test results his bloodwork showed were the beginnings of kidney disease, and, according to the vet, likely caused by the cushings. If not caused by cushings (if for some reason he winds up not having it - which is not likely), he can go on some medication to slow the progression of the kidney disease itself. Liver was normal, his heart was a little muffled, but the vet said that was common for his age, as the heart muscle will weaken some. So I don't really see how his body is "shutting down". Slowing down, sure.
Although hes blind in his left eye, and almost blind in his right eye, his eyes are still bright. He can hear, he can smell, and he's very alert. He's a little confused at times due to the dementia, but it comes and goes. He's not really lethargic, he "wants" to get up and go, it's just kinda hard for him. He sleeps a lot, but not more than a dog of his age would be sleeping. But when he's awake, he's really AWAKE.

My husband has been irritated by the frequent potty accidents, so a lot of the time we have the little fella in a diaper (around his midsection) to help control the mess. We have another dog, a cocker spaniel that my husband ADORES (and I love her too), but he has very little patience with Max...its a huge point of contention. However, Max has been around longer than my husband, and if I ever had to choose between them my husband would be very surprised at the outcome...
So those opinions have been playing with my head a little bit and I am starting to second guess EVERYTHING.

I know that at 15 he doesn't have much time left as it is. But what can I realistically expect the Cushings treatment to do for him? I am certainly willing to do as much as I can if it will help him to be more comfortable and a little more "normal" for the time he has left.
I'd love to know your thoughts and hear your feedback.
I'll be talking thru it all with my vet, too, on Thursday. But so far, I've only heard the "worst" advice from my family and it would help so much to hear from those of you who have actually had experience with this.

Thank you in advance. And I'll keep you posted

[LauraA]

Treatment can help with the muscle weakness, my girl even started jumping up on things again after a few months on the Vetoryl. She had no control at all over her bladder but after a week or so on the meds she was back to normal and we actually got to sleep through the night - heaven!!

About 18 months before her diagnosis she would have periods where she would just want to roam about all night, she was really restless and just wouldn't settle. Looking back we are sure this was related to the Cushings. Since she has been on the meds we have not had this happen.

For my girl the meds really have been a life saver. She had absolutely no quality of life before we started treatment but now some 17 months later she is doing so well. Her protein in her urine which was caused by the Cushings cleared up after about 6 months and she is concentrating her urine well :)

Laura
Bulger the grump (Cushings) and Maggie Mae (the hyperactive crazy dog).

[labblab]

Hello Brooke, and welcome to you and Max! It is obvious that you are a wonderful advocate for your boy, and I commend you for so thoughtfully investigating options that may be of help to him. At this stage, we don't yet know whether Cushing's is at play. But if it is, there can be both pluses and minuses in terms of a treatment decision for a dog of Max's age.

First off, in terms of diagnostics, you mention your new vet having performed a urinalysis that showed elevated creatinine. Were there any other abnormalities with Max's urine: low specific gravity, blood or protein present, evidence of a possible urinary tract infection?

How about any standard blood panels? Cushpups typically exhibit elevations in some of the liver markers, and often have high cholesterol and/or certain abnormalities in white blood cell levels. Also, if your vet is concerned about kidney disease, it's my understanding that it is the creatinine and BUN levels in the blood that are of significance in this regard -- I don't think that urinary creatinine, in isolation, is a meaningful result.

The reason why I am asking about these other indicators in advance of the diagnostic ACTH blood test is because the issues you are describing could be associated with Cushing's, but they could also be associated with other unrelated conditions, too. For instance, excessive thirst/urination could be caused by a UTI, or by primary kidney or liver disease. Max's mobility issues and loss of muscle mass could be related to Cushing's, or they could instead be natural aging. For instance, my senior non-Cushpup Lab has recently developed the very same stiffness/hobbling/muscle weakness that you are describing in Max. We just had x-rays done and she has a lot of significant arthritic changes and also severe hip degeneration. Has Max had any x-ray diagnostics performed in conjunction with his apparent mobility pain that might help identify the most significant underlying cause?

For a dog of Max's age, I think it becomes especially important to recognize that even if he does have Cushing's, some quality of life issues may be improved but others may be worsened, and that will become the judgement call that you must make. This is why differential diagnostics can be be very important. For instance, if arthritis is at play for Max, it may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be very stressful for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

Regardless of cause, I think the extent of any kidney dysfunction must be explored as thoroughly as possible. For instance, in terms of Cushing's treatment, trilostane cannot be used in the face of significant kidney impairment. Off the top of my head, I do not know if there is a similar warning with Lysodren.

So the point of my saga is that I think you will want to gather as much diagnostic information as possible before making any treatment decisions, and then you will need to decide which factors carry the greatest weight in terms of Max's overall quality of life as well as the likelihood that Cushing's treatment will help them improve. We will do our best to help you sort through the testing, and the way you can help us the most is to get copies of all the actual test results and then post any abnormal values here.

Thanks in advance for this info, and once again, welcome!
Marianne

[BrookeB]

Thank you Laura!

And thank you, Marianne...I ve added some comments for you below....what I could recall from the vet I will know more tomorrow after our next visit....



First off, in terms of diagnostics, you mention your new vet having performed a urinalysis that showed elevated creatinine. Were there any other abnormalities with Max's urine: low specific gravity, blood or protein present, evidence of a possible urinary tract infection? there was no blood or sign of infection....there was evidence of protein in his urine


How about any standard blood panels? Cushpups typically exhibit elevations in some of the liver markers, and often have high cholesterol and/or certain abnormalities in white blood cell levels. Also, if your vet is concerned about kidney disease, it's my understanding that it is the creatinine and BUN levels in the blood that are of significance in this regard -- I don't think that urinary creatinine, in isolation, is a meaningful result. His blood work showed some liver change, but the vet did not seem concerned with it, other than to say that combined with his other symptoms it looked a lot like Cushings. She did not share the liver numbers with me, as she moved right on to the Cushings discussion, and I didn't ask for more specifics.


The reason why I am asking about these other indicators in advance of the diagnostic ACTH blood test is because the issues you are describing could be associated with Cushing's, but they could also be associated with other unrelated conditions, too. For instance, excessive thirst/urination could be caused by a UTI, or by primary kidney or liver disease. Max's mobility issues and loss of muscle mass could be related to Cushing's, or they could instead be natural aging. For instance, my senior non-Cushpup Lab has recently developed the very same stiffness/hobbling/muscle weakness that you are describing in Max. We just had x-rays done and she has a lot of significant arthritic changes and also severe hip degeneration. Has Max had any x-ray diagnostics performed in conjunction with his apparent mobility pain that might help identify the most significant underlying cause?the vet did blood work first. When the vet got his blood panel back, she saw the kidney problem and said that could be the beginning of kidney disease. Then she moved on to say that because there was a slight change in his liver numbers, plus his other symptoms, it was likely Cushings. She said we could likely slow the progression of the kidney disease with meds. She asked me to bring in urine, which I did. I asked her if she wanted to check into the Cushings possibility, but she said she wanted to sort out his kidneys first. She said the kidney issues would be more problematic for Max in the immediate future and wanted to focus on that.
She did the basic urinalysis and then went on to do the test which came back with the 4.5 number related to his creatinine. WHEN She called to tell me THAT result, she said, "this could likely be related to the Cushings so I'd like to go ahead and do the blood test for Cushings" Now I will say that confused me....because before she said that we needed to sort out the kidney thing before moving into the Cushings....now...she thinks the kidney issue could be RELATED to Cushings, so she wants to move ahead with that.


For a dog of Max's age, I think it becomes especially important to recognize that even if he does have Cushing's, some quality of life issues may be improved but others may be worsened, and that will become the judgement call that you must make. This is why differential diagnostics can be be very important. For instance, if arthritis is at play for Max, it may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort.there is some arthritis, as she said we'd have to be careful of the type of meds he gets, depending on his kidney situation
Also, especially at the beginning, there can be numerous vet visits and blood draws which can be very stressful for a dog who's nervous at the vet (and also hard on the owner's pocketbook ).

Regardless of cause, I think the extent of any kidney dysfunction must be explored as thoroughly as possible. For instance, in terms of Cushing's treatment, trilostane cannot be used in the face of significant kidney impairment. Off the top of my head, I do not know if there is a similar warning with Lysodren.

So the point of my saga is that I think you will want to gather as much diagnostic information as possible before making any treatment decisions, and then you will need to decide which factors carry the greatest weight in terms of Max's overall quality of life as well as the likelihood that Cushing's treatment will help them improve. We will do our best to help you sort through the testing, and the way you can help us the most is to get copies of all the actual test results and then post any abnormal values here.

Thanks in advance for this info, and once again, welcome!
Marianne

[labblab]

Brooke, thanks so much for this additional info since it does help us better understand the diagnostic path that your vet is following. Based on what you've told us, my best guess now is that perhaps there was indeed some mild elevation in Max's kidney bloodwork (creatinine and/or BUN), but that the 4.5 number relates to a urine protein:creatinine ratio, which is a measure of protein that is found in the urine. Persistent protein loss of that magnitude would indeed be an issue that signals an abnormal condition that would benefit from intervention. If the protein loss is due to renal glomerular disease, there are some specific medications that can be added to directly improve the situation. But yes, Cushing's is an underlying condition that can cause or contribute to the kidney dysfunction in the first place. So especially for a younger dog with a finding such as this (assuming my speculation about the testing is correct), there would be very good cause for treating the Cushing's in the hope that the kidney problem will be eased, as well. We do have Cushpups here who are facing this very same issue right now, so I am hoping you'll hear more about this from those members.

At any rate, I do think I now better understand your vet's thinking re: the diagnostics. It is definitely the case that the more info you have in hand, the easier it may be to sort out the best treatment approach. We'll be really interested in that ACTH test result, and also, please do get copies of all the previous labwork as well. I think it will make things a lot easier for us all to organize our thoughts if we know exactly what the testing has revealed.

Marianne

[BrookeB]

Just wanted to give a little update from our vet visit today.

We had a little recheck on his eyes (they were not looking gret last week, but after a week of an anti-inflammatory ointment, his eyes are much clearer and less inflamed. His right eye-vision is a little better becuase of that.

We opted to do the ACTH( I think that is right? Blood was drawn and an injection given...after 1hr another blood draw..then we wait for results) test while we were there, because the vet had time. So we might have definitive results tomorrow.

I got a little more clarification on what my vet is thinking abou this kidneys. She said his kidney function result (the 4.5 creatinine thing) was within reason that the Cushings could be causeing that level of result. Had that number been REALLY high, it would likely not be related to Cushings. So...if there is no indication of Cushings from the ACTH test....then we treat the kidneys appropriately.

I asked about what the next stpes would be if he does have Cushings and she did say that if Cushings is the issue, that she will most likely prescribe him Vetoryl. She said that for a dog of his age, his size and with the other things he has going on, she feels like Vetoryl is the better option because it can treat everything and not be extremely taxing on him and will be easier to work out the proper dosage.
She said she has prescribed all the different medications before, and they all have benefits, but based on what she sees now, if she had to pick one for Max, that would be it. She said she has had great results from it in similar cases.

So I will update more here as soon as I know what his results look like. They were closing up today when I was finishing up with Max, so I did not think to ask for his test results so far. But I will.

In the meantime, I'd love to know about Vetoryl. Max is between 13.5-14lbs. so I am wondering about general dosage amount, price I should expect, side effects, etc. I'd love to hear what your own experiences have been with it.
And how do I ask my vet to prescibe it for me so I can go to a less expensive pharmacy to get it? (I am so timid about asking stuff like that....)

Oh and by the way....his ACTH test today was $215 and she said each of his tests that he'll need to have in order to monitor him until we get his dosage right will be in the $150 range every 2 weeks or so.
Wondering if that pricing is in line with what others have paid?

Thanks very much everyone. You don't know how much it helps me to be able to communicate about this with others who have not only been thru it, but who can, in many ways, help me to know if I am doing the right things for my little guy....as opposed to just telling me to give up. Thank you :)

[Harley PoMMom]

In the meantime, I'd love to know about Vetoryl. Max is between 13.5-14lbs. so I am wondering about general dosage amount, price I should expect, side effects, etc. I'd love to hear what your own experiences have been with it.
And how do I ask my vet to prescibe it for me so I can go to a less expensive pharmacy to get it? (I am so timid about asking stuff like that....)

Dechra, the makers of Vetoryl, have revised their initial dosing recommendations to a formula that does not exceed 1 mg per pound. So for Max's weight of around 14 lbs I would suggest his starting dose be 10 mg once a day. Here's a link to this information: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Some members use a compounding pharmacy for their dog's Trilostane (which is the active ingredient in Vetoryl), and this can be a huge cost savings. Diamondback is a reputable pharmacy that I have seen members on the forum use: http://www.diamondbackdrugs.com/home-mobile/


Oh and by the way....his ACTH test today was $215 and she said each of his tests that he'll need to have in order to monitor him until we get his dosage right will be in the $150 range every 2 weeks or so.
Wondering if that pricing is in line with what others have paid?



$150 for an ACTH stimulation test sounds pretty reasonable, actually that's a good price. Those ACTH stim tests are expensive because of the stimulating agent. Cortrosyn is generally the stim agent used and another cost savings would be for the vet to reconstitute the Cortrosyn. Dr Peterson, who is a renown canine Cushing's expert, states on his blog on how this can be done, here's an excerpt from his blog:
Cortrosyn is expensive. And once reconstituted, it has a limited shelf-life.

However, by following the protocol outlined below, you can easily dilute, aliquot and store Cortrosyn after reconstitution for up to 6 months. This makes each ACTH stimulation test much less expensive, because each vial of Cortrosyn can be used to perform as many as five ACTH stimulation tests. http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

I am also including a link from our Resource thread where you will find information regarding Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources

Hope this helps :)

Hugs, Lori

[LauraA]

Initially you do need frequent Stim testing. Usually at 2 weeks, then 4 if all is good, and then you can go 3 monthly - so it does become less of a financial burden once you settle on the correct dose :) If the Vetoryl/trilostane dose needs adjusting at any time then it is recommended to have an ACTH Stim test around the 2 week mark.

Like Harley PoMMom said, 10mg would be a good starting dose. It is much easier and safer to increase the dose than start to high and have the dogs cortisol go too low.

[BrookeB]

Thank you Laura and Lori :)

I have an update today.

Max's ATCH test came in at 21.4 -- so the vet said it is likely Cushing's disease. And to make sure, she wants me to take him for an abdominal ultrasound to get a look at his renal glands.but also to check to see if there is anything major happening anywhere else in his abdomen (tumors, deteriorating kidneys, etc)....if so, she said that depending on the severity, it may not be wise to treat for Cushings, and instead to focus on fixing a bigger problem if it exists. Or....if there is a bigger issue that really can't be fixed, then...well....decisions will have to be made.

I attached lab results at the end of this message. It's from the online system they have set up to see all his records, but his ACTH test results were not loaded in there yet.

But...I did not get the feeling that she expected something else to be wrong. There were a few red flags in the first blood test and urine test that she did, but nothing that alarmed her other than for her to say "These results could indicates some beginnings of kidney disease, or, most likely, I think he may have Cushing's disease"

I am hoping that if his bloodwork showed up some things that were just off the charts (or if she suspected something from his examination and such), she would have told me if there were other things that concerned her.

So, in order to spread the cost out a bit, I asked her if it would be ok to postpone the ultrasound for a couple of weeks but go ahead and start him on the Vetoryl. In 2 weeks, we'll do another test to see what, if any, effect the Vetoryl is having. Then we will move forward with the ultrasound. My vet was ok with that, as I explained that I'd like to start him on some kind of treatment rather than wait another 2 weeks (or more depending on when the specialist vet can do the utrasound) to even get the ball rolling.

I was prescribed 15mg Vetoryl for him. I purchased 30 of the 30mg capsules, and 15 of those are being compounded at a local pharmacy, down to 15mg doses. So I will have 30qty 15mg doses. Then, if his dosage needs to be lowered or increased, I have 15 more 30mg capsules that can be compounded accordingly. The cost was $100 for the 30 capsules...and another $30 at the pharmacy.
I also was given prednisone in the event of an adrenal crisis.
I am thinking once we get his dosage nailed down (barring no complications, etc) I can then ask for an Rx to get filled online or elsewhere for less money.
So, since the meds had to be compounded, I won't have them until Monday...then we'll see how it goes from there.
Fingers crossed.

Here are his labs:
Protein/Creatinine ratio 4.9 (I thought she said 4.5 on the phone, but 4.9 is correct, I misunderstood her)
Total Protien 7.2
Albumin 3.7
Globuin 3.5
A/G Ratio 1.1
AST 22
ALT 52
Alk Phosphate 357 (this was high)
GGTP 4
Urea Nitrogen 58 (high)
Creatinine 1.7 (high)
BUN/Creatinine Ratio 34 (high)
Phosphorus 5.4
Glucose 90
Calcium 11.1
Magnesium 2.2
Sodium 154
Potassium 7.0 (high)
Na/K Ratio 22
Chloride 111
Cholesterol 290
Triglycerides 179
Amylase 1,179
Lipase 601
CPK 112

From his CBC
WBC 7.2
RBC 5.6
Hemoglibin 14.3
Hematocrit 45
MCV 80 (barely over the high limit)
MCH 25.2
MCHC 31.8
Platelet 714
Neutrophils 4824
Lymphocytes 1512
Monocytes 720
Eosinophils 144
Basophls 0

Total T4 1.1

[Harley PoMMom]

Could you edit your post and add the reference ranges and unit of measurement for those values you listed...thanks.

That 21.4 for the ACTH stimulation test, are the reporting units in ug/d and this was the post number, right? And if so what are the reference ranges? If that 21.4 is the post number than to me, that is not very elevated and I would hold off on giving her the Vetoryl.

Many of her elevations, such as the UPC, potassium, BUN, and creatinine are more indicative to a kidney problem than Cushing's, and therefore could raise her cortisol in itself so if this were me I would not start treatment until an ultrasound can be performed to get a look at those kidneys. Now, these are my thoughts and hopefully the others will share theirs as well.

Hugs, Lori

[Squirt's Mom]

I'm with Lori - I would NOT start treatment, especially with Vetoryl, until those kidneys are checked out thoroughly. Vetoryl is contraindicated in dogs with kidney disease so you would not want to use this drug if there is kidney disease present. ;)

[labblab]

If you are planning to perform an ultrasound, I would also hold off on starting the Vetoryl/trilostane treatment until after the imaging is completed. You obviously have some definite concerns about the kidneys, but in addition, the pre-treatment appearance of the adrenals can aid in confirming a Cushing's diagnosis. Dogs suffering from pituitary Cushing's often exhibit abnormal enlargement of both adrenal glands. However, trilostane treatment itself can cause similar enlargement on ultrasound imaging. I don't know how quickly this occurs, but if it were me, I would want to receive the full diagnostic value of the ultrasound -- meaning, I would want to have a totally "clean" baseline image against which to compare any future changes.

Especially if you are only talking about the delay of a couple of weeks until you can perform the ultrasound, I would hold off on the Vetoryl until it has been done.

Marianne

[BrookeB]

Hi there everyone. I wanted to pop back in with a few updates and a few questions, too.
First of all...thanks to all of you who helped me thru the initial part of my boy's diagnosis. I really appreciate everything.
I meant to get back here before now, but we moved 1/2 way across the country last month, and well, what with the preparation of the move, the move itself and getting settled...I've just had a lot going on.

Second, after I typed all this out, I realized its REALLY long and drawn out...so I am sorry for the length. But I've just got some things to "talk" through....and hopefully those of you who have been thru this will be patient with me, and offer up some guidance and maybe some encouragement. I really need it.

So an update on Max for you...
We kept him on 15mg of Vetoryl after the cushings diagnosis was confirmed. At the time of that he weighed about 12 pounds. It was recommended here that he start with 10mg of Vetoryl, but my vet insisted on 15. Well....I'm sure you know what happened.
He had a stim test (thats what my vet called it) 2 weeks in and things looked good....within about 7-8 days after that the diarrhea began one weekend. He's never had more than the very occasional episode of diarrhea, so I knew there was a problem..but that was the only symptom.
Monday, we went to the vet, stim test showed him to be on the lowest end of the range, and so the vet concluded he was beginning to go into an adrenal suppression situation (not quite a crisis). So he came off the Vetoryl for a week to give his adrenal glands a rest. Then we started him on 12mg. for 2 more weeks.
At this point his weight had dropped to 10 pounds. He's always been around 12-14 pounds, so the sudden weight loss was alarming to me, but his pot belly was gone, and his appetite had decreased a little, too. Plus, the vet said the episode of diarrhea could've been a factor in the weight loss as well.

Given the weight loss I was concerned 12mg would still be too much. The day before we moved he got a stim test after being at 12mg for 2 weeks...his levels were normalized. And my vet said he would need to continue with that for 3 months, then get re-checked, unless of course there was evidence of adrenal suppression again.
He was also back up to 11 pounds.

Then it was time to move.
With Max being blind, I was worried about the car ride (1100 miles) and the adjustment to the new place.
The car ride was, thankfully, uneventful...at 15 years old, he sleeps a lot, and he slept the majority of the time in the car. If he's anxious, he paces, pants, and whimpers....there was none of that. He slept and had a peaceful, comfortable ride. We kept his meal times the same, and made lots of stops for water and potty breaks. The 1100 mile trip was split over 2 1/2 days and 2 nights, and he was fine in the hotels at night. Thank God. I was incredibly worried that it would be stressful...but it was ok.

That was about a month ago. We've since begun to get settled in our new place. He is adjusting ok. It's helpful that our furniture and rugs have a familiar smell. He seems to have taken it all in stride and I worked with him the first few days to "show him around".

I haven't found a vet here yet, but I have some recommendations and will probably be taking him in within the next week or so if not sooner - more on that in a sec.
My vet set me up with 60mg capsules of Vetoryl, which I took to a pharmacy here and got 6 of them compounded down into 12mg each. Basically, I paid about $140 for a box of the 60mg capsules, but Max will end up getting 5 months worth of medicine out of that when they are compounded. I appreciated my vet coming up with that solution.

Max has been doing ok on the 12mg dose. But I'm afraid there are other issues now.
He has lost more weight and muscle...not just in the back legs, but everywhere. He's skin and bones. My vet said cushings is called the stick-man syndrome. I'll be surprised if he's 10 pounds.
He has had some softer stools, once in a while, but no diarrhea really. Most of the time his poop is normal and regular. And he doesn't have any of the other symptoms the vet told me to look out for with and adrenal crisis.

One of the worst things that has been going on with him since before the Cushings diagnosis was the weakness in his back legs. My vet said that she had never had a dog regain strength when being treated for cushings...she did not seem optimistic that the vetoryl would help with that in any way.
She confirmed there was some arthritis going on, and that once the cushings was under control, we could explore options to help a the arthritis....gotta be careful not to damage kidneys (he did show some slight kidney disfunction in the beginning, which my vet attributed to the cushings)

Within the last week, my boy has started to have a more difficult time getting up after he's been lying down. He's been stiff up to this point, and while he's had some trouble getting into a comfortable lying position, and then getting up, he was a little shaky and clumsy...but this past week has been harder. He has to work MUCH harder to get up, sometimes it takes a few tries. Occasionally, he whines for some help....and there have been a few times when we have been out of the room where he literally WAILS for us to come get him.

The first time I heard the wailing, i was terrified. I have never heard that sound come out of him. I had no idea if it was due to pain, confusion, frustration, or just trying to get attention for some help.
I am inclined not to think it was due to pain. He has, in the past, bitten both my husband and me when we mistakenly tried to pick him up when he was going thru a pretty bad disc issue in his spine.
I can pick him up, carry him, help him stand touch his hind quarters and legs with out even a flinch from him. If he's hurting....he's not showing any other sign of it.

This evening we had gone to dinner, and when we came home, I could hear the wailing. I raced into the room to find him and he had gotten up and was walking. I picked him up to see if he was panting or if his heart was racing (if he exerted himself) and he wasn't. He also didn't indicate my lifting and holding him was painful in anyway. That's when I thought "maybe he's just wailing because he is stuck - like 'somebody come help me!' and not because he's hurt.
His dementia/cognitive functions are declining some due to his age, and being blind doesn't help...so maybe it could be just his mind/emotions causing him to wail. I don't know....

I am REALLY trying to be sensitive to whether or not he's having pain. I DO NOT want him to be hurting. I have moved his legs, his feet, squeezed and palpated him from his shoulders to his hind feet, and he just does not give me any indication that anything hurts.
Which is why I'll be getting him to a vet here within the next week. IF there is pain, I want to be able to help him manage it.
If it can't be managed, and there will only be more pain as things progress......well....I have a really hard decision to make.

This is long, you guys, I am sorry......But I have one other dilemma that I'd like to share.
In about a month, I am returning home to NC for about 3-4 weeks.
I am flying and planning to take Max with me.
I went over this with my vet in NC before we left and told her what my plans were and asked her to weigh in. She said that he'd probably be ok to fly....told me to really pay attention to how he did on our car trip (which as I already mentioned, went very well....no stress at all) and she would provide me with some tranquilizer (acepromazine) for the plane if I thought it would be useful.
I was instructed to give him a very small dose (1/4 of a 25mg tablet) and that should be enough to relax him.
So I have the acepromazine now. He has taken it before (he HATES the groomer so he was given some maybe 4 other times in his life for grooming)
The other nite, he was really restless..again not acting like he had pain, just couldn't settle down...anxious and not sleeping. Lie down, get up, lie down, get up, repeat...over and over. He has a certain routine that he does before sleep time and he was just not able to settle down.
I was really upset for him...he was having a really bad night, so I decided to give him 1/4 of an acepromazine to help calm him down.
It knocked him completely out, and I could tell it changed his respiration...his breathing was pretty ragged for about the first 30 minutes. I put him in bed with me and laid awake so I could make sure he kept breathing. After 1/2 hour, things normalized out. It was enough to scare me though...and decide to NOT give him the acepromazine when he's on the plane.
So that's one thing I have to talk to the vet about here.
I have to get a health certificate for him, and he has to get checked out for all that......so I am going to rely on the vet to answer me honestly when I ask if he thinks it's a good idea to fly with him.

So here is what I am struggling with... and why I gave you all the background and stuff from the last months to the last week....
I DO NOT want to leave him behind with my husband while I go back home. Bless his heart, but my husband forgets to give him his medicine often (I have to remind him every day), and he just........doesn't pay attention to him. If Max is pushing himself up to try and stand, my husband will walk by him and not even bend down to help him up. He's not cruel....he's just really oblivious.
Plus, Max is my dog, he's attached to me, and he "looks" for me when I am not around. Even blind, he will find me in the house wherever I am, just to be near me.

I have been reading stuff that I probably shouldn't have been reading about folks who have just gone ahead and put their dogs down rather than leave them behind (in a kennel or with someone at home) because they were afraid of the stress the dog would be under while they were gone...and would likely die.
I am struggling now, with.....when will I know his time is up? When will I know it's time for me to help him move on? Do I need to put him through an airplane flight, just so I can keep him with me? What is the right thing to do??

While he is struggling more with getting up, he can still get up on his own (sometimes he doesn't struggle at all). Once he's up he can walk...he still a bit stumbly at times and he falls over (from the weakness and losing balance), especially when trying to go backward. He tires easily and his legs get weak, but he can stand to eat. He can walk outside on a leash to potty. He still has control of his bladder and bowels.
He eats like a champ still, drinks plenty of water (although much less now since being on the Vetoryl). And while he sleeps a lot, he doesn't sleep ALL the time and when he's awake, he's very alert. And he still likes to be talked to and petted and held....he hasn't lost interest in us.

I am in a very weird place with all this. I don't think it's time to let him go. The best person to take care of him is me...he wants to be with me and I need to be able to take him back to NC when I go..and bring him back when it's time for me to return here.

I don't want to be one of those people who selfishly tries to put off the inevitable just because they don't want to let go yet. But I truly don't think he's ready. I've read thru so many sad stories here...and I resigned myself that (unless there's some other obvious sign) when my boy can't eat anymore, that will be my threshold. He's always eaten like a horse...when he begins to refuse food, that will tell me everything I need to know.
But the thing is... what if he doesn't lose his desire to eat?....I am not so sure I'll be strong enough to recognize when the time comes otherwise.

Bless his sweet heart. I know that you can't cure cushing's but I really thought I'd be buying him a little time with all this. He's been doing so well on the Vetoryl and I do think it's helped him....but it seems like now there are other things to have to contend with.

Best I can hope for I guess, is that the vet here can give me some guidance on how to manage what may be happening now...over and above the cushings. If there's arthritis and some pain...I want to manage that until we can't anymore.

I'd love to hear your honest thoughts and any experiences you all may have had. My husband is kind of removed from it...he sort of brushes my worries off, saying "Max is just having a bad day". He's just really kind of apathetic.
I think I just need some folks to talk to about all this...

so....thank you for reading....I'll be around if you have questions about anything. It's just been crazy the last couple of months or I would have popped back in sooner.

[My sweet Ginger]

Hi Brooke,

I haven't read your prior posts before because some of your posts are, eh hem, kind of long and I now have a very short attention span. :o However, I've read your post from this morning and I'd like to tell you a couple of things that are strictly from my personal point of views as I've gone or been going through the very same issues myself.

My pup, now 15 1/2 yrs old Chi who was diagnosed with Cushings in Oct. 2013 also has high BP, IBD, hypothyroidism, focal seizures and dementia. Not going into our long journey up to this point, now she's pretty much under control on most of her symptoms I'd like to say.

Firstly, she also cries or wails when she's stuck and can't get herself out. She doesn't have reverse gear anymore. Very loud, I will say the cries we'd never heard before all this. So I think I agree with you that Max is not crying because he's in some kind of pain and I can only imagine it must be (the panic he feels) much worse for him being blind.

Secondly, for the last two years I was exactly where you are right now. Couldn't visit mom overseas because I couldn't leave my baby under my husband care, who like yours loves her very much and has a good heart but just not really a caring type. So finally I thought I wanted to fly her with me and had a talk with her neurologist. She's been exclusively seeing him for some time now. No IMS or PV.
Him fully knowing her condition, still encouraged the trip and was more than offered to prepare paperwork for us. That'd have been a 13hr non stop flight.:eek: I ended up not taking her with me because my daughter offered the care full time and she did a fantastic job for three weeks. :) He's tiny enough so for a few extra $$ he can stay in a bag or carrier under your seat and I think you and him can manage 2-3 hours of flight without a lot of issues. Otherwise you know you will not be able to enjoy your stay in NC. ;) Talk to your vet about melatonin, I hear that also has a calming effect for a few hours.

My Ginger weighed over 10 lbs. before Cushing treatment but now weighs around at 8 but pretty much maintaining. She is very frail and and sleeps most of day and night. Falls over sometimes and wears rubber paws for a better grip because her legs slide out on all different directions especially while she's eating. Shows no emotions of any kind and detached from everything and everybody. She wears diapers all the time and takes many medications daily. She gets stuck 20times every day and the places she gets stuck is very hard to get to for us. I sometimes have to crawl down underneath couches or behind tv in the corner or behind the toilet :eek: and you will usually find her under a chair peeking out, stuck if she is awake. She also does head pressing against a wall and thinks she's stuck there so another cry for help.
So I know she has a VERY low quality of life and the test proves it and I must admit that it sometimes gets me into depression I think because I have to pass a lot of things what I'd like to do to care for her. But she still eats and is not in pain. Smells the grass and her tail goes up. Follows me around and come to the door to greet me sometimes when I come home. Long ago I'd decided that either her not eating or in pain or both will be the sign for me so we go on because I don't know any other way to know it so I'm trying to cherish every little happy moment I get with her and not really waiting or looking for 'the sign'. Btw, her neurologist agrees that it not time for that talk yet. ;)

I don't know I'm helping you in one way or the other but I wanted to share my story with you. Take care. Hugs, Song.

PS: Writhing this took longer because I had to go and 'rescue' Ginger like 10 times where she thought she was stuck. She's wide awake but very busy getting stuck this morning. :o

[BrookeB]

Hi! Thanks so much for your reply. I'll try to keep this reply short....LOL. It does seem like you and Ginger are in a very similar place to me and Max. I really do appreciate you sharing that with me. Our vet said lots of his behaviors are attributed more to his aging and cognitive issues and not anything else, so I know his emotions are affected when hes in distress.

As for the travel, I'm apprehensive, but I think I'll feel better after I talk to the vet. I have a really great carrier that I ordered, and I'm going to start putting him in it and taking him on some short trips out to the store in it, so he gets used to it. He's all set to travel in cabin with me. I've got a flight that is in 2 legs...a little over an hour with over an hour layover (so we can go outside and walk around) and then 2 more hours in flight. So not bad. But I don't have to pay his travel fee til I get to the airport, so if he ends up not being able to go, I've not lost anything.

I'm glad you are still able to enjoy time with Ginger, even though she requires a lot of looking after. I have to keep reminding myself (and my husband, especially) that someday I'll likely be in the same position, and need others to help care for me. It sure sounds like Ginger has the best life possible for her right now. :)

Thanks for the idea about the rubber "shoes"! I had not thought of those, but it's a great idea. Max has lost of trouble with his legs splaying as well. I need to give those a try.

Thanks for reading my long post. I'll try to be more concise. I just haven't been here in a while, and had a lot to go over. Plus, having moved away from all my family, and with they way my husband tunes it all out, etc...I kind of don't have anyone to talk to about all this. It helps to know there are others facing the same things.

[deannah]

Just believe me, you are not alone in your feelings and protection of Max. I'm new here and reading all that I can to educate myself about this disease. Don't have the husband not dealing with the problem due to the loss of him a few years ago, but fully understand your need to convey your feelings to others who have faced similar problems as yourself.

Hang in there and always know you are doing the best that you can in these difficult times.

Love and best wishes for you and Max ..

Deanna and Puckie