Dog got diagnosed with Cushing's - Chuck has passed

[randomguy]

Hello, i chanced upon this forum and am very grateful you guys are here. I have a 14 year old dog that has been diagnosed with Cushings. We suspected he would be for a while. Anyway, he weighs about 20 lbs and the vet is prescribing him with 20 mg of Vetoryl (then more blood work to see if it needs to change).

My question to you is: where can I get this medicine for as little money as possible? Also, should I get the 10 mg chewables and give him 2, or get the 30 mg chewables and give him 2/3rds? Thank you very much!

[judymaggie]

Hello and welcome to you and your pup! I have manually approved your membership so now all your posts will be seen right away.

To start off with your question re the chewable tablets -- I have never used the chewable tablets. You could call the pharmacy from which you are getting the tablets and ask them if they are scored. However, even if scored, I do not know how you would get an accurate "2/3". So ... I think your best bet is to give your pup two 10 mg. tablets. For future, if they are scored, and your pup needs to have an increase in dose based on the ACTH after the first month has gone by, you would be able to split the tablet in half and do a 5 mg. increase. It is always better to increase in small increments.

Okay ... on to other things. If you have spent any time reading other posts, you will see a pattern with new members. We love to ask questions and get lots of info -- in particular, testing results! :D In order for us to help guide you along the Cushing's path, please post the results of recent lab tests. With regard to blood tests, you need only post the highs and lows along with the stated range. Some urine tests will also have such highs and lows and others will have numbers (such as dilution factor). Please also provide us with the results of any tests that were done to diagnose Cushing's, i.e., ACTH, LDDS, ultrasound.

You say that you suspected Cushing's for a while -- what symptoms led you to this suspicion?

With regard to obtaining trilostane at the best price, many of us purchase it from pet pharmacies. They may offer Vetoryl at reduced prices or compounded trilostane. The compounding pharmacies are only allowed to sell the trilostane in doses not offered by Dechra, the manufacturer of Vetoryl. I purchase 10 mg. Vetoryl capsules from California Pet Pharmacy and 4.5 mg. compounded trilostane capsules from Diamondback Pet Pharmacy (in Arizona). Both of these pharmacies require a prescription from my vet (either faxed or provided verbally). We have heard from a few members here that their vet is not willing to work with these pharmacies. My vet, knowing that I need to save money as much as possible, very willingly works with me on this.

We have a great resource forum. Do spend some time reading -- here is a link to the section on trilostane:

http://www.k9cushings.com/forum/showthread.php?t=185

Within that section are the pamphlets from Dechra -- both the client brochure and the technical brocure provide outstanding information. Here is the link for the latter -- page 11 has a very useful flow chart:

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

Hopefully, I haven't overwhelmed you -- we are looking forward to learning more about your pup (name?)!

[randomguy]

Thank you for the well thought out and helpful post! My dogs name is Chuck. As far as blood work, unfortunately I don't have any. We had a full panel done about 7-8 months ago for cushings, and they told us that that while the pertinent liver enzyme levels were high, and above the limit, they were not as high as they would normally see in a dog with cushings. Two separate vets (going off the same blood work) told us that.

Anyway, we have suspected for, looking back, probably a year or two that something wasn't quite right. He first started losing hair (and it started becoming slightly lighter and flatter/less shiny) and the vet thought he had male pattern baldness (or something like that :)). We also noticed his tummy was getting bigger even though we were giving him less food. The vets recommended a ACTH stimulation test when/if we noticed any other problems/progression of problems.

Lately his back legs seem to have gotten weaker and his belly seems even larger and he seems to have lost a lot of muscle. More hair loss, etc. He does pee a lot but he has always peed a lot. He was never trained very well so accidents in the house have always happened. Apparently he is supposed to be extremely thirsty, but he is consistent in the amount of water he drinks and has been for years, so no thirst issues i see. He doesn't pant excessively but he doesn't exercise a lot anyway.

We got the ACTH stim test last week and the results came in this week. Vet wants to start with 20 mg (he weights 20 lbs). He is generally a very happy dog and gets around just fine (but can't jump as well, like I mentioned earlier). He does seem more lethargic. But he doesn't seem to be in pain. Honestly he just seems like hes old, but the stim test, plus the hair loss, plus the huge belly and muscle weakening all seem to be cushings. The vet said he's been in practice for 20 or so years and sees about 5 cushings cases a year.

So that's my story! Hopefully we can control this thing and allow him to have a good life. I really was hoping to not have to get the 10 mg version since that'll be like...$100 or so a month (who knows what the final dosage will be). Thanks for any and all info--I'm very grateful to have this forum as a resource.

[MyBabyScooter]

Hello... I joined a few days ago too. I'm sorry to hear about Chuck. I am undecided if my dog has Cushings, as when he had a blood test, all readings were normal except for the ALP. As for symptoms, he has extreme hunger, a pot belly that changes in size and isn't really too bad most of the time, and possibly thinning hair. He still has lots of energy, no weakness, and very soft, glossy hair.

What has made me optimistic that it might not be Cushings is lack of drinking - he only drinks twice a day, about a cup at the absolute most. But now I have read Chuck doesn't drink much, I am more worried that he may have it, and really may have the ACTH test done :(

Thankyou for your post - it's the first time I've read drinking little is not proof they don't have Cushings. Best of luck with your dog :)

[DoxieMama]

Welcome to you and Chuck, though I'm sorry for the reasons that brought you. Judy mentioned it but I wanted to reiterate - you may be able to save money by purchasing Trilostane instead of the brand-name Vetoryl. You could get compounded Trilostane at 20mg which I am certain would be less than $100 for a month's supply (even with shipping).

I would also highly suggest asking your vet for copies of all test results done on Chuck, for a couple reasons. First, it is a good idea to keep those copies in a file... if you ever need his history for an emergency or a pet sitter, it's really handy to have available. Also, though I'm sure your vet is very good, if you can share the results here then our admins and other knowledgeable folks can review and support you and Chuck best. As your vet only sees 5 cases per year, you may benefit from having the support of those that "see" a lot more than that... and have been doing so for years. :) Not only that, but I found it invaluable to be able to look back on past results and compare them, research and ask questions here, to gain a better understanding of what is going on with my own dog.

Shana

[randomguy]

I will try to get the blood work--is it ok that it's probably 7-8 months old? My vet said he sees about 5 cases a year (I asked him how rare the disease is) and he said he has probably dealt with dozens of cases in his career. So I'm confident that he has a good idea what he's talking about, but I'd definitely be thrilled to get some other opinions from people on here if I can!

I asked him about compounding trilostane and he told me about an I think, 2013 study that looked at the doses of compounded trilostane and found them to be variable so he doesn't recommend it. I can see that the people on this forum have good luck with them, though, so I may switch in the future!

Thanks for the information everyone!

[kanga]

Hello, welcome to the forum!

Sorry to hear about Chuck health situation right now, I know it's hard to you to see your doggy suffer with this kind of disease. I just want you to know that you and Chuck are always in my thought, hope you get some good information & advice on the other member. I pray for you and Chuck, keep us update.

[DoxieMama]

Sure, it's okay that they're 7 or 8 months old if that's what you've got. :) I find it curious they didn't perform more recent tests. You only need post the blood test results that are abnormal, along with the reference ranges. Include all results for the ACTH.

[molly muffin]

20mg per lb would be the recommended starting dose for a dog with cushings with a retest in about 10 - 14 days. To see how the cortisol is doing.

I think the key to using trilostane compounded is making sure you use a reputable pharmacy. Some have good luck with it and others not so much and some do a combination, with the majority being vetroyl and then a compounded to go up in smaller increments.

[Harley PoMMom]

20mg per lb would be the recommended starting dose for a dog with cushings with a retest in about 10 - 14 days. To see how the cortisol is doing.



I think what Sharlene meant to post was that 1 mg per pound is what's recommended so for Chuck's weight of 20 lbs the 20 mg of Vetoryl is a great starting dose. ;)

Hugs, Lori

[molly muffin]

Holy bat (*&^% robin! 1mg/1lb is what i meant, as Lori said.

:) :)

[randomguy]

Thanks very much for the information and prayers everyone! My dog doesnt display the classical signs like drinking very much water (but does pee a lot--but always has peed a lot), panting a lot, or being very hungry (though he does seem a bit hungrier). However, he does have the very large stomach, thinning skin, large amounts of hair loss, increase in infections, and muscle weakness.

Has anyone else seen this before? The vet wants me to get a urine test to see if there is protein in his urine, but he said in his eyes its almost 99% cushings and he doesnt know what else it could possible be, especially since we did the ACTH test. He said that every dog is a bit different and symptoms present themselves differently and he really recommends I go ahead with the medication. So...I should, shouldn't i? I guess I could get a second opinion from our other vet just in case. It's just that, other than these signs (which I don't consider to be insignificant, mind you!), he really just seems like a healthy old dog lol. Thanks all!

[randomguy]

Just gave my pup his first dose of medication! :) I'm trying to look at this in a positive light--we have been given the chance to try make his remaining time with us as healthy and happy as possible. The vet said he wants to test him in 14 days. In the meantime, does any know a good pharmacy for compounded trilostane? Thanks a lot! :D

[judymaggie]

Hi! Hooray for the first dose! :D It is sometimes hard to just plunge in and start treatment so kudos to you. I, and many others here, are using compounded trilostane from Diamondback Drugs in Arizona. Here is their website:

http://www.diamondbackdrugs.com/

Keep in mind that compounded trilostane must be in amounts that are different from the brand name Vetoryl that Dechra manufactures. Your vet will need to provide them with a prescription via phone, fax and, I believe, e-mail. After I set up an account, my vet called them.

Just a thought -- I decided to start Abbie out on brand name Vetoryl until I was sure of her daily dose. I also felt that using the brand name would lessen any possible reaction she might have to the medication. I purchased 10 mg. Vetoryl from California Pet Pharmacy. After the first 30 days, she needed a slight increase so I ordered 5 mg. from Diamondback (at that time Dechra was not offering 5 mg. capsules in the U.S.). I stayed with Diamondback for future refills, changing it to 4.5 mg.

[randomguy]

Thank you for the information and encouragement! :D I was thinking of that exactly--stick with brand name until I figure out exactly what he needs and then figure out my options from there. So far he seems to be tolerating the medication well. I made sure to give it to him with food and will monitor for any lethargy or any other adverse reactions.

I'm going to try to see if I can scrounge up some money and get any blood tests he needs and post them here--I might just wait until his 2 week ACTH stim test and do it then. I do remember we got x-rays taken of him probably about 7-8 months ago and the doctor and radiologist said his organs appeared a bit large, but in line with what they'd expect for a dog of his age. He's an old man (14-15) and seems in better shape than most dogs even with Cushing's so hopefully we'll see some improvement in his big stomach, hair, muscles, and any recurring infections or anything! :) I just wish I had more money--I had no idea how expensive this would all be! :eek:

[randomguy]

Very interesting about hypothyroidism! I googled the symptoms and can see how they would get confused. If my dog has had an acth stim test, would that definitively rule out his symptoms as being cushings? Just curious! Will call my vet about it tomorrow!

[judymaggie]

Hi -- my Abbie is 13 and she is definitely showing signs of slowing down and, in the last few months, her hearing has greatly deteriorated. Hard to see our loved ones age!

With regard to blood tests, it is recommended that electrolytes be checked at the time an ACTH is done. I do a super chem panel, which includes electrolytes, just to make sure nothing else is going haywire. My vet charges $82 for the super chem.

Since you are not seeing the more typical symptoms of excessive drinking or eating with Chuck, it might take a bit longer to see resolution of other symptoms although my Abbie's belly did get smaller fairly quickly. Abbie also has intervertebral disk disease -- unfortunately, her back legs are getting weaker as time goes on. Chiropractic adjustments every three weeks help a bit.

[randomguy]

Thank you! Yes, the doctor said the exact same thing--usually they can monitor it by seeing if water consumption has lessened but in my case not so. I'm going to also ask the doctor if it could be hypothyroidism. I saw someone mention it in a different topic and a lot of those signs my dog has. But I'm assuming the acth stim test ruled that out. Thanks for all of your help--the people on this forum are wonderful.

[lulusmom]

Hi and a belated welcome to you and Chuck.

Yep, we've all wished for a money tree at some point in our dog's cushing's journey and luckily there are some cost savings measures that can help save you hundreds and hundreds of dollars. One is the compounded trilostane which others have mentioned. Your vet is correct that a study was done a few years ago that showed variations in strength in compounded trilostane from eight online pharmacies. If you are contemplating compounded trilostane, I highly recommend Diamondback Drugs as they are definitely a trusted pharmacy used by many, many members over the years. My dogs were diagnosed well before Vetoryl was FDA approved and even if it had been, there were no doses small enough for them. Therefore, like thousands of other small dogs, they were effectively treated with compounded trilostane. I think your decision to stick with name brand Vetoryl right now is a good one but if at some point you may be interested in switching to compounded trilostane, you can either call Diamondback or use their online form for a quote. I've included a link for that below:

http://www.diamondbackdrugs.com/get-a-quote/

Now here's another big money saver. Cortrosyn is the stimulating agent used by most vets for the acth stimulation test and it is ridiculously expensive which is why the test is so expensive. The instructions for cortrosyn calls for using the entire vial but a lot of vets are unaware that only a fraction of the vial is necessary to achieve accurate results. One vial would provide five acth stimulation tests for Chuck! If your vet does not already know this and is willing to learn how to split and store the remaining cortrosyn, the savings is huge for you. It's been our experience that most vets are very much agreeable to this for their clients so you have everything to gain by discussing this with your vet. I have included a link below to a Q & A page from Dr. Mark Peterson's blog that provides instructions to vets on how to split and store the agent. I recommend that you either print it out or share the url with your vet. Dr. Peterson is renown endocrine expert who started this blog for vets and pet owners who want to learn. I think it's awesome that he is so giving of his time. He's answered a number of questions for me so don't hesitate to ask your own questions.

http://www.endocrinevet.info/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Glynda

P.S. When you take Chuck in for his next acth stim test, can you please get copies of the original acth stimulation test that was done by your vet to confirm the cushing's diagnosis? I would be very interested in seeing those results as well as the results of the upcoming stim test.

[randomguy]

Wow, thanks for the info! Yes, certainly, I'll get the results tomorrow if I can. What exactly are you looking for if I may ask? Also, here's part of the email I was sent if it helps:


There is no induction phase involved with the administration of trilostane. Dogs are started on 2-3 mg/kg q 24 h initially, and an ACTH stimulation test is performed approximately 10-14 days later. The test must be performed 4-6 hours post-pill to assess cortisol levels at peak inhibition. Thus, the pill should be given in the morning. The target post-stimulation cortisol concentration for a well-controlled dog is 2-6 µg/dL. This range is flexible, depending on clinical response; a dog that has been on trilostane for six months and is doing well with a post-stimulation value of 1.6 µg/dL may be fine, whereas a dog that has GI signs with a post-stimulation value of 2.1 µg/dL may need his dose decreased. Similar holds true at the upper end of the range.

Of note, the effects of a given dose of trilostane often increase even after the first two weeks of therapy. For example, if a dog is on 30 mg and has a post-ACTH stimulation cortisol value of 9 µg/dL at 14 days, this may decrease to 5.5 µg/dL two weeks later, even if the dog is maintained on the same dose. Thus, if the 14 day post-stim cortisol is < 10 µg/dL following initiation of trilostane, I usually wait to increase the dose until after the next ACTH stimulation test two weeks later. Depending on those ACTH stim results, the trilostane dose may be increased or decreased by 10-25%.
Each time the trilostane dose is changed, an ACTH stimulation test should be run about 10-14 days later. After the appropriate dose is determined, the dog should return for an ACTH stimulation test two weeks later, 3 months later, and then every three to six months. The dose of trilostane may need to be increased, as patients seem to become more resistant to it with time. Additionally, adrenocortical necrosis is possible at any point during therapy. It must be stressed that owners still need to be cautioned that this drug can also lead to disastrous consequences if appropriate monitoring is not followed.

Some dogs don't seem to be well-controlled on once-daily trilostane dosing, likely because the duration of efficacy of trilostane is variable, from 10-18 h. In these dogs, the dose may be divided and given BID. Dogs on the BID protocol generally need a lower total daily dose than those on SID dosing, and their clinical signs are often better controlled. However, dogs on BID dosing may have a higher incidence of side effects and Addisonian crises. One plausible explanation for this is that production of cortisol and aldosterone is inhibited for the entire day, with no chance to "escape" the inhibition to avoid a crisis. Because of the increased efficacy of trilostane based on ACTH stimulation tests, some authors prefer to start patients on BID dosing (1-2 mg/kg BID).

I would be thrilled if the acth test isn't definitive and he has hypothyroidism lol. Wishful thinking probably, though! ;)

[lulusmom]

Very interesting about hypothyroidism! I googled the symptoms and can see how they would get confused. If my dog has had an acth stim test, would that definitively rule out his symptoms as being cushings? Just curious! Will call my vet about it tomorrow!

I copied this post from another member's thread so that we keep Chuck's information here.

Clinical symptoms, as well as lab abnormalities, commonly associated with cushing's overlap with those of dogs with primary hypothyroidism. A very large number of cushingoid dogs will have a low T4 at the time of the cushing's diagnosis but this is most often sick euthyroid instead of primary hypothyroidism. Non-thyroidal illness, and most certainly cushing's, can cause a transient decrease in T4 which corrects itself once the underlying cause is treated. That is why most cushing's savvy vets will treat the cushing's first and once the dog has been stabilized, recheck the T4 to see if it has returned to normal. I am not really sure what question you are asking but if Chuck symptoms are commonly associated with cushing's, his lab abnormalities are consistent with cushing's and a diagnostic test, such as the acth stim test is consistent with cushing's, I would say his symptoms are probably caused by cushing's. However, if Chuck's T4 is also low, you can't rule out primary low thyroid until a recheck of the T4 after he's stable on an appropriate dose of Vetoryl. I hope that makes sense.

Glynda

[randomguy]

That does make sense, i think, thank you! Man oh man, are you a vet? You have an incredible amount of knowledge! I guess I was just wondering if its possible it's not cushings but instead hypothyroid. I called and left a message asking the vet; hopefully they'll know more.

[lulusmom]

No, I'm not a vet. I'm an insurance professional by trade. I, like many of our staff and members, have spent a good bit of time researching and trying to keep up with the latest developments. I have cared for multiple cushingoid dogs, my own and rescued. Plus I have been involved in small senior and special needs dog rescue for most of the last 25 years and have rehabilitated or provided hospice care for scores of little dogs with any number of medical issues.

If your vet did a thorough job of diagnosing Chuck with cushing's, then I don't believe you are dealing with a misdiagnosis. Cushing's is second only to hypothyroidism in canine diseases that are frequently misdiagnosed so we like to look over a vet's shoulder. The key to determining that possibility will be the results of the original acth stimulation test that was done to confirm the cushing's diagnosis. If the post stimulated cortisol on that test is greater than 22 ug/dL, I think the diagnosis is probably correct; however, it would have been optimum had your vet done differentiating test to determine whether Chuck has adrenal or pituitary dependent cushing's. Did your vet discuss the type of cushing's Chuch has? When you call your vet's office tomorrow, please ask them to tell you the results of the original stim test. There are only two number, the pre and post so you can easily jot them down and post them here.

[randomguy]

He told me that 85% or so cases are pituitary and that his gut feeling is that it's pituitary. But unless I get an LDDS test (i think thats it) he won't know for sure. I can't afford that test in addition to the last one ($~250) so I elected to not do it. He said that adrenal is not treatable or not as easily treatable (i don't remember!). He is definitely a thorough vet, so I'm assuming he's correct, but he sometimes has to work around my budget, which makes things more difficult. I'll definitely get those numbers for you. Thank you for helping me with your breadth of knowledge! And bless you for taking care of dogs in need! :)

[randomguy]

Ok, got the pre and post acth results and spoke to the doctor. She said she really doubts it's hypothyroid based on the results. The pre was 4.4 ug/dl and the post was 23.5 ug/dl. The testing sheet says there can be false positives due to stress so the results must be interpreted with symptoms in mind and I feel like we've done that. Hope that makes sense and thanks!

[lulusmom]

It makes perfect sense. Thank you for sharing those results. A post stimulated cortisol of 23.5 ug/dL is definitely a result that is consistent with cushing's. In case I confused you in my previous posts, I want to clarify that I am more concerned about a primary hypothyroid misdiagnosis in a dog with suspected cushing's than the other way around. I would not suspect that low T4 thyroid hormone would cause enough stress to yield a false positive on an acth stimulation test.

Glynda

[randomguy]

Thanks for replying and checking everything out Glynda! So far, day 2, he seems to be tolerating the medication well so I guess that's a good sign. I guess we'll see how his levels are doing at the 2 week test...I'm gonna be optimistic! :)

[flynnandian]

http://www.tipper-squirtcushingfund.org/apply.html here you can apply for help with your medical bills.

[randomguy]

Thank you very much! I think I will be able to make due without that generous organization, but am definitely very happy it's there! :) I would love to donate to it someday.

Does anyone know where the cheapest place to get Vetoryl is? So far it seems like california pet pharmacy. Day 3, my dog is doing fine on the Vetoryl, which is nice. It may be me imagining things, but he seems to be wanting to play more than usual lol.

[molly muffin]

California Pet Pharmacy and Diamondback are both pharmacies that members here have used with success.

[randomguy]

So, if the medication is working, how long will it be until I see results? Like, when will his stomach get smaller, when will his hair grow back, etc? Thanks for any info! :)

[judymaggie]

Hi! In response to one of your earlier posts, I said:


Since you are not seeing the more typical symptoms of excessive drinking or eating with Chuck, it might take a bit longer to see resolution of other symptoms although my Abbie's belly did get smaller fairly quickly.

That said, every dog is different. If a dog has been showing any anxiety or aggression prior to treatment, that might get resolved when cortisol levels are in check. As you mentioned, it appears to you that Chuck is feeling more playful.

[randomguy]

Thank you! Yeah, that makes sense. How fast did the belly get better for you? For some reason I was expecting things to happen in days, though I know better. I'm really hoping his dose is correct (and that he's responding to it) so we won't have to mess with it too much. I appreciate the info!

[judymaggie]

Hi -- my memory is pretty poor but, if I had to guess, I would say that I noticed Abbie's belly getting slimmer in about a month. Actually, others noticed it before I did -- hard to see some differences since I see her every day!

[randomguy]

So the doctor told me his gut says that it's pituitary cushings (probably because pituitary is a way higher percentage) but he can't really know unless he runs an LDDS test (couldnt afford both at the time). We will get his follow up ACTH stim test this coming week. Is there any way to tell if it's pituitary or adrenal cushings before then or will we just not see a reduction in the cortisol levels in the next stim test if its adrenal? Is it possible to treat adrenal cushings at all? So far so good with the medication, but I dont notice much difference (if any), though its only been 6 days. Just trying to get more info! Thanks!

[Harley PoMMom]

Unfortunately the only way to know if the Cushing's is pituitary and/or adrenal based is through more testing. Vetoryl can be used for both types of Cushing's and it lowers the cortisol in either situation too.

Just in case this hasn't been mentioned before, Vetoryl has to be given with a meal to be absorbed properly.

As Judy had mentioned, some of those Cushing's symptoms that Chuck has (the large stomach, thinning skin, large amounts of hair loss, and muscle weakness) will take a while to see improvement in. This disease takes a lot of patience, I know how hard that is as I am not a patient waiter! :eek:;)

Hugs, Lori

[molly muffin]

I think it took a bit longer for me to see any stomach differences, my molly has always, even as a puppy had a bit of a belly on her. I think again it just depends on the dog.

[randomguy]

Deleted, never mind!

[randomguy]

Thanks for the replies and information! The people on this forum are amazing. :) What if I'm noticing some lethargy in my dog? I don't think it's the medication, I think it's due to the fact that he needs to be coned right now and can't sleep well, but just in case, is there anything I should do if I'm noticing a pattern of lethargy? Appetite and everything seem great. Honestly it could just be that he's old and I'm paying more attention that I used to lol. ;)

[Harley PoMMom]

If his appetite is good and the stools haven't changed in color, texture (this requires poop patrol :eek::D) than the lethargy can be from the sudden drop in the cortisol which is known as corticosteroid withdrawal syndrome and can be seen during the first 10 days of treatment.

Now, if at anytime you believe Chuck is acting "off" than stopping the Vetoryl is recommended, and depending on what adverse symptoms Chuck displays an ACTH stimulation test should be performed along with checking the electrolyte levels.

Remember we are here for you so please do not hesitate to ask any questions you may have. ;)

Hugs, Lori

[randomguy]

Thanks again Lori! :) That's good to hear. Another question: I've read a couple things about dogs on Vetoryl having trembling hind legs as a side effect. Well, my dogs legs have been trembling ever so slightly but that started many months ago. He walks just fine and it's not a constant tremble. He stopped going up steps several months ago as well.

This week he's stopped going down stairs. It's very likely that's due to a recurring cyst on his foot that just popped up again. I also kinda feel like his sense of smell is worse and he can't hear or see quite as well lately. I think most of it is due to him aging but just wanna make sure it's not the medicine (or effects of cushings--but we're treating him for that so I don't think so?). I really appreciate all the help! :o

[Whiskey's Mom]

Hi I just read your post on Buffy's thread. I had just posted in mine about always second guessing my decisions regarding Whiskey. At his time of diagnosis almost a year ago, there was no question that we would treat him. There's no way to know what his health would be like now if we didn't treat. I was unaware of this forum at the time unfortunately. But anyway you're not alone in your confusion. I just remind myself that every dog is different and we love them and want the best for them. Good luck

[randomguy]

Thank you so much for the kind reply! :) So now that we've done Vetoryl for about 8 days, I'm wondering if you guys have any tips on how I can tell if my dog has arthritis that the Cushings was actually helping. He does seem tireder sometimes but I'm not sure if it's just the vetoryl or not (it's not been 10 days since he's on it, and as I was told earlier, 10 days of lethargy is normal). He doesn't like to jump down the stairs as much and almost doesn't seem to move around as much. But his joints don't seem to hurt and he's not licking them any more than he usually does. He's not limping. Ugh...I'm so confused! I really hope he's not dealing with arthritis.

[randomguy]

So, I dunno, my mother also seems to think that he's just been really sleepy lately. He's fine in the morning, before I give him his medicine. I don't really know if he has arthritis--he seems to be walking fine and his joints don't hurt when I touch them. Tomorrow will be day 10 of vetoryl, so I guess I'm still within that window. He has a follow up stim test this week. He's eating and drinking and pooping just fine, he's just more tired/quiet than usual. I just got home however and he seemed amped up so I guess that's good lol. Guess we'll see how it goes--I'm gonna be optimistic! :)

[Harley PoMMom]

If he is still eating/drinking normally and no change in the poop it would make be believe that he is fine...however, only YOU know your boy best and if there is any doubt about how he is acting withholding the Vetoryl is recommended.

Cortisol leaves a dog's system rather quickly so if a dose is skipped and Chuck seems less lethargic than you pretty much got your answer. When is his ACTH stim test scheduled?

Hugs, Lori

[randomguy]

His test will be scheduled for the end of the week! To be honest, he seemed pretty great tonight lol. So thats a positive sign. He was running down the stairs again too which is a plus. I'm gonna go ahead and give it to him tomorrow and call the vet and get the test scheduled and just see what they say. I'm really hoping (and assuming!) it's just his body getting used to the difference. :) Thanks for the reassurance/info, as always!

[molly muffin]

It does seem that he is fine and you will know more after the test as to what his levels are.

[DoxieMama]

Glad that he was doing well last night. Be sure to schedule the test 4-6 hours after his dose! :)

[randomguy]

Thanks, I definitely will! I scheduled it for Thursday morning. Turns out he's also a dachshund. :) He seemed to be doing a bit better today but still sleepy. It just kinda bothers me because sometimes when I'd expect him to wag his tail he seems not to, and I can't tell but sometimes it seems like his ears are droopy and he may or may not be more sleepy/less quick to want to get up/both.

I took him for a short walk today and he did will on the way out, but on the way back he panted more than he normally does. I'm not sure if it's because he was thirsty or tired or he has some kind of arthritis somewhere (maybe his back?) or if it was just insanely hot (90+ :eek:)! I guess we will get him tested and see where to go from there, but if he doesn't improve his sleepiness I will probably just not treat him. Unless I can treat the cushings and whatever else he has (arthritis?) at the same time. He's a pretty old guy and I want him to be as comfortable as possible! It just kinda sucks because he seems *less* lively on the medication as opposed to more lively, which is what I was expecting. Ugh!

[Harley PoMMom]

It could just take some time for Chuck's system to get used to the Vetoryl and/or the decrease in cortisol. If it turns out to be an arthritic problem, there are medications and supplements that can help that. Don't give up, hang in there, ok? ;)

Another thing I wanted to mention, I am a firm believer that how a dog feels/acts while on medication for Cushing's is just as, if not more, important than those ACTH stimulation results. What works for one dog may not for another, meaning some dogs do great with their cortisol within the therapeutic ranges, however, some may not and need their cortisol to run a bit higher.

Hugs, Lori

[randomguy]

You are so optimistic and amazing, thank you! He does indeed feel a lot better today and night so I'll hang in there. I tend to get very pessimistic but I'll try to stay up beat! Thank you so much for everything! :o :)

[randomguy]

Two questions I've thought of: first, I cant remember if I fed my dog before his first ACTH stim test. Is that ok (as in, will it affect the results)? Second, I'm planning on giving my dog a good breakfast with his vetoryl 4-5 hours before his next one. Should I not give him anything after that (in the intervening 4-5 hours before the test)? Thanks!

[Squirt's Mom]

Your baby needs a full meal with the Vetoryl every time. The ACTH should be done within 4 hours of the dose WITH the meal every time. So if your baby gets his dose at 7AM the ACTH must be performed no later than 11AM. If your vet tells you to fast for the ACTH, they are in error and should call Dechra for clarification of testing protocol. If the vet is wanting to run other tests that do require fasting, those tests will have to be done separate from the ACTH - at a different time. ;)

[DoxieMama]

The first ACTH test was before you started on Trilostane, right? In that case, it may have been fasted and I'm pretty sure that's okay. Once they are on the Trilostane you don't fast, because as Leslie said, that has to be given with a full meal.

[randomguy]

Oh, yes, sorry! For clarification, I meant what doxiemama was talking about. :o Is it best to have him there literally 4 hours after I give him the medicine or is anywhere in the 4-6 hour range ok (i guess I just want to figure out optimal timing)? Thanks guys!

[Budsters Mom]

Trilostane needs to be dosed with a full meal because it is metabolized through fat absorption. Without food, you would be throwing money down the drain because your ACTH test would not be accurate. Those cost a fortune as it is!:eek:

Four hours after eating/dosing is optimal. I always managed to be there at the four hour mark when Buddy was getting an ACTH Test. Within a 4-6 hour range is okay though. I always took a sick day from work to take him and stay. He was calmer that way and so was I.

Kathy

[lulusmom]

Kathy and I adhered to the same timetable for our cushpups but to simplify things for you, all you need to remember is that the acth stimulation test needs to be completed within 4 to 6 hours of dosing. If you drop Chuck off three or four hours post dosing, you're golden and your vet should be able to complete the test. FYI, if your vet uses cortrosyn as the stimulating agent, the test takes one hour from start to finish. If he uses an acth gel, the test takes two hours.

[randomguy]

Thanks for the info and advice! :) He does use cortosyn (listed at ~$38 per unit, if I recall correctly). Last time the test took about 2 hours, maybe a little longer, since I we didn't make an appointment. I booked it in advance this time, so hopefully it's a bit faster. He doesn't seem to mind the vet much, luckily. I'm gonna make him some chicken or something so he's 100% on schedule tomorrow lol. I'm really hoping his dosage is correct...there's no way I can keep affording a test thats about $225 on top of his medication (and this vet is cheaper than the other vet we occasionally go to for the test (and other vets too, I asked around)). :/

[randomguy]

Just dropped him off! :) So what exactly is the process? The vet tech didn't seem 100% sure, but it seems that they take a baseline, inject him with the medicine, then wait an hour or two and check again. Is that right? I asked him if they had to wait for him to relax for a bit (read it somewhere on the Internet) and he didn't seem positive but said that may be and he'll ask the doctor. They said if he's showing signs of arthritis they can prescribe him rimadyl or a arthritis medication and that they'll talk to the doctor about it. So that's good I guess.

[DoxieMama]

Initial draw, injection of cortrosyn, then one hour later another draw. I take my dog home in between (we're only a few minutes from the vet). We get our results the following day.

[randomguy]

Ok, great, thanks! :) This time only took about an hour and 15 minutes so that's good. Question: what medications do not play well with vetoryl? I occasionally give him a Benadryl if he seems like he has allergies and sometimes a carprofen if he seems like he's in pain (or an aspirin). Thanks!

[Harley PoMMom]

Vetoryl needs to be used with caution if a dog is taking ACE inhibitors (blood pressure medication) and even some diuretics.

Carprofen (Rimadyl) is one non-steroidal anti-inflammatory drug (NSAID) that I am wary of especially in dogs with uncontrolled Cushing's as they are at greater risk of stomach ulcerations/perforations if treating with Rimadyl or any other NSAID. Although Rimadyl is a great drug for arthritis it can be hard on the liver and kidneys so monitoring those levels is highly recommended.

With respect to the Benadryl, it should be fine to give it concurrently with Vetoryl.

Hugs, Lori

[randomguy]

Thanks very much Lori! I had the same thoughts about rimadyl. However, I'm a little conflicted. I guess I can take another little while to see if it's just his body getting used to the vetoryl. If it does turn out to be arthritis, I'm gonna have to decide whether to treat that as well as the cushings, or just stop treatment of both. I guess I can also try supplements. I have a lot to think about. I guess we should get the results of his stim test in another day or two. I should continue to give him his dose until I get those results, right?

[Harley PoMMom]

A couple days wait for ACTH stimulation results sounds like the norm to me, and yes, you want to continue with the Vetoryl (unless you see adverse signs).

I'm lazy today :eek::D so I copied this post from me to another member regarding arthritis meds:
From what I have read glucosamine/chondroitin are two supplements that are usually given for dogs with arthritis, another medication that some members have used is called Adequan, which is an injectable medication. Fish oil also has some anti-inflammatory properties. Duralactin is another supplement that can be used for arthritis, here's a link to a thread where this medication is discussed: http://www.k9cushings.com/forum/showthread.php?p=58306&highlight=duralactin#post58306


Hugs, Lori

[randomguy]

Hey guys! I talked to the doctor and he said the test results were great and to keep giving him his dosage. I've already emailed the vet about this, but typically I give my dog his vetoryl at 9:30. The test was scheduled for 11, so I gave him the vetoryl at about 6:45. Would this mess the test results up at all (since the time between dosages was about 21-22 hours instead of 24)? Also, I thought the pharmacy was open today and i was going to pick up some vetoryl. However, it is closed. That means that tomorrow, if I cant get to the pharmacy on time (or they have no vetoryl) he will have it later or not at all that day. Is that ok? Thanks for any info!

[Harley PoMMom]

As for the timing, I don't think it is critical that the doses be given precisely 24 hours apart, however they should be done in a consistent time frame.

Since Chuck's stim test was at 11 o'clock you really want the follow-up ACTH stimulation test performed at the same time so that you have a fair comparison.

Also, with Vetoryl/Trilostane it is critical that it is given with a meal so that it can be properly absorbed and those monitoring ACTH stim tests have to be performed 4-6 hours post pill...both of these protocols were followed, right? And, could you please post Chuck'e stim results...thanks!

Hugs, Lori

[Harley PoMMom]

Also, I thought the pharmacy was open today and i was going to pick up some vetoryl. However, it is closed. That means that tomorrow, if I cant get to the pharmacy on time (or they have no vetoryl) he will have it later or not at all that day. Is that ok? Thanks for any info!

There's no harm in giving or not giving his Vetoryl dose tomorrow, getting back on track when you get the Vetoryl will be important, which I know you will do. ;):)

[randomguy]

You are so amazing, thank you for the information! :) I did indeed follow those two protocols to the T! :D I dont have his pre numbers, but his post injection number was, I think, 6.4 ug/dl (or maybe 6.5). The doctor seemed to think that was pretty good so that made me happy. I've started him on joint supplements and we'll go from there! So far I haven't noticed much changes with him, though I could swear he's having accidents in the house a lot less frequently which is great. :eek: In an effort to get him to eat his medicine on time, since he likes to eat his food at his own pace, I've taken to giving him chicken breast and other stuff. That gets him to eat pretty quick haha! :p

[Harley PoMMom]

6.4 ug/dl or 6.5 ug/dl, both are great numbers, still would very much like to see you post them ;)

If even his numbers were higher than the therapeutic guideline ranges it is recommended that the dosage NOT be increased at that 10-14 day window because their cortisol can continue to drift downward during the first 30 days of treatment.

Improvements in peeing/urinating are commonly seen within 2 weeks of treatment, so it's awesome that it seems that Chuck is having less accidents!

Hugs, Lori

[randomguy]

So, just a quick question: I'm not even sure my dog is in pain. He just seems a lot...calmer. Is that a possibility with the medication? I know that cortisol is a stress hormone so I figured I would ask. It's actually kinda nice...in situations where previously he would kind of shake in nervousness he's perfectly fine now lol.

[Harley PoMMom]

I know when my boy, Harley, had elevated cortisol it seemed like he was hyper all the time, he also became so food focused,,,so yes, I believe that getting that cortisol level down could make a dog feel less antsy.

Hugs, Lori

[randomguy]

Hi guys, I picked up vetoryl yesterday for my dog and it appears to be in a chew and not a capsule. Is that right? The pharmacist seems to think there was a mix up and to bring it back and get the capsules. In that case, I might not be able to go until a little later. Can I give him his dose either later today if it's not too late, or not at all for a second day? This is so annoying lol.

[Harley PoMMom]

Since the pharmacist thinks that there is an issue with Chuck's dosage strength being that the Vetoryl/Trilostane is not in the capsule form that you've been giving, yes definitely, I would take them back.

And it will do no harm in withholding the Vetoryl/Trilostane especially if there is a question regarding his dosage strength..Kudo's to you for being so observant, you're doing a great job at being an advocate for your boy!!!

Hugs, Lori

[randomguy]

Wierdly enough, I don't even think it's a dosage issue, just that they're not actually capsules! :eek: They're like a brown oval dog chew with a line down the middle to break it in half. I checked dechras website and it doesn't look like they make them in anything but capsules! Thanks for the feedback! :o

[randomguy]

Turns out that the pharmacy gave me the wrong medicine. Glad i didnt give it to him lol. Anyway, gave him the vetoryl today and all seems fine. I could swear he seems more lethargic while he's on it, though, which is so weird. I cant figure out why. I really dont think its arthritis but who knows. I may just treat him for a few months and see if there's any difference and if not, just stop. Another ACTH stim test will be performed in 2-3 months so i guess we'll see.

[DoxieMama]

I apologize if this was asked before but I don't see it --- when the ACTH test was done, did you also have electrolytes tested? That's important to do. (My pup had to have his dosage reduced because of an imbalance in electrolytes, rather than too low cortisol.)

[randomguy]

I apologize if this was asked before but I don't see it --- when the ACTH test was done, did you also have electrolytes tested? That's important to do. (My pup had to have his dosage reduced because of an imbalance in electrolytes, rather than too low cortisol.)

No i didn't! I think the doctor actually did mention that in one of his emails or phone conversations with me. I guess i should figure out how much that costs and see if I can spring for me. Are there any symptoms or anything I'd see if he did have low electrolytes? Thanks! :o

[DoxieMama]

Electrolyte testing is rather inexpensive. Our cost $13.80, though if it is not done along with other testing like the ACTH then there is also a blood draw fee. I think they should always be done together. I don't have the reference handy but I know I read that you should stop or lower the dose if either cortisol is too low OR the electrolyte balance is off (in our case it was high potassium causing a low potassium/sodium ratio).

[randomguy]

Thank you very much for the info! :) So I'll be needing to get some more vetoryl for my dog soon. When should I think about switching to compounded? Any time? After the next stim test when we know more about his dosage? How much is 20 mg of trilostane from diamondback? I tried looking but I couldn't find pricing info. Are there other websites I should consider for compounded? Thank you so much for all the help! :o

[DoxieMama]

I started with compounded right away, though I know others use Vetoryl until they get the dosage right (or close). As for pricing, you can call/email/contact Diamondback through their website and get a quote.

[dsbailey]

This is a reply I got from diamonback asking in the 15 / 20 / 25 mg range.

Darrell and Lolita



"Hello Darrell,

Thank you for your price quote inquiry.

Diamondback Drugs compounds TRILOSTANE (C) 20MG CAPSULE, a quantity of 30 will cost $37.95. The other strengths will cost the same amount.


To order this medication, please have your veterinarian call, fax or email pharmacist@diamondbackdrugs.com

Thank you,
Diamondback Drugs
P: 1-866-646-2223
F: 1-866-646-2235
VAM"

[randomguy]

Wow, thank you so much!! That is a pretty huge discount and I'm gonna switch. You guys are really amazing--I can't thank you enough! :)

Quick question: so I accidentally ordered medication from a site that doesn't ship to people and then ordered from a different website and I thought the process would be faster, so it totally messed up my shipping times. The Vetoryl won't be here until Monday and I ran out on Wednesday. Is it ok to wait until Monday or Tuesday to give it to him or should I go buy more (at a high price) so he can have it tomorrow? It's just so frustrating because I've already been in this position and specifically planned ahead so that this wouldn't happen like it did last time! I figured I would ask again since this time it's gonna be about 5 days without and last time it was only 2 days without. Thanks for any info!

[dsbailey]

My girl would have the medication tomorrow. I've been in your spot before and paid the price and taken a long drive to get it. ;)

[Harley PoMMom]

It definitely will not do harm in waiting the 5 days but his symptoms may start to rebound. ;)

Hugs, Lori

[randomguy]

Thank you both! :) I'll try to pick some up tonight if I can. Other than that, you better believe I'm gonna order in sufficient quantities in the future! :o

[randomguy]

Hey gang! It's been about a month on Vetoryl and I have noticed a reduction in urination in the house which is great. I think his stomach has gotten a bit smaller but not too much (sometimes it does seem a lot smaller but sometimes it seems about the same lol). His hair doesn't seem to be growing back like I thought it would. I do think I have seen an increase in his muscles which is great. Should I just be patient and expect to see this in the future or will I not see it? Thanks for the help! :)

[Harley PoMMom]

Glad to see that Chuck is doing well on the Vetoryl! Regarding the hair issue: This will take a long time to improve. When dogs have elevated cortisol over a period of time it can do damage to the hair follicles. Hair follicles have to go through a cycle so they die off and then regrow and that can take a long while to see any regrowth. We have had some dogs on the forum that when their new hair grew in it was a totally different texture/color.

Patience is needed when treating this dratted disease and I know hard it is to do that :( You're doing a great job, Chuck is lucky to have you as his pet parent!!

[Renee]

The hair growth can be fickle. In fact, don't be surprised if he blows his entire coat - I mean, nearly bald, then gets it back. About 2-3 months into treatment, Tobey lost her entire coat. You could see all of her skin. It came back super thick, like puppy coat, haha.

Now, 3 years later, it's not as nice as it was but it's still a full coat. Her front legs are permanently bald where they've been shaved for multiple IV's over the past year. I don't think those areas will ever grow back.

It's all good. That's what coats and sweaters are made for. ;)

[DoxieMama]

Your comment reminded me how difficult it is for us to see day to day (or even week to week) changes, both in ourselves and others. This applies to our pets, too! We see them every day, so those subtle changes escape our eye. It's usually not until someone else, who doesn't see them as often, mentions it that we recognize the truth. When you're trying to lose weight, I think it's doubly true. For those moments, measurements are important to recognize those subtle changes in our body composition that the scale doesn't register. Even more vital is pictures.

Take pictures of Chuck from different angles if you can. Do so regularly - once a month is probably good. You may not see changes between one month and the next, but between one month and three months later you just might.

[randomguy]

Thanks for the help and advice! :) That makes a lot of sense! :P So far so good, I think. He seems to have more energy than he had before we started him on the Vetoryl which is great. Frankly sometimes it's kinda annoying lol. Still feel like his stomach is too big and I'd love to see him grow more hair but you've told me that takes time, so I guess that's that. I do think I've been feeding him a bit too much so I'll cut that out.

We will take him to get his next test in about a month and a half. The doctor (and I read it on here too, I believe!) said its so that we can check his levels to make sure they're not too low since its been seen that the levels drop even more after the first couple weeks. Is it possible that the levels get higher? Just figured I'd ask! Thanks for all the help! :)

[randomguy]

I'm a little concerned that urination in the house has increased a bit after initially having stopped when we started the Vetoryl. It could just be that we've been out of the house more and haven't been able to take him out. He also seems a bit hungrier lately, but I'm wondering if that's just due to him being more energetic and exercising a lot more lately (which makes me happy lol). Is it possible that his cortisol levels could have increased? The way I understand it, its more likely that they fall in the 30 days after the initial stim test with vetoryl. Thanks guys! :)

[Joan2517]

Lena's symptoms became noticeable again after about 3 weeks on the same dose. My vet increased her to 20mg and then another increase 10 days later to 30mg (she was only 6lbs). I never should have let him increase until she was on the same dose for 30 days, but I didn't know that then...he should have.

[lulusmom]

Yes cortisol levels are likely to drift downwards in the first 30 days of treatment but we've seen dogs have a great first acth stim test at 14 days and the 30 days stim test showed cortisol had increased quite a bit. Dogs who have been stabilized for a any length of timecan escape control or suddenly crash due to low cortisol so you just never know. When is the next acth stim test scheduled? A good predictor of high cortisol is dilute urine. If your dog's urine is concentrated and smells like pee, chances are it's behavioral and not cushing's.

Glynda

[randomguy]

The vet wanted the next test 2-3 months after his last (which was 10-14 days after his initial test, in case anyone cares!) so I think about a month or a month and a half or so from now (which would make it two and a half months, just about). The urine looks pretty good to me (;))...pretty much just regular. Otherwise I guess I can't complain. Energy seems up, which is good. Guess I'll just wait! Thanks everyone! :)

[randomguy]

deleted...

[randomguy]

Hey gang! :) Got him tested again a few weeks ago and the vet said his levels were optimal again. He has actually gained about 1-1.5 lbs. His stomach is still big and he still is losing hair. I know you guys said that he might lose all his hair before he regrows it and that takes a while. I dunno if the weight gain is the reason for his still big stomach or it just hasn't gotten much smaller. I asked the vet why I'm not seeing much in the way of stomach reduction and hair regrowth and he said that it just takes time and different dogs have different outcomes. It's been probably 4 or so months he has been on the vetoryl.

Either way, I am happy that his levels are good (I think around 6 whatever units lol :p) but wish I'd see his stomach getting smaller and his hair growing back. I guess we could run some more blood work to get some possible answers, but I am in a tight spot with money and when we ran his previous tests a while ago his thyroid levels were optimal, so i dunno. His energy levels are pretty good and appetite and all this is great.

[Harley PoMMom]

So happy to hear that Chuck is doing well!! I know I'm a pest in asking but could you post his ACTH stim results for us?

And yes, it may take a good while to see improvements in his hair and pot-bellied appearance. Some of that bulgey tummy is from the muscle loss and the enlarged liver that cush pups get...all good things take time, right :D

Thanks so much for the great update!!!

Hugs, Lori

[randomguy]

Thank you so much for replying! :) I bet some of it has to do with him being old too. I can't remember what the result was pre injection, but post it was 5.5, I think. I'm pretty sure it was 6.1 last time (post). I'll try to find out the pre values for you! The vet consulted with a couple endocrinologists and they all agreed that it would be best to stay the course instead of slightly lowering the dosage. I believe they do the cortosyn and some kind of gel as well (just fyi!)? He said the gel is really expensive if I recall correctly. Well, thanks again, I really appreciate your help! :o

[molly muffin]

My vet always said that mollys tummy was from loss of muscle and the enlarged liver which usually goes along with cushings.

[randomguy]

Hey guys! My dog is still alive which is good. :) He's doing alright. It's extremely cold out so it kind of sucks for him but he's doing alright inside. Unfortunately, his tummy is still large and he is still losing hair. I dont even think his stomach has gotten smaller to be honest. He also had some muscle loss overall and on his hind legs (i think) and that doesn't seem to be getting much better--it may actually be getting a bit worse.

I really was hoping these things would all be getting better but who knows...i wonder how much of it is due to old age. I really dont think there is gonna be a lot of muscle gain since he's 15+. His levels have been perfectly fine the last few times he's gotten tested. I guess we should get blood work done for thyroid (which were good the last time we tested) and maybe diabetes. Well, this was just an update! Have a merry Christmas and happy New Year!

[randomguy]

Hey all! :) Dog is still doing alright and it's not as cold as it was earlier so thats good.

I guess i'm wondering...will his stomach actually get smaller? I talked to one of my vets and he said it takes time and it's different for every dog. I talked to another of my vets and he said that in his experience cushings dogs dont really lose their bellies. I am guessing his age isn't really helping. He is still about as energetic as usual and has a good appetite which is excellent. His hair is still falling, though a few members here said all their dogs hair fell before it grew back. But they said that happened within a few months, and its been probably 6 months so i dont know.

His legs do seem weaker than they were a long time ago, and they occasionally shake when he is in certain positions standing up, but not often and it doesnt seem to bother him. I do feel like he has lost some muscle otherwise overall because his skin is looser. But also, again, he is pretty old so this is also to be expected, so I dunno. I mean, the last two or three times his levels have been optimal so i dont think we can just stop his medicine nor would it be a good idea to, i just wish it was doing a bit more. I guess we can get him tested for diabetes if its that but I dont think it is.

Also, for the last year or so, he has been getting little interdigital cysts/furuncles on his feet which has been annoying but i dont think its reduced his quality of life. We give him antibiotics for those if it gets bad and benadryl and other stuff.

Any advice? Thanks very much! Hope everything is well with you all! :)

[molly muffin]

My dogs belly always seem to be what I called a Buddha belly, even when she got skinny through her back end and spine. They told me it was due to the enlarged liver and muscle weakness in that area, so no I don't think all dogs bellies go away.

Well, a general senior bloodwork would show if there was other things going on, but between age and cushings, the muscle weakness may be there to stay. As long as quality of life is good, then that is the most important thing.

[randomguy]

Hey, my dog is still alive! He had some kind of a stomach problem the other day but that seems to be better. I think he's at the end of his life, though, which is sad but not unexpected--he is nearly 16. His stomach seems to have grown which is sad for me to see and he does seem to have lost some more muscle. I got a senior panel done the other day but the results are not yet it. His next ACTH test is in a couple months I think.

The vet I did his senior blood panel at said that he looks pretty good and that between the cushings and his age muscle loss is to be expected. Same with the thin skin--weirdly enough he seems to have a lot of loose skin. Basically this doctor told me that in his experience the vetoryl isn't a cure but just tries to slow things down. Well, I'm going to sign off, if anyone has anything to add I would appreciate it! :)

Edit: senior wellness panel came back a ok so that's great! Doc said his liver levels are good and cushings is well controlled. I'm left happy but also kinda confused lol.

[Harley PoMMom]

WOW, 16 years old, you are doing a great job in taking care of Chuck!!

The vet is correct in that the medications used for Cushing's do not cure the disease but help to slow down the damage that excess cortisol can do.

That's super great that his blood panel levels are good and his Cushing's is controlled, could you post those results for us? Please don't think that we are second guessing the vet it's just that many of us have put blind faith in our vet and our pet paid the price for it, so we just like to double check those test results.

Hugs, Lori

[randomguy]

I'll definitely see if I can get my hands on those results! He said that one of his pancreas levels was kind of high so the reason he may have been in pain was due to a mild case of pancreatitis. I told him that (since we took him to the vet as soon as it opened) he hadn't taken his vetoryl that day and he said that was ok as long as he's been taking it regularly. Well, thank you so much Harley! :)

[Harley PoMMom]

You done good in not giving Chuck the Vetoryl when he wasn't acting normally, that is one protocol that can not be stressed enough, so Kudos!!

My Harley had pancreatitis so if you have any questions or concerns just ask. ;)

Hugs, Lori

[westcoastflea1]

my declan had crepey skin bald large belly pyoderma you name it he had it. it took a year and a half and a dose of 300 mg of vetoryl per day to finally get a uccr test results of non cushings but i wasnt seeing any improvement over the year and a half he just kept losing more hair his belly got bigger. although his thryoid test came back as normal thyroid all of his levels were below normal except ft4 with was barely low normal i had my vet put him on thyroid meds in the last couple of months he has lost the belly. all hair has grown in. he has energy and is playful no more utis pyoderma crepey skin its like he doesnt have cushings. Vets still dont know everything about cushings or the endocrine system. cortisol suppresses thyroid stimulating hormone which means a thyroid may be healthy but isnt doing its job, perhaps a normal cortisol level doesnt mean thyroid is working as correctly as it should. i see no harm in starting your dog on a low dose of thyroid meds for a month or so to see if any improvement if no improvement take him off. or get another thyroid panel done first if cost is not an issue, just make sure your vet emails you the exact test results as they came from lab. you can see exactly where each level is if high normal of course dont go with thyroid meds medium normal to low normal i would give it a shot. most vets follow standard cushings protocol start on vetoryl do stim tests etc etc they have no clue or it seems no interest in actually doing their own research on cushings so it is a cookie cutter approach that is used for cushings dogs. owners need to think outside the box, if your dog is not showing signs of improvement in symptoms that overlap with hypothyroidism with cortisol under control there is no harm in trying a thyroid med. check with doc to make sure dog has no underlying issues like heart condition before doing so. a month on meds wont harm if dog is healthy and may actually help improve symptoms that vetoryl is not helping with, if not no harm no foul. also with possible pancreatitis i would go with all meat diet low fat no carbs there are several canned products out there i wouldnt go raw too many products recalled because of listeria and salmonella immune systems are not good in cushings dogs so thats one problem you dont need:) good luck

[randomguy]

Hey, thanks very much for the info! If I can swing the extra bucks I definitely will. Question: what should I be doing for this mild case of pancreatitis? The doctor told me basically only bland food like rice and chicken and not a lot. I have a low dose of pain medicistion in case it's needed as well. He told me to expect it, but it's a bit frustrating seeing him be great for a day or two and then not great and so on and so forth. Thank you all for your help! :)

[Harley PoMMom]

A low fat diet is required and small meals (3-4) should be fed throughout the day. Making sure he is hydrated helps with the healing of the pancreas. Also, having him at his ideal weight is a significant factor because studies in humans have shown that obesity can cause pancreatitis. Were his triglycerides checked to see if they are high? Dogs that have pancreatitis are more prone to get diabetes too so getting that pancreatitis under some kind of control is important but it is not an easy thing to do.

I found a lot of good information in this roundtable discussion: http://www.idexx.de/pdf/de_de/smallanimal/education/client-education/pancreatitis_roundtable_discussion_2006_us.pdf It is lengthy but very informative.

Hugs, Lori

[Budsters Mom]

Well Random Guy, around here you aren't so random. I would say AMAZING, not random. Of course, if you called yourself "amazing guy", that would just be creepy! Lol ;):D

Anyway, you have brought Chuck a long way! To the ripe old age of 16, while plugging along. Kudos!! :)

Keep doing what you're doing because it's working. Chuck is blessed to have you in his corner.

Kathy

[randomguy]

Ha! You guys are too flattering! :p You can call me amazing guy, I wish everyone would LOL. :D So, on saturday I was very worried for him and took him to an awesome 24/7 vet around here because he wasn't moving much. She said that yeah, its partly the pancreatitis but also (mostly the reason he wouldnt move) is because he probably has degenerative disc disease which these kinds of dogs often get, especially when they're older, and there are flare ups. She prescribed him a couple meds and he is feeling wonderful, which is great news. :o

As for test results, here are the ones that are either too high or low:

HCT is a tad high. Monocytes were a bit high. Absolute monocytes were a bit high. Alk phosphate was a bit high. Creatinine was a bit low. BUN/creatinine ratio was a bit high. PrecisionPSL was high (something to do with pancreatitis they said). Everything else was fine. All the ones I said were a bit low or bit high were almost normal, only the precisionPSL was a lot higher.

She was a bit concerned that he wasnt seeing improvements with the vetoryl but said that each dog is different, he's a bit older, sometimes there isn't much improvement, could be that he had the cushings before we gave him medicine for a while so it's taking longer, etc, but she doesn't know for sure. I'm scheduling his 6 month acth test soon. Thanks as always for your helpful advice and friendliness! :)

[lulusmom]

Long time, no post here. :D

I just refreshed my memory by reading your entire thread and I have to admit that you are the only member who disappears for a time and upon returning says; "Hey, my dog is still alive." LOL That is always awesome news and I can't help but giggle. In going over things, it appears that Chuck never has improved to the point that you expectedbut he's still alive and according to his last blood labs, appears to be doing well. The thing I noticed is that Chuck has not had that many acth stimulation tests, or perhaps you haven't posted all of the results for us. When was the last acth stim test done and can you please post the actual pre and post stimulated numbers? He is on once a day dosing, right?

Glynda

[Harley PoMMom]

Pancreatitis can be a bugger to get control of, I couldn't get Harley's Spec cPL levels under 300 (RR 200-400).

Has the vet mentioned having another PrecisionPSL test done to monitor Chuck's pancreatitis? Even the mild form of pancreatitis can be painful, is Chuck getting pain medication?

You are doing an awesome job advocating for your precious Boy!

Hugs, Lori

[randomguy]

Hey all! :) It's been a while since I updated. Doggo is still alive which is wonderful! :p Realized its been a little over 6 months (actually a little over 7) since the last test, so I just scheduled a new one for Thursday! No sign of his belly getting smaller, hair getting more plentiful, or muscle gain, so that's not great, but otherwise he eats fine, drinks fine, has decent energy for an old man and all that stuff, which is awesome. :eek: I'll ask the doctor why I'm not seeing any positive signs since I've given him medicine, thats for sure. Briefly toyed around with going to a different doctor in case they're doing something wrong, but I dont believe thats the case and I wanted to keep all the tests in the same place and his doctor is a very caring person which I love. So, hopefully more updates soon.

At this point I'm a lot less stressed out than I used to be--he's quite old and whatever will happen will happen and I'm gonna do my best to keep him happy! Which he is. :D If the medicine slows things down thats great, but I'm honestly not expecting miracles since he is so old (it's my opinion that his age is the reason I'm not seeing any dramatic improvements). In case the vets office is testing wrong or something, is there anything I should have them do? It's just draw blood, inject with 'stuff', wait a bit, then draw blood again, right? I've heard that stress can skew the results but I dont know how that all works. Well, as always, you guys are great and thanks for any help! :)

[Harley PoMMom]

The improvements that you are not seeing can definitely be age related, and sometimes even when a dog is stabilized with treatment there may not be a huge positive change in the hair, muscle, or size of the belly. :(

The two important rules with the monitoring ACTH stimulation test is that the Vetoryl has to be given with a meal and the test has to be do done 4-6 hours post pill. Probably running a senior wellness blood panel would be a good idea, and another thought of mine would be to ask if the thyroid level is checked on that blood panel, if not, I'd ask that it be added because the muscle weakness, hair issue, and I even believe an enlarged liver can be symptoms of hypothyroidism.

Keep n us updated!

Hugs, lori

[randomguy]

Thanks so much lori! :) So, we were going to get him tested the other week, but he came down with a sudden case of diarrhea, which I realized as a symptom of a minor pancreatitis attack. So he's still having loose stool and there's a bit of blood in it, which means he probably needs metronidazole again. Which is annoying because I need to make another appointment. He is eating and drinking and behaving normally so I am not terribly concerned, but this pancreatitis thing is a huge pain in the butt. He's taking the pepcid and eating a bland food diet but it's not yet under control. So once we get this taken care of, then he'll get another acth test. I really wish there was more we could do to combat this pancreatitis!

[Harley PoMMom]

Pancreatitis sure can be a bugger to get under control :mad: With Harley, he had chronic pancreatitis and we never could get his spec cPL results under 300 (RR 0-200), I even had his diet formulated for pancreatitis :mad::(

That pancreas is a fickle organ and anything or everything can set it off, winning the battle against pancreatitis, sometimes, just can't be done which I know is so frustrating. Like Harley, Chuck may have the chronic type of pancreatitis so flare ups may be a common occurrence.

Hugs, Lori

[randomguy]

Hey all! :) Chuck is still alive! :p He's doing pretty good--about the same as normal except for the annoying pancreatitis that comes and goes. Just did his ACTH test yesterday and got the results today. The Dr. said that his results were 2.2 (post) and that last time they were 6.7 (post). He told me that 2.2 is still considered normal but since there's a trend of it dropping we have to keep an eye open but that he thinks (seemed kinda iffy on this) he will continue with the 20mg that he takes once a day. Any thoughts or suggestions? Thank you so much, you guys are all wonderful! :o I hope things are going good for everyone! :cool:

[molly muffin]

Hi great to hear from you. If they dropped from 6.7 to 2.2, while that is good and in range, you don't want it to drop any lower. Could decrease dose to 10mg or 15mg maybe if you want to be on the safe side.

[randomguy]

Hi great to hear from you. If they dropped from 6.7 to 2.2, while that is good and in range, you don't want it to drop any lower. Could decrease dose to 10mg or 15mg maybe if you want to be on the safe side.

Yeah, thats what I'm thinking too. He wants to discuss it further with me since it was just a voice mail, so we'll talk on Monday. Thanks for your advice! :)

[randomguy]

Doctor and endocrinologist recommended going to 10mg and retesting in 2-4 weeks. I can't afford it that early so it may be a couple months. Can't complain about the savings for medications but the testing isn't cheap lol. Here it goes!! :)

[PennysDad]

We are dealing with the same potential situation now. The tests are just brutal! Especially because our dog is so big that we are on 180mg/day!

[randomguy]

We are dealing with the same potential situation now. The tests are just brutal! Especially because our dog is so big that we are on 180mg/day!

Oh my gosh, that is BRUTAL! I don't envy you! :eek: At least his levels aren't rising, though, haha. I'm confident we will get it leveled out (and glad we caught it before it became an issue!); the doctor told me that he has seen this happen before and did advise me it may happen before we started treatment. Good luck and best wishes to you! :)

[molly muffin]

If you notice any change that might signify that the cortisol has dropped too much, even on a lower dosage, then just stop the meds.

Hopefully decreasing to 10m that won't be an issue though.

Yes those test costs can be Brutal indeed.

[randomguy]

So far things are looking normal! What should I look for specifically? Thank you so much for being so helpful all the time! :)

[Harley PoMMom]

Symptoms of cortisol dropping too low: vomiting, diarrhea, lethargy, loss of appetite, or Chuck just not acting his normal self; if any one of these symptoms are observed withholding the Vetoryl/Trilostane is recommended.

[molly muffin]

Yep, exactly what Lori said. :)

[randomguy]

Hey all! My dogs still here with us and doing quite good! :D Just did another acth test and got weird results. The doctor said his levels were around the same as last time, even a bit lower (like .5 lower, so around 1.5-2). He told me to stop giving him trilostane and to keep an eye out for any clinical signs of cushings.

He told me it's not unheard of for this to happen especially for older dogs. He said he recommends a general blood test as well as thyroid panel just to make sure no other illnesses are affecting his results. So...what should I be thinking here? Very strange! Thanks for any advice! :)

[Harley PoMMom]

Was Chuck's Trilostane reduced from 20mg to 10mg? If not, and in light of his most recent ACTH results, I would definitely have the Trilostane dose decreased

And your vet is correct, cortisol levels can fluctuate even when there hasn't been any adjustments to the Trilostane dosage.

Lori

[randomguy]

Yes it was reduced to 10mg. So this test was for the 10mg dosage. He's going to talk to his friend that's an (animal) endocrinologist but for now he says to stop the vetoryl. I guess we could go to 5mg and then test again but I dunno. I do plan to get some more comprehensive testing when I get some more money. I guess I'm just happy that he seems to be feeling quite good. :) This is so crazy lol.

[molly muffin]

It's possible that you will go to a 5mg anyway at some point, since he now seems to be more sensitive to the medication and yes, he is correct, it is actually rather normal to have to reduce the dosage after long term use.

[randomguy]

Well, so far so good--he seems to be in good spirits. He's very old, 16, but I'll be damned if he doesnt make me throw around his dolls every night and chase after them at a pretty fast speed haha. ;) Doc recommended a general blood test and resting ACTH test (or something) and I'll probably do those when he wants me to--they aren't as expensive but still not cheap. Thanks for being so helpful and supportive! :)

[molly muffin]

He sounds very lively for a 16 year old and that is a good thing and sure shows that you continue to do really well with him and his treatment.

good job!!

[randomguy]

Hey all! :) My dog is still alive and well haha. :D We got another ACTH test since he went off the meds and the doctor said his levels are within the normal limits still so that is good. I do think his water intake and urination have steadily increased (though his urine doesnt seem dilute or anything) and the doctor said he would like to get his kidneys tested but I dont have enough money for that right now. I do feel like his stomach has gotten bigger (though he has gained some weight) and he has been losing hair like he was before so no changes there. Overall I'd say he is quite active and happy and hasnt had anymore pancreatitis attacks or anything bad so I'm pretty happy! :cool: Until next time! Which will be when I get more money for tests and stuff lol. Thanks for reading and any advice! :)

[Harley PoMMom]

Thanks for the update and I'm so happy to read that Chuck is doing well!!! Did the vet perform a full ACTH stimulation test or just a pre? And can you post those results here for us..thanks!

It could be an UTI that's causing the increased drinking/urinating. Does it seem that when he pees it's a small amount or is it a good stream of pee?

[randomguy]

I want to say its not a UTI because he just took a two week dose of cephalexin for his interdigital cysts (or whatever they are called), but its possible because he's had UTIs before (and I dont know if cephalexin treats UTIs lol). His pee is usually a decent amount, but sometimes not. Honestly he always kind of peed a lot and has never been very well trained. He had a full ACTH stim test. I dont remember the pre (I think 3.5?) but i do recall he said the post was 15 or 15.5. Thank you so much for responding! :)

[Budsters Mom]

I love how you start your messages! So glad that Chuck is still alive and doing well overall.

Kathy

[molly muffin]

Great to hear that chucks journey is continuing on. Tough guy isn't he. :)

[randomguy]

Hey all! :) Hope everyone is doing well! My dog is still alive! :D He’s extremely old at this point, though he seems to be doing pretty great when he’s good but I have been through several scares in the last year. Anyway, after the vet found that with no vetoryl his levels were normal I got lazy and didn’t test him for a while. He started peeing a lot and drinking a lot of water (even though those symptoms were never really prevalent when he was initially diagnosed) several months ago so about a month ago I took him in and his levels had gotten higher again (I think post was 22ish). His liver and kidney and all those other values were normal (I think his liver values were slightly elevated which is another thing that led us to know that his cushings had “come back”). So we started him on 5mg of vetoryl.

Anyway, initially he seemed fine but I’m a little concerned that he’s acting strange and maybe kind of lethargic. It could be my head playing games with me but maybe his breathing is a bit more labored and his heart rate may be up too. I guess my only question is: is there anything I should watch out for? Should I stop giving him vetoryl? At this point he is so old that whatever is going to happen will happen, cushings treatment or not. I’m going to miss him dearly when he is gone and am dreading that day but my gosh is it getting exhausting taking care of an old pet—I had forgotten how difficult it was. My first and only other dog didn’t get quite this old and I was much younger.

Well, thanks so much for any advice!

Edit: I wanted to add that I think he seemed normal earlier in the morning before his medicine. Also I gave him a carprofen when he seemed like he wasn’t feeling good on the chance that maybe the vetoryl exacerbated his potential arthritis that the cushings masked. He seems quite ok now. Hmm.

[labblab]

Thanks so much for updating us about Chuck! If I’m figuring correctly, he must be 17 years old now, so that is quite a milestone indeed. If he were my own dog, I’d totally do whatever seems to keep him feeling the most comfortable. If the Cushing’s symptoms are bothering him a great deal, I’d try to persist with the Vetoryl. But if not, or if he seems even worse taking the Vetoryl, then for sure I’d just discontinue it altogether. As you’re guessing, it’s entirely possible that the Vetoryl may be increasing his discomfort from arthritic pain. So the trade-offs of treating vs. not treating have to be balanced.

One other issue with the Vetoryl is that if Chuck remains on it, you really will need to have his blood levels retested. Even at this relatively low dose for his weight, you have to know how his cortisol is being affected. One piece of good news in that department is that a new monitoring protocol has been developed that involves only a single blood draw to check the resting cortisol level right before the daily dose of Vetoryl is given. This is much simpler and much less expensive than the full ACTH stimulation test. If Chuck stays on the Vetoryl, however, this monitoring testing should be done in order to evaluate the appropriateness of the dose.

You have done an amazing job of supporting Chuck throughout such a long and well-loved life. You both deserve to have as much peaceful time as possible now during these waning days. And if that means just forgetting about the Vetoryl altogether, I say “so be it.” If, however, you want to know more about this new testing protocol, just let me know and I’ll provide a link.

Big hugs to Chuck, and a huge pat on the back for you, as well!
Marianne

[randomguy]

Thank you so much for your kind words Marianne! I do believe he is right around 18 or so. Very old! I obviously don’t want anything to happen to him but at this point I am at complete peace (well, as much as you can be) with it. He’s lived such a long and joyous life that I really feel like it’s just nature at this point. Unfortunately none of us can live forever, which has been a hard lesson I’ve learned as I’ve grown older. I skipped his dose for today and he seems normal and better than yesterday (pre carprofen). I’ll give it to him tomorrow just to see if I haven’t been making things up, haha.

He is due for another test in 4 weeks if I keep giving him the medicine. We all know the testing sucks and I feel bad for him but I think the people at the vet are really nice and it’s not too bad. That new test does sound interesting. I wonder if my vet would go for it and how much less it is. I’ll have to talk with him about what’s going on and see what we can do. I guess I’m gonna have a lot of questions for him like maybe would giving it at night help? Would I be allowed to give it every other day? Maybe a half dose? Maybe continue with the carprofen? I dunno.

Either way, you have been so helpful and nice and I always appreciate that! We honestly thought he wouldn’t make it past 15-16 so I’m pretty pleased lol. My father likes to joke that he’s been living these last few years with a free pass haha. :) Well, have a nice day and thank you again!

[labblab]

Wow, almost 18!! That is an amazing life for a very special little boy.

Here is a link to that new monitoring protocol I was telling you about. I think your vet might seriously consider it for Chuck if you tell him about it in advance. At this stage, anything that makes Chuck more comfortable makes sense to me, even if it involves an unconventional dosing schedule. In terms of safety, the biggest think is to check to make sure that Chuck’s cortisol is not dropping too low. Something is finally going to end things for his aging body, but you’d rather not have it be an uncomfortable crisis with low cortisol. This new protocol should be able to help guard against that happening.

http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1252#post1252

Please do let us know how things go!
Marianne

[Squirt's Mom]

Glad to hear Chuck is ticking along and seems happy! Every day is a blessing....I have a Chi who we think is around 19 so I understand how precious each day can be.

[randomguy]

Wow! 19! That’s amazing, good for you! :eek: I’m honestly not sure if I can do this much longer lol. Taking care of an old dog is a job in itself! :D So, sorta update: gave him the vetoryl today and again I feel like he’s sort of in pain. He eats and sleeps and even kind of plays but he’s not as excited or mobile in my opinion. I do believe he wouldn’t jump down from the steps when he normally would so I want to say I think it’s arthritis. That being said, which symptoms should I watch out for so that something serious doesn’t happen? As always, thank you thank you thank you!

[labblab]

Things such as loss of appetite, diarrhea, vomiting, and extreme lethargy can all be signs that cortisol levels are dropping too low or that chemical imbalances are being caused by trilostane overdosing.

Marianne

[randomguy]

Things such as loss of appetite, diarrhea, vomiting, and extreme lethargy can all be signs that cortisol levels are dropping too low or that chemical imbalances are being caused by trilostane overdosing.

Marianne

Hmmm...alright, thanks! I don’t think it’s *extreme* lethargy per se. That sounds like complete lack of energy. He just seems to have less than regular energy. But then all the sudden I’ll notice he’s perfectly fine, so I dunno. Thank you very much! :)

[randomguy]

So he doesn’t feel good today either and I didn’t give him vetoryl. I did give him a carprofen. I’m a bit scared it’s an addisonian crisis. Will this pass or do I have to get him to the vet? He’s eating and drinking and stuff; he just seems so sleepy.

Edit: he seems to be doing much better. I’ll monitor his situation! Thanks! :)

[labblab]

I’m really glad to hear he’s doing better again. Since he is, I doubt that low cortisol is the problem because I wouldn’t think he’d rebound so quickly. I’m thinking he may just be at the point that, overall, he’s slowing down and has good moments and bad moments. But since he’s doing better now after having not had any Vetoryl today, I’d probably still hold off on it again tomorrow and see how he does.

Marianne

[Squirt's Mom]

Some of what you are seeing might be attributed to the Carprofen - https://www.drugs.com/pro/carprofen.html

[labblab]

I wondered about that, too, Leslie. Thanks for checking that out.

Marianne

[randomguy]

Hey all! Sad news this time. He passed away a couple days before thanksgiving. His breathing had been getting shallower and shallower for probably 6-8 months but he never really had any issues with anything. One morning I realized he was breathing very very shallow and quickly, but not panting. He wouldnt even put his head down to obstruct his air passageway. Anyway, we took him to the vet and ultimately made the decision that enough was enough. The vet said it was likely that his liver/gut had just grown too large, and probably there were other complications from very old age like a weakened diaphragm and possibly age related pulmonary fibrosis and possibly some heart related issues as well as possible damage from allergic bronchitis. So...a lot of things. They said they could do x-rays and blood work and all that stuff but that in their experience when a dogs breathing gets that bad it usually wont get better and its just better to end their suffering. Especially since it was a progressive breathing problem.

It really hurt my soul that they were fully booked and I had to do a drop off and he was apart from me for an hour but I was adamant he shouldnt suffer and I didnt want to take him to a different vet or make him wait another day. Gosh, i'm tearing up as I write this. I guess a pet dying is never convenient or easy or goes how we like but there it is. Wish I could've just made an appointment and been there with him but it is what it is. By the time we got there we had already made the decision and so they sedated him and we were with him for a bit and then they did it. I guess i would have liked to spend some more time with him while he was fully cognizant but understand that the vet was packed and honestly he was in such a poor state that being fully awake/cognizant wouldn't be in his best interest. So I suppose in a sense im sort of glad it happened the way it did because I really really didnt want him to be awake and suffering more than he had to (for his sake as well as mine). Our vet was really great and sympathetic like always, so that helped.

I dunno. A lot of disjointed thoughts. I know we did the right thing but its just never easy and I sometimes question myself (who doesnt?). Makes me feel sort of guilty I guess. I miss him dearly but was very happy to have been able to spend so much happy time with him and he had a good life and gave me a lot of happiness. Thanks for your support over the years!

[Joan2517]

I am so sorry to read this sad news. Chuck sure put up a good fight. We all have regrets and feelings of guilt. It's so hard to know what to do for them and when enough is enough. He had a very good life with you and I'm sure he knew how much you loved him and you know he loved you right back.

[labblab]

Oh my, I’m so very sorry, too. But thanks so much for returning and telling us what has happened. Chuck has now joined our other precious babies on our special memorial thread of honor:

https://www.k9cushings.com/forum/showthread.php?8846-Remembering-All-Who-Have-Left-Us-(2018)

If you care to tell us the exact day he passed, we can add that, too. We’d also be honored to add a photo link if you’d wish. If so, you can send us a photo at k9cushings@gmail.com. You can do this at any time, now or in the future.

Just like Joan says, in one way or another, I think all of us carry regrets about losing our babies. Hindsight always seems to be 20/20, but at the moments that we must make such difficult decisions, our vision always seems clouded by questions and indecision. It’s just the way it is. But you made your decision based on your love for Chuck and your desire to spare him any unnecessary pain. So even though it’s hard for you now, please know that your decision was the “right” one. I’ve written this same thing to folks before, but in my heart I still believe it to be true. That one hour of separation was just the blink of an eye during a lifetime filled with love and companionship. Throughout it all, Chuck was still cradled in your love, whether you were physically present or not.

So thank you again for coming back to us. Please return again at any time if you want to talk more about Chuck, or your lives together, or anything else that’s on your mind. We send you our warmest wishes, always.

Marianne

[Harley PoMMom]

I am so sorry for the loss of your beloved Chuck and my heart goes out to you and your family. Please know we are here for you and if you should need a shoulder to lean on, just come back to us.

With Heartfelt Sympathy, Lori

[Squirt's Mom]

I am so sorry to hear about your sweet Chuck. :( He had the best family he could have had during his life and certainly during his illness, one who always put him first even on the last day. A member once said that we take their pain so they can be free of it and it is true, as you fully understand today. We do that because of the love we have for them. This most painful decision is one we make because we love them so...and our babies understand that and are grateful for that last gift we give them. Today your precious boy is breathing deep and freely, running wild in the Rainbow Fields with so many of his new friends from here and elsewhere. From there, he will keep watch over his family just as you watched over him and he will carry the love you shared in his heart until that day when you are reunited....and we WILL be reunited with our babies. Know we are here if you need to talk, vent, scream, cry, whatever - we do understand.

My deepest sympathies,
Leslie



My Friend, My Companion, My Pet

C’mon, old friend, the time has come
For you to finally rest.
You’ve given me your finest years
And I feel truly blessed.
We’ve walked many trails together
The best of times we’ve known
And now your aging body aches
And I must let you go.

You’ve taught me things I want to know
How to love, to share, to give,
To play, to laugh, and most of all
How wonderful it is to live,
And perhaps the most important thing-
How to graciously let go.

Good-bye, old friend, we’ve shared it all-
Our youth, our aging years
The best of times, and some hard times…
I’ve shed my share of tears
Worrying about you, watching you,
Fearing when we’d part
And now old friend, the time has come.
You know you take my heart.

I’ll miss you every moment
My heart hurts so inside
But you’ve suffered much too long, my friend
And that I can’t abide.

I pet you, gently hugging you.
I hear you softly moan.
You must depart,
You take my heart,
But you must go alone.

I’ll hold you in my arms, my friend
And my tears will wet your fur.
And you’ll know I’ll always love you
Our loyal bond endures. . .

by Christina

[randomguy]

Just a quick question: are laryngeal paralysis, chest muscle weakening, and lung calcification actual symptoms of Cushings? I do think muscle weakening is one, but wasn't sure if that was all muscles or just some.

Also, I wanted to let you guys know I really appreciate your kind words!

[labblab]

You are so welcome, and we continue to send you our sympathy over your loss.

Although I don’t know a lot about it, I do believe that Cushing’s can make dogs more vulnerable to laryngeal paralysis. It also can cause areas of calcification throughout the body. The effect that we’re most familiar with here is a skin condition known as “calcinosis cutis.” This involves the formation of calcium deposits under the skin that eventually erupt and cause weeping lesions and skin sores. I do believe calcium deposits can also form internally, as well. As far as chest muscle weakness, I’m more familiar with weakness in the hind end and abdominal area as being specific Cushing’s problems. But I suppose that chest weakness may result, as well.

Marianne

[randomguy]

Hey all, just trying to get a little closure here. I've been thinking about how his breathing got poor and was wondering if anyone had ever heard of that with cushings. They did tell me his liver was larger but (at least the last time we took x-rays, which admittedly was a while ago) they didn't say it was absolutely huge or anything. Ultimately his breathing was what killed him. I just dunno what it was. The vet said it could have been the liver and gut getting larger, and age related stuff like his diaphragm weakening, something to do with his heart and/or lungs, or a combination of all of the above. But I guess I'm just curious if you guys have heard of something like that. It slowly got worse over probably 6-8 months or so I'd say (though I may be off a bit, i dont know). Thanks and merry christmas!

[Squirt's Mom]

To put things in perspective a little bit, a 14-year-old dog is in the mid-70's in human years. Bodies just start to wear out by then, even bodies that are healthy and have no diseases or issues. Add in a little bit of Cushing's alone and that process is bound to speed up. I imagine your vet has it right - the enlarged liver presses on the diaphragm making it more and more difficult to take a breath; the aging process on the heart alone could easily make breathing more difficult and put more strain on the lungs and diaphragm. I'm overweight by about 50lbs and have COPD - I can tell you that the weight I have gained over the last 3 years has definitely made it much harder for me to breath simply because there isn't enough room for things to work as optimally as they can. The same could easily be true for a cush pup with a liver that is enlarged.

I understand the desire to have answers but trust me answers are sometimes much worse than the wondering. I had to know what caused my Trink to die because none of her vets could tell me what was wrong with her toward the end. The necropsy told me why she died but it also proved that her vets and I allowed her to suffer horribly for a long time. Sitting where I am today, I wish I didn't know, that I had simply continued to wonder what really took her life and filled in the blank as best I could.

The important thing to hold on to is this - Chuck knows you loved him and did everything you possibly could to make his life the very best, even when he got sick. Our babies know we can't perform miracles but if we could we would so we love them to the fullest instead. You did the right thing and gave him the greatest gift of all - freedom. Chuck knows that and loves you all the more for that gift.

Hugs
Leslie

And the Merriest of Holidays to you and yours!