No physical signs of improvement....Mia has crossed The Bridge

[AW2016]

Hi there, hoping for some advice here please.

Our 12 year old boxador has been diagnosed with cushings recently after having all of the classic symptoms. Chances are she's had it for quite some time now but we had just put it down to old age and didn't realise such a condition existed until we brought her to the vets. She's on vetoryl now for the past 6 weeks and although her cortisol levels have come down significantly since she started the medication, that's the only real improvement we've noticed.

She spends most of her day sleeping or on the floor as it seems too much of an effort for her to move. She also has a few other issues going on at the moment that we're trying to treat - arthritis in her back legs which the vet advised would become more apparent when her cortisol levels started to reduce so she's stiffer but also she has hyperkeratosis which old boxers are prone to, resulting in dried, cracked skin on her paw pads which makes it uncomfortable for her to walk.

As a result, she'll only get up if she feels it's worth her while - so going for a short walk, getting food or needing to go to the toilet. Apart from that she's lying down the whole time and I'm concerned that although we can treat the hyperkeratosis and arthritis, I'd still expect to see her a bit brighter than she is so wondering if I should now make the difficult decision to put her down as her quality of life doesn't seem to have improved in spite of taking the medication.
She's so expressive and I just feel she's depressed and regardless of the vets saying her blood results have been good, I'm not convinced that the medication is having the positive effect it should be. Or am I being too impatient and should wait another few weeks to see if things get better? When I see her lying down on her side she just doesn't look comfortable as her paws don't look relaxed as you'd expect in a dog.

Any advice you have would be greatly appreciated as I absolutely don't want her to suffer at all but am concerned she is already suffering and I'm just prolonging the agony for her.

[Harley PoMMom]

Hi and welcome to you and your precious girl!

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

It would be a huge help to us if we could see all test results that were done on your girl, we are especially interested in all diagnostic and ACTH monitoring tests, would you post them here for us? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. What Cushing's symptoms was your girl displaying that led to test for Cushing's in the first place? Also, how much does your girl weigh and what dose of Vetoryl was first prescribed to her and what is the dose she is taking now? Is she on any other medications/herbs/supplements? Has there been any diarrhea or vomiting episodes? Two of the most important things when treating with Vetoryl is that is has to given with a meal to be properly absorbed and those monitoring ACTH stimulation tests have to be performed 4-6 hours post pill, are these protocols being followed?

The lethargy can be attributed to her cortisol dropping so suddenly, or that her cortisol is too low, this is the main reason we ask to see those test results. ;)

Since dogs can have a different reaction to Vetoryl treatment the therapeutic drug level does take some tweaking. And the cortisol level that works for one dog may not work for another, meaning your girl may need to have her cortisol level run a bit higher than the therapeutic ranges that are listed when treating with Vetoryl.

Long term elevations in cortisol will cause systemic damage but I don't worry so much about this with senior dogs because, I feel, that quality of life is the primary concern. And as I mentioned before treating her for the Cushing's but letting her cortisol levels run a bit higher could be a reasonable option for your sweet girl.

So please hang in there and once we receive those answers to the questions I asked we can get a better understanding of your girl and provide you with more meaningful feedback. We are here for you and will help in any way we can.

Hugs, Lori

[AW2016]

Hi Lori,

Thanks so much for your quick reply and your lovely positive thoughts.

I don’t have copies of Mia’s results but I know that when she first had the ACTH test done her levels were over 1,000 nmol/L and after a month of treatment, she’s down to 216 nmol/L. The acceptable level should be under 200 but our vet said she’s doing well so far in that respect we’ll keep her at her current dosage of 60mg per day of Vetoryl which is the minimum dosage she could start her at. She weighed approximately 35kg at the beginning of treatment but is now up to 37kg due to lack of exercise and movement. She’s had no side effects to the medication which is something at least, although the vet did say she might become a bit more stiff in her hind legs which does seem to be the case. She has been given the medication at the same time every morning when she’s being fed.

In relation to the symptoms she has that led to her diagnosis she seems to have them all! Excessive panting, drinking water all the time, pot belly, distended liver, lethargy, bald patches, calcified lumps on some of her joints, lying on cold surfaces, hind leg weakness (although this is a new one – she’s struggled on a few occasions recently to stand up which has been frightening for both her and us), reluctance to walk up steps and really smelly urine (although the vet tested a urine sample and found nothing suggesting she had an infection and I haven't seen this listed anywhere as a symptom). She hasn’t wet the floor indoors but that’s because she’s on Propalin long term for incontinence issues in the past.

She’s had an ultrasound done and all organs came back looking fine (apart from the distended liver) which was great.

She’s also had the usual blood tests done to rule out other conditions such as diabetes just in case her symptoms were being caused by something else but the vet more or less knew by examining her that she had Cushings but had to follow the normal protocol of ruling everything else out first before testing her for that and as you can see from her results above, she came back with a very clear positive for the disease.

Over the weekend we’ve noticed a new bald patch appearing on her coat which makes no sense to me if the meds are working. During her first week of treatment we noticed an improvement in her coat but now it seems to be going back to being dull. She also seemed to perk up a bit in the first week of treatment but now is going back to be disinterested in what's going on around her.

It’s really hard for mum and I to look at her in this state as we’re so concerned she’s in pain and what we’re putting her through isn’t helping her enough to get back some quality of life. She was never a really active dog to begin with as she loves her sleep but she just seems to come in and flop on the floor and stay there for the majority of the day looking sorry for herself which is breaking our hearts as we really don't want her to suffer and I feel if we don't see an improvement in the next few weeks, we'll have no choice but to put her down. Hoping for a miracle and soon!

[randomguy]

My dog has been on vetoryl for about 2 weeks now and I've noticed that he pees a lot less but never drank a lot or ate a lot so I can't comment on that. His belly and hair loss I've not seen much improvement on but it's still early. However I'd like to echo what you've said: he seems really calm, almost depressed. He never really moved around much to begin with and he's quite old so I'm not super worried about it but I was expecting him to become a lot more active, not less. I just don't know if he's in pain or not. If he is, I'll probably stop treatment. His cortisol levels dropped to "optimal" levels. Our doctor also talked to us about arthritis and we are considering giving him a pain reliever to see if that is indeed what's causing it. I wish you the best of luck!

[Harley PoMMom]

Although she is in the acceptable range for Vetoryl and her symptoms are controlled, it just may benefit her to have her cortisol a bit higher that what it is now.

Dechra, the makers of Vetory, state in their product insert that the therapeutic ranges for treatment with Vetoryl are 40 nmol/L - 150 nmo/L with a post as high as 250 nmol/L, since we are used to seeing ug/dl units I've converted those therapeutic ranges to ug/dl which makes it: 1.5 ug/dl - 5.4 ug/dl and as high as 9.1 ug/dl.

So, with Mia's post result at 216 nmol/L (7.8 ug/dl), she does have some wiggle room and it may benefit her to have her cortisol rise to the upper limit (250 nmol/L), maybe talk this over with her vet and see if this could be an option for Mia.

Hugs, Lori

[AW2016]

Hi all,

Thanks again for your comments and suggestions and sorry for not replying before now but I just wanted to let you know that things took a turn for the worse unfortunately on Saturday. Her breathing hadn't been good in general and seemed much faster that morning so we took her to the vets and when we brought her home, she had either a fit or a stroke and it looked like she lost the power in her back legs afterwards. We were devastated and asked the vet to call but knew at that stage that we'd have to say goodbye to her. We're so upset and will miss her terribly but we wouldn't want to watch her suffer so know it was the right decision to make. Wishing all your doggies a better outcome and speedy recovery from this awful disease.

Anndrea

[Joan2517]

I'm so sorry for your loss...this is a terrible disease. My thoughts are with you and your family.

[DoxieMama]

I am sorry for your loss. RIP sweet girl.

[judymaggie]

Anndrea -- my heart goes out to you on the loss of your sweet Mia. They are never with us long enough and it so hard to be placed in the position of decider between life and death. Every time I have to do that I vow that I won't bring another dog into my life but the joys definitely outweigh the negatives. Take care of yourself!

[Allison]

I'm sorry for your loss of Mia. Such a pretty name. She looked like a very sweet girl. Hugs.

[Bluester]

So sorry for your loss.

RIP sweet Mia.

[Help4Bailey]

I'm so very sorry to hear of the loss of your precious Mia. May she run free over the Rainbow Bridge. I fear I am also approaching this decision/outcome with my Bailey who has kidney disease and Cushings and is not doing well. My thoughts and prayers are with you.
Lynette and Bailey

[molly muffin]

My sincerest condolences on the loss of your sweet girl, Mia

[budindian]

Just wanted to say sorry for your loss.