Senior Silky, Cushings Since 2012 - sweet Gizmo has passed

[Allison]

I just found this forum and would like to share our family dog's story with hope maybe someone can give me feedback on how to improve the quality of his life.

In 2012, we started to foster a senior dog who had Cushings and deteriorating eyesight. For the first year, we managed his medications and cleaned up the occasional accident in the house. Otherwise, Gizmo enjoyed walks, play, and food. He even did obedience classes. He was a happy-go-lucky dog who acted more like a pup.

In 2013, Gizmo suffered a back injury that made him unable to use his back legs. A specialist determined that he still had severe pain and steroids would be the best help. Over the next month, he seemed to suffer from some depression but soon regained enough use of his back legs to take short walks. This improved his spirits, except by now his hearing was also starting to go.

In 2014, we adopted Gizmo and also began to see other changes. He swung between bouts of limited appetite and pancreatisis brought on perhaps by our efforts to get him to eat. He also began to have a lot more accidents in the house and more infections.

This brings me to 2015. Due to worsening symptoms of Cushings such as increased thirst and hair loss, the vet increased the dose of Gizmo's medications. These symptoms seem to have stabilized again, but now his back legs have given out again and the steroids have not worked this time. He also routinely has accidents in the house and sleeps for huge amounts of time. In contrast to when we first got him, he often now seems vacant and like an old guy.

We have an appointment with our vet to see if there are alternatives to the steroids. My husband is also going to pick up some belly bands. However, I have a couple of questions:

First, are all these recent developments signs that the Cushings have gotten worse?

Second, especially given all the issues our dog has, does anyone have ideas of things my husband and I can do to improve Gizmo's quality of life?

[labblab]

Hello and welcome to you and Gizmo. You are wonderful to give him a forever home filled with loving care!

As far as his treatment history, I want to clarify a very important point.


This brings me to 2015. Due to worsening symptoms of Cushings such as increased thirst and hair loss, the vet increased the dose of Gizmo's medications. These symptoms seem to have stabilized again, but now his back legs have given out again and the steroids have not worked this time.

Is Gizmo taking actual Cushing's medication (either trilostane or mitotane)? If so, the medication and supplemental steroids are working at exact cross-purposes. The Cushing's meds are trying to lower cortisol at the same time that the steroids are increasing them. I'm afraid this is not a reasonable drug combination at all, and I am very confused as to why your vet would prescribe them in tandem. :o :(

Before we go any further, can you confirm whether Gizmo is receiving actual Cushing's medication? Thanks so much!

Marianne

[Allison]

My husband is the main caregiver. According to his records, the main medications Gizmo receives are:
* Vetoryl
* Thyrosyn
* Phenobarbital
* Aller G-3 (fish oil)
* Super Joint Enhancer Tablets (glucosamine, chondoitin, MSM)
* Alprazolam

At times, Gizmo has also received other medications depending on what need arises. My understanding is that main one being used for Cushings is Vetoryl or at least this is the medication that was recently increased for that purpose.

As for steroids, we used them in Fall 2013 for successful treatment of his legs and no ill effects on the rest of his health. The steroids were used for only a few weeks. We started using them again recently with hopes that his back legs would regain strength again a second time, but that has not happened and so we have an appointment to talk with the vet about other options.

[labblab]

Dear Allison,

Thanks so much for returning and clarifying Gizmo's medication regimen. I now better understand the short-term use of the steroids, although their use in conjunction with the Vetoryl (trilostane) remains a bit of a management dilemma. As I said above, the two drugs directly compete with each other in terms of systemic steroid levels: one raises the hormone level while the other lowers it. If Gizmo's Cushing's symptoms have worsened since resuming the steroid (I am assuming it is prednisone?), they may quiet again once the steroid is discontinued since supplemental steroids can induce the very same symptoms as Cushing's. Gizmo's naturally-occuring Cushing's may not be worsening at all.

Can you tell us how much Gizmo weighs, and also what his Vetoryl dosing has been? Has his cortisol level been monitored via periodic ACTH stimulation tests? If so, recent test results will be really helpful for us to know.

I am interested in the phenobarbital and the alprazolam (Xanax). This implies that Gizmo suffers from seizure disorder. Can you also tell us more about that?

I am sorry for so many additional questions, but your answers will really help us as we try to sort out the best path forward for your sweet boy.

Marianne

[Allison]

Thanks for your questions and interest. I can answer some of your questions now but others will have to wait.

STEROIDS:
Regards the steroids, we only started them this month. His Cushings symptoms however started to flare up weeks ago. Most notable ones were increased thirst and hair loss, along with decreased leg mobility. When he lost all back leg mobility, we had him tested for deep pain and tried steroids.

WEIGHT:
Prior to January, Gizmo's weight bounced around 10 pounds. Since that time, his weight has started to decline. Right now, he's hanging around 9.5 pounds. Part of what has us wondering if he's getting worse is that he's gotten more tired, bonier, and accident-prone in recent months. This is the reason for my question about how one knows if a dog with Cushings has gotten worse.

VETORYL:
For months, Gizmo has taken 10mg of Vetoryl and been a happy dog. This year, the dose got increased to 30mg to control symptoms that had flared up.

OTHER MEDS:
Yes, I believe the phenobarbital is for seizures. I can verify that later when my husband is around.
The alprazolam is for anxiety. When we first fostered him, the dose was increased. For a long time, we were able to discontinue it, but at some point we started it again for his nerves.

CORTISOL LEVEL:
I'll have to check on this.

A huge issue for Gizmo remains complications. He's struggled with infections, kidney stones, pancreatisis. Also, as I mentioned, he's also basically blind and deaf.

Finding ways to give him a quality of life is a challenge. We did get some belly bands finally for Gizmo and really like them. Even the littlest ideas I'm sure would help make our household happier.

[Allison]

We will ask about cortisol levels at our appointment this week. The bloodwork results I have don't seem to include this.

Other updates:
* Gizmos's weight is now 9 pounds, a steady decline since January.
* We got belly bands. He seems to soak one every six hours. We're also picking up doggy diapers today too. His previous owner had just given us human diapers and those weren't overly useful.

I've decided to try to take Gizmo out in the yard more often to give him some qualify of life. He used to love walks, but we've had to take him in a stroller since he lost use of his legs. Given that he can't see or hear, we don't know if the stroller rides give him much meaning.

[molly muffin]

Hello and welcome from me too. Dogs are pretty resilient when it comes to their hearing and sight, as long as they have other interactions to keep them interested in their surroundings, so general play, which might be harder with his legs acting up.

With the increase from 10mg to 30mg I'm concerned about cortisol levels, because while you might increase due to symptoms if the numbers aren't in range, a small amount, you increased quite a bit. The cortisol that is naturally in their body, helps with the legs if there is pain.

So my question is what where the cortisol levels when you increased and what are they now? If the numbers are in controled range, before the increase in medication, then the increased urination and accidents might be caused by something other than cushings, such as kidney issues.

So, a few things I think we need to look at. Cortisol levels before and after drug increase, and urinalysis results including specific gravity, protein, etc, and any abnormal results on a cbc.
I'd think your vet would have these and you need only ask for a copy of test results so you can better monitor and keep track of how he is doing. (most of us do this and keep our own files to refer back to)

Okay that should get you started - Welcome! :)

[Allison]

I finally have lab results from March and am waiting to see if there were ones prior to this, so that I can compare.

Are there particular items I should list here? There are two pages of results and don't know if I need to post all of them.

Also, how would results for cortisol levels show? I don't see anything labeled as ACTH.

[Harley PoMMom]

Post all values that are marked abnormal, usually marked with a (H) which is high, or a (L) = low....e.g...ALT 150 U/L (5-50)

With an ACTH stimulation test there are 2 numbers; a pre and a post.

[LtlBtyRam]

Checking in on you and Gizmo. I will check again in the next few days to see if you got your test results posted.

Angela & Shasta & Family

[Allison]

Thanks to everyone who posted. Unfortunately, since my first post, the frequency of his pancreatic attacks has increased. Each has caused continued deterioration of his body, which meant treating pancreatisis has been our priority. This last attack left Gizmo so weak, we don't know that he'll recover. We're going to the vet again tomorrow. If there is a positive prognosis, I'll return with test results. Otherwise, I may have found this board a little too late. Thanks though for being willing to help.

[Harley PoMMom]

Oh no, I am so sorry to hear that Gizmo is not feeling well, pancreatitis sure can be difficult to control. I just posted to Marianne's thread regarding an article published in 2013 and written by Dr. Jörg M. Steiner, who is a guru when it comes to canine pancreatitis, here is a link to that article: http://www.wvc.org/images/session_notes_2013/2013_sa143.pdf

Hoping that today you will find that Gizmo has improved.

Hugs, Lori

[molly muffin]

I a. So sorry to hear that Gizmo is still suffering from the continued pancreatic attacks. I hope they can do something to help him. I am sure this is a very stressful time for al of you.
Let us know what the vet says today. Crossing fingers for positive news and prognosis.

[Allison]

Despite injections to treat his pancreatisis, Gizmo stopped eating and drinking and showing energy after this last attack. He was the strongest fighter imaginable, but we lost him today. Should we ever have a dog again who has pancreatisis, I'll know where to find help.

[judymaggie]

I am so sorry for the loss of your dear Gizmo. You and your family are in my thoughts and prayers.

[Harley PoMMom]

Oh my, I am so sorry for the loss of dear Gizmo and my heart goes out to you at this most difficult time. Please know we are here for you and understand the pain you are feeling.

With Heartfelt Sympathy,
Lori

[molly muffin]

I am so sorry to hear that Gizmo has passed. He sure was a fighter and went through so very much. Poor baby. His body probably just couldn't do it any more.

I send my sincerest condolences to you and your family.

[Allison]

Thanks to everyone for the condolences. It's really nice, especially given that I barely posted questions before suddenly my husband and I were facing the loss of Gizmo. My apologies that I didn't respond until today.

Your messages were most welcome. I've reread them every day since we lost Gizmo. I just didn't have the emotional energy to respond. He's greatly missed.

[Allison]

Judy, hi.

Thank you for your condolences and prayers. The first few days have been rough. For only having Gizmo for three years, he sure left a huge imprint on our lives.

Allison

[Allison]

Lori, hi.

Thank you for your sympathy. I wish I had found this site earlier, as I'm sure there would have been great support in our struggle to help Gizmo with his many ailments. He had such a zest for life, but also had so many knocks against him. We admired and loved him.

Allison

[Allison]

Sharlene, hi.

Thank you for your condolences. Gizmo was my sixth dog, but I don't know that ever a dog had so much passion to live. In the end, this fight came to just trying to survive and the past few months we saw how weak his body had become. It broke our hearts every day that nothing could be done to heal him. All we do was love him and spend time with him. It aches still to talk about, because he was such a character.

Allison