Newbie Seeking Advice for Casey Cooper Super Duper

[evolvedn2]

Hello Everyone,

I am posting in hopes for advice about our wonderful boy, Casey Cooper Super Duper. Casey for short :). I will try to summarize his story the best that I can...

He is a 15-16 year old mixed breed (American Bulldog, Boxer, Pit) that weighs around 45-50 lbs. He had a rough life until we adopted him about 4 years ago. He was "owned" by a homeless person so we assumed that he received subpar health care if any. He is a little reserved and stoic which is why we think he stayed in the pound for almost a year before we were fortunate enough to adopt him.

He was diagnosed with cushings about 16 months ago after having a stroke like event that placed him under the care of Blue Pearl in Virginia Beach, Va. They placed him on 30 MG of Vetoryl two times a day and he responded great. In addition to Cushings, he has arthritis and a heart murmur. He also has blood in his urine from time to time. He is taking Rimadyl (stopped this last night after finding this site), Tramadol, Dasoquin and recently prescribed Gabapentin for pain. He eats Royal Canine Gastro Intestinal food. On occasion, he will stop eating eat so we cook him chicken and rice then start re-introducing the Royal Canine when he seems ready for it.

He started having issues during our move cross country which was about 3 months ago. He became very lethargic, wouldn't eat, couldn't really stand, and starting having tremors. Luckily, we mapped out our route so we would stay near an emergency vet when possible. We took him to IndyVet in Indianapolis where he had a battery of test. He had very low blood pressure and a high heart rate which they reported as being confusing. He stayed in the vet for two nights before he was stable enough to travel and so they could do test on him. He had an ultrasound, spinal tap, heart monitor, and many blood work panels. He was discharged with instructions to discontinue the Vetoryl and follow up with a vet when we arrive in Seattle. He made the rest of the trip with no issues. Although my wife and I were a mess!

After arriving in Seattle, we started taking him to Seattle Veterinary Services in Kirkland. We placed him back on the Vetoryl and take him for frequent blood work and ultrasounds. They dismissed the heart issue and focused on his cushings. They recommend that we check ACTH every 3 months but if his water intake increases or has any other changes then we will take him in for a check up.

In the last month, he has started having tremors again. Every time we take him for ACTH, the vet indicates the results are fine. We had his ACTH testing 3 times in December all of which were normal. The last trip was because he stopped eating and was having tremors. The ACTH test reported good levels so our vet indicated that he is no longer responding to Vetoryl. They recommended stopping it or giving it once a day to see how he reacts. We tried stopping it completely but he just does not seem comfortable. While not on Vetoryl, he is drinking large amounts of water and asking to go out almost every 15 minutes. He doesn't seem comfortable at all. He paces and has labored breathing. I mean his breath rate is really messed up when not on Vetoryl. So we started him on 1 30 MG Vetoryl in the morning about 3 days ago to try and give him some releif. It seemed to be working until last night.

Last night, he was having major tremors but still responsive and eating, we stumbled across this site, thank goodness! We did the salt test which he passed so we just stopped the Vetroyl and monitored him. We also stopped Rimadyl based on suggestions on the site. He is much better today. He is eating, pooping, and has stopped the tremors. Our concern is that this is the calm before he starts displaying cushing symptoms again and he starts becoming uncomfortable. I have already reached out to our vet and we will probably take him in next week but after our last visit, they are suggesting an MRI as a next step which we are considering but we are not sure how that will help us. We are concerned because it seems that he needs the Vetoryl but at this point when we give it to him something bad happens and it seems our current vet is running out of options. We are concerned about quality of life and keeping our boy happy. We have struggled through the decision of euthanasia many times before and it breaks our hearts to even consider it.

So we are not sure what to do next, should we do an MRI? Do we have other options other than Vetoryl?

I don't have his last test results (ACTH and Ultrasound) in his file so I have requested those from his vet already. I should be able to post those tomorrow.

I hope that everyone has a great day and thanks in advance for any advice that you can offer.

Steve

http://1drv.ms/1IL3b8E

[labblab]

Hello Steve, and welcome to you and Casey! I'm very sorry that we are so late in welcoming you, but we are surely glad you've found us and I'm sure you will indeed be receiving more thoughts and suggestions from our members in the coming days.

I must offer a double apology because I do not have the time to write a more comprehensive reply right now. But I will come back later on today in order to give you a more proper welcome, myself.

Once again, I'm really glad you're here.
Marianne

[evolvedn2]

Hello Marianne,

Thank you for the response!

I hope to have Casey's latest test results later today to post which should provide more information for you. We had his cortisol levels and an ultrasound performed at the end of December. I will post those as soon as I can get the actual numbers from the vet.

Thanks again,

Steve

[evolvedn2]

I have inserted Casey's latest results. I am waiting for the doctor to call me back so I can let them know that his appetite is better and the tremors have stopped after stopping the Vetoryl.

Cortisol:
9/28 Pre 2.98 Post 4.71
11/23 Pre 3.56 Post 5.18
12/9 Pre 4.39 Post 4.66
12/23 Pre 4.07 Post 7.69

Test/Ultrasound on 12/23:
1. CBC/chemistry panel – Normal
2. Blood pressure – 170 mmHg (high), but he was nervous
3. Abdominal ultrasound – Intestinal irritation, incidental liver cyst, small bladder polyp, and big adrenal glands consistent with Cushing's disease.

[molly muffin]

Hello and welcome from me too.

The ACTH results are good and right where they need to be. Is that on the 30mg?
Is he taking 2 different pain meds currently? I think normally you take one or the other and yes, Rimydl is hard on the liver and not recommended, while tramadol which is safter can make them lethargic and loopy. So perhaps a decrease in that a bit if lethargy is a problem.

You could also try a split does, 15mg am and 15mg pm, but he does have good control with his current dose it seems. You could also try reducing to 20mg and see how he does on a lower dosage.

An MRI will show you if he has a macro tumor of the pituitary, which might be what they want to check for. This is normally done if radiation therapy is going to be considered to reduce the size of the tumor. MRI's can be very expensive and if treatment of radiation in case of a macro is not an option then some choose not to do the test.

Is he still doing well today?

[labblab]

I am finally back again, and remain very sorry that Casey has been having such a rough time. His condition really pulls at my heartstrings, because it is very similar to the dilemma my husband and I faced with our Cushpup, too. With our dog, we ended up strongly suspecting that the pituitary tumor that was causing his Cushing's was expanding and placing pressure elsewhere in his brain. We ended up feeling as though we were in a Catch-22 situation because without his trilostane, he was miserable due to his Cushing's symptoms. However, he was losing his appetite and desire to drink, and those were life-threatening problems that seemed to worsen when we continued giving him the medication. Our compromise was to give a lower dose of trilostane, but our boy worsened quickly and dramatically, and unfortunately we lost him before having the opportunity to really experiment with dosing options.

I don't want to scare you unnecessarily, but as Sharlene says, I feel certain that the recommendation for the MRI is for that same reason -- to see whether a tumor in Casey's head is expanding and forms the basis for these new problems. Also as Sharlene says, the imaging is very expensive. We ended up not performing it on our boy because we had decided not to pursue invasive therapy even if a large tumor was found.

In the absence of performing an MRI or CT (I believe CTs may be a bit less expensive), I think your best option is to continue experimenting with dosage just as you are doing. It may be the case that you can arrive at a level that can still keep him sufficiently comfortable without worsening the undesirable problems.

I can so easily understand how sad, worried and helpless you are feeling. I do think that if an expanding tumor is the problem, you will soon see even more evidence of worsening issues. We will surely hope that is not the case, however, and that the dosage tweaking will help stabilize things for Casey and for you.

Marianne

[evolvedn2]

Hello Sharlene and Marianne,

Thank you both for your responses.

I spoke to his Vet yesterday and she would like us to stop the Vetoryl until Thursday to see how our boy reacts. He is doing much better not taking the 30MG Vetoryl twice a day but our vet feels that is just a coincidence. She suspects similar to your thoughts that it is a tumor. We have also decided not to do invasive treatment so our vet is not really pushing for the MRI.

The confusing part is that we did have a CT scan completed in Indianapolis and it didn't show any clear signs of a tumor but they also said that it was not completely accurate in detecting them and they also suggested an MRI.

At the moment, we are just monitoring him until Thursday. He does seem comfortable which makes it easier. The good news is after speaking to the vet yesterday. She indicated if it is indeed the Vetroyl causing the symptoms (irregular breath, not eating, shaking, not able to stand well) that we could try a compound or adjust the dose like the two of you were suggesting.

Thank you so much for your responses. I will post an update on Thursday or sooner if anything should change.

I hope you both have a great day!

Steve

[evolvedn2]

Sorry, I didn't answer one of your questions. He was on tramadol and gabapentin for pain but we are currently (starting today) are testing him just with gabapentin. Tramadol made him lethargic and seemed to upset his stomach.

Does that sound better?

Thanks again, it really is comforting to hear your feedback. I am truly sorry that each of you have dealt with these same issues!

Stee

[molly muffin]

I think I would try just one pain med at a time to see how he does.

We've had others who said that tramadol seems to make their dogs sleepy, lethargic, wobbly, etc.

We'll be waiting to see how he is on thursday.

hmm, I think that if he had a macro tumor that it would show up on a CT scan. A CT scan is what places like University of Davis (California) uses for instance prior to starting radiation treatment.

[evolvedn2]

Hi Sharlene,

Thanks for the advice!

Casey seems to respond better to the Gabapentin so we are currently just giving him that...He was off the Vetoryl for 3 days and his Cushing symptoms returned as expected. He was up to 12 cups of water a day which seemed like a lot to us. We just started tracking his water consumption after finding this site so we really don't have anything to compare it to. He also was restless, had a few accidents, and vomited which may have been related to consuming too much water to fast. He was however eating and some what interactive.

So we gave him one Vetoryl this morning (one day early) after he ate and will monitor him to see if his tremors and poor appetite come back.

We spoke to the Vet again and she suggested that we take this course of action and defer the MRI until we can find out if we think Vetoryl is actually causing the lack of appetite and tremors. He was great while off of it so we expect that it is the Vetoryl.

Are we being too sensitive do his water intake and restlessness when he is off the Vetoryl? Should we ride it out longer? He just seems uncomfortable when he is not on it then add in the increased water and then when he vomited that freaked us out so we placed him back on it. We are also worried because he had a stroke like event over year ago when he was off the Vetoryl which was terrible. I think that lingers in the back of our mind.

I wish that he could talk!

Any feedback that can be provided is helpful.

Thanks again,

Steve

[molly muffin]

An ounce of water per body weight is the norm, that can be a bit up or down of course, but that is an average to watch for.

See how he does, and then you have a plan in place, the split dosage or go a bit lower even depending on the reaction from restarting the vetroyl.

I don't worry too much about them over drinking when they have cushings, as they need the water because their kidneys is working over time. That does usually clear up eventually as things settle down in their body and evens out.