View Full Version : Max the Beagle Rescue Boy
ErikaD
08-01-2016, 05:33 PM
Hi Everyone - I am new to this Cushings diagnosis and was looking for some advice on my little guy Max. Max is about 10 years old and 1 year ago he had surgery to remove a ruptured disc in his back, so that he could walk again. He had some ups and downs with the recovery, but was walking again, albeit a little different.
Back in April, my husband and I noticed signs that I attributed 100% to Cushings disease. He was taken to our normal vet and they game him the low dose test that takes 8 hours. The results came back that he was not positive for Cushings, only a slightly elevated thyroid. He began on thyroid meds and after a bit I noticed that he had begun wheezing, so I stopped giving him the medication and things got a bit better. In the meantime he did make a trip to the ER Vet that kept him for a couple of days and noted that him liver was 'chunky' and his liver enzymes were a bit elevated. They also said he was going through a case of Pancreatitis. They released him and as I said, he was acting fairly normally.
Skip up to July and he was back again with the same symptoms - panting, drinking excessively, ravenous appetite and now he had skin rashes on his back. I took him to the ER Vet again and told them he needed to take the ACTH test because I was positive he had Cushings. He took the test and yes, he has Cushings. They also gave him antibiotics to clear up the rashes/infections on his back. I then took him to my regular vet the day after and they did the urine test to be positive it was Cushings, and again it was positive for Cushings. They prescribed Vetroyl 30 mg 1 x per day. He has now taken the medication for 10 days and we are going for a blood test on Wednesday morning as a follow-up.
So here's where the advice is needed: over the weekend it seems as if he is panting more than ever, just as hungry, skin rashes/infections are back and now he has terrible gas and diarrhea. He also appears to be slightly weaker in the back legs, though I imagine that attributable to his back surgery as much as the Cushings. One last note - Max is overweight - he's gained 6 pounds in one year and weighs 24 pounds at the moment, though in April he was at 26.5.
I am petrified that I'm now poisoning my dog and I don't know what I should do. Can anyone tell me if this is typical when first starting this medication? I just ordered the Adrenal Harmony Gold for Dogs.
Any advice - I am not prepared to lose this guy yet, but I do not want to hurt him with medication if it's only going to make him feel worse....I'm so afraid he's on death's doorway...though he eats, drinks and seems happy for the most part (he has been a happy dog since I rescued him).
judymaggie
08-01-2016, 06:16 PM
Hi, Erika -- welcome to you and Max! I am sorry for the reasons that brought you to us but now you are part of our family and we are here to reassure, support and work with you.
First, a big ar-o-o-o to Max from my Abbie! Abbie is 13 and, this past February, had spinal surgery to remove a ruptured disk in her neck so she and Max definitely have things in common although we could have both done without this similarity!
Second, take a deep breath! You are not poisoning Max but rather you are doing your best to take care of him. The ACTH test on Wednesday will give you the exact measure of Max' cortisol and you will know if it is too strong a dose for him. Has your vet advised that you should give Max his regular breakfast followed by the Vetoryl and then the test should be 4-6 hours later?
With our new members we ask a lot of questions. This is not because we are nosy but, instead, it allows us to provide you with our best possible feedback. So here it goes ...
Could you get copies of all tests that were done on Max and post any abnormalities that are listed? 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. Is Max still not taking any thyroid medication? Is he taking any supplements, medications or herbs? Please also provide us with the exact numbers from the LDDS (will be three numbers: baseline, 4 hr. and 8 hr.). You will get two numbers from the ACTH (a pre- and a post-).
With regard to the hind leg weakness, Cushing's (and high cortisol) can mask arthritis. When cortisol is lowered, the arthritis is often more apparent and Cushing's pups often show this in the hind legs. If it is severe, some owners keep the cortisol levels a bit above the recommended levels.
We have an excellent resource forum -- here is the link to the forum:
http://www.k9cushings.com/forum/forumdisplay.php?f=10
Within that forum is a section on trilostane and the last post contains the pamphlets from Dechra, the manufacturer/distributor of Vetoryl. Here is a link to their technical brochure which includes an excellent flow chart on page 11 which will help you navigate through the testing/dosing:
http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf
It does sound as though you vet is familiar with the recommended testing/dosing protocol although Max' starting dose is a bit higher than is currently recommended (1 mg/lb.). Max could have started on 25 mgs. which is a bit closer to his weight but 30 mg. isn't that far off. Dechra now makes a 5 mg. tablet. Are you giving Max the Vetoryl wrapped in something fatty? This does help with absorption. Many of us use cheese.
Just one comment about the Adrenal Harmony -- we have had members try this and, although it may reduce symptoms for a short while, in the long run it will not control cortisol levels. I would strongly recommend that you not start it until you have had a chance to make sure that Max is on the correct dose of Vetoryl and given it a chance to work.
Others will be along to add more guidance (and probably ask more questions). Looking forward to learning more about Max!
dsbailey
08-01-2016, 08:16 PM
Hi Erika,
I agree with leaving the "Adrenal Harmony" out of the equation until Max is stabilized on Vetoryl and you figure out what is causing these side effects.
If it were me I'd dose him in the morning (Tuesday) and call to see if there are any tech openings for an immediate ACTH test 4 - 6 hours after dosing. I'd not want to wait another day plus another to get the results back. My girl was 57 lbs and started in 60 mgs and I had her tested at 10 days. Her levels were very low and she has finally settled down on 35 mg. You may also want to have an electrolyte test done at the same time (about 40$). Those results should be available immediately and let you know if there is immediate danger.
You mentioned a "Chunky Liver". Did they do an ultrasound? If not then that is a good starting place to confirm Cushings and if it's adrenal or pituitary dependent. It will also give you a good picture of the other organs in the abdomen because it sounds like something else may be going on.
I'm new here and I'm sure others may disagree and rightfully so. The combining and different opinions of this groups experience is what makes it an invaluable resource.
You can read my dosing story under the thread "Lolita".
Darrell and LO
ErikaD
08-02-2016, 06:50 AM
Thank you guys so much for the welcome! I can get all of the results of Max's tests and will post here when I do. Also to answer a few of your questions, we did have an ultrasound done in April, as well as x-rays, that's when I was told his liver was chunky and that's also what the vet went from in deciding that he was not an adrenal Cushings case, as the adrenal glands looked ok.
I give Max his Vetoryl at 7pm, so I'm guess I should make this much later today, as I have to take him for his first blood test at 8am on Wednesday.
Max is actually doing a bit better today, his stool is loose but not runny and he seems more comfortable sleeping. My biggest concern is his wheezing attacks - it sounds like asthma and happens when his body tenses up. It's alarming, but it only lasts for a few seconds at a time. He probably did this wheezing thing a dozen times yesterday.
Again, when I get the copies of the results I will post. Thank you so much for your help and support! Max is happy to meet Abbie and Lolita!
judymaggie
08-02-2016, 11:41 AM
Morning, Erika! I have a couple of questions--I am curious why you are giving Max the Vetoryl in the evening. Is that his only mealtime? As you can see, you are running into scheduling issues with the ACTH. Dechra and endocrinology experts recommend a morning dose if the dog is on once a day dosing. I give Abbie her morning dose at 8 am and then leave her at the vet at noon for her ACTH. It is also recommended that the same timing be used for all ACTH tests so results can be compared accurately. I'm not quite sure how you are going to handle the timing od tomorrow's test ... I would recommend that, after Wednesday, you shift to a morning dose--you can skip one day to get on the right schedule. If Max is not currently getting a morning meal, you could split the evening meal in half (to make sure he is not getting extra food) or just give breakfast and maybe a treat in the evening (because you know Max will be looking for food then).
When you say the adrenal glands were okay on ultrasound, do you mean that they were not enlarged at all or that one was not larger than the other? The latter would likely rule out an adrenal tumor but it would be atypical for a Cushing's dog to have completely normal adrenal glands, i.e., not bilaterally enlarged.
With regard to the wheezing, are you sure that Max isn't reverse sneezing? This is very common in beagles.
For the loose stools, you might add pumpkin (pure pumpkin, not pumpkin pie filling). Start out with just a tiny bit and then increase very gradually. Too much will aggravate, not help. I now give Abbie about a tablespoon a day (split into her three meals). You also might start giving Max a probiotic--I give Abbie Forti-flora once a day. Abbie's chronic soft stools/diarrhea is now controlled.
ErikaD
08-02-2016, 12:44 PM
judymaggie - the reason I've been giving Max his dose at night is because I picked up the medication after work and wanted to get him started on it right away. Also, I called the vet and wanted to make sure of the timing and they told me they are doing a blood test tomorrow, not the ACTH stimulation test, the vet wants that done at 30 days.
Thank you so much for the advise though, I'm going to give Max his dose tomorrow morning (skipping this evening), as I do feed him 2x times a day.
Also, I'm sure it's wheezing because he's never done this before - he is 1/2 beagle and 1/2 Jack Russell terrier (according to the DNA test I did 5 years ago). He displays classic beagle characteristics though, without the baying. He barely ever barks - whimpers excitedly to see people and other animals. But back on point, I've watched a video of a beagle reverse sneezing and what he's doing is not that...I likened it to heavy wheezing, as if he has something in his throat that he's trying to clear, but can't get enough airflow? It's really hard to explain, but it is very disturbing.
ErikaD
08-02-2016, 12:51 PM
https://youtu.be/jPXDa_7JZHg
This is a video I just took of a "wheezing incident"
judymaggie
08-02-2016, 04:42 PM
Erika -- it does sound like Max is wheezing. Does your vet have an e-mail address so you could e-mail him with the video link? It would be good for him to see it so that you can discuss it with him during Max' appointment tomorrow.
ErikaD
08-02-2016, 04:55 PM
I have the video on my phone, so I will show the vet, but honestly I think I may make an emergency trip tonight...I'm very worried about this wheezing, though they have told me recently he has no heart issues.
judymaggie
08-02-2016, 05:08 PM
Erika -- it is worrisome. I was thinking more along the asthma line but your thought about being heart-related may be more on point.
ErikaD
08-02-2016, 05:12 PM
I am thinking that, but it could also be an infection - I believe they are typical with Cushing dogs and he was just treated for skin infections with antibiotics and since he's been off them this wheezing has started! Ah ha! I am not a vet, but I think I am putting the pieces together...thanks so much for your help :)
judymaggie
08-02-2016, 10:11 PM
Erika -- forgot to mention that, since your vet is foregoing the 10-14 day ACTH, be sure to make note of any negative symptoms (lethargy, diarrhea, vomiting) that may indicate Max's cortisol has gone too low. You would need to stop the Vetoryl and get Max in to the vet for an ACTH and electrolyte check. Did your vet give you prednisone to give Max in case this happens when your vet is not available? If not, please get some from the vet tomorrow. You would only be giving him what we call an "emergency" dose (.25 mg/kg).
FYI, we are seeing more vets skipping the first ACTH at the 10-14 day mark--most in an effort to save their clients money. I, personally, didn't want to wait the full month to find out Abbie's cortisol levels.
Will be interesting to learn what your vet thinks about the "wheezing".
ErikaD
08-02-2016, 10:56 PM
We have some answers...the vet said that he thinks Max may need more Vetoryl because he still has a voracious appetite.
We had the electrolytes checked and all are good - he did point out that his liver enzymes are on the border of high.
He was very concerned by the wheezing and did some x-rays...Max's heart is slightly enlarged and when laying down it is pressing against his trachea, causing the wheezing. He said that it's obviously not good to have an enlarged heart, but he wants to keep an eye on things...it is not congestive heart disease.
We left with more antibiotics for the skin infections and oral medication to open his bronchial airway when he has these wheezing attacks.
We are going back in about 2 weeks for the ACTH test and he suspects his Vetoryl dose will need to be upped. I asked him if he sees anything that puts Max in immediate danger for his life and he said not at all. There are issues present but he feels good that once his Vetoryl dosage is adjusted appropriately we will see improvements.
ErikaD
08-02-2016, 11:00 PM
Also I have an emergency Rx of prednisone :). If something goes wrong, Max is covered!
judymaggie
08-09-2016, 03:36 PM
Hi, Erika! Just checking in to see how Max is doing -- hopefully, everything is stable.
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