Mini Poodle assumed cushinoid; given Vetoryl - Please help us [Archive] - Canine Cushing's Information and Support Forums

GoldenAngel

03-23-2016, 12:13 AM

UPDATE

Hi everyone! So just a big update on my little girl and needing your wisdom once again.

My baby isn't doing well. She's been seeing an internologist and getting checkups regularly and blood work and ultrasounds.
She's now at around 11.8lbs and very thin and extremely picky eating. She's eating 90% chicken and picks at other stuff. Spits things out she doesn't like. She's on 5mg of Vetoryl, Ursodiol, Famotidin, liver supplement (forget the name) and I forget the name but it's a human antipsychotic that's used in pets to stimulate appetite. She used to be on pain meds and anti-nausea meds to see if it would help appetite but no change so we gave those up.
She seems like a happy girl, just less energetic. More sleepy but still gets perky and engages with us well.

Ultrasound results: Her pancreas keeps looking brighter and brighter each ultrasound which is concerning. Treated for pancreatitis (low fat diet) and no effect. Her intestines are a bit bright suggesting extra fat deposits... a bit concerning. Lymphoma is a possibility but to find out they have to knock her out and scope her which terrifies me. Tumors aren't suspected because bright areas are general.

Blood results: two kidney values are concerning and suggest her kidneys are on their way down. Getting re-checked to see if they are worst this Wednesday as this is a more recent issue. Her liver is still high levels but stable so Ursodiol is working thank god.

So at this point we still haven't increased her Trilostane dosage because at fist her liver was concerning and now it's the weight and not eating. WHAT DO WE DO? Vet says increasing trilostane can make her lose more weight and she's extremely thin as it is. But I wonder if allllll these problems are because her Cushing's isn't fully controlled? She was at around 400 I think last ACTH test. What do you think? I'm scared we're killing her! :'( Maybe she has cancer hidden somewhere why else would she get anorexic? Should we "scope" her or do biopsies? I really don't know if it'll tell us anything that's treatable and with her condition I'm scared about recovery... and Vet even said we might still find nothing.

We'd do anything for her. I'd rip out my organs for her. I would die for her... we don't care about $$ we just want her healthy. :'( What do you think we should do?

Sorry for the long post and eternal thank yous to anyone who reads it </3

http://oi68.tinypic.com/15zox6p.jpg

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First Post from March 22nd:

Hi everyone, my 11-year-old baby girl (Miniature Poodle - 15ish pounds) is named Piros (Peerosh). Please help us decide if we are making the right decisions to treat her symptoms. We live in Canada and it appears as though she has Cushings and vet prescribed Vetoryl... but I've read the side effects and they are pretty scary! Is this the best thing we can do for Piros? Can we do anything to monitor her to prevent a tragedy? Like sudden death/collapse/crisis/adrenal necrosis etc omg. I don't care about $$ I just want to give her the best chance. We just picked up meds today but waiting for your replies before administering.

DETAILS:

I had noticed a pot-bellied look on her inApril 2015 but the vet did wellness bloodwork and xrays and said she was fine (ALT was elevated = 341. PLT=550. PCT=0.58). Weight =15.6lb

In October I went to a different vet because her pot belly was still concerning me and they did bloodwork and said the liver was "stressed." ALT=520 (worst from April) PLT=505 + PCT=0.53 (better). Weight=15.2lbs. Recommended low-protein diet to help liver.

January - Her hair is thinning. Skin is dry. ALT=418. PLT=512. PCT=0.54. Suspecting Cushings. Alk phostphate levels normal. ACTH Test: Cortisol pre=209H post= 1247. Weight = 14.4lb. Blood tests apparently "inconclusive." Ultrasound showed an enlarged liver and "huge" adrenals. Stick to low-protein diet. Given s-adenosil tablets to help too. Has a hard time jumping on furniture.

February - Hair looking thin/mangey. Skin really dry. Really pot bellied and rest of body looks really thin/skinny. Thin, dry, flaky skin. Massaging her with coconut oil to moisturize. Vet prescribed Humilac and fish oil. Can't jump on furniture anymore.

March - Weight 13.8lb. Low dose Vetoryl prescribed. Normal dose is 30mg but she'll start at 10mg an increase in 10 days. She seems wobbly like she's weak and wasting away. Same pot belly. Has a urinary tract infection so given Baytil antibiotics. Has had two utis since December and received antibiotics.

She is drinking up to 16 ounces of water a day, but I hear 1 ounce / lb is normal so that's not too much is it? She is hungrier than she used to be a year ago but still really picky so she only wants the "tasty" stuff. She's really losing weight and muscle tone. She's always peed often so that hasn't changed to suggest she's going more often.

Is Vetoryl the answer?? Is it life-threatening should I be scared :'(

labblab

03-23-2016, 09:54 AM

Hello and welcome to you and little Piros, although I'm sorry for the problems that have brought you to us. We surely understand why you are feeling so worried, and it is certainly true that Vetoryl (trilostane) is a powerful drug that must be respected and used properly. However, catastrophic events such as sudden adrenal necrosis are very rare. When dosed and monitored properly, most serious side effects can be minimized or reversed. We have many dogs here who have done very well on trilostane, and who have returned to normal activity and behavior. For dogs with Cushing's, trilostane and mitotane (Lysodren) are the two drugs that offer the most effective medical treatment that is available at this time.

One of the really tough aspects of Cushing's, however, is establishing an accurate initial diagnosis. There are many classic symptoms, but not every dog will exhibit every symptom or even many symptoms. In Piros' case, she does display many consistent symptoms. The absence of a few are a bit surprising. For instance, you note excessive urination but not excessive thirst, and a picky appetite. Also, her ALT is elevated but her ALKP is normal -- I suspect you already know that the ALKP is usually always elevated in Cushpups. So there are some oddities alongside the consistencies. Yet, overall, Piros has the appearance of a Cushing's dog.

Turning to the lab tests, you state that the blood work is "inconclusive." Yet, if you are reporting her ACTH results in units of nmol/L, a post-ACTH result of 1247 (converts to approx. 45 ug/dL) is very highly elevated and "positive" for Cushing's. Is that truly the correct number? Also, out of curiosity, is her thyroid level (T4) within normal range? Hypothyroidism and Cushing's can share many similar symptoms.

I guess the bottom line for me is that if the ACTH result is actually the number you typed above, personally, I would consider Cushing's to be likely even in the face of some of these inconsistencies. My other thought would be some sort of primary liver issue, but you've had the ultrasound and apparently it did not reveal any liver problems that couldn't be explained by Cushing's. So, yes, I do believe trilostane treatment is a reasonable next step. And I'm especially glad you are starting at no more than 10 mg., and actually, that dose should not be increased until Piros has had monitoring testing performed after one month at that dosing level. Recommended dosing amounts have been lowered within the past year or so, and your vet may not yet be aware of this. But we can talk about that more later. In the meantime, here's a link to a technical brochure published by the maker of Vetoryl that will give you a wealth of info about the medication:

http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf

I'm sure other folks will also soon be by to welcome you and to offer their thoughts, some of which may differ from mine. But that's the beauty of a forum like this -- you get to hear things from many different perspectives. ;)

And once again, welcome!
Marianne

GoldenAngel

03-23-2016, 11:56 AM

Hi Marianne, eternal thank-yous for your fast and thorough reply; it means the world to me. Yes, the vet wrote in her notes that alk phos is strangely not elevated but that the ACTH test is suggestive of cushings with exaggerated cortisol levels. Her weight loss is really scaring me as well because she looks so frail now and sometimes even wobbles a tiny bit.

ACTH Test Results:
CORTISOL (PRE) 209H 28 - 120 nmol/L
CORTISOL (POST) 1247H 220 - 550 nmol/L

T4 in October:
TOTAL T4 13.3; 13.0 - 53.0 nmol/L
Vet notes: "T4 is low"

So if I'm reading these results correctly, yes it's reported using nmol/L and the range they are giving is the normal range it should be. So her cortisol is really high and the T4 is "low" but within normal range.

With Vetoryl, do the serious side effects potentially occur just at the beginning of treatment or are they always looming? Meaning if she doesn't show serious side effects in the first few weeks is she out of the woods? I'm starting the brochure now! And thank you Marianne I'll definitely wait for a month and have her tested first before increasing the dosage.

Edit: Brochure says we should be sure whether it's pituitary or adrenal cushing's. Should I be telling the vet we want to find out?

Thanks from the bottom of our hearts,
Laura & Piros

budindian

03-23-2016, 12:49 PM

Please keep coming and asking questions, this is a wonderful forum.
I think the hardest part is getting the Vetoryl at the right dosage for your baby. 1mg per pound. I don't think I ever got the correct dosage but coming here and getting help and advice I know I was close.

molly muffin

03-23-2016, 09:46 PM

Hello to a fellow canadian. :)

The ultrasound showed bilaterally enlarged adrenal glands which is suggestive of pituitary cushings. If it is adrenal cushings, then normally one gland is larger than the other, caused by a tumor on the gland.

I would not Expect side effects starting at 10mg per day. I guess my main thought is to wonder if there is a liver problem (ALT raised but not ALKP) that is causing the cortisol to rise.
You want to watch for, in any case, diarrhea, vomiting, wobbly - can't stand, won't eat.

Since high cortisol can cause a variety of problems if left uncontrolled, starting vetroyl/trilostane seems the reasonable thing to do. With that high of cortisol I would want to have her Blood Pressure checked regularly, and also her kidneys, for any kind of protein loss or other issues that can develop. Those are sort of the stand by along with regular blood test to check how those values are doing.
You said you are give in s-adnysol, but you might want to consider adding in a milk thistle for the liver. My internal medicine specailist also added in recently vitamin e for the liver. I give her a treat that contains the omega 3's and the vitamin e.

Welcome again! I'm in Ontario also.

GoldenAngel

03-24-2016, 01:42 AM

Thank you Bandit's mom and Sharlene! :) Nice to know I have a neighbor! We're from Hamilton. :)

Ok we'll be brave and start our little one with Vetoryl in the morning. We'll guard her with our lives. I'm worried about her liver as well... ok I'll grab those things for her! (I did hear milk thistle was good) Especially since she's on antibiotics for her uti now, too, I hope it doesn't get stressed any more. :(

I felt so lost and alone before I found this place... thank you all for not letting Piros and I go through this on our own. <333

~ Piros & Laura

EDIT: I've been reading till my eyeballs fell out and it looks like the most life-threatening symptoms are hypocorticism and adrenal necrosis/rupture. Sounds like they can happen suddently without warning. Is there anything that can be done to detect necrosis before it can be deadly? Like, should she be getting an ultrasound again or something? I think we might camp outside the vet emergency office for the next few weeks! Hehe I know I'm overreacting... such an overprotective mom! :S

molly muffin

04-01-2016, 09:43 PM

GoldenAngel

04-07-2016, 01:21 PM

Hey neighbor! How is Piros doing? You started treatment?

Regular testing follow up (ACTH) help to gauge how the adrenal glands are doing. I usually do ultradsounds anywhere from once to twice year to keep an eye on things.

Looking forward to hearing from you.

Hey neighbor!

Thanks for the tips and for checking in. That sounds great, that's what I'll do too. Piros is on her 13th day of the 10mg Vetoryl and thank the stars everything is ok! She's drinking about 11 ounces of water when it used to be up to around 16 ounces, and she rarely if ever wakes us up to go out to pee at night (used to be at least once or twice or even 3 times). Vet didn't want to do an ACTH test until I insisted (it's so expensive omg... but that's what Vetoryl manufacturer recommends right??) so she's going in for that today plus checking her electrolytes and doing a wellness blood test to check other stuff to make sure everything else is ok.

Only thing that scared me recently is a huge bruise (size of 3 Loonies) on the inside of her knee that was black/purple/red. She's had others too but not as bad. I'm scared it's her liver but I guess the blood tests will show! :(

Please cross you fingers for us so that her tests turn out ok!! :)

Harley PoMMom

04-07-2016, 05:11 PM

Piros is on her 13th day of the 10mg Vetoryl and thank the stars everything is ok! She's drinking about 11 ounces of water when it used to be up to around 16 ounces, and she rarely if ever wakes us up to go out to pee at night (used to be at least once or twice or even 3 times). Vet didn't want to do an ACTH test until I insisted (it's so expensive omg... but that's what Vetoryl manufacturer recommends right??) so she's going in for that today plus checking her electrolytes and doing a wellness blood test to check other stuff to make sure everything else is ok.

Don't know if you're aware of this cost saving tip for those expensive ACTH stim tests, so I'm pasting it here:

The blood test needed to monitor treatment is the ACTH stimulation, and unfortunately it is costly because of the stimulating agent. Most vets use Cortrosyn as the stimulating agent and we call it liquid gold because that's what drives the ridiculous price. Those ACTH stim tests are very expensive but very necessary. One question I would ask the vet is what stimulating agent they use. And depending on how much Panda Bear weighs there is a cost saving tip on saving money on those stim tests. You see, the vial of Cortrosyn is .25mg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5mcg per kg is all that's needed. Some vets are not aware of this so we always provide the url to Dr. Mark Peterson's blog which instructs vets on how to dilute and store Cortrosyn for future use.http://www.k9cushings.com/forum/showpost.php?p=69247&postcount=61 so I would ask the vet if s/he is doing this.

And you are absolutely correct, a monitoring ACTH test is recommended, by Dechra, to be done 10-14 days after treatment begins. Dechra also recommends having a chemistry blood panel done to check the electrolytes, liver and kidney markers...etc.

Only thing that scared me recently is a huge bruise (size of 3 Loonies) on the inside of her knee that was black/purple/red. She's had others too but not as bad. I'm scared it's her liver but I guess the blood tests will show! :(

Please cross you fingers for us so that her tests turn out ok!! :)

Dogs with Cushing's are prone to bruise easier but I would have the vet check her out.

All finger and toes crossed that we get good test results. ;)

Hugs, Lori

molly muffin

04-07-2016, 07:15 PM

If they are sending results to the IDEXX lab then they have shared the protocols for dividing the bottle with vets. Or at least they did so with the ER hospital on Bristol Rd Mississauga Oakville that I use.

Yes I'd have the vet take a look at that bruising too. I know they get them from blood draws quite often.

GoldenAngel

04-10-2016, 09:54 PM

Thank you so much Lori about the info on splitting the vial! I'll speak with my vet about that for sure.

So the results are that her cortisol levels were much better. Not ideal but at a very good number. BUT her liver values that apparently should have gotten better with the Vetoryl actually got worst. :( So the vet is halving the dose to just 5mg (Piros is just under 14lbs). She thinks the bruising is just from a very hard bump because she's fine with her clotting factors.

I'm starting to get very worried about her liver because it seems to continually be getting worst! :( Vet was in a hurry on the phone with me (as usual) so I didn't get to talk to her for long... and I asked them to send me the test results which they said they won't do till next week when the vet is back... wtf. So I can't post them here yet.

So here we are, with half a dosage of Vetoryl and a stressed out liver (and mama!!). Don't know where to go from here... she's due for another blood test in two weeks as per the vet. I'm also taking her to another vet after I get her tests for a second opinion because I'm scared about her long-term health! :(

Sharlene, and any other Canadian; do you get 5mg pills? From where? Our Vet says the lowest dose their supplier gives them is 10mg so we've had to tamper with and split the 10mg pills to give her 5mg... which is ridiculous and inaccurate!!

labblab

04-11-2016, 07:52 AM

I am really sorry that things are not going smoothly for you guys. But your own instinct about splitting the 10 mg. capsules is correct -- your vet should not have advised you to do this for the very reasons you cited -- it is unsafe, inaccurate, and may also render the drug's effect inactive if it is being absorbed before entering the stomach (like if you are sprinkling it on food that is being chewed in the mouth). If you truly need a 5 mg. dose and the 5 mg. capsules are not available in Canada, then turning to a compounding pharmacy to custom make capsules/tablets would be the safer route to go. I know that Sharlene's vet prescribes to a compounder on her behalf.

But I'm also concerned about the decision to lower the trilostane dose, anyway. If Piro's cortisol level is still "not ideal," that implies that the drug had not yet reached a high enough dose to be truly therapeutic. So why would your vet lower the dose instead of increasing it? If his concern is that Piros has some type of primary liver damage that is separate from Cushing's and that is being worsened by the trilostane, I would think he would want to halt the drug entirely and pursue additional liver diagnostics. So cutting the dose in half doesn't make sense to me, either way.

You say the vet will be back in the office this week? If your phone conversations with him are unsatisfactory, perhaps you can book a brief appointment time to talk with him personally, without even taking Piros along. At that time, you can obtain copies of all the actual test numbers and also clarify his strategy going forward. And also make clear that given the manufacturer's specific warning to never open and split Vetoryl capsules, you need a different alternative if there is truly a good rationale for shifting to 5 mg.

Marianne

molly muffin

04-11-2016, 10:29 PM

Ugh, halving the dosage will cause the cortisol to rise, not go lower. Which makes me really wonder what that test number was.

I can't remember if you are on a liver support, but I'd try, sam-e and milk thistle to help with that. Something like Zentonil advanced has both in it.

Our liver numbers keep going up to and that is with control of the cortisol.

I haven't seen any place to get 5mg of vetroyl here. You can buy the 10mg and get a compounding pharmacy to compound them down to 5mg for you. Or just order compounded 5mg of trilostane, which is what my IMS does for us. But I'd want to know what the numbers are really so you know yourself where the cortisol is at.

GoldenAngel

06-10-2016, 09:21 PM

Hi everyone,

Thank you so much for your replies. I've been going to two separate vets just to always have a second opinion. Could you please review her status and blood test results?

My observations: Piros is drinking and peeing normally now but has no hair improvement. She looks even more bald. Skin still very dry. No weight change. I've wanted her to gain weght because she looks very frail. Pot belly still there but a little less "inflated" looking. Now looking more saggy. She still can't jump on furniture and sometimes stumbles on stairs.

Vet #2 who did not test GGT reviewed all her blood results and says she's fine and that it takes a while to see skin improvements. He's not worried and says continue what you're doing.

Vet #1 reviewed her blood results and wanted to test GGT. After that she said it's high and got worst and should have improved. So she referred me to an internal specialist for possibly a liver biopsy or ultrasound or MRI.

*RESULTS*

April 7th

ALT 617 H
ALKP 230 H
Chol 10.99 H
PLT 577 H
PCT 0.57 H
GGT 62

April 21st

ACTH TEST
Cortisol Pre: 195H
Cortisol Post: 370
Apparently indicates medication is working fine at 5mg.

L = Low, H = High
ALT 764 H
ALKP 229 H
Chol 10.34 H
EOS: 0.05 L
PLT 548 H
PCT 0.52 H
GGT 58

June 2nd
ALT 492 H
ALP 166 H
Eosinophil 0.1 good
Platelet 577 H

June 9th

ACTH stim test and GGT tested. ACTH is "normal" so keeping her at 5mg. For GGT I think she said it's back to 62. On the paper it says "N 0-7" So I'm guessing that's the normal range? So it's very high and I've been referred to an intenal specialist by Vet #1. Vet #2 hasn't seen GGT results yet.

Could you kindly share your thoughts an wisdom? Are we doing the right thing and should we do more tests on her or let her be? I don't wanna make her a pin cushion. :(

Tammysmom

06-12-2016, 11:11 PM

molly muffin

06-12-2016, 11:38 PM

When you say ACTH result. Or all do you have the exact number? Post should be under 250 at minimum with all symptoms better or gone. This is normal for being n trilostane.
Her alt appears to be back to what it was around earlier in the year it has gone up and down both on and off trilostane ( before treatment)
I too a, concerned about the lover as I mentioned before a higher alt like that is not the norm in Cushing dogs. Cortisol can go up though if another primary disease is in play.

Did you ever start on a liver supple the like I mentioned before? This vpcan be helpful.

I would definitely go see the specialist.

Harley PoMMom

06-13-2016, 08:04 PM

Getting copies of those monitoring ACTH stim tests and posting those results would be great, that will give us a better picture of her cortisol levels with treatment, and as Sharlene mentioned, the therapeutic ranges for a dog on Trilostane should be between 40 nmol/L - 150 nmol/l (1.5 ug/dl - 5.4 ug/dl) with a post as high as 250 nmol/L (9.1 ug/dl) if symptoms are controlled.

With cushdogs we usually don't see high elevations in the ALT, so an ultrasound or a bile acid test would be the 2 options I recommend.

Hugs, Lori

GoldenAngel

06-16-2016, 11:55 AM

Hello and a late welcome to you and Piros. She is just adorable. Love her name. I have very little knowledge on results of bloodwork. But i am sure someone here will be able to review her bloodwork and offer suggestions. I think you are doing a great job with your baby girl. Brianna

Thanks so much Brianna! :)

When you say ACTH result. Or all do you have the exact number? Post should be under 250 at minimum with all symptoms better or gone. This is normal for being n trilostane.
Her alt appears to be back to what it was around earlier in the year it has gone up and down both on and off trilostane ( before treatment)
I too a, concerned about the lover as I mentioned before a higher alt like that is not the norm in Cushing dogs. Cortisol can go up though if another primary disease is in play.

Did you ever start on a liver supple the like I mentioned before? This vpcan be helpful.

I would definitely go see the specialist.

Unit Title CORTISOL (1 HR ACTH)
CORTISOL (1 HR ACTH) 419 -- 220 - 550 nmol/L
Unit Title ACTH STIMULATION (2 SAMPLES)
CORTISOL (PRE) 201H -- 28 - 120 nmol/L

These are the June 9th results. Says the 201 is High but the 419 is in normal range (between 220-550). Does this look like she's being well controlled?

The high GGT (62) is what prompted one of my vets to want to seek a specialist. ALK ALT came down so those are apparently on good track and not concerning them anymore.

Yes she is on AllerG-3 Omega F/A as well as Ceva S-Adenosyl :) She's also on a low-protein diet.

Getting copies of those monitoring ACTH stim tests and posting those results would be great, that will give us a better picture of her cortisol levels with treatment, and as Sharlene mentioned, the therapeutic ranges for a dog on Trilostane should be between 40 nmol/L - 150 nmol/l (1.5 ug/dl - 5.4 ug/dl) with a post as high as 250 nmol/L (9.1 ug/dl) if symptoms are controlled.

With cushdogs we usually don't see high elevations in the ALT, so an ultrasound or a bile acid test would be the 2 options I recommend.

Hugs, Lori

Thanks Lori, yes an ultrasound was conducted months ago and just showed enlarged liver. :( I researched that High GGT could mean bile duct problems so yes I'll ask about the bile acid test, thank you!

One other thing she's been doing is her jaw quivers sometimes. Like, she licks her face and instead of just closing her mouth after, it vibrates then closes then vibrates then closes as if something is either bothering her or it's doing it involuntarily. Now I'm freaking about neurological problems. I'll tell this to the vet. :(

Thank you all very much for your wisdom!!

dsbailey

06-16-2016, 12:42 PM

GoldenAngel,

Hello, my girl Lolita has the same jaw quiver. It started before starting Vetoryl. I'm interested in what your vet has to say about it, my vet didn't have any idea what could be causing it. By any chance do you use Revolution for flea and heartworm control?

Darrell and Lo

One other thing she's been doing is her jaw quivers sometimes. Like, she licks her face and instead of just closing her mouth after, it vibrates then closes then vibrates then closes as if something is either bothering her or it's doing it involuntarily. Now I'm freaking about neurological problems. I'll tell this to the vet.

lulusmom

06-16-2016, 02:36 PM

Hi and a belated welcome to you and Piros.

In reviewing all of the test results, I am inclined to agree with Vet #2 who referred you to an internal medicine specialist. Have you scheduled an appointment yet?

With respect to Vet #1's opinion that all of her blood results were fine and that it takes a while to see skin improvements, I disagree on both counts. It does take a while to see skin improvements but that's only if cortisol is well controlled and based on the most recent acth stim results, Piros is most certainly not. Apparently neither vet understands that you cannot use the lab ranges meant for diagnosing cushing's and addison's to assess an acth stimulation test for purposes of monitoring Vetoryl treatment. Normal range for monitoring purposes is much lower. I believe Sharlene already provided you with the appropriate range. I have included a link below to Dechra's Continuing Education (CE) page which includes a very handy flow charge that you should be able to follow. You may want to share this with the vet who felt that Piros last post acth stimulation cortisol was acceptable because it clearly was not. With results that high, you can expect to see no improvements in Piros' skin or any other clinical signs until you get the post number down. If skin or coat issue is severe, I personally would want the post number under 150 nmol; however, the specialist will provide appropriate instruction based on his/her examination.

I also share Sharlene's concern with the abnormally high ALT as well as the persistent elevation in GGT. That in itself would be good reason to see an internal medicine specialist who can sort everything out. A specialist will also help you get Piros regulated on an appropriate dose of Vetoryl. I am still scratching my head that your vet felt it was a good idea to lower the dose from 10mg to 5mg for the reasons Marianne already mentioned to you.

http://www.dechrace.com/pdfs/vetoryl/VETORYLTreatmentMonitoringBrochure.pdf

I will be very much interested to hear about your consult with an IMS. I think you will get some very knowledgeable and experienced guidance that will benefit Piros greatly.

Glynda

GoldenAngel

06-19-2016, 03:26 PM

Hi and a belated welcome to you and Piros.... Glynda

Thank you for your thorough reply, Glynda. I did go to an internal specialist and she reviewed everything and did an ultrasound. She said it looks like Piros has pancreatitis and inflamed gall bladder... suspects some problems with her bile duct I think. Her adrenals are still large and he liver as well. Doesn't look like there are any tumors anywhere or anything.

Her recommendation is to go on a low fat diet. Low protein isn't necessary but for her age we can follow it but most importantly very low fat. She said to stop with the Omega 3 oil and switched us to low fat veterinary dog food and gave a list of fresh foods we can give her like cooked carrots, sweet potato, rice, chicken etc (what we feed her anyway). Specialist said we need to fix up the pancreas first, then give meds for the gall bladder, then when those are stable, increase the Vetoryl dosage because like you said, her Cushings is better but not fully treated.

Do you guys think this sounds like the right way to go? Specialist said Cushings isn't life threatening and we should help her organs first before increasing the dosage of Vetoryl. She will re-check her in about a month.

GoldenAngel,

Hello, my girl Lolita has the same jaw quiver. It started before starting Vetoryl. I'm interested in what your vet has to say about it, my vet didn't have any idea what could be causing it. By any chance do you use Revolution for flea and heartworm control?

Darrell and Lo

Hello! The specialist said she's not sure but it's possibly due to pain. Since Piros has enlarged organs it could hurt. Specialist poked her and said it looks like she's painful so that's her best guess with the jaw. :( Hope your little girl is ok. No, I don't use Revolution I use Sentinel.

lulusmom

06-19-2016, 04:15 PM

Hi Laura and thank you for posting a response to my questions. I've posted my comments in blue text below.

I did go to an internal specialist and she reviewed everything and did an ultrasound. She said it looks like Piros has pancreatitis and inflamed gall bladder... suspects some problems with her bile duct I think.

That certainly could explain the persistent high ALT and GGT. Since one of the isoenzymes of ALKP comes from the pancreas, that could be contributing to the elevated ALKP as well.

Her adrenals are still large and he liver as well. Doesn't look like there are any tumors anywhere or anything.

Her recommendation is to go on a low fat diet. Low protein isn't necessary but for her age we can follow it but most importantly very low fat. She said to stop with the Omega 3 oil and switched us to low fat veterinary dog food and gave a list of fresh foods we can give her like cooked carrots, sweet potato, rice, chicken etc (what we feed her anyway). Specialist said we need to fix up the pancreas first, then give meds for the gall bladder, then when those are stable, increase the Vetoryl dosage because like you said, her Cushings is better but not fully treated.

Is Piros slightly overweight or very weight? I ask because obese dogs are at much higher risk of pancreatitis than cushdogs. As a matter of fact, the once presumed connection between canine cushing's and pancreatitis has been largely dismissed by the veterinary community. That doesn't mean that feeding a dog high levels of fat is a good thing but pet owners should not be terrified that their newly diagnosed cushdog's current fat intake from their current diet is going to land him/her in the vet hospital with pancreatitis. My mom has a bad habit of overfeeding her dogs, much the same as she's always done to her family....and you wonder why obesity runs in our family. It's not genetic, it's my mom. LOL Anyway her dogs have always been obese and the last two have had chronic pancreatitis because of it. She's been very lucky that neither has developed diabetes or early heart disease. My mom lives with me now and I'm in charge of appropriate food and portions so we've got her dog down to a healthy weight. It is truly amazing now much more energy she has at a healthy weight as well. I wish I was as successful in getting my own weight down. Somebody needs to make my meals, serve them to me and keep all other food out of my reach. :D

Do you guys think this sounds like the right way to go? Specialist said Cushings isn't life threatening and we should help her organs first before increasing the dosage of Vetoryl. She will re-check her in about a month.

I agree that Cushing's isn't life threatening and it wouldn't be my primary focus either if my dog had pancreatitis and gall bladder problems. It would actually be a bad idea to increase the dose now because any acth stimulation test results necessary to check the new dosing at 10 to 14 days could be skewed by the stress of unresolved pancreatitis and gall bladder issues. A recheck at 30 days sounds sensible to me.

GoldenAngel

06-21-2016, 12:44 AM

Hey Glynda thanks so much!! Hehe lol at the food! No, Piros isn't overweight at all, she's actually pretty frail looking now. She used to be slightly overweight at 16lbs but lost weight in the last few months and now she's stable at 13.6lbs. She has no fat anywhere other than her cushbelly. Her skin is paper thin and she lost lots of muscle so she looks really fragile to me poor baby.

And ok I'm glad you agree with the specialist's decision to treat her organs first then her Cushings. Hopefully we're on the right track then! I'll keep everyone posted on how she does on this diet. Gosh I hope it helps my little girl!

Here are a couple of pics if I may share. :)
https://www.facebook.com/photo.php?fbid=10154008707179360&set=pcb.10154008726484360&type=3&theater
Here she's sleeping on my desk at work. :')
https://www.facebook.com/photo.php?fbid=10154146709409360&set=a.10150284715964360.350743.506259359&type=3&theater

DoxieMama

06-21-2016, 04:45 AM

Oh look at that sweet darling! I love the picture of her sleeping. She looks so peaceful.

I hope the new plan works out well!

Hugs
Shana

Joan2517

06-21-2016, 08:34 AM

She is a beauty!

GoldenAngel

09-26-2016, 04:25 PM

Hi everyone! So just a big update on my little girl and needing your wisdom once again.

My baby isn't doing well. She's been seeing an internologist and getting checkups regularly and blood work and ultrasounds.
She's now at around 11.8lbs and very thin and extremely picky eating. She's eating 90% chicken and picks at other stuff. Spits things out she doesn't like. She's on 5mg of Vetoryl, Ursodiol, Famotidin, liver supplement (forget the name) and I forget the name but it's a human antipsychotic that's used in pets to stimulate appetite. She used to be on pain meds and anti-nausea meds to see if it would help appetite but no change so we gave those up.
She seems like a happy girl, just less energetic. More sleepy but still gets perky and engages with us well.

Ultrasound results: Her pancreas keeps looking brighter and brighter each ultrasound which is concerning. Treated for pancreatitis (low fat diet) and no effect. Her intestines are a bit bright suggesting extra fat deposits... a bit concerning. Lymphoma is a possibility but to find out they have to knock her out and scope her which terrifies me. Tumors aren't suspected because bright areas are general.

Blood results: two kidney values are concerning and suggest her kidneys are on their way down. Getting re-checked to see if they are worst this Wednesday as this is a more recent issue. Her liver is still high levels but stable so Ursodiol is working thank god.

So at this point we still haven't increased her Trilostane dosage because at fist her liver was concerning and now it's the weight and not eating. WHAT DO WE DO? :( Vet says increasing trilostane can make her lose more weight and she's extremely thin as it is. But I wonder if allllll these problems are because her Cushing's isn't fully controlled? She was at around 400 I think last ACTH test. What do you think? I'm scared we're killing her! :'( Maybe she has cancer hidden somewhere why else would she get anorexic? Should we "scope" her or do biopsies? I really don't know if it'll tell us anything that's treatable and with her condition I'm scared about recovery... and Vet even said we might still find nothing.

We'd do anything for her. I'd rip out my organs for her. I would die for her... we don't care about $$ we just want her healthy. :'( What do you think we should do?

Sorry for the long post and eternal thank yous to anyone who reads it </3

http://oi68.tinypic.com/15zox6p.jpg

molly muffin

09-26-2016, 10:41 PM

I'm going to go the other way and suggest maybe stopping the vetoyl for now to see if it helps her appetite at all. Discuss that possibility with your vet.

They can give her an antinausous shot that might help. I think it lasts for 24 hours.

Getting the pancrease support and liver/kidneys is first and foremost I think, so I'd keep to low fat.

But see if they can concentrate on that first as the body might be responding to the other issues by increasing cortisol production, irrelevant to cushings itself.

That is just my initial thought and a discussion that you can have with your vet.

GoldenAngel

09-27-2016, 02:37 PM

Oh really that's very interesting! I hadn't considered that.

What I do know is that she started losing weight before we started Vetoryl, and we initially started at 10mg then two weeks later went down to 5. And her appetite did go down with 10mg but no difference between 10 and 5 mg (meaning her appetite didn't change at all with halving the dose).

Knowing this, should we still take her off Vetoryl and for how long? Meaning when will we know if that helps her appetite and do we know this won't damage her organs further?

Harley PoMMom

09-27-2016, 04:09 PM

As Sharlene has mentioned, I would probably stop the Vetoryl too for right now.

My Harley had chronic pancreatitis and it can be a bugger to get under control. Pancreatitis will make a dog lose their appetite so I would suggest having a spec cPL test performed, this type of test measures pancreas-specific lipase concentrations in the bloodstream and can validate a diagnosis of pancreatitis.

Pancreatitis is painful and generally pain meds are prescribed. A very low fat diet is required for this type of disease and these meals (3-4) should be small and given throughout the day. Making sure the dog is staying hydrated is important too as this helps with the healing of the pancreas.

If this were me I would want to see if she really does have pancreatitis, and if not then at least this is ruled out.

Lori

GoldenAngel

10-04-2016, 11:08 AM

Thank you Lori!

Her kidney values were better... she thinks they were high before because Piros was dehydrated so we made sure she was hydrated this time and they looked better thank goodness.

Blood pressure was really high... she was up at 230 I think!! :( So she put her on BP medication. Says kidneys could cause this so shouldn't we be helping the kidneys instead of covering up with BP meds? :( Poor baby just has problems all over.
She's been peeing a lot at night again lately... waking us up 4x a night... Talking to vet again today to see where to go from here.

Harley PoMMom

10-04-2016, 03:38 PM

Getting that high BP under control is very important because elevated blood pressure can damage blood vessels in the kidneys which reduces their ability to work properly. What BP meds is she taking?

Hugs, Lori

molly muffin

10-04-2016, 10:42 PM

It is definitely important to get that BP down. When the kidneys are having problem, yes the BP will go up, but you also need to get it down independent of the kidneys that still need to be treated.

It can be really hard to do when there are kidney issues also, but you want that BP down quite a bit.

GoldenAngel

02-01-2017, 08:43 AM

Hi everyone, as always thank you so much for helping us get through all of this. I have another update and once again desperate with more questions as her condition evolves. Two weeks ago they increased her Vetoryl dosage to a total of 8 mg per day, taken as 4 mg in the morning, and 4 mg at night. She is looking like a skeleton from the back legs and is really weak, and had stopped eating completely before that. We have been feeding her with a syringe six times a day and she is handling that like a very good girl. She stopped losing weight when we started doing that. She is due for another ACTH test next week. All of her organs appear to have stabilized! Thars the only good news I have. Her blood pressure medication is called Benazapryl.

For the first two days of increasing the medication, she only woke us up once to pee, but since then it went back up to around four or five times a day! How does that make sense?!

The thing that is scaring me now is that she seems to be twitchy and is also wobbly. I am having a hard time telling if it is because she is weak, or if she has a neurological problem. What could this be? Meds? Is the tumor growing? :'(
Example: she will curl up in bed and one of her legs (usually the back) Will keep moving as if she needs to re-adjust its position continuously. As if she has restless leg syndrome.
Another example: she will be standing in front of me and suddenly start twitching her head a little bit and stumbles as if she lost her balance. It's freaking me out as if it is a mini seizure!
Last example: after she goes out to pee at night, it is sometimes difficult for her to settle. She will grind her teeth, be twitchy, and keep moving her head around as if she can't get comfortable.
Another observation is that she is not all bouncy and happy when we come home anymore. This has been a gradual change in her. She still waits for us at the stairs and greets us but her tail barely wags if at all, and it's just a quiet acknowledgement and that's it.

I really want to avoid having to knock her out to do tests, because the vet says she has to be knocked out to get an MRI. Is there any other way to find out if the tumour is growing? Or a non-invasive way to shrink it? Or are her symptoms from something else? She suggested radiation which also has to knock out my baby! :( Any thoughts or suggestions very much appreciated. Thank you so very kindly.

labblab

02-01-2017, 09:32 AM

I am so sorry for these problems, and I apologize that I have only a moment to post right now. But most importantly, what (and when) was your baby's most recent ACTH result prior to the Vetoryl increase? Quite honestly, I am baffled that the vets would recommend continuing to give Vetoryl at all to a dog who has to be force-fed, let alone increasing the dose. :( :(

From the sound of things, an enlarging pituitary tumor is certainly possible. But so is a Vetoryl overdose or some other as yet unknown issue. If it is an enlarging tumor, then a higher level of cortisol or the addition of supplemental steroids may reduce the swelling and inflammation in the brain. So again, increasing the Vetoryl dose may actually be making things worse.

Does your vet know how poorly she is doing since upping the Vetoryl? I would let the vet know immediately so that either the ACTH testing can be moved up or the Vetoryl decreased again, or stopped, in order to see whether that improves things.

I'll try to come back later to add some more thoughts.
Marianne

molly muffin

02-01-2017, 09:42 AM

I am also stunned that they would continue and up the vetroyl, as the manufacturer clearly states in their literature to not give vetroyl to a dog who is not eating, (the vetroyl must be given with food for it to work correctly) and in general not to give it to a dog that is not doing well.

So, I would probably discontinue the vetroyl until she is more stabalized and then retest. It could be it is too much for her body to handle right and now. Also make sure you are checking her electrolytes for an imbalance in sodium and potassium especially.

Squirt's Mom

02-01-2017, 01:00 PM

My first step would be to STOP the Vetoryl today and give her some prednisone. If you don't have any, call the vet and demand that they give you some now. I cannot believe a cush savvy vet would tell you to increase the dose when you are having to force feed your baby - loss of appetite is a hallmark sign that the cortisol has gone too low. So stop the Vetoryl and get some pred into her now. If her vet will not do as you ask, find an ER vet and go asap.

Keep in touch and let us know how she is doing.
Hugs,
Leslie and the gang

GoldenAngel

02-01-2017, 01:28 PM

Oh wow thank you to the three of you! The reasoning the vet gave me is that it took us such a long time to stabilize her organs that she thinks stopping the vetoryl could throw everything off again. It has been a big balancing act for all these months. She also still has a potbelly and appears to have lost more hair. Her skin is a bit better but that's it. Her last ACTH test said she was still above the normal level of cortisol, which is why she increased the dosage ( i'll go find the numbers!). For the past year, her appetite has been going down gradually until stopping eating all together a couple of months ago. Our internologist says it is likely the tumor! She didn't say it was the medication, ugh. For a big chunk of that time, she was on 5 mg of trilostane. Then 6, and then once she stopped eating completely, vet/internologist decided to increase again to fix her muscle weakness and get her back to normal levels. Her legs have been getting very spindly and she is not walking much at all.

The internologist is away this week which is why the test was scheduled for next week, but I will call them right away and ask for prednisones and ask if we can do the ACTH test asap!! Should I stop the medication cold turkey? Or keep it going just until we get the ACTH test over with?

DoxieMama

02-01-2017, 04:38 PM

I am also very interested in knowing what that last ACTH test showed. What were the numbers from that - and when was it, especially in comparison to the dosage changes?

Squirt's Mom

02-01-2017, 06:57 PM

Sorry for the late reply but stop cold turkey on the Vetoryl. This is one good thing about this drug - it can be stopped and restarted without losing ground like you do with Lysodren. You can simply stop Vetoryl then restart later. ;) I hope you did get some pred and that you are seeing some improvement!
Hugs,
Leslie

Carole Alexander

03-13-2017, 12:45 PM

Hi, I just read through your thread and see that you haven't posted for awhile. How is your girl doing? Did you stop the Vetoryl and or did they conclude that she has a macrotumor? My dog Skippy is not responding well to the Vetoryl either so I am wondering what you learned? Thanks,

GoldenAngel

04-11-2017, 12:05 AM

As always I want to thank everyone for their unconditional support while we go through the hardest times of our lives. And thank you for checking in Carole!

We have had a very bumpy ride all this time. After everyone was worried that she was going into crisis, we gave her her ACTH stim test the next day. Turns out she was not in crisis. I spoke to several vets and they insisted taking her off trilostane would not be a good idea... ugh I was so lost. Her trilostane dosage is now 5 mg in the morning and 5 mg at night. She's also on a bunch of other stuff for other things like high blood pressure and kidneys and liver. Cortisol level was 181 which the vet said she was happy with. Is that good?

She is still not eating so we have to feed her by syringe. It's not bad, she is such a trooper and lets us do it without any problems. Occasionally she has a small handful of chicken on her own which was surprising because she hadn't voluntarily touched food in months prior!

But what is really frightening us now are her partial seizures. Or at least that's what everyone thinks they are. :( she will be acting normal and then she'll start to wobble. At first we would just see her have a bobble head, but then it looks like her back legs start to get bouncy and give out and she stumbles. Then acts normal again. He's episodes would happen in clusters. Maybe a couple of times a week then nothing for a month, then a handful of times within four days and then nothing, then there was one weekend where she got them dozens of times in a single day. A neurologist checked her out but noticed nothing wrong. But she was prescribed anti-seizure medication because they suspect that's what she has. they said we could start to give it once a day and then go up to two times or even three times if necessary. But we noticed her episodes would happen more at night so we were only giving it once a day in the evening. She was good for a month but just the last few days it started happening again in clusters and was happening even after she had taken her medication. :( An hour ago she started coughing/hacking and then fell over into a larger partial seizure that totally freaked us out. We're actually not even sure what we saw! :( :(

What the heck is this, is it a macro? We have been trying to avoid the stress of an MRI... but we don't know what direction to go. Apparently we would have to fly out of Canada to get it operated? And radiation would be terrible to have to put her to sleep a dozen times! Omg what do we do now? Seizures were our worst nightmare :'(

Squirt's Mom

04-11-2017, 11:34 AM

I'm sorry, but there is no way I would continue the Vetoryl for now. If nothing else, taking her off of it will give you, and the vets, a chance to see if it actually is causing some of these issues. If this is a macro, studies have shown that Vetory, and more than likely Lysodren as well, cause the tumor to grow more rapidly. The cortisol is a corticosteroid so it "treats" the tumor helping it remain smaller for as long as possible. So if for no other reason I would stop the Vetoryl and just see if there was any improvement.

You said the cortisol results were "181" - can you give us the little letters after that number - like mnol/L, ug/dl, etc. - and the normal range? Also, is that a post number, one of two numbers, or is that a baseline ACTH number?

Harley PoMMom

04-11-2017, 12:20 PM

Cortisol level was 181 which the vet said she was happy with. Is that good?

Was the 181 in nmol/L units? And was the number her post cortisol level?

She is still not eating so we have to feed her by syringe. It's not bad, she is such a trooper and lets us do it without any problems. Occasionally she has a small handful of chicken on her own which was surprising because she hadn't voluntarily touched food in months prior!

If she is not eating than as Leslie posted I would withhold the Vetoryl. If the Vetoryl is not being eaten with a meal it cannot be absorbed properly.

It is always recommended if a dog is acting off in any way the Vetoryl should be stopped until the dog is acting normally again.

Hugs, Lori

GoldenAngel

04-11-2017, 02:03 PM

Ok thank you I will post details tomorrow! Going back in for an ultrasound and chat. Vet is thinking of stopping Vetoryl for a week then trying mitotane... says new data shows this has helped with appetite. She also suggested to get her on a steroid along with suppressing her cortisol to help with the tumor... thoughts on these options?

Thank you so much!!!!

GoldenAngel

04-12-2017, 12:57 PM

Here are some videos I made of her weird episodes!

https://www.youtube.com/watch?v=nZQaQA7_XEI

https://www.youtube.com/watch?v=7EUunx9ksbo&feature=youtu.be

https://www.youtube.com/watch?v=TaKYhu5Plk8

Squirt's Mom

04-12-2017, 03:01 PM

One of the side effects of Vetoryl is tremors. Whether that is what is going on with Angel or not I can't say. I use Lysodren in my house but hopefully someone who has used Vetoryl and seen the tremors associated with that drug can help you decide if that is what you are seeing or not.

As for switching to Lyso, do NOT start her on the Lysodren with only one week between the two drugs. I would wait a month myself. At the very least, call Dechra yourself and ask them how long to wait. ;)

judymaggie

04-12-2017, 03:49 PM

Hi! I took a look at the video and the tremors do look very similar to what I had been seeing in my Abbie when on trilostane. If I didn't happen to be nearby when they happened, she did sometimes lose her balance. Interestingly, now that Abbie is no longer on trilostane I have not seen one tremor.

GoldenAngel

04-12-2017, 04:48 PM

That's very interesting thank you for sharing your input. We are at the vet office right this moment and I will definitely tell them I'd like to stop the trilostane. And we will consider switching mets with a longer break than just one week. Vet did say it used to be a month but apparently they have been shortening the time period lately. But I'd rather be on the safe side! Will keep you guys updated!

ETA: Judy, how much after you stopped the medication did you stop seeing the tremors? We are stopping the Vetoryl now so hopefully she gets better because she has been pretty bad in the last few days shaking and trembling.. :(

Carole Alexander

04-13-2017, 02:43 PM

Hi Laura,
I am very sorry that Piros is struggling and I want to comment on a few things although your thread is going down side up on my screen.The tremors and unwillingness to eat (but not seizures) could be Vetoryl related; Skippy experienced both and my IMS says that many dogs simply cannot tolerate Vetoryl. Since stopping Vetoryl, is the tremoring slowing; has his appetite returned at all? You mentioned the stumbling and weakness, these could be related to the fact that Piros is thin and weak. Are there other cognitive problems in addition to the seizures, e.g., starring, barking sound has changed, not willing to play, walk or sometimes respond to commands? Is he going into corners, seem confused or disoriented, pacing at night? The symptoms of a macro tumor can be very subtle and different dogs have different symptoms. In Skippy's case, he had some cognitive symptoms since last year, but he is eleven and I assumed it was age related. And, even when I continued to raise the cognitive issues, five different IMS's said nope, it is just Cushing's. That was until we had to stop the Vetoryl as he was so sick.

Squirt's mom gave you excellent counsel. Stop the Vetoryl if you haven't already as it can make a macro grow if that's what is going on. Regarding an MRI, the anesthesia used is the smallest amount possible for the shortest time. After the MRI, Skippy had diarrhea but that has cleared with medication. If it is a macro, treatment is a big and expensive decision. U of Washington is the only place in the US that has considerable experience doing this surgery. (About 60 so far.) Utrecht in the Netherlands has done hundreds of surgeries on pituitary tumors and I would be happy to send you my research if you are interested.

I have also done extensive research on radiation but only in the US. I would be happy to share that info as well.

But to not get ahead of ourselves. Stopping the Vetoryl may allow Piros to stabilize a bit, hopefully start eating and give you time to breathe and consider next steps. I don't mean to sound abrupt as I know how agonizing and complicated this journey is for you and Piros.

GoldenAngel

09-01-2017, 01:31 PM

Hi everyone,

It's been a while since I've posted and wanted to give everyone an update. And may I ask for your final advice as we think she might be getting tired of fighting. We need some words of wisdom. :'(

First off, you guys were right that those tremors were from the Trilostane; the tremors faded as soon as she stopped and it only took a couple of days for them to disappear!!! Thank you all for your great advice.

She went on Mitotane and everything with that went well... no issues with Mitotane... the only big downside is that Piros never got her appetite back. She doesn't eat on her own at all. And her weight declined yet again (she's down to 4.3kg) despite us feeding her as much as possible. She has also continued to get weaker. She can stand and walk and sit up, but can't get up on her own. But she's very smart and barks whenever she wants to stand so we come running right away to help her. Her bark is a tiny raspy one now. A neurologist looked at her and thinks all her weakness is at least partially due to the tumor... :(

Mentally she fluctuates a bit but is still very "present". Sometimes she does space out and seems to slow down but we are always able to grab her attention back. And she always engages and tells us when she wants anything at all; drink, stand, out, car, cuddles, bed, etc. Super smart girl.

Vet says we've done an amazing job given all her problems. Just never feels like it's ever enough! About once a week she goes through a day of feeling terribly sick/nauseous/yuky and it's killing us and making her suffer. Vet says it's all her problems piling up (bad kidneys, pancreatitis, possible IBD, etc). Mitotane is not fully controlling her Cushings because she thinks it'll make her feel more sick (since it can irritate stomach). She's already on both Cerenia and Ondasteron for her nausea. And if she has IBD, then prednisone would be the answer but it would bring Cushings symptoms all back... is this over, are we at the end? :( Anyone know of anything else we could do for her so she doesn't feel so sick? That's our only concern is quality of life. If she keeps suffering weekly, we think it's too much for her. Any thoughts would be so so much appreciated. <3

Here's a pic of her just to show her off. :') https://www.facebook.com/photo.php?fbid=10155451029304360&set=a.10150284715964360.350743.506259359&type=3&theater

Joan2517

09-01-2017, 01:57 PM

She sure is beautiful. Making the decision to let go is a personal one, and a very hard one. I always wait too long and then feel bad about it, but I have always had trouble letting go. Hugs to you and your darling girl...

GoldenAngel

09-01-2017, 03:46 PM

Thank you so much! She's an angel for sure; love of our lives! :) Definitely the biggest struggle of our lives lately too. <3 I just thought I'd give it one last ditch effort here to make sure we absolutely looked at every possible option. <3

Harley PoMMom

09-02-2017, 09:26 AM

What a beautiful picture, she is so precious. My Harley had pancreatitis and in the beginning I used pepcid ac but as time went on it seemed to make him nauseous so I switched him to slippery elm bark (SEB).

I'm including part of this article regarding SEB:
In the gastro-intestinal tract, Slippery Elm acts directly. It can be thought of as a sort of natural “Pepto-Bismol.” (Pepto-Bismol itself should not be used because it contains salicylate, a.k.a. aspirin). Its mucilage content coats, soothes, and lubricates the mucus membranes lining the digestive tract. Slippery Elm is an excellent treatment for ulcers, gastritis, colitis, and other inflammatory bowel problems. It is high in fiber, and so helps normalize intestinal action; it can be used to relieve both diarrhea and constipation. It may also help alleviate nausea and vomiting in pets suffering from non-GI illnesses, such as kidney disease. A syrup made from Slippery Elm Bark can be used to help heal mouth ulcers from all causes (see recipe below).

Slippery Elm is said to relieve inflammation of virtually any mucus membrane, and has been used in the treatment of inflammatory conditions of the lungs (bronchitis, asthma), kidneys, bladder (cystitis, FLUTD symptoms), throat (tonsillitis), and joints (arthritis).

One note of caution is that SEB may interfere with absorption of medications so it is advised to give SEB a couple hours before/after any medications.

Hugs, Lori

This article that I'm including a link to is very informative as it tells how to mix it and what dosage to give: http://www.littlebigcat.com/health/slippery-elm/