Is it time to let him go? (Buddy has passed)

[flightsimmer]

I have a miniature pincher named bud, for buddy.
He is anything but miniature at nearly 40lbs.
He has been diagnosed as having Cushing's desease.
We do not know if it is adrenal or pituitary, no ultrasound taken.
He has most of the classic symptoms but he doesn't throw up.
He has been on Vetoryl 10 mg two times a day for some time.
His worst visable problem is that he cannot stand, he is just too weak.He used to crawl some but now he isn't able to do even that and he doesn't even maneuver around without great difficulty so I carry him around on a rug so that he can be where we are in the house.
He whines sometimes, mostly at night and we give him Tramadol 25mg for pain and it seems to help.

I had to have his mate, Missy put down because of kidney failure and it like to kill me. I cried and cried it seemed like forever and I don't want to do that with bud, but it's beginning to look like I'll have no choice.

Is there anything to help him get his strength back or is it just to late and I need to let him go?

[labblab]

Hello to you and Bud. I am so sorry about your loss of Missy, and I surely understand why you are so worried about Bud right now. You say that he has been taking 10 mg. of Vetoryl twice daily for quite some time? Can you tell us more specifics about his testing and treatment history? I am especially wondering about the results of any monitoring ACTH blood tests performed since starting the Vetoryl. This is the test that tells you whether or not this is the correct Vetoryl dose for Bud. If his cortisol is running either too high or too low, that could be at least partly responsible for why he is doing so poorly. Thanks in advance for this additional info, and I'm really glad you've found us.

Marianne

[mytil]

Hi and welcome to our site.

I agree with Marianne on this - it could be that the cortisol levels are not being controlled or have fallen too low. When you can post the results of the most recent ACTH test - and ask your vet if his electrolytes need to be checked too. If there is an imbalance there, it could be at least one reason why he is so weak.

How old is Buddy? You said he has been on this dose for some time now - does he have a lot of symptoms still?

What has your vet indicated on why he cannot stand at this point?

I am so very sorry about your Missy. I know first hand how painful this is to make this decision and miss them so very much.

Don't give up hope yet
Terry

[flightsimmer]

Hi and thanks for the reply.
Bud is about 10 or 11 years old, not really old, old as far as I can see.
He has been on Vetoryl for maybe 6 months, I hope that's about right.
He has had at least 2 ACTH blood test and his cortisol levels were acceptable at that time but the test are just so expensive, around $240 a pop.
He had another blood test for liver and kidney function about 2 weeks ago and they were high but I believe she said, not that unusual for his age and history. That cost me another $300+ that I cannot afford to continue plus,
he's on a special canned food diet that is costly.
To be more accurate I should get a copy of his records.

I don't recall the Vet offering any specific help for the weakness accept more blood test

It's not about the money entirely although I spent somewhere between 3 & 5 thousand on Missy and still lost her. Bud is my friend and I hate to see him suffer and not be able to do anything about it or do the wrong thing and hurt him.
Thanks for your attention.

[flightsimmer]

I have contacted the Vet for answers to the questions you are asking and will get back to you as soon as I get them.
Thanks.

P.S. He has the shakes so I'm thinking his nervous system is effected also.

[Budsters Mom]

The money thing is reality.:o:( Many of us have, or are suffering with it now. I spent thousands of dollars on my little Buddy fully aware that he was dying and there was nothing I could do to save him. I did what I felt I needed to, to help him as feel as comfortable as possible for as long as possible. I would do it again in a heartbeat, but it was not easy and I totally sympathize with your situation.

Sometimes it does get to the point where enough is enough. Finances are drained, pet parents are exhausted and fur babies are suffering. There is no judgment here. We understand the situation you're in and many of us have been there. It is a sucky place to be. Know that you're not alone and whatever you decide to do, we are here to support you.

Hugs,
Kathy

[labblab]

From what you are describing, one of my biggest worries is that the Vetoryl may be driving Bud's cortisol too low or otherwise unbalancing the ratio of potassium and sodium in his body (an Addisonian condition). I surely do understand the financial constraints, but I honestly must warn you that it is not safe to continue to give Vetoryl to a dog who is behaving unwell unless monitoring blood testing is done to ensure that drug overdosing is not the problem.

Given Bud's almost total lack of mobility and tremoring, I actually believe it is safer to discontinue the Vetoryl entirely right now if ACTH testing is not an option for you. Continuing to give Vetoryl to an Addisonian dog is life-threatening. At this point, I don't think this is a reasonable risk to take, considering how ill be sounds.

Marianne

[mytil]

Thanks for getting back to us with some additional information.

From what you describe I would really consider stopping the Vetoryl. I would contact your vet and tell them you will be stopping until this is sorted out. You can always start back up again if necessary.

Looking forward to the test results information.

We all know how incredibly expensive this is and the toll it takes.

Terry

[flightsimmer]

Yes! I had considered taking him off of Vetoryl for a while to see how he would respond. He is now off of it at least until I see a positive change in his behavior, may take a month or more but, as I have read, Cushing's disease is generally not life threatening where as Addison's disease is life threatening.

If he recovers enough to walk and get around (Oh, I hope he does) then I'll see about restarting him on a much leaner dose, like say 1, 10mg pill every two or three days instead of the 2 pills every day that he has been on.

OK, let's see what happens and thanks for your encouragement.
I'll keep in touch.

[mytil]

Thanks for the update.

I would see, if you can, about getting another ACTH test just to see the current amount of cortisol levels in his system. You can ask your vet to spread this payment out. I have done that before myself. If this is not feasible, I would discuss with my vet about giving him prednisone. If his levels have fallen too low and this is an Addison crisis, this will help replace the cortisol he needs.

Keep us posted
Terry

[flightsimmer]

Mr Freeman,
I can copy your lab results for you tomorrow morning. Buddy's Potassium on his last blood work was in the high normal range and his sodium was in the normal range. Without a ACTH or a resting cortisol, it is difficult to know if he is Addisonian or not. His last cortisol level was normal and not low like it would be with Addison's disease but that test was taken in July. His alk phosphate is elevated from prior lab work which can occur with Cushing's disease but other things can cause that too.
His weakness based on Dr Blake's exam appears neurologic but we can't rule out weakness. Since you have stopped the trilostane, we can see if he improves over the next few days. If he is not improving, I would recommend seeing an orthopedic specialist to evaluate his lameness.

Hopefully this helps. I will be in the office tomorrow.

Dr Sarah Jarrell

[flightsimmer]

I'm curious, do some other dogs with Cushings disease develop tremmers or weakness like bud has? His electrolytes seem to be in the normal range.
But just like people, some may be allergic to the meds.
He is alert and seems normal except for this.

[molly muffin]

That is good that the electrolytes are in range, but even if the results were normal on the test in July, it is now 5 months later and things can change quickly.

If he improves off the trilostane, then there is a good chance that his levels where too low for him. As you said he is not an older dog for his breed, so there is definitely something going on.

If I had to choose testing at this point, it would be a follow up ACTH, and an ultrasound if feasible at some point to see if there is another cause for this.

My dog, if her cortisol is too low for where she is comfortable, exhibits problems with her legs. This is entirely based on her specifically, as where any dog is comfortable at could be different and quality of life is most important.

Give it some time and see how he does and as soon as it is possible to do so I'd get the ACTH.

[flightsimmer]

OK, thanks.

[Gatorlmc]

Has he been tested for hypothyroidism? My Abby could not even walk, I had to carry her everywhere and help hold her up to use the bathroom. Once I wound up at the Vet Specialists they found that not only was she severely cushinoid she also was hypothyroid. After just a few days on thyroid medication she regained mobility! Almost like a miracle!

[flightsimmer]

Okay I just set up an appointment to have a full blood workup done so we can find out what's going on with him, thanks

[molly muffin]

Great. Let us know what the blood work shows (ask for copy when the results come in)

Most of us keep copies of tests because we are such worriers, that we tent to revisit and compare all the time to see how our furbabies are doing.

[flightsimmer]

Well, I'm supposed to get the test results back tomorrow, Tuesday, I hope we find out something and we can help him.

[molly muffin]

Did you get the test results back today?

[flightsimmer]

I called them this evening and they said some of the test we're back but not all of them, they would call me tomorrow and let me know what they found.
I'm anxious to see if buddy can be helped.

[addy]

Make sure to ask for copies of all the test results be emailed to you:)

Always good to have a file!

[flightsimmer]

I did. They will.

[flightsimmer]

Ok, we got Buds test results back today. His cortisol level is 14.7 the reference range is 1.0 - 5.0 and his addon free t4 ed, whatever that is or his free t4 equilibrium dialysis is 12.9 and the reference range is 8 - 40 so the veterinarian said that he didn't have any thyroid problems at all so that leaves us with the question, what else could it be?

She said that the only other things that she could think of were things that we could do nothing about, like tumors, ect, ect. and we might have to enjoy him while we can because his prognosis doesn't look good.

Frankly, I'm going to pray for him. It has helped me many times.

[labblab]

As you can see, 14.7 is way higher than the reference range of 1-5 for his cortisol. Given the range and the single number, I am guessing that only the resting baseline cortisol was tested as opposed to a full ACTH stimulation test. Baseline cortisols can vary widely even in healthy dogs, but given the high elevation of the result, I have to wonder whether at least part of Buddy's problem has been that his Vetoryl dose has been too low in recent months rather than too high. For sure, he is not Addisonian. It is not considered to be safe to increase Vetoryl dosing on the basis of baseline cortisol levels alone. But I'm wondering what your vet had to say about that reading.

Marianne

[flightsimmer]

Quote,But I'm wondering what your vet had to say about that reading.
Unquote.
As I recall, she just said it was high.

My concern at the moment is that she said we could start him back on Vetoryl, but, one of the listed side effects is "collapse/weakness". I take that to mean that they don't have the strength to walk or get around.
If that's the case I don't want to do it.

I want to see if he gets his strength back, if possible.
What do you think?

[flightsimmer]

I contacted Dechra-us.com, the makers of Vetoryl and ask them if Buddy would recover from these side effects and how long might it take, if ever.
Waiting for a reply.

I'm not going to restart his medication. He's better off without it.
We'll have to find another way to control his Cushing's disease if there is one.

[Lpearce]

My dog had a very similar reaction to Vetroyl. She got weaker and eventually could not walk. We had to carry her outside for potty and inside she would drag her back end and then collapse. And her ACTH tests were not low. It was heartbreaking. We discontinued Veteroyl and she regained all her strength back in a week. So she is now currently not being treated. At least she can walk. Veteroyl has worked great for many Cushings dogs but some dogs don't do well on it. Good luck to you.

[flightsimmer]

I hope these are good signs.
Today buddy crawled out of his bed in the living room and made his way all the way down the hallway towards the bedroom while we were gone.
That's about 20 or 25 feet.
He hasn't moved that much in a month, I hope he's getting stronger.

[mytil]

That is very good to hear about his mobility, energy and interest. Please continue to keep us posted.
Terry

[Budsters Mom]

YAYYY for Buddy!!!!! We celebrate baby steps around here! :D


Today buddy crawled out of his bed in the living room and made his way all the way down the hallway towards the bedroom while we were gone. That's about 20 or 25 feet.
He hasn't moved that much in a month

[molly muffin]

That Is progress. Hopefully he will continue to do better and better.

[flightsimmer]

He got an upset stomach yesterday and he's still feeling punk today.

If he is able to recover and get his strength back then what else can I do about the Cushing's disease? The Vet hasn't said anything about that.
I haven't found any alternative treatments online.

Oh, he just threw up again, gotta go.

[flightsimmer]

Bud threw up again this evening. I'm getting concerned that he may be getting dehydrated and that could cause kidney failure. I hope not, I'm pushing the water on him.
He doesn't even want to look at food, even the really good stuff.

[lulusmom]

If Buddy continues to vomit and you have to force water into him, your concerns with dehydration are very much valid. If you don't see any improvement today, I highly recommend that you at least have the vet check his hydration status as this can become life threatening very quickly.

Glynda

[molly muffin]

How is Bud doing today? Is he still throwing up?

Baby steps, first get him stable and back on his feet and more himself.

[flightsimmer]

I'm sorry to report that my Buddy is gone.
His kidneys had failed to the point that there was nothing left that the Doctors could do for him and we had to let him go.
He will be missed and remembered just as Missy is.

I'm satisfied that we did all we could for him.
It's just to bad that he had an adverse reaction to the Vetoryl.

Thanks all for your support, it is appreciated.

[Harley PoMMom]

I am so sorry for the loss of dear Buddy and my heart goes out to you. You and your family are in my thoughts and prayers.

With Heartfelt Sympathy,
Lori

[labblab]

I am so sorry for your loss of sweet Buddy. Thank you so much for telling us what has happened, though, so that we can always honor Buddy here. If we can be a comfort to you, as well, please do return at any time to share memories or just to talk.

My heart goes out to you tonight,
Marianne

[Budsters Mom]

I am so very sorry for your loss. :o

Buddy has joined our other fur angels at the rainbow bridge. They will watch out for him now.

We will remain here to support you.

Fly Free Buddy, fly free!!

Hugs,
Kathy

[flightsimmer]

Thank you very much and again thank you for your support.

[judymaggie]

I am so sorry for your loss of Buddy. My thoughts and prayers are with you during this difficult time.

[molly muffin]

My sincerest condolences. I know we had all hoped thst Buddy was recovering.
I am truly sorry.

[Tammysmom]

Adding my condolence along with others on the forum. Buddy will live forever in your heart. I will pray for you. Brianna

[Tina]

So sorry to read that you have lost Buddy. My deepest sympathy.

Tina

[mytil]

I am so very sorry!!!!! I know you did what you could for your sweet boy. Thank you for letting us know. You and your family have my deepest condolences.

Deep peace of the quiet earth to you Buddy, deep peace to you.
Terry

[spdd]

I've been following your story of Buddy, and I'm so very sorry. Thinking of you in the days ahead. My sincerest condolences.

[My sweet Ginger]

I'm so sorry for your loss. I hope you will find comfort in knowing that Buddy no longer is in pain. RIP sweet Buddy.

[SandyH]

I am very sorry to hear about Buddy. My thoughts are with you.

[mcdavis]

So very sorry to hear of the loss of your Buddy. I was following your story and, as others have said, you did everything you possibly could.
My thoughts are with you.

[Gatorlmc]

I'm so so terribly sorry for your loss.

[flightsimmer]

I'm having a hard time with Buddy, I miss him so much.

[Harley PoMMom]

Gosh I am so sorry, it is hard letting them go and we sure do understand how you are feeling. Just know we are here for you, always.

Sending huge hugs, Lori

[labblab]

I just want to "second" Lori -- please know that you can return to us at any time, especially if it would help at all to write about what you are feeling or to share some memories of your life with Buddy. Each of us who has lost a furbaby understands completely how much it hurts. We also know that not everybody in the outside world does understand. Many people expect you to just "get over it," because after all, this was "just" a pet :o. I know that, for myself, I grieved harder over the death of my dog than I had ever grieved for anybody or anything else in my life. So this is truly a safe place to return, any time at all, to talk to people who understand.

Sending you continuing hugs across the miles, always in loving memory of your sweet boy.
Marianne

[Budsters Mom]

It's the triggers that get me, even still. I'll find a hidden toy or favorite Chewie (or Rosie will). He isn't sitting in the window waiting for me when I come home. No smiles. So many things. Grief comes in waves, usually triggered by the smallest, but most meaningful things.

Your Buddy passed recently. Give yourself all the time you need and know that we understand. :o

Hugs,
Kathy

[mytil]

I certainly agree - we are all here for you!!!! I also know firsthand this tremendous numbing grief; many here have. Please lean on us for support.

My continued (((((hugs)))))
Terry

[flightsimmer]

"It's the triggers that get me"

Yes, I'll be doing just fine and something will set me off crying.
Well, I've always been emotional about some things.

[Budsters Mom]

If you are truly doing fine until some things sets You off, you're doing much better than you think!;) I was a basket case. I was totally numb. I didn't sleep, or eat much of anything for several days. I left my purse somewhere and have no idea where I lost it because I don't even know where I went during that time. So again, you are doing much better than you think!;)

Coming here and talking with friends that understood, helped more than I can express. All of this takes time. If you stick around, you'll find out that ever so slowly it will get easier.

Kathy


Yes, I'll be doing just fine and something will set me off

[molly muffin]

That is the real bugger when you think you are recovering then something sets off the tears.
The heart just isn't ready as much as your mind might think. Logic and grief are not always in sync. In dp fact I'd say seldom are so take what time your heart needs.

Share stories of Buddy. Talk about him whatever works till one day you find more smiles than tears when thinking of him.