PDA

View Full Version : Echo the Cocker Spaniel - 14 years old, 3 months into Cushings meds



Echo02
06-20-2016, 06:32 PM
Hello. I'm at somewhat of a crossroads with my 14 year old dog. He is a very sweet dog, loving, and he's definitely part of the family, but over the past few weeks, things have gotten worse. He was diagnosed with Cushings at the end of Feb, early March of this year.

Symptoms of all this were mild to begin with, which we just attributed to age. But after numerous peeing on the carpet and wood floor incidents, going outside 20+ times a day, lots of pacing, panting, huge thirst, and hind legs failing we knew something was up.

During the initial exam, he was tested for bladder infection, had a sonogram of his bladder and blood testing. His results came back negative. The blood test and symptoms all pointed to Cushings.

He was given Vetoryl 30 mg once per day (he's about 26/27 pounds). After the first 3 weeks, another blood test was taken and according to our vet, was responding well to the meds. (I'll post results of that second test).

The next test isn't until the end of August. It's every 6 months after that second test for loading.

In the last month, he is having days where he goes outside, comes back in, goes back out, over and over. He won't go downstairs on our deck every time. He'll come back in then just pee or poop, some days this happens up to four times, other days there are no issues.

He sleeps in the morning to afternoon for about 5 hours or more at a stretch.

He paces at night for a couple hours before he finally circles about a dozen times and about falls over settling down.

Some nights he sleeps through until about 5am-6:30am, other nights, he is up pacing and going out throughout the night. Not to be selfish, but this is killing my own ability to get a good night sleep.

The panting goes on and on at night, whether he is in pain, hot, or anxious, I don't know.

We spoke to the dr. and he said we could bump him up with another 10mg in the evening. With the cost of the already expensive 30 day supply, I couldn't justify another 10mg at night for a total of about 140 a month, plus another return to the vet after 3 weeks to have his blood tested again ($250).

Now, to top this off, we go on vacation in July. We need to have him boarded for a week. My worry is that 1) he goes out many times during the day, not like without the meds, but still a lot, and will have multiple accidents a day; 2) possible anxiety while boarded 3) there is some other underlying issue he has and at this point, I'm just keeping him alive for our own benefit. He doesn't seem "happy" like he used to. He doesn't see well, he gets confused, his hearing is shot, falls going up or down the stairs......the list doesn't end. But then some days he just shines and everything seems like it used to be.

I currently have an appointment for him to cross the rainbow bridge on Friday. It's killing me to have to do this. I canceled the first appointment at the beginning of June because it didn't feel like the right time, and I don't expect it will ever feel like that.

Below is his last lab work from the end of March. Oh yeah, I started giving him about 2.5mg of melatonin at night to stop the pacing and going out. He has slept great the past 3 nights without any issues.

Any suggestions?

http://i1178.photobucket.com/albums/x376/EchoDog02/part1_zpstdqy0way.jpg (http://s1178.photobucket.com/user/EchoDog02/media/part1_zpstdqy0way.jpg.html)

http://i1178.photobucket.com/albums/x376/EchoDog02/part2_zpsjmflsech.jpg (http://s1178.photobucket.com/user/EchoDog02/media/part2_zpsjmflsech.jpg.html)

judymaggie
06-20-2016, 06:59 PM
Hi and welcome! I have manually approved your post so that members can start responding to you. Please check your email, possibly your spam / junk folder, for a message from k9cushings. You will need to reply to that email so that your post go directly to the board and are not delayed waiting for approval. If you have already received and responded to the confirmatory email, please be patient. Your registration will be finalized shortly.

I need to be away from my computer for a bit but, hopefully, others will be along to address your concerns and add input. I will check back in later!

DoxieMama
06-20-2016, 07:01 PM
Hello and welcome to you and Echo. I'm so sorry I don't have any suggestions for you right now, but I wanted to post anyway. You've come to the right place and have provided excellent information. Thank you for that. I am sure others will respond before too long.

Hugs.
Shana

Harley PoMMom
06-20-2016, 07:49 PM
Hi and welcome to you and Echo!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Was Echo diagnosed with pituitary or the adrenal type of Cushing's? Is the vet performing those ACTH stimulation tests 4-6 hours post pill? And is Echo getting his Vetoryl with a meal so that it is properly absorbed? When he had his first monitoring ACTH stim test were his electrolytes checked too?

I see that Echo did have his first monitoring ACTH stimulation test within the 10-14 time frame which is what Dechra, the makers of Vetoryl, recommend. However, Dechra also recommends

Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days and every 3 months thereafter. You can find this info in their product insert which I'm including a link to: Dechra's U.S. Product Insert (http://www.dechra-us.com/Admin/Public/Download.aspx?file=Files%2fFiles%2fProductDownload s%2fus%2fvetoryl-5mg-pack-insert.pdf)

Even though Echo's ACTH results at that 10-14 day window were good, cortisol levels tend to continue to drift downward throughout the first month even when the dose remains unchanged so having an ACTH stim test at that 30 day mark is pretty important.

Panting is very common with cush dogs this is due to a few things: the increased fat deposition over the thorax, an enlarged liver (which is common in a cushdog) that puts pressure on the diaphragm, and with the fat distribution to the abdomen along with the muscle loss in the abdominal area these are factors that can cause the panting. With treatment the panting does decrease, but this could take a bit of time.

The test used to monitor treatment in dogs with Cushing's is the ACTH stimulation, and it's the stimulating agent that drives that cost up. Most vets use Cortrosyn as the stimulating agent. The vial of Cortrosyn is 250 μg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5 μg per kg is all that's needed. For Echo, he weighs 27 lbs - the lbs need to be converted to kg which is 25/2.2 = 12.28 kg. Now we take that 12.28 kg and multiply that by the 5 μg of Cortrosyn needed for each stim test = 61.37. Dividing that 250 μg (entire vial of Cortrosyn) by 61.37 = 4.07 so that means the vet could get 4 stim tests out of 1 vial which is a huge cost savings. 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.endocrinevet.info/2012/03/how-to-dilute-and-store-cortrosyn-for.html

Also to save on cost you could find an online pharmacy that may be cheaper that what your vet wants for the Vetroyl/Trilostane or you can get the dose compounded. A lot of our members use Diamondback drugs to get their dog's medication compounded : http://www.diamondbackdrugs.com/?gclid=COu81vuny8wCFYk9gQodOI8Fsg However they can not compound a dosage that Dechra (makers of Vetoryl) already manufactures so a 30 mg would have to compounded to either 29 mg or 31 mg.

You may want to look at these: to help you find the best price for prescriptions (http://www.k9cushings.com/forum/showpost.php?p=183349&postcount=1) [/quote]

I am sorry for the reasons that brought you here but glad you found us and we will help in any way we can.

Hugs, Lori

Echo02
06-21-2016, 12:15 PM
Thank you for the responses and huge amount of information. He has the adrenal type of cushings.

This type of decision is weighing heavy on us and I'm not sure which way we may go yet. We certainly don't see the happy dog we used to see a year ago and I'm not certain putting him through the tests is going to make it much better for him (and selfishly, our family) in the long run. 14 years is a long time in a dog's life, but we are taking the info provided into consideration.

Thank you very much!

Harley PoMMom
06-21-2016, 04:56 PM
The treatment for Cushing's can be taxing on our furbabies, all the monitoring tests that have to be done, multiple trips to the vets, etc...can be really stressful.

You have done an awesome job in keeping your boy healthy and happy, 14 years is a pretty long life span for a cocker spaniel and I am a true believer that the quality of life for a dog is of the utmost importance.

Your love and devotion for Echo is very obvious and that deep love will guide you in making the right decision for your girl because only you know Echo best.

Remember we are here to support you with whatever decision you make, we are some of the best hand holders. :)

Hugs, Lori