Questions about Cushings - Charlotte has crossed the Bridge

[LaurieS]

My name is Laurie, I am new here and have some questions about Cushings symptoms and diagnosis. My Boxer Charlotte is approximately 7-8 years old (we don't know for sure since she was a rescue). We have had her for 2 1/2 years and she has always been healthy up until recently. Over the past few months her water intake has increased and for the past month it has been excessive. She is very lethargic and no longer acting like herself. She also trembles a lot and has a hard time staying warm even with her sweater on, which has always been enough when she is in the house. Her breathing is more labored but she isn't panting and she is ravenous all the time. She has always been a "chow hound" but lately it's been even worse. She has gotten into the trash and taken food off the counter when we aren't home. She also has eaten a roll of toilet paper. We have also noticed a little hair loss in areas where her hair has always been sparse. Other than that her hair coat looks pretty healthy.

A couple of weeks ago we had her blood work done along with a urine test and everything looked fairly normal. Urine was dilute but that was to be expected due to the large amounts of water she is drinking. We have seen 2 vets and both have said there are no indicators in the blood work that suggest Cushings (or diabetes which was another thought with her symptoms). She is getting worse and we have been made to feel like we are imagining it. The first vet took xrays of her abdomen and found some air/gas pockets and has put her on metoclopramide to clear it out. He thought maybe she was in pain due to gulping air when she eats. She has been on that drug for 2 days now and is about the same so far, except she seems to be trembling more.

My question to all of you is should we have her blood work and urine tests run again? Should we have a cortisol/creatinine test? How about an abdominal ultrasound? This is horrible timing for us as my husband is currently unemployed so money is tight. We will do what we have to do, Charlotte is a family member, but I hate to keep spending money and not figuring out what is wrong. I'm posting here only because her symptoms seem so much like cushings to me and I know Boxers are on the list of breeds that are higher risk for the disease. Any suggestions on how we should proceed will be greatly appreciated!

[Harley PoMMom]

Hi and welcome to you and Charlotte!

I apologize, I'm at work and only have a moment to post :eek: It would help us if you could get copies of all the test that were done on Charlotte and post the results. I assume that an UTI or issue with the thyroid has been ruled out?

I have to run but I will try to make it back later, I am sure the others will be by to offer their support and advice. ;)

Hugs, Lori

[LaurieS]

Hi and welcome to you and Charlotte!

I apologize, I'm at work and only have a moment to post :eek: It would help us if you could get copies of all the test that were done on Charlotte and post the results. I assume that an UTI or issue with the thyroid has been ruled out?

I have to run but I will try to make it back later, I am sure the others will be by to offer their support and advice. ;)

Hugs, Lori

Thanks Lori! I'm not sure how to put a picture or document in this post as it asks for a URL rather than to browse an image already in my computer. When my husband come home I'll see if he knows how.

[Squirt's Mom]

Hi and welcome to you and Charlotte! :)

On the test results, we only need to see the abnormal results from the test that shows things like BUN, CHOL, ALP, T4, and so on. Some call that a wellness check, some a Chem test, but you will know by the values reported like the ones I just mentioned. So the best way is to simply type in the abnormal values along with the little letters and ranges that follow. For example -

ALP 323 85 - 115 ug/dl (EXAMPLE)

While some of the signs you posted are typical of Cushing's some are not - like the inability to stay warm. Cush pups are generally just the opposite and have trouble dealing with heat, seeking cool places to lay year round. And Cushing's usually comes on very slowly, over years, not a few months time. BUT it is a disease with very few hard, set rules and we have seen many oddities thru the years. ;) So those test results will help us a great deal in helping you sort this out.

So for right now, lets get those test results then we can start giving you some more meaningful feedback. Call and get the copies, post the results, and love on your sweet girl as much as you can. Ya'll are now part of our family here at K9C and we will be with you all the way regardless.

Hugs,
Leslie and the gang

[LaurieS]

Thanks Leslie, I would love to post the results here but I have no idea how to post pics to this forum. My images are on my computer, not on a website. When I click to post a pic it asks for a URL rather than to browse for a photo. If someone can advise me I will post the image of the test results.

[labblab]

One way in which to do this is to set up a personal photo album, and then you can directly upload any images from your computer. Once you've logged in to the forum, click on the "User CP" tab at the upper left-hand side of any page. Once there, select "Pictures and Albums" from the left-hand menu bar, and off you'll go.

In honesty, though, we are really only interested in knowing about any abnormal lab values, along with the reference range. So if you want to just list them within the body of your reply here, that will be great and will save us from needing to search through multiple pages of labs in order to find the abnormals.

Marianne

[LaurieS]

One way in which to do this is to set up a personal photo album, and then you can directly upload any images from your computer. Once you've logged in to the forum, click on the "User CP" tab at the upper left-hand side of any page. Once there, select "Pictures and Albums" from the left-hand menu bar, and off you'll go.

In honesty, though, we are really only interested in knowing about any abnormal lab values, along with the reference range. So if you want to just list them within the body of your reply here, that will be great and will save us from needing to search through multiple pages of labs in order to find the abnormals.

Marianne

Thanks Marianne but I'm also unable to upload any pictures to the photo album either so I'm going to have my husband take a look at my computer because this must be a problem on my end. I'm going to attempt to post her report now from a photo on Photobucket...

[LaurieS]

Hopefully this works...Here is a photo of her blood and urine test results:

http://i1376.photobucket.com/albums/ah32/Laurie_Gomes_Storey/Charlotte%20tests_zps7pfuwhz8.jpg

[molly muffin]

It looks like the only thing out of range at all on the blood work is EOS and LYS (?) is low. Everything else is perfect. Not what we normally see with cushings.

The urine concentration is 1.015, yellow clear and it does say WBC occ and cellular debris. Drinking water, etc, did they rule out Urinary Tract Infection?

I don't see anything about a thyroid test on this. So I would want that checked out next, as this can have many of the same symptoms as cushings. Diabetes is ruled out based on this, kidneys and liver are good, so over all she looks to be a healthy dog, just have to figure out what is causing these symptoms.
I'd do a thyroid panel.

and hello and welcome to the forum

[dsbailey]

Definitely doesn't look like a Cushpup's bloodwork.

Maybe this can help someone in the know:

LYM—immune cell highly responsive to “stress” and potentially increased during chronic infection.

EOS—inflammatory cell associated with parasitic disease, hypersensitivity and allergy

http://www.animalmedicalcenterofchicago.com/pdf/understand-diagnostic-test.pdf

[LaurieS]

It looks like the only thing out of range at all on the blood work is EOS and LYS (?) is low. Everything else is perfect. Not what we normally see with cushings.

The urine concentration is 1.015, yellow clear and it does say WBC occ and cellular debris. Drinking water, etc, did they rule out Urinary Tract Infection?

I don't see anything about a thyroid test on this. So I would want that checked out next, as this can have many of the same symptoms as cushings. Diabetes is ruled out based on this, kidneys and liver are good, so over all she looks to be a healthy dog, just have to figure out what is causing these symptoms.
I'd do a thyroid panel.

and hello and welcome to the forum

They said no UTI. And yes she looks healthy according to this. I think the vets thought we were doggie hypochondriacs! But there is definitely something going on. I asked about thyroid but the 2nd vet said she didn't feel anything when she palpated that area. I know sometimes they can feel swelling but I know that's often not the case in humans so I will ask for them to test for that next. Thanks!

[LaurieS]

Definitely doesn't look like a Cushpup's bloodwork.

Maybe this can help someone in the know:

LYM—immune cell highly responsive to “stress” and potentially increased during chronic infection.

EOS—inflammatory cell associated with parasitic disease, hypersensitivity and allergy

http://www.animalmedicalcenterofchicago.com/pdf/understand-diagnostic-test.pdf

Thanks! Both vets told me there was no indicator of cushings from this bloodwork but she had so many symptoms I wondered if something went wrong with the test. But thyroid problems have some similar symptoms so maybe that's what we are dealing with. That will be next to test for.

Thanks so much to all of you for your input and I will keep you posted.

[LaurieS]

Update on Charlotte... We saw a new vet and had a senior CBC done as well as some abdominal xrays. We are still waiting on the Thyroid test results but her liver enzymes are up and the xrays showed an enlarged liver and a huge bladder. Although they do ultrasound there they don't have a radiologist on staff so they suggested we take her somewhere else for that. This vet felt like Cushings could definitely be a possibility after examining her so I thought about contacting UC Davis (we live about an hour away) to see if they are still conducting the study there. It sounds like if they accept her it could save us a lot of money. We have already spent $1000 and have no answers. She continues to drink a ton of water, she is trembling all the time and very lethargic. We are running low on money to spend on tests so I need to pick and choose carefully. I will post the CBC here tomorrow when I get it in case anyone might have some suggestions.

[LaurieS]

I've been reading posts on here frantically, trying to learn more and make decisions for my girl Charlotte (7-8 year old Boxer, 75 pounds). We have already spent $1000 on tests and still don't feel like we know much. I have another thread I started a few days ago but wanted to ask about my dog's specific symptoms. Here is what we are witnessing:

Excessive water intake with frequent urination
Lethargy
Lack of interest in exercise/playing with our other dog
Trembling/shaking
Ravenous appetite
Slight pot belly
Loss of muscle

In the past week she has been panting and not wanting to wear her sweater even though it's cold but this is something new (she normally ran cold in the winter). I've also noticed her gait has changed, something seems wrong in her hind end. She almost squats and then turns to look at her as if there may be pain. A couple of times it almost looked like she was constipated (which she hasn't been) because she was squatting and walking strangely. She is reluctant to wag her tail which she always has done in the past. She also stretches her back legs a lot which seems odd but there is obviously something going on back there, not sure if that would have anything to do with cushings.

We were not at all confident in the first vet we saw (I posted the bloodwork in my other thread) so I found another vet I feel good about who did a senior CBC, urinalysis and abdominal xrays. I will post results tomorrow as we didn't have all the results tonight but we do know that the xray showed an enlarged liver and the bloodwork showed elevated liver enzymes. We are waiting on urine culture to rule out UTI and also thyroid levels to rule out hypo or hyperthyroidism. We ruled out diabetes. This new vet said she thinks cushings is a possibility but there may be other things going on as well.

I'm just sick because Charlotte is trembling all the time now. We have given her tramadol the past couple of days in case she is having pain but it doesn't seem to stop the shivering/trembling. Is this something you see in cushings dogs?

[tank&kat]

Hi and welcome! I only have a minute but wanted to share some quick thoughts with you. I will do a search for your other thread later today and take a look at the blood work you mentioned.

Shaking/trembling is not a recognized symptom of Cushing's in my textbook. However, I have heard many pet owners describe this as a symptom. The symptoms you did list are all very common signs that point to Cushing's.

I'm happy to hear diabetes has been ruled out. Keep in mind with the thyroid test that cushingoid dogs can sometimes have a transient low T4 result. Here is a general explanation of what that means:

"Sometimes a Cushing's dog may be truly hypothyroid and need to be taking medication for that condition along with the Cushing's medication they are prescribed. But there is also a form of hypothyroidism called "Sick Euthyroid Syndrome" or "non-thyroidal illness" which may actually only be secondary to (caused by) another condition such as Cushings, and this type of hypothyroid condition will often resolve without need for medication once the excessively high cortisol production caused by the Cushing's is lowered and brought under good control." You can read more about it here http://www.k9cushings.com/forum/showthread.php?t=191 (http://www.k9cushings.com/forum/showthread.php?t=191)

It broke my heart when you mentioned she was reluctant to wag her tail. I will never forget seeing my dog wag his tail for the first time in almost a year. This was after a month of being treated with vetoryl. I felt so horrible because I had dismissed this as a sign of him just getting older (he was 15!).

I hope the tests come back negative. I will check back later today or tomorrow.

~Kat

[labblab]

Hello, and here's an overdue welcome from me! You'll see that I've merged your new thread into your original thread so that we can keep Charlotte's medical history and related information all in one place. This way, we won't be repeating ourselves or, even worse, overlooking important info.

I am so sorry that Charlotte is doing so poorly and looking increasingly ill. From the list of symptoms and the new elevations in liver enzymes, I am betting that Cushing's is a very strong possibility and I'll be keeping my fingers crossed that Charlotte makes it into the Davis research study. She really sounds like a perfect candidate to me.

Even if her thyroid testing turns out to be low, this does not mean that Cushing's is not actually the underlying issue. Kat has already explained this well. So regardless of the outcome of the thyroid test, I would additionally want her worked up for Cushing's, and Davis will do a great job of that if she's accepted into their study. It's a pain that it's a holiday week, because that may slow down the communication. But again, I think she sounds like a perfect candidate and I hope you'll hear back quickly. If she's not accepted, though, then we can help you sort through the most efficient testing protocol with your new vet.

I can really sympathize with your worry, though. We were really slow in arriving at a diagnosis for my own Cushpup, even though in retrospect, it seemed clear he'd been advancing with the disease for quite a long time. By the time we determined he did have Cushing's, he looked really, really bad (and also had trembling episodes). I truly thought we were going to lose him, and I could not get that first capsule of medication in his mouth quickly enough! But we did see some rapid improvement right away once treatment was begun.

So please try not to feel too downhearted, and do let us know just as soon as you hear back from Davis.

Marianne

[LaurieS]

Thank you Kat for the good explanation of the thyroid condition and thanks Marianne for merging my two threads so all the info is in one place. This forum is so helpful and although my heart breaks for all the people and their pups that are going through this, it's so great to be able to get help and support from all of you.

I will post the additional results here later today when I get them. my vet suggested we start her on an antioxidant that will support her liver (similar to milk thistle) along with Ursodoil and Baytril. She does not have a fever and her white cell count is good but the vet still thought there could be a minor infection of the liver or gall bladder, or possibly gallstones, causing the liver problems. Thoughts on these medications would be greatly appreciated. I don't know how long it will take to get her into the UC Davis program, if she is even accepted, and I feel like I should be doing something for her in the meantime but don't want to put her on something that could cause more problems.

She slept in bed with me last night because my husband is out of town and she trembled non-stop, I hardly slept. My heart is breaking for her because I don't know if she is in pain and I feel like I should be doing more to help her. I will be taking her to work with me today because she stresses so badly when she is left home alone. She still enjoys socializing with people so maybe this will be good for her.

[tank&kat]

Your welcome. You are doing everything humanly possible to make her feel better. I know what you mean though. My boy used to stare at me as if he was asking me to help him but I didn't know how. Those were the worst times. It gets better. You'll see.

~Kat

[LaurieS]

I didn't get by to pick up a copy of the bloodwork today but I did get an appointment for an exam at UC Davis to see if she will be acceptable for the study. Unfortunately the first available appointment wasn't until December 12th. I hate to wait! So here is my question to all of you who are so knowledgeable about this...

My vet thinks we should go ahead and put her on the Baytril antibiotic along with Ursodoil and the antioxidant to support her liver. Is there any reason I shouldn't go forward with these meds? I'm very cautious about unnecessary meds but then if I can be helping her while we wait to see the vet at Davis I sure want to do anything I can.

[molly muffin]

Did she have sludge in her gallbladder? If so starting on Ursodoil would be helpful. I've seen vet prescribe antibiotic before if they think there is an underlying infection and to be on the precautionary side. So it might be worth a shot since you can't get into UDavis till mid December.

Poor baby. I hope this helps her to feel better. If it were me, I'd probably give it a try.

[labblab]

Yes, I believe I'd give the meds a try, too. I know it's hard to wait, but I'm really hoping the appointment with Davis will turn out to be well worth it!

Marianne

[LaurieS]

Did she have sludge in her gallbladder? If so starting on Ursodoil would be helpful. I've seen vet prescribe antibiotic before if they think there is an underlying infection and to be on the precautionary side. So it might be worth a shot since you can't get into UDavis till mid December.

Poor baby. I hope this helps her to feel better. If it were me, I'd probably give it a try.

Since we haven't done an ultrasound (waiting to do that at Davis if we are accepted) my vet was unable to tell if there was sludge or stones in the gallbladder. I think she was just guessing it may be a possible problem and figured it might be something helpful we could be doing in the meantime. I want to do everything possible to help her but don't want to do anything that could make her worse.

[LaurieS]

Yes, I believe I'd give the meds a try, too. I know it's hard to wait, but I'm really hoping the appointment with Davis will turn out to be well worth it!

Marianne

Thanks Marianne, it seems like it won't hurt to try these meds and they should be out of her system by the time we get to our appt at Davis on the 12th.

[tank&kat]

I also agree that you should go ahead with the meds. The 12th will be here before you know it.

[LaurieS]

Charlotte has been on the meds (Baytril, Ursodoil & Denamarin) for 4 full days now and so far seems to be about the same. The trembling has gotten worse though and it's so hard to watch! She is with someone all the time, if my husband isn't home she goes to work with me. I just pray she isn't in pain. I've given her Tramadol and it doesn't seem to help so I'm hoping its an involuntary reaction to whatever is wrong and she's not trembling because of pain. I hate giving Tramadol since we know she has liver issues but then I don't want her hurting either. I wish these babies could talk!

We went on a short walk today and she really perked up while we were out. She doesn't tremble when she is moving around, only when she is at rest. Has anyone experienced this with their cushings pup?

I'm going to post her most recent labs in a few minutes. Counting down to our appt at UC Davis on the 12th!

[LaurieS]

Here is page one of Charlotte's labs from last week:

http://i1376.photobucket.com/albums/ah32/Laurie_Gomes_Storey/Charlotte%20labs%20Nov%2021%20cropped_zpsv5j26gdt. jpg

[LaurieS]

Here is page 2:

http://i1376.photobucket.com/albums/ah32/Laurie_Gomes_Storey/Charlotte%20labs%20Nov%2021-2%20cropped_zpsa2vparxu.jpg

[labblab]

Hi again, Laurie! I just have a moment free to post right now, but I noticed your question about Charlotte's trembling and wanted to paste in a copy of a reply that I'd previously given to another member.


Hello and welcome from me, too! I just want to "second" what Lori has said above: through the years, we have had other members who have worried over unexplained tremoring episodes. My own Cushpup, a Lab, suffered from intermittent involuntary tremoring episodes across his shoulder blades that made him look as though he was shivering. For him, the episodes happened most often when he was sitting down or at rest -- even when he was sleeping. Sometimes he would jerk himself awake, they were that severe. But just as is true for your boy, he would usually just stretch afterwards and never seemed to be in any particular pain or discomfort. The tremors began before he started trilostane treatment, worsened significantly when he first started the drug, and then ended up stopping entirely a few months down the road.

We never did figure out what caused them. Through the years, other members here have reported similar issues with their dogs under a variety of circumstances: some using trilostane, some using Lysodren (another medication), and also dogs not yet being treated at all. For this reason, it has been hard to point to a single "trigger." It is true that tremors are now listed as a possible side effect of trilostane. But I've always wondered whether such tremors more often just somehow relate to rapidly changing cortisol levels. But the good news is that they didn't really seem to bother my dog at all -- it was ME who was going crazy trying to figure them out!

Marianne

I'm anxiously awaiting the 12th right alongside you!!
Marianne

[LaurieS]

Thanks so much Marianne! It makes me feel better to hear other pups have had the same thing with the tremors. You described Charlotte's situation exactly in that post. I hope once we get her on meds it will stop. I'm feeling in my gut that this is cushings but we will have to wait for the official diagnosis.

Thanks so much to everyone who has chimed in and been so incredibly caring and helpful! This forum has been such a blessing! I will keep you posted!

[molly muffin]

It seems that her liver values are now elevated, ALT, AST, GGT and PSL, indicative of pancreatis? I believe that is what i am looking at and wondering if that isn't the cause of the excess shaking, tremors (pain)

It looks like the labs in October where maybe an in house test? and the labs were more normal.

It does make me wonder if the shaking isn't a result of the pancreatis and that is also causing the liver enzymes to be elevated.

Are you seeing any change on the meds?

[LaurieS]

Im not noticing any difference on the meds after a week. Would the antibiotic, Baytril, target pancreatitis? Its been many years but i had a lab who suffered with pancreatitis and symptoms included vomiting and loss of appetite. Charlotte still has her usual "piggy" appetite and she has not had any vomiting or diarhea. She has not had a fever either.

And yes the first bloodwork was done in-house and the second was a more indepth senior workup. I wasnt impressed with the first vet we saw, the second was much more thorough and seemed to feel that cushings was a real possibility. It scares me that she could be in pain and we might not be doing everything we could be doing but Marianne described, in her above post, exactly what happens to Charlotte when she trembles so evidently this is something that happens to some dogs with cushings. But of course i want to look at every possibility so is there a specific test that is done to diagnose pancreatitis? I remember it was easily diagnosed when my lab had it so i assumed it was ruled out in Charlottes case. Any advice would be appreciated.

[labblab]

I believe it's the elevated PSL reading on the second page of Charlotte's bloodwork that especially raises the question of pancreatitis. I'm really glad Sharlene noticed this. Here's a link that describes the interpretation of this test:

http://precisionpsl.com/faq.html

As you'll see, the diagnosis of pancreatitis is made from a combination of factors including this test result, imaging, and a dog's behavior. If a dog is behaving totally normally, then an elevated test result would be less worrisome. The fact that Charlotte retains her appetite and is not experiencing any vomiting, diarrhea, or fever is good. However, in reading back in your thread, I see that about ten days ago you noticed some odd squatting behavior, etc. that made you wonder whether she's in pain in the rear half of her body. Hunching the back and a tender abdomen are often listed as symptoms of pancreatitis, so that does make me wonder whether Sharlene is on to something.

Has the odd squatting behavior continued? Especially if so, I would call the vet and report it along with asking her about the elevated PSL reading. I know you'd hate to get involved with a bunch more diagnostics right now prior to your Davis consultation. But just on the basis of that test result and symptoms alone, your vet may advise you to temprarily switch Charlotte's diet to several small bland meals each day such as white rice and chicken. Since she is not acutely ill with vomiting or diarrhea, simply altering her meals may be the best therapy if chronic pancreatitis is suspected. Anyway, since you are still ten days out from the Davis visit, I'd want to let your vet know if Charlotte indeed seems to be exhibiting behavior that could signal an inflamed pancreas.

Marianne

[LaurieS]

Thanks so much for all the info and insight Sharlene and Marianne! I have put a call into Charlotte's vet but in the meantime I have made her up a big batch of chicken and rice and will keep her on a bland, low fat diet, feeding small amounts numerous times a day, for awhile and see if I can see a difference. I think the purpose of putting her on the Baytril and Ursodiol was to address any underlying infection that hadn't been detected. I've read that both drugs should address pancreatitis but I also know that diet needs to be changed so at this point I think she is being treated accordingly if the pancreas is involved.

Thanks again and I'll keep you posted!!!

[LaurieS]

Only a couple more days until our appt at UC Davis. The Baytril and Ursidiol didnt seem didnt seem to make a difference and she continues to tremble over her shoulders almost all day long, but especially when she is at rest. Im hoping we are accepted to the study but im a little concerned because she has lost some weight and im not seeing the typical pot belly of a cushings dog. Ive tried to be conservative with the tramadol but i worry she is in pain and she has continued to circle and squat and look back at her hind end about twice a day and always immediately after eating. Other times she seems almost normal, although she doesnt have the energy she would normally have. She definitely has lost a lot of muscle in her hind end and can no longer jump up on the bed. Its so sad, she isnt the same dog she was 6 months ago. My heart breaks for her.

Sorry, i know im rambling and just repeating what ive already posted. Somehow it makes me feel better to get it out in writing. Im just very scared and nervous, trying not to freak out. I dont have kids, my dogs are my babies, just so hard to watch her go though this.

Laurie

[labblab]

Dear Laurie,

There's no such thing as rambling here ;), and we totally understand your worry. It always helps me, too, to write things out amidst our family here. I remain so glad that Charlotte will be seen there at Davis. Even if she is not a candidate for the study for some reason, I remain hopeful that they will have some helpful feedback or suggestions to guide the path forward. Hang in there -- just a couple more days, now!

Marianne

[Squirt's Mom]

See our motto at the top of the page and that first promise - "support"? We are here to listen anytime you need to talk, to scream, to laugh, to cry, whatever....we are here. Never worry about rambling, honey...besides you are talking to a champ rambler and you have a LONG way to go to catch up to me. :D So "ramble" away anytime!
Hugs,
Leslie and the gang

[LaurieS]

Charlotte was accepted to the Cushings study! Im here at UC Davis waiting on more tests. The vet thinks she also has a heart condition so we will also be seeing a cardiologist.

Ill keep you all posted, thanks again for all your support and kind words!

[labblab]

Oh Laurie, I'm so glad to hear that Davis will be following her!! That is really, really great news!! We'll be anxiously awaiting any and all info.

Marianne

[Joan2517]

Good news, Laurie!

[LaurieS]

Charlotte Update...

She was officially diagnosed with Cushings, the pituitary type. The Davis vet put her on Trilostane, 30 mg twice a day, although he had me start with 30mg only once a day for the first few days. We are scheduled for another ACTH stim test in 2 weeks. Although I sure didn't want her to be diagnosed with Cushings, I'm relieved we now know what is wrong with her and can start treatment. What we thought could be another issue, a possible mass of some sort in her abdomen, turned out to be nothing. They did detect some heart issues but they think it may be Cushings related so we will just keep an eye on the situation and see if it improves.

My question to all of you is what should I be looking for as far as symptoms of her not handling the meds? The vet said this was actually a low dose in comparison to what the manufacturer recommends but yet it's what Davis considers to be their high dose for her size (70 pounds) because her symptoms are so severe. I'm hoping she won't have any negative reactions to the Trilostane but I want to be prepared. The vet mentioned vomiting, diarrhea and severe lethargy as symptoms to watch out for. Anything else I should be watching for?

Laurie

[judymaggie]

Laurie -- as tough a diagnosis as it is, just having one can bring some peace of mind. The negative effects that the Davis vet mentioned are the primary ones to look out for -- if Charlotte demonstrates any of these, stop the trilostane right away and contact the vet. Did they give you any prednisone to keep on hand for an emergency dose? Since Davis is most likely a 24 hour establishment and they would want to see her right away, they may not have done so. That said, it would be a lot easier in the middle of the night to give some prednisone and head there in the morning.

Hang in there -- you and Charlotte will do just fine!

[LaurieS]

Thanks Judy! No they didnt give me any prednisone but now i wish i had asked for it. It would be nice to have it just in case. She had her first dose this morning and will continue with just once a day for the next 3 days. Ive noticed more trembling today but other than that she seems the same.

****UPDATE****I forgot to mention that Charlotte had diarrhea about 5-6 times during her last day at Davis while they were doing the low dose dex test. It started in the car ride there, she had diarrhea and vomited once. This was before any meds of course and they thought maybe it was the stress of all the tests. Ive been feeding her boiled chicken and rice since then. She has been very restless tonight and the trembling continues to be bad.

****UPDATE****This morning Charlotte had very loose stools and this afternoon she vomited. No blood in either. Called UC Davis and they don't think it's from the meds because she had diarrhea and vomited once the day of her low dose dex test, which was Wednesday, before starting any meds. I also asked about prednisone and they said they used to give that but they don't anymore. She seems to be acting fairly normal, was eager for her short walk and wants to eat. They said to continue the meds (only once a day, so that's 30mg which would be a half dose for her size) unless we see more signs. I have her on white rice, boiled chicken and cottage cheese and they suggested a probiotic which I just picked up from my local vet. Soon I'm going to be the one vomiting and having diarrhea! I'm a nervous wreck!!!!

Laurie

[LaurieS]

We just started Charlotte on her Trilostane, this is her 4th day. She seemed to be doing well yesterday after getting past some diarrhea and vomiting, which started before we gave her meds and while she was still undergoing testing at UC Davis. She is still on a mild diet and for the past few days has been given a probiotic. This afternoon she went outside to urinate and must have squatted 25 times after pretty much emptying her bladder. Im not seeing blood but she didnt even want to come in the house because she kept trying to pee. She is eating well, no diarrhea or vomiting yesterday or today. Any ideas of what might be causing this? Bladder infection? Side effect from meds? Davis is on emergency status only today and my vet isnt available either.

Laurie

[Gracie123]

Sounds like a UTI. My Gracie kept cleaning herself repeatedly because she kept having to pee. You'll have to take your dog in for a urinalysis/culture. She'll need antibiotics if it is a UTI.

Betty

[CalliesMom]

It definitely sounds like a UTI. Only a urine culture can determine which bacteria May be causing it. Which symptoms did she have that led you to her cushings diagnosis?
My girl has been suffering with recurrent utis for over a year now. If she seems to be in pain, you may want to try an emergency vet or be prepared for her asking to go out all night long. I feel your pain!

[Squirt's Mom]

MODERATOR NOTE: I have merged you post about Charlotte trying to pee into her original thread. We like to keep all info about each pup in one thread so it is easy to look back thru the history. Thanks!

[LaurieS]

Sounds like a UTI. My Gracie kept cleaning herself repeatedly because she kept having to pee. You'll have to take your dog in for a urinalysis/culture. She'll need antibiotics if it is a UTI.

Betty

Yes seemed like a UTI to me too but after a few hours she stopped this behavior and hasn't done it since. I expect to speak to the vet at Davis today so I'll ask about it. She may have a mild UTI that needs to be treated. My understanding is Cushings can increase chances of these infections.

[LaurieS]

It definitely sounds like a UTI. Only a urine culture can determine which bacteria May be causing it. Which symptoms did she have that led you to her cushings diagnosis?
My girl has been suffering with recurrent utis for over a year now. If she seems to be in pain, you may want to try an emergency vet or be prepared for her asking to go out all night long. I feel your pain!

I'm very tired of going to the vet, and so is my credit card! :) Not sure what was going on with Charlotte yesterday with the constant squating and peeing but she seems fine today. I will be watching her closely and will ask the Davis vet about it when she calls.

Symptoms that led us to the cushings diagnosis were: drinking a ton of water and urinating all the time (checked twice for UTI, before cushings tests started, but tests were negative), lethargic, loss of muscle and strength in her hind end, loss of hair, hyperpigmentation, trembling. After all the testing they determined she had the pituitary type and her condition was severe. She is on day 5 of meds and I've already noticed a difference. Less frequent drinking/peeing, more alert and active and less trembling. Hoping we are now finally going in the right direction!

[judymaggie]

Hi, Laurie! Sorry I haven't been around to follow up with you and Charlotte but have been without internet/phone for several days ... am sorry that you have been under so much stress with Charlotte but it does sound like she has turned the corner for the better. I do think it curious that Davis vet advised that they no longer prescribe it. Would love to know why ...

I have given my Abbie probiotics (I use Forti-flora) for several years and I do think that it has helped with her intermittent diarrhea/soft stools. I also now put pumpkin in with her food.

Hang in there -- you are doing great!

[molly muffin]

I used Forti-flora also with my molly.

How is Charlotte doing now after being on trilostane for a few more days. When does she get retested on the ACTH?

[dsbailey]

Maybe she passed a stone :eek:

[LaurieS]

Finally I'm back with an update. Charlotte had her ACTH test yesterday and I just got a message from the vet at UC Davis and he said was surprised at how good it looked. He didn't give me any numbers, he just left a voice mail because I was at work and couldn't answer my phone, but he said to keep her on the same dosage (60mg) and come in for another test in 30 days.

What I have noticed in the 2 weeks she has been on the Trilostane is she is drinking less water, still more than normal but way less than before we started the drug. She is definitely perkier and seems generally more interested in everything. She is still trembling a lot but overall I think she is doing a lot better so I'm happy at this point and look forward to more changes in the next couple of weeks.

Now I need to do some research and find the best price on Trilostane and also I'd like to know if I can get the ACTH test cheaper anywhere else. I just paid $240 at UC Davis, not sure if I will get it for a better price or not. Feeling broke but happy. :)

[Harley PoMMom]

Glad to hear that Charolette is doing well on her Trilostane and that her symptoms have improved. Could you please get the results from her ACTH stimulation test and post them here, Thanks!

You may find the Vetoryl/Trilostane cheaper from an online pharmacy and I'm providing a post from me to another member that includes links to threads regarding online pharmacies, hope it helps.The price the vet charged for the ACTH stimulation test was pretty reasonable.

Keep us updated

Hugs, Lori



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

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

Vetoryl - Best Site for Purchase (http://www.k9cushings.com/forum/showthread.php?t=4592&highlight=Vetoryl)

Where to get Vetoryl? (http://www.k9cushings.com/forum/showthread.php?t=6355&highlight=compounding+pharmacies)

Hugs, Lori

[LaurieS]

Thanks Lori, I will check into the vetoryl/trilostane links you sent. I paid Davis $114 for 2 weeks worth so I'm hoping to find it cheaper!

I'll post her ACTH test results when I get them. So far I've been playing phone tag with the vet but I'll email and have him send them.

Thanks again to everyone for all your helpful suggestions and support!

Laurie

[LaurieS]

I finally got Charlotte's ACTH Stim test results:

12/27/2016
Pre 4.6 ug/dL
Post 5.0

The vet was very pleased with this after less than 2 weeks on her full dose of 30mg of Vetoryl twice daily. Her original test results were:

12/13/2016
Pre: 12.8 ug/dL
Post: 41.5

Overall she is doing better. She is more alert and active, although nowhere near normal, she still sleeps a lot. She is drinking less and her temperature seems to be regulated, no more panting and actually wanting to wear her sweater and be under a blanket when it's really cold. I worry because she is still trembling a lot and it's so sad to watch. And she actually lost weight during all of this but maybe because she started having diarrhea and vomiting prior to her starting Vetoryl. I added a probiotic and put her on a bland diet for about 5 days and it cleared up. She has gained a little weight back although I'm not sure how much as I haven't weighed her but visibly I can see it.

While at UC Davis for the Cushings study they found Charlotte has a heart murmur and an irregular heart rhythm. They did an ECG and is showed it was "atrial premature contractions" which evidently means that one of her heart chambers is beating early. They didn't feel it was something to be very concerned about at this time and the cardiologist said it could even be caused, or made worse by, the cushings. They suggested a follow up with the cardiology department but I'm out of money right now so it will have to wait. :(

I found Vetoryl online at Drs Foster and Smith for a reasonable price. It was $61.80 for a 30 pack of the 30mg which is 2 weeks worth for Charlotte. A savings of about $60 a month. The vet suggested I only buy a month or 2 supply since her dosage may change after her next ACTH Stim test. She is scheduled for the next test at the end of this month.

Laurie

[Junebug49]

Hi my name is June

About 2 years ago my dog was diagnosed with cushing's and they had suspected it for about 2 years before. I have a real problem trusting my Vet as for the first year I did what she said and had a test every month and the results always were just to stay on the 10 ml of Trilostane. She had a complete yearly check up and all was good on her lab work (kidney and liver etc) this was at about 15 months. I told my Vet I could not afford a $250.00 every month plus $69.00 for meds a month and because my dog was showing no symptoms for over a year of the hair loss, thirsty, hypertension, or starving, that I thought she could go on a test every 4 months. 3 days after I left her office she called and said she was taking my dog off of 10 ml and putting her on 5 ml Trilostane and would need a test in 4 weeks. I was very upset but did as told and the test came back questionable and she left the dose alone. She wanted me to go every month again after that. I have not come in for a test but I know that the 5ml is too small a dose and my dog has all the signs of cushing's again and needs to be on 10 ml. But she will put her back on 10 and then want a test every month. I was told that after they are first on Trilostane that every month for 3 months and if good once every 3 months and if still good you can go 4 to 6 months without a test. But she keeps finding ways to keep me on every month. I do not trust my Vet? What should I do?

[LaurieS]

Charlotte continues to tremble a lot. She started this a few weeks before diagnosis but it has gotten worse since being on Vetoryl. Her thirst has decresed and she is less lethargic but is still very weak in her hind end. I realize it takes some time, she has only been on the Vetoryl for 3 1/2 weeks, but it breaks my heart to watch her lay there and tremble all day. She will be having another ACTH stim test at the end of this month. Her numbers were good on her 2 week test so i guess i expected to see her improve more than she has. Would love to hear from some of you on how long it took to start seeing your babies return to a more normal life.

Laurie

[molly muffin]

With my molly, the trembling came and went. Sometimes it would be completely gone, then come back. Usually when laying down or when looking out the window. Getting her moving seemed to help a little bit with the tremors, but it can be a side effect of vetroyl too.

Muscle wise, some gain strength in hind legs back right away and some don't ever get back to what they where. Maybe some aquatherapy would help build the muscle?

[Joan2517]

Lena would tremble on and off, too. Mostly while she was laying down. I would put my hand on her back and just keep it there until it stopped. It is hard to watch them go through that, but I don't think it bothered her as much as it did me.

[LaurieS]

Hi my name is June

About 2 years ago my dog was diagnosed with cushing's and they had suspected it for about 2 years before. I have a real problem trusting my Vet as for the first year I did what she said and had a test every month and the results always were just to stay on the 10 ml of Trilostane. She had a complete yearly check up and all was good on her lab work (kidney and liver etc) this was at about 15 months. I told my Vet I could not afford a $250.00 every month plus $69.00 for meds a month and because my dog was showing no symptoms for over a year of the hair loss, thirsty, hypertension, or starving, that I thought she could go on a test every 4 months. 3 days after I left her office she called and said she was taking my dog off of 10 ml and putting her on 5 ml Trilostane and would need a test in 4 weeks. I was very upset but did as told and the test came back questionable and she left the dose alone. She wanted me to go every month again after that. I have not come in for a test but I know that the 5ml is too small a dose and my dog has all the signs of cushing's again and needs to be on 10 ml. But she will put her back on 10 and then want a test every month. I was told that after they are first on Trilostane that every month for 3 months and if good once every 3 months and if still good you can go 4 to 6 months without a test. But she keeps finding ways to keep me on every month. I do not trust my Vet? What should I do?

I'm so sorry to hear that June. From all that I've read here, many people have has issues with vets that really aren't very well educated on cushings. I feel so fortunate that I am close to UC Davis and can go there as well as work with my local vet. Can you search for another vet in your area? Do you have a VCA clinic in your area where they have specialists who could help you? I'm sure others on this forum can be of more help than me but maybe there is someone on here who lives near you and can recommend a vet.

[LaurieS]

Sharlene, thanks for the aquatherapy suggestion, I hadn't thought of that. This morning she jumped up on our bed with no assistance and I couldn't believe it! I'm hoping since Charlotte is still fairly young she will get at least most of her strength back.

Joan, yes I think you are right, the trembling probably bothers us more than them. Charlotte does it most when she is laying down but awake. When she goes into a deep sleep it subsides and when she is active it also seems to go away.

Laurie

[LaurieS]

Charlotte had a bad day today. She has had no energy and hasnt been as interested in food, even though she did eventually finish her food she rarely leaves any in her bowl so that seemed odd to me. She has slept all day and hasnt had much interest in anything. Is this something we need to accept, some good days and some bad days? Since we cant rush in and test her cortisol levels everytime she seems a little down what would you guys suggest i do when she has a bad day? Or is there anything i can do?

Laurie, concerened doggie mom

[DoxieMama]

Hi Laurie,

Hopefully one of the more experienced folks will see your post and provide some helpful suggestions. Personally, since she did eventually eat, I would make a note of it and keep an eye out to see if that behavior continues. As it is possible for cortisol to continue to decrease during the first month of treatment, it could be that it is starting to drop a bit too low. In that case, it would be worth getting another ACTH test done sooner rather than waiting.

I know, I just said wait but don't wait. :eek: It's a fine balancing act. You know her best and I know that you'll make the right decision for her, even when you feel like you have no idea what to do. ;)

[labblab]

I finally got Charlotte's ACTH Stim test results:

12/27/2016
Pre 4.6 ug/dL
Post 5.0

The vet was very pleased with this after less than 2 weeks on her full dose of 30mg of Vetoryl twice daily. Her original test results were:

12/13/2016
Pre: 12.8 ug/dL
Post: 41.5

Hi again, Laurie. I'm sorry Charlotte was feeling poorly yesterday and I hope she is better today. If not, I encourage you to contact the folks at Davis and let them know. It is very true that it is impossible to continually test cortisol levels, but this may be a time when it is very important to do so. Charlotte's cortisol lowered quickly and very significantly after beginning the Vetoryl, and as Judy says, it is common for cortisol to continue to descend further within the first 30 days of treatment, even when dosing is left unchanged. It is entirely possible that Charlotte's cortisol is now too low for her comfort and safety, and the dosage needs to be reduced.

The formal recommendation from Dechra is to test at both the 10-14 mark and again at the 30-day mark. So Davis was giving you a "break," if you will, by waiting until the six week mark to schedule the second monitoring test. And if Charlotte was doing well, this would probably be OK. But if she's not doing well, it is much better and safer to go ahead and retest now. Even if a dosage adjustment is called for, then you can have greater confidence that you are arriving at her truly optimal dose, at which time the testing window will lengthen.

Hope this makes some sense, and please keep us updated. But do please contact Davis, as well.

Marianne

[LaurieS]

Thanks Shana and Marianne! Today Charlotte ate well but she is no longer acting super hungry and scarffing down her food like she has since the day we got her. She is sleeping a lot and isn't very responsive like she used to be with a wag of a tail when we speak to her. I had hoped she would act a little happier by now but maybe I'm asking for too much too soon. But she was very excited to go for a short ride today and also slept 8 hours last night which is the longest she has been able to go without having to urinate so I guess that's a positive. And she is rolling around on her back like she used too which is super cute. I will email her Davis vet and ask him what he wants me to do but I have no problem going for the next ACTH test a little early.

Laurie

[molly muffin]

That drop was a pretty big one and the worry is that it has continued to drop into an area that is too low for her. So, watch her carefully, and definitely contact the Davis vet. I'm guessing her post cortisol number has dropped some more.

[LaurieS]

Ive noticed Charlotte's inner ear flaps and bottom of her paws get really pink sometimes. It usually doesnt last long and then they are back to normal color. Could this be related to blood pressure? Ill be asking her vet at Davis when we see him but thought id ask all of you if this is something you have seen in your cush pups?

Laurie

[judymaggie]

Laurie--the pink coloring you describe happens to my Abbie when she gets stressed so I usually see it at the vet. Since Abbie has too many other things that concern me, I let this one go. Have you seen any pattern with Charlotte as to when this occurs?

[djalbo]

Hopefully this works...Here is a photo of her blood and urine test results:

http://i1376.photobucket.com/albums/ah32/Laurie_Gomes_Storey/Charlotte%20tests_zps7pfuwhz8.jpg

Oops, never mind. Didn't realize there were more pages to this thread.

[LaurieS]

Laurie--the pink coloring you describe happens to my Abbie when she gets stressed so I usually see it at the vet. Since Abbie has too many other things that concern me, I let this one go. Have you seen any pattern with Charlotte as to when this occurs?

I haven't seen a pattern with this and it's been at home while she wasn't stressed for any reason. I will keep a closer watch but she was sleeping in my husband's lap last night when we noticed it. It usually subsides after an hour or so. I have a message into her Davis vet and that's one of the questions I asked. I'll let you know what he says.

Laurie

[LaurieS]

We have an appointment for Charlotte's next ACTH Stim test on 1/23 but I have a message into her Davis vet to see if he thinks we should come sooner. She is with me at work today and acting very lethargic. But yesterday she had a pretty good day out and about with my husband. He said she was very attentive and more active than she had been the day before. So she obviously has good days and bad days.

One thing I have noticed is that they want to do her ACTH 3-4 hours after she gets the Vetoryl. I have seen it posted here, and also on Dechra's website, that the test should be run 4-6 hours after medicating. I have confidence in Davis but I think I should still ask why they want to test her a little sooner than recommended.

Laurie

[LaurieS]

I just heard back from Charlotte's Davis vet and he thinks it's ok to wait for our scheduled appointment on 1/23. In addition to the ACTH stim test he wants to recheck her chemistry panel also (electrolytes, kidney values, liver, etc). As for the continued trembling/tremors he said he would have expected those to get better by now and thinks we should see a neurologist. He said he would have expected some improvement by now if it were just related to muscle atrophy from cushings. I did read that "shaking" was a symptom of addisons disease and if her cortisol levels have fallen in the past couple of weeks could this be what I'm seeing? Not sure what they mean by "shaking". What is going on with Charlotte is the same as what she was doing before she started on the Vetoryl. Mostly trembling over or shoulder area and front legs when she is at rest. But I do believe it is worse now than it ever has been. Thoughts?

But I have a big problem. I'm out of money. I have just enough to pay for her ACTH stim test but nothing more. I feel sick because I want to do everything possible for Charlotte but I have run out of resources. I have maxed out the Care Credit card and my personal credit card. How do all of you pay for all these tests? I've spent over $3000 and if she hadn't been in the UC Davis diagnostic study it would be a lot more. I'm on a very tight budget and don't know what to do.

[Joan2517]

Call Credit Care and see if they will up your credit limit. Or see if your vet will set up a payment plan...can't hurt to ask.

[LaurieS]

Call Credit Care and see if they will up your credit limit. Or see if your vet will set up a payment plan...can't hurt to ask.

I'll be calling Care Credit tomorrow morning. I don't know if Davis has a payment plan but I will ask them tomorrow as well. Thanks Joan!

[Carole Alexander]

Have you considered setting up a "Go Fund Me" page? I don't know how much it would raise but I will contribute. Since I am going through nearly the same process with Skippy, I am painfully aware of how expensive this is. Also, UC Davis may be able to help. Charlotte is in their research study; certainly that benefits you and Charlotte, but it also benefits Davis. Someone (maybe Drecha?) funded them to study Cushing's treatment. Their research will bring prestige and credibility to them. It will also bring additional research dollars and new patients to their clinic. My experience with Purdue X 2 is that they are very firm in their payment policies and people who look as if they ill prepared for the exorbitant costs somehow raise up the money. But, these are not clients whose pups are in research studies. I am also aware that Purdue offers deeply discounted rates to veterans and their staff and students, as they should. I would discuss this first when you meet with them as it is clear that many issues are yet to be determined regarding Charlotte's conditions. Let us know how this goes and hang tight.

[labblab]

Hi again, Laurie. First off, I want to address your earlier question about the timing of Davis' monitoring ACTH testing (3-4 hours after dosing). For quite some time now, Davis has advocated for a testing window that is a bit earlier than Dechra's. I can only speculate that perhaps Davis thinks it is more likely that they are catching the cortisol at its absolutely lowest point by testing within that window. Regardless, as long as all of Charlotte's monitoring tests take place within the same time frame, I don't think that should present any problems because you will be comparing apples-to-apples, if you will.

As far as the tremoring, since it started even before the trilostane treatment, it does seem as though something other than low cortisol is likely involved. Coupled with Charlotte's lethargy and lack of appetite, one disconcerting possibility is that the pituitary tumor that is causing the Cushing's may be enlarging and putting pressure on other areas of her brain. Given the shape of a boxer's skull, I believe that she may be at a heightened risk for this problem, and that may be one of the possibilities that is prompting the Davis internist to suggest a neurological consultation. Unfortunately, neurological diagnostics and subsequent treatment can be quite expensive. I know this personally because my husband and I opted out of pursuing neurological imaging or treatment for our own Cushpup, partly due to the expense. We ultimately ended up losing him to what we assume were the effects of an expanding tumor. :o

Under your current circumstances, I believe I would just try to hold tight until the ACTH is performed, and if at all possible, it would be great if your vet could also run at least a very basic blood chemistry panel. Those tests alone may provide you with some answers, especially if it appears as though a dosage change is warranted. However, if Charlotte's cortisol level is optimal at the same time that the tremoring and other problems worsen, then some other decisions may need to be made. I don't want to worry you unnecessarily about an enlarging pituitary tumor, but I do feel compelled to mention it because I do think it is a possibility.

I surely understand your frustration and sorrow over these medical costs. In a perfect world, we'd hope to be able to opt for any treatment or any test that's necessary. But very few people are lucky enough to be able to do that, and the rest of us have to choose whatever will deliver the best hope for the least cost. I do think the money spent on the next ACTH will be worth it. And then, as I say, you may have a better idea as to whether there is value in looking elsewhere for the source of these problems.

Please hang in there, Laurie. You've done a great job of advocating for Charlotte, and she's very lucky to have you as her mom.

Marianne

[LaurieS]

Hi again, Laurie. First off, I want to address your earlier question about the timing of Davis' monitoring ACTH testing (3-4 hours after dosing). For quite some time now, Davis has advocated for a testing window that is a bit earlier than Dechra's. I can only speculate that perhaps Davis thinks it is more likely that they are catching the cortisol at its absolutely lowest point by testing within that window. Regardless, as long as all of Charlotte's monitoring tests take place within the same time frame, I don't think that should present any problems because you will be comparing apples-to-apples, if you will.

As far as the tremoring, since it started even before the trilostane treatment, it does seem as though something other than low cortisol is likely involved. Coupled with Charlotte's lethargy and lack of appetite, one disconcerting possibility is that the pituitary tumor that is causing the Cushing's may be enlarging and putting pressure on other areas of her brain. Given the shape of a boxer's skull, I believe that she may be at a heightened risk for this problem, and that may be one of the possibilities that is prompting the Davis internist to suggest a neurological consultation. Unfortunately, neurological diagnostics and subsequent treatment can be quite expensive. I know this personally because my husband and I opted out of pursuing neurological imaging or treatment for our own Cushpup, partly due to the expense. We ultimately ended up losing him to what we assume were the effects of an expanding tumor. :o

Under your current circumstances, I believe I would just try to hold tight until the ACTH is performed, and if at all possible, it would be great if your vet could also run at least a very basic blood chemistry panel. Those tests alone may provide you with some answers, especially if it appears as though a dosage change is warranted. However, if Charlotte's cortisol level is optimal at the same time that the tremoring and other problems worsen, then some other decisions may need to be made. I don't want to worry you unnecessarily about an enlarging pituitary tumor, but I do feel compelled to mention it because I do think it is a possibility.

I surely understand your frustration and sorrow over these medical costs. In a perfect world, we'd hope to be able to opt for any treatment or any test that's necessary. But very few people are lucky enough to be able to do that, and the rest of us have to choose whatever will deliver the best hope for the least cost. I do think the money spent on the next ACTH will be worth it. And then, as I say, you may have a better idea as to whether there is value in looking elsewhere for the source of these problems.

Please hang in there, Laurie. You've done a great job of advocating for Charlotte, and she's very lucky to have you as her mom.

Marianne

Thank you Marianne, as much as I don't want to think about it I do realize the tumor could be enlarging and causing these additional problems. I appreciate your encouragement and understanding. I'm so sorry you lost your cushpup to this. I will wait and see what the ACTH test and blood panel reveal and go from there. I'm calling first thing in the morning to see if I can move up her appointment.

I think I've gone through a whole box of tissues tonight. I'm not ready to lose her. She has been with us less than 3 years. I got her the day after I lost my beloved dog Tanner who most likely had a brain tumor. I truly believe he left this earth when he did so we could rescue Charlotte. As she lays here in bed with me I'm trying to be strong and positive.

Thanks to everyone for sharing your knowledge, advice and stories. It's been so helpful and I don't know what I'd do without all of you!

[LaurieS]

Have you considered setting up a "Go Fund Me" page? I don't know how much it would raise but I will contribute. Since I am going through nearly the same process with Skippy, I am painfully aware of how expensive this is. Also, UC Davis may be able to help. Charlotte is in their research study; certainly that benefits you and Charlotte, but it also benefits Davis. Someone (maybe Drecha?) funded them to study Cushing's treatment. Their research will bring prestige and credibility to them. It will also bring additional research dollars and new patients to their clinic. My experience with Purdue X 2 is that they are very firm in their payment policies and people who look as if they ill prepared for the exorbitant costs somehow raise up the money. But, these are not clients whose pups are in research studies. I am also aware that Purdue offers deeply discounted rates to veterans and their staff and students, as they should. I would discuss this first when you meet with them as it is clear that many issues are yet to be determined regarding Charlotte's conditions. Let us know how this goes and hang tight.

Thanks for the suggestions. I may try a Go Fund Me page once we know more about what's going on. I will also check and see if Davis has any sort of help or payment plans available. One day at a time I guess. I will keep you all posted.

[molly muffin]

One day at a time is the only way to go. You just never know how things are going to progress.
Just wanted you to know that we are all here with you.
I really think all forum members should just invest in Kleenex stock. Obviously we would keep the market value up by our use alone!!! :)

[LaurieS]

One day at a time is the only way to go. You just never know how things are going to progress.
Just wanted you to know that we are all here with you.
I really think all forum members should just invest in Kleenex stock. Obviously we would keep the market value up by our use alone!!! :)

Yes for sure on the kleenex comment! Sad but true.

Charlotte has an appt at Davis on Friday for her ACTH stim test and a chem panel. I never thought id say this but i hope her cortisol levels are low because maybe a medication adjustment will help her. She did so well for about a week or so then back downhill again. The trembling is so bad. Its so sad to watch. I hope she isnt hurting. I made an appt with the neurologist already because they are booked about 6 weeks out. Our appt isnt until March 6th! I may have to go to VCA if she gets worse and it doesnt seem to be related to the meds or cushings.

Ill post again as soon as we get her results.

Laurie

[labblab]

Laurie, I totally understand about you hoping that this is a cortisol issue -- I agree! Wishing both you girls the best of luck on Friday as far as getting some workable answers. Please let us know.

Marianne

[LaurieS]

Laurie, I totally understand about you hoping that this is a cortisol issue -- I agree! Wishing both you girls the best of luck on Friday as far as getting some workable answers. Please let us know.

Marianne


Thanks Marianne!

[molly muffin]

Got fingers and toes crossed here too.

Let us know what they say. So hoping for good news.

[LaurieS]

Charlotte had her ACTH Stim test and a chem panel yesterday but we were told we wont have results til Monday. Im really worried because she is getting worse. Very lethargic and eating less. Her ears are red inside and her head is really hot. My husband says not to give her any more meds but i know thats not right. But i really think we are over medicating her! Would it be awful to skip a pill tonight?

[labblab]

Hi Laurie,

In this situation, I actually agree with your husband. I don't believe I'd give Charlotte any more Vetoryl until you get those ACTH results on Monday. You can always start right back again if it seems appropriate. In the meantime, missing a couple of days worth
shouldn't really hurt her, and it may be a big help if her cortisol is running too low.

Poor baby! :o :(

Marianne

[LaurieS]

Hi Laurie,

In this situation, I actually agree with your husband. I don't believe I'd give Charlotte any more Vetoryl until you get those ACTH results on Monday. You can always start right back again if it seems appropriate. In the meantime, missing a couple of days worth
shouldn't really hurt her, and it may be a big help if her cortisol is running too low.

Poor baby! :o :(

Marianne

Thank you Marianne, I'm so worried about her. This is the worst I've seen her. She has no energy, isn't interested in food other than really good treats (gave her some beef I was cooking for dinner) and is shaking so badly. We won't be giving her any more Vetoryl until we get the test results. I wish there was something more I could be doing for her. She is so weak. :(


Laurie

[Squirt's Mom]

I think you did the right thing by stopping the Vetoryl. This is one of the good things about this drug - it can be stopped and restarted without losing much ground at all and, in fact, is the correct thing to do when a dog presents as Charlotte has. I hope she starts to perk up soon as the drug leaves her system; it has a short life in the body so you should see changes quickly. Let us know how she is doing!

Hugs,
Leslie and the gang

[LaurieS]

Charlotte colapsed last night when she got up from her bed so we brought her into bed with us. She was trembling badly last night before bed but while sleeping with us it almost completely stopped so we were hoping she was improving. But she is still very weak and she just vomited, only a very small amount but its the first time she has since starting the vetoryl. I called Davis and although they have the test results back from Friday they said that only her vet can discuss them with me and he wont be in until tomorrow. My husband is furious and doesnt want to take her there for an emergency call but i think she needs to be seen. Since its Sunday her local vet is closed and the closest emergency clinic wont have her records or the results from the ACTH test. I dont know what to do. I assume they will probably want to give her steroids but if i knew the test results i would have a better idea of whats going on. From everything ive read her symptoms indicate low cortisol level, like maybe she has been thrown into addisons disease. It has now been 24 hours since her last dose of Vetoryl (30mg) so i had hoped she would be doing better by now. How long does it usually take to get out of the body? Im scared and dont know what to do.

[Squirt's Mom]

Get her to an ER NOW. If her cortisol has dropped that low, she is in a life-threatening situation. If it is not the cortisol, something is going on and she needs to be seen asap.

Let us know what you decide and how your sweet girl is doing.

Prayers and healing energies flying her way.
Hugs,
Leslie and the gang

[labblab]

I agree with Leslie, I'd go ahead and take her in whether it's to Davis or locally. I am furious with Davis, too, that they are not offering you more direct feedback and guidance, and I would definitely take that up with your vet next week. If they are not going to provide 24/7 support, you should have been given oral prednisone to have on hand at home. But that is beside the point right now. I hate it that you'll have to bear the cost of a weekend ER visit. But if you haven't been given any oral prednisone to give Charlotte at home, then it's safer for her to be evaluated at an ER and given a steroid there if it's deemed appropriate. I guess the bottom line is that a temporary steroid won't hurt her, no matter what. And if that's what she needs, it sounds as though she should be given it sooner rather than later.

Marianne

[DoxieMama]

Yikes! I'm so sorry you're not getting better suggestions from Davis but also glad you have come here and Leslie and Marianne were available to respond. Please let us know what you find out, wherever you take her.

[LaurieS]

Thank you Leslie, Marianne and Shana. I was feeling so desperate and confused this morning. I ended up getting in touch with my local vet and he was in this afternoon for emergency only. He gave Charlotte a cortizone shot, fluids and an injection for pain. He believes her shaking is from pain. I'm not sure it is but it breaks my heart to think it could be. She is resting now, still trembling and very lethargic. She couldn't even walk into the vet's office, we carried her in and out. This vet said he was worried that if we aren't prepared to spend a lot of money on testing then we may have to put her to sleep. The weird part is nobody can really figure out what is wrong with her. The vet today took xrays (didn't charge me for them) just because he was so sure he would see something that gave him some indication of what is going on. He didn't like the way she was breathing but found nothing he could contribute it too. He palpated her abdomen and didn't think there was pain there. Her liver is enlarged but not abnormally so for a Cushings dog. He did an in-house basic blood panel and said most of her levels were normal or only slightly elevated and there was nothing to indicate an obvious problem.

While I was waiting today I got a call from Charlotte's Davis Vet. He is home sick but had been alerted I had called and wanted to go over her test results with me. He was surprised she was doing so poorly. He said her bloodwork is improved over what it was when he first saw her and her ACTH Stim test was low but not low enough to send her into an addisonian (sp?) episode. Here are the numbers from the test Friday:

Pre 1.6 ug/dl
Post 3.1

He said maybe this is too low for her and suggested we not give her anymore Vetoryl (which we had already discontinued). He said if it is indeed the Vetoryl (which he doubts) she should be doing better tomorrow. I asked about a macroadenoma and he said it's very possible. The next step would be a ct scan and then radiation, which is more of an investment than we can afford. I feel so hopeless right now. I don't have money to keep throwing at all this just to find out nothing. It makes me sick to think about euthanasia just because I don't have money to continue testing, but I don't have it.

I sit here typing and she is laying at my feet. She trembles and seizes her front legs and over her shoulders when she is resting but awake. When she goes into a deep sleep it almost always stops. She stretches her front legs out, probably trying to stop it. I don't see a difference in this now after having an injection for pain. We haven't asked her to get up but the vet told me to have her move around a bit tonight. I hope she is able to do it.

I've cried my eyes out and can't even eat. I feel so helpless. If any of you have any light you can shed on her situation I sure would appreciate it. I really didn't expect all this. I know this is a horrible disease but I thought we would be able to control it, at least for awhile.

Laurie

[DoxieMama]

Laurie, I am so sorry you don't have an answer for what is going on. And I wish I could offer you wisdom or even a suggestion to try. Please try to be kind to yourself. You are a wonderful mom to Charlotte and she knows it. I hope you are all able to get some rest tonight, and pray she will show improvement in the morning.

[LaurieS]

Update... Charlotte went from not wanting to get up to not wanting to lay down. She is walking all over the house, following us everywhere. She seems a little confused but she responds to her name. She acts like she wants to drink but she goes to her bowl and just stands there and looks at it. She wont use her mouth or tongue. Its like she doesnt remember how. I gave her some very tempting treats and she acts like she wants them but doesnt know what to do. But its incredible how much she is moving around compared to earlier today when she really acted like she was a limp rag. I will update in the morning. I need sleep!

[labblab]

Laurie, I am absolutely heartbroken that you and Charlotte are suffering in this way, especially since it mirrors my own experience with my Cushpup so closely :( :(. I've already shared with you that he suffered from unexplained tremors that sound so similar to Charlotte's. But in addition, here is a description that I've posted elsewhere about our final days with him.


Acted distant and dazed, as though "he" was leaving us;
Was very restless;
Started pacing endlessly through the house;
Started relieving himself in the house and in the car;
Lost his balance and coordination.

The crisis came suddenly when he stopped eating and drinking entirely. We had stopped the trilostane by that time, and again his cortisol level/labwork was fine. The hardest part was that he acted thirsty and would walk over to his bowl and lower his head and try to lap up water. But his tongue just wouldn't make contact with the bowl -- it was as though he had lost the ability to understand how to coordinate his mouth. It was awful, and that was when we said, no more. Our IMS thought it still might be possible to buy him some quality time with radiation therapy. But for a variety of reasons, we decided against it.

As you see, our experience was eerily similar to yours with Charlotte. And so I do have to believe that she may be suffering from a macrotumor, as well. I am so sorry to write this, Laurie. But I just want you to know that you are not alone in your pain. You have been doing everything within your power to help Charlotte. But sometimes the miracles we are hoping for just aren't there and there are limits to the options we can consider, both for ourselves and for our beloved fur babies.

Of course my vision is colored by my own experience, but I think sometimes we just have to make the best decision we can with the information and resources that are immediately before us. This doesn't mean you (or I :o) failed our babies. Sometimes there simply isn't enough time or money or ability to do more in the face of their suffering. We love our babies so much, and our decisions for them are made out of that love. As one of our members has said, first and foremost we have to ease their suffering, even if that means we must take on that suffering ourselves.

I do not know what this day or week will hold for your family. It may be the case that the steroid injection has indeed provided some anti-inflammatory and additional pain relief, and I will surely hope that discontinuing the trilostane may bring additional improvements! But if Charlotte remains severely compromised overall, I want you to know that my heart is with you. Whatever happens or whatever you decide, I can promise you I will understand and be here to support you.

Sending so many hugs,
Marianne

[LaurieS]

Thank you for sharing your experience Marianne, that is exactly what ive been afraid as i witness what is going on and my heart is breaking.

Last night after i went to bed my husband got her to drink. Since then she has acted confused at her water bowl several times but then finally starts to drink on her own. So for now im not worried about hydration but she still hasnt eaten anything. She was up several times during the night to pee and poop. She is so much more alert than she was over the past week but yet seems distant and confused over certain things. We brought her in bed with us and she snuggled up and slept pretty well. She was still trembling but not too bad. Our local vet feels like the trembling is from pain but yet he gave her an injection of pain meds and she was still trembling just as much. I guess there is no way of knowing for sure but we dont want her to be in pain.

This is going to be a tough week. I have oral surgery on Thursday, ive been thinking of rescheduling but im in pain and have already arranged my work schedule around it. Im barely able to eat, im a wreck.

Laurie

[labblab]

Thank you so much for your update, Laurie. It is interesting (and of course good!) that she's more physically active since discontinuing the trilo and getting the steroid injection. Even though Charlotte's ACTH results were very good in terms of Cushing's treatment, it is indeed possible that she will feel better with her cortisol running higher, especially if she does have a macrotumor. We have had members whose dogs underwent head imaging and received confirmed diagnoses of macrotumors. And in some instances, their neurologists recommended dosing with a daily controlled amount of oral prednisone in addition to the trilo, or shifting solely to the prednisone alone. Strictly from a Cushing's standpoint, this doesn't make much sense. But the higher level of steroids apparently served to reduce the swelling and inflammation of the brain tissue, and gave the dogs some degree of temporary relief. Of course, the flip side is that you may end up seeing a rebound of Cushing's symptoms.

Anyway, I just wanted to mention oral prednisone as a possibility that you might want to discuss with the Davis specialist. Even in the absence of confirmatory head imaging, he might feel it's worth giving a try. Definitely please keep us updated as to how things proceed.

Marianne

[Squirt's Mom]

I am so sorry to read the latest with your sweet girl. The way she is acting about the water and food reminds me of how my Squirt was after she had a stroke. It was like she had forgotten how to use her tongue or mouth. She was like that, slowly improving, for several months but she DID get better. I pray it is something like that with Charlotte and she will get better over time.

Please keep us informed as you can and know you are not alone.
Hugs,
Leslie and the gang

[LaurieS]

I took Charlotte in for a follow up with the local vet today and he said she made his day. He told me he thought that it was a 90% chance she wouldnt make it through the night. She not only walked in the door today she trotted. She jumped up on our bed when she got home which she hasnt been able to do in a long time. She is eating now, although still finicky, and she rode all the way to the vet with her head out the window. She is going to be a tired pup tonight!

The vet gave her another cortisone shot and sent me home with prednisone and 3 days of antibiotics. He also gave me some antacid and nausea medication. He said as long as she is doing well we can come back on Monday for reevaluation. He thinks we will keep her on pred for awhile and then watch for cushings signs to come back and then decide how to procede.

Im just so thankful she is doing well right now. I hope we have some quality time left with her!

[labblab]

Laurie, that is super news -- you've made my day, too! :)

I think for right now, you just take things day-by-day, and what a good day you all had yesterday. Long may they continue!

[DoxieMama]

Yay! I'm so happy to hear this news, and hope she continues to do well.

[Joan2517]

Wonderful news...you must feel so relieved!

[Squirt's Mom]

Oh goodness! This is GREAT news! Low cortisol was the best hope for what was going on and it sounds like that was exactly what the problem was! YAY!!!! :cool::cool::cool:

[LaurieS]

Thanks everyone! Charlotte has that cute Boxer expression back on her face that I haven't seen in quite awhile. She is acting almost like she used to before she got sick with Cushings. But now we have a new problem. She doesn't want to settle down. She slept a little last night but for very short periods. She would wake up and walk all over the house, like she wanted us to get up with her. She would walk over to my side of the bed and stare at me like she wanted me to get up. I'm thinking the 2 injections of steroids in 2 days was probably too much. Maybe it has caused her to have insomnia? I was worried at first she was in pain and couldn't get comfortable but I would get up with her and she was so perky and would trot outside when I let her out to potty. It's like she's all "hopped" up on something and I assume it's the cortisone. Does that make sense?

Laurie

[labblab]

Yes, I would think the steroid injections could be contributing to insomnia and restlessness, so hopefully that will abate as the steroid level normalizes a bit. What instructions have you been given re: timing and dosage of oral prednisone if you do switch to that? And does the Davis specialist yet know about these changes in Charlotte?

As pleased as I am that she is doing better, it does raise a host of questions in my mind. Her ACTH results were right within therapeutic range for a Cushpup, and so this dramatic turnaround while being given supplemental steroids is a puzzler to me. Has the Cushing's diagnosis been an error? Is there something else going on that the steroids are addressing? And not to be a downer :o, is the macrotumor still a possibility, with the supplemental steroid offering enough relief from the pressure and swelling to normalize some of her behavior but not all of it? I'd be curious to know what the vets at Davis think about this whole scenario...

Marianne

[LaurieS]

Yes, I would think the steroid injections could be contributing to insomnia and restlessness, so hopefully that will abate as the steroid level normalizes a bit. What instructions have you been given re: timing and dosage of oral prednisone if you do switch to that? And does the Davis specialist yet know about these changes in Charlotte?

As pleased as I am that she is doing better, it does raise a host of questions in my mind. Her ACTH results were right within therapeutic range for a Cushpup, and so this dramatic turnaround while being given supplemental steroids is a puzzler to me. Has the Cushing's diagnosis been an error? Is there something else going on that the steroids are addressing? And not to be a downer :o, is the macrotumor still a possibility, with the supplemental steroid offering enough relief from the pressure and swelling to normalize some of her behavior but not all of it? I'd be curious to know what the vets at Davis think about this whole scenario...

Marianne

Yes Marianne, all of this has occurred to me as well. I spoke with Charlotte's Davis Vet the night we brought her home and filled him in, then emailed him yesterday with an update and asked him about oral pred and this was his reply:

"Thanks for the update. Glad she is doing better! I think another dex injection is fine, but i would not do oral pred — she will have plenty of steroids in her from the Cushing’s now that she is off of trilostane.

Remember, we did the acth stim to prove that her cortisol wasn’t dangerously low - and it isn’t. I’d give her time w/o extra steroids. They resume the trilostane at a lower dose (15mg twice/day?) when she is symptomatic again.

The only treatments for macroadenoma are surgery (in the Netherlands) or radiation. There is no medicine for it (although sometimes the anti inflammatory effects of the Cushing’s steroid hormones helps to shrink it a little)."

This all makes sense to me but since we aren't completely sure what we are dealing with it does make it a little harder to decide what to do. The Trilostane did not do her many favors. It helped with her water intake/frequent urination and she did perk up a little, but not a lot. After the first couple of weeks she started to go down hill and ended up much worse than before we started her on it. So I think we are all in agreement the dosage was too high for her, and maybe at a lower dose she will do better on it. But I guess my question is why not a low dose of pred to keep the inflammation down? I guess his explanation was that she may get some anti-inflammatory effects from the Cushings steroid hormones, which is maybe why she got worse on a high does of trilo that was suppressing those hormones?

I have a tremendous amount of respect for the vets at US Davis for the obvious reasons. My local vet has treated cushings but admits he is not an expert. But at Davis they push more testing and treatment which I simply can't afford, and my local vet understands my financial limitations. We want to do the very best for Charlotte and I know the best would be a CT scan to be sure what we are dealing with. Unfortunately we just can't afford it right now. So not sure what to do at this point other than just watch her and see how it goes day to day.

Laurie

[labblab]

I would do exactly as you are right now, Laurie. I think the Davis response makes sense, in that I wouldn't launch into oral prednisone right away, either, since she's totally off the Vetoryl right now and cortisol does offer similar anti-inflammatory benefits. I would want to wait a bit and see how she responds once the injection wears off and her natural cortisol level builds back up. If she truly has a macro and Cushing's, you'd be looking for a balance between offering relief from the neurological symptoms and also the classic Cushing's issues. Layering prednisone on top of uncontrolled cortisol could perhaps tip things too far in the other direction. I do think that's why some neurologists prescribe both trilo and pred simultaneously -- in order to control the cortisol level in addition to a specific dose of prednisone. But I'm honestly not sure how well that regimen truly works. So for right now, what Davis is recommending makes sense. And we'll all be right here alongside you, taking things a day at a time. Once again, I think you and your husband are doing an awesome job of caring for Charlotte under such emotionally trying circumstances!

Marianne

[LaurieS]

I would do exactly as you are right now, Laurie. I think the Davis response makes sense, in that I wouldn't launch into oral prednisone right away, either, since she's totally off the Vetoryl right now and cortisol does offer similar anti-inflammatory benefits. I would want to wait a bit and see how she responds once the injection wears off and her natural cortisol level builds back up. If she truly has a macro and Cushing's, you'd be looking for a balance between offering relief from the neurological symptoms and also the classic Cushing's issues. Layering prednisone on top of uncontrolled cortisol could perhaps tip things too far in the other direction. I do think that's why some neurologists prescribe both trilo and pred simultaneously -- in order to control the cortisol level in addition to a specific dose of prednisone. But I'm honestly not sure how well that regimen truly works. So for right now, what Davis is recommending makes sense. And we'll all be right here alongside you, taking things a day at a time. Once again, I think you and your husband are doing an awesome job of caring for Charlotte under such emotionally trying circumstances!

Marianne

I totally agree with you Marianne. I think at this point we just wait on both the pred and the trilo. Just watch her and see how she reacts once the steroids are worn off. Maybe with the higher cortisol level she will do alright for awhile without any drugs at all. I sure wish we could afford to do the CT scan so we would know for sure if we were dealing with a macrotumor, but that is what makes the most sense right now.

Of course after keeping us up all night, now she is sleeping!

[molly muffin]

Whew. Oh my goodness. I can't believe what a horrible weekend you had and a terrifying one too. I bet you just want to sleep for a week after that.

I'm glad she is doing better. yay for that! It does seem to be a trial and error right now and the plan you have is a good one. So crossing fingers that she continue to do okay and be more like herself.

[labblab]

Hi Laurie, I just now saw your new reply posted on the "Macroadenoma" thread, and I'm wondering how Charlotte is doing today. You mentioned there that you had started the oral prednisone after all. How are things going for you guys?

Marianne

[LaurieS]

I had oral surgery this morning so im in bed recovering and Charlotte is laying next to me. She is barely tremoring while she sleeps but its gotten worse when she is awake. I feel like she is having some pain too, although i dont know whats causing it. I wish i knew if the tremors were painful or just a neurological response that are just highly irritating. She is drinking well but hardly eating. The only thing she wants is boiled chicken and ground beef. And giving her pills is a struggle because she doesnt want anything she used to like. Ive tried everything...pill pockets, cheese, hotdogs, peanut butter and even ice cream which worked with one of my old dogs. Ugh!

When she is up moving around she looks stronger than she has in weeks. She is moving faster and her ears are perked up more. But then she will look at me like she is hurting and it breaks my heart. Its hard to think about euthanasia when she doesnt look old and feeble but i dont want her to suffer! And sometimes she is shaking so bad i wonder if we are being humane.

We started her on some pred last night because she was shaking so badly and starting to be more lethargic. She seems a bit better today. We are also giving her tramadol. Oh how i wish these babies could tell us what they are feeling!

[judymaggie]

Laurie -- another thing you might want to try re pills is what I resorted to when nothing else worked with my Abbie. My vet suggested I get some very palatable cat food (I used Pro Plan Focus Chicken & Liver Pate) and put that on the outside of the cheese ball (I use american sliced cheese as it is very moldable). Abbie loved it for a while. Now I take the cheese ball and roll it in very, very thinly sliced chicken. Both options I have to stick down her throat (actually in a little pocket at the side of her throat) and hold her mouth shut until she swallows. I also have at the ready another small piece of the sliced chicken to give her as soon as she has swallowed the cheese ball. Every once in a while I don't get the cheese ball in exactly the right spot and she manages to spit it all up -- I rarely try a second time as I don't think it is worth it!

[LaurieS]

Laurie -- another thing you might want to try re pills is what I resorted to when nothing else worked with my Abbie. My vet suggested I get some very palatable cat food (I used Pro Plan Focus Chicken & Liver Pate) and put that on the outside of the cheese ball (I use american sliced cheese as it is very moldable). Abbie loved it for a while. Now I take the cheese ball and roll it in very, very thinly sliced chicken. Both options I have to stick down her throat (actually in a little pocket at the side of her throat) and hold her mouth shut until she swallows. I also have at the ready another small piece of the sliced chicken to give her as soon as she has swallowed the cheese ball. Every once in a while I don't get the cheese ball in exactly the right spot and she manages to spit it all up -- I rarely try a second time as I don't think it is worth it!

Thanks Judy, i will give the cat food a try. Right now she just isnt very interested in anything. I assumed once the cortisol levels incresed she would get hungry again. Right now we are doing pretty much what you described. I hate it though and hope she will start taking something well.

On a side note, i see you are in Florida. We have been thinking of moving there for awhile now (Tampa area) and im wondering about vet care there? Being from California im used to certain things that will be hard to get there but not sure about medical and vet care vs here. Would love your thoughts.

[LaurieS]

She was tremoring so badly late yesterday we decided to go ahead and give her 20mg of oral pred last night and again this morning. She is doing better so we will give her a half dose again tonight. Its just kind of trial and error at this point. She took a short walk with my husband and is sleeping really well right now. Exercise seems to help her but i dont want to over do it. She is drinking a normal amount of water but still not too interested in food. Any suggestions Marianne?

[LaurieS]

Hi Laurie, I just now saw your new reply posted on the "Macroadenoma" thread, and I'm wondering how Charlotte is doing today. You mentioned there that you had started the oral prednisone after all. How are things going for you guys?

Marianne

She was tremoring so badly late yesterday we decided to go ahead and give her 20mg of oral pred last night and again this morning. She is doing better so we will give her a half dose again tonight. Its just kind of trial and error at this point. She took a short walk with my husband and is sleeping really well right now. Exercise seems to help her but i dont want to over do it. She is drinking a normal amount of water but still not too interested in food. Any suggestions Marianne?

[labblab]

Hi Laurie, I'm glad the prednisone seems to be helping with the tremoring, but my worry is that the dose you are giving her is really, really huge -- 50 mg in the space of 24 hours. Unless your vet has specifically told you that's OK, I don't think you can keep giving her that much and you will need to back off considerably. I really have no idea what the optimal dose is in this situation, but unless I was told differently, I wouldn't feel comfortable with more than 10 mg. every twelve hours. But again, I really don't know what's OK in this situation, especially since she's also off the Vetoryl. I'll be very anxious to get today's update.

Marianne

[Budsters Mom]

Adding Prednisone can temporarily reduce neurological symtoms by reducing the swelling around the macro. It is a tricky situation because it acts like cortisol in the body. Our Cush pups already have very high levels of cortisol. It is sometimes precribed along with Vetroyl as a combo, thus keeping the cortisol at a safe level. It did help my pup for about a month. In the case of an enlarging macro, most of us manage symptoms to keep our pups comfortable for as long as possible. The tumor will continue to grow and eventually take over.

A neurosurgeon with her team of neurologists oversaw Buddy's treatment. He was monitored by phone daily (seven days a week) by this very dedicated neurosurgeon. Dosages were tweaked according to how well Buddy was, or wasn't doing each day. He was on the combo, but even then adding Prednisone was done very carefully. Buddy weighed 16 pounds. Intially was half of a 5mg. Tablet ( 2 1/2 mg. once per day. He was eventually dosed twice per day, but NEVER MORE THAN 5mg. In 24 hours. We tapered down as soon as Buddy started doing better to find the smallest possible dose. He was often taking a quarter tablet twice per day. It was a daily shifting. Too little, he'd be miserable. Wouldn't want to get up. It was a very fine line.

I understand how how hard this is. I lived through it and still relive it often. Please proceed carefully and make sure that someone who knows what they are doing is monitoring VERY carefully. I am so sorry that Charlotte is having such a hard time. This situation sucks! I am so sorry. :o

Kathy


If she truly has a macro and Cushing's, you'd be looking for a balance between offering relief from the neurological symptoms and also the classic Cushing's issues. Layering prednisone on top of uncontrolled cortisol could perhaps tip things too far in the other direction. I do think that's why some neurologists prescribe both trilo and pred simultaneously -- in order to control the cortisol level in addition to a specific dose of prednisone.

[LaurieS]

Hi Laurie, I'm glad the prednisone seems to be helping with the tremoring, but my worry is that the dose you are giving her is really, really huge -- 50 mg in the space of 24 hours. Unless your vet has specifically told you that's OK, I don't think you can keep giving her that much and you will need to back off considerably. I really have no idea what the optimal dose is in this situation, but unless I was told differently, I wouldn't feel comfortable with more than 10 mg. every twelve hours. But again, I really don't know what's OK in this situation, especially since she's also off the Vetoryl. I'll be very anxious to get today's update.

Marianne

The pred is 20mg tablets and instructions from her local vet was to give her 1 tab in the morning and a half tab at night the first 2 days and then back off to a half tab every 12 hours. So you are right on with your thoughts Marianne. He told me that to reduce inflammation in a macrotumor it would be 20-25mg twice daily but if it was a addisonion type crisis it would be much lower, about 5-10mg per day. Of course we dont know for sure but we are assuming its a macro so she will most likely need more than the 5-10mg but we dont want to over do it either. So today she starts a half a tab twice daily which will be 20mg a day.

She slept a lot yesterday, kept me company in bed while i was recovering from my oral surgery. She hardly tremored at all. Her appitite is a little better this morning but still picky and wont eat her dog food alone without treats. Overall the tremors are definitely better from a couple of days ago but still bad when she is resting. She isnt as perky this morning but moving around quite a bit and drinking well.

One day at a time...

Laurie

[labblab]

Laurie, thanks so much for this additional info, and now I feel very much relieved about the dosing! I'm also so glad that Kathy had the chance to chime in. It looks as though her Buddy was maintained for a time on a prednisone dose that would translate into about 20 mg. daily total for a 60 lb. pound (not sure how much Charlotte weighs, but am guessing), so that's right in the ballpark as to where you're also transitioning for the moment.

I'm sending big well wishes to you on recovering from your oral surgery (BIG YUCK :(). And yes indeed, one day at a time. As you can already tell, I'll start bugging you if I don't get your updates, so please do keep checking in with us...:o ;)

Marianne

[Budsters Mom]

Buddy was also dosing Trilo at the same time. Please consider that when estimating prednisone dosages in dogs with already high cortisol due to Cushings. Trilo kept Buddy's cortisol levels in check. That would make a difference as to how much Prednisone can be safely given. ;) There are many variables. That is why close monitoring is essential.

Kathy

[LaurieS]

Laurie, thanks so much for this additional info, and now I feel very much relieved about the dosing! I'm also so glad that Kathy had the chance to chime in. It looks as though her Buddy was maintained for a time on a prednisone dose that would translate into about 20 mg. daily total for a 60 lb. pound (not sure how much Charlotte weighs, but am guessing), so that's right in the ballpark as to where you're also transitioning for the moment.

I'm sending big well wishes to you on recovering from your oral surgery (BIG YUCK :(). And yes indeed, one day at a time. As you can already tell, I'll start bugging you if I don't get your updates, so please do keep checking in with us...:o ;)

Marianne

Thanks Marianne, you have been so incredibly helpful and supportive! I will keep you updated. Yes Charlotte is about 60 pounds, she used to be 75 before all of this. She has of course lost all her muscle mass (she was such a strong dog!) but she still looks ok weight wise. She actually chased a squirrel up a tree this morning but otherwise she is still about the same.

Laurie

[LaurieS]

Buddy was also dosing Trilo at the same time. Please consider that when estimating prednisone dosages in dogs with already high cortisol due to Cushings. Trilo kept Buddy's cortisol levels in check. That would make a difference as to how much Prednisone can be safely given. ;) There are many variables. That is why close monitoring is essential.

Kathy

Thanks for all the info Kathy, and I'm so sorry you had to go through this with Buddy. Charlotte's cortisol levels were fairly low when we stopped the triostane. Last week her ACTH stim test showed pre: 1.6 and post: 3.1. Although that is within the management level they are looking for, Charlotte was going downhill fast and so maybe she needs to run on higher levels. Both of her vets agreed we should not start the trilo again until she starts showing signs of cushings again. The one symptom I wish she would get back is the hunger. She is so finicky now and we have to put pills down her throat.

I'm so thankful to all of you here on this forum, I just wish none of us had to be here!

Laurie

[LaurieS]

My husband took Charlotte and her brother Lido for a walk late last night. He was able to let them walk off leash since it was so late and nobody was out and about. Charlotte was very interested in everything and acted almost like normal, just getting a little more tired than she would have in the past. He let her go at her own pace so she was able to do what felt right to her.

She slept well last night and hasnt had any pain meds today since she seems to be comfortable. She is still not eating well but decided she likes salmon so ive been mixing that into her other food along with home made bone broth. We also started her on a turmeric paste due to its anti-inflammatory and healing properties. Hopefully all of this high quality food will make up for the small amounts she is taking in. She refused pumpkin and any other veggies that she used to eat but right now im just happy she is eating something.

She has tremored less today so its been a pretty good one. Im hoping my husband will be able to take the dogs out again tonight as it seemed to do her some good.

Laurie

[Joan2517]

Some hopeful news...good to hear.

[LaurieS]

This is the worst disease!!! I know im not saying anything new here but its been so confusing and upsetting to not know what to do.

Charlotte has had a rough morning. The tremoring has gotten worse again and she just looks at us like she wants us to make it stop. Ive always known when it was time to let a dog go but this is so hard because she will be shaking and tremoring like crazy then ill open the door and she will go trotting out like she is feeling fine. Even chasing a squirrel up a tree!

She was pacing this morning and wimpering a little so i decided to take her for a short walk. She was very responsive and wanted to sniff around with her ears all perked up. I let her go at her own pace and a couple times she started to trot and actually pulled on the leash a bit. Then back to the house and she lays down and starts the tremors again and cant seem to get comfortable. We gave her some tramadol which she hasnt had for about 24 hours so im hoping that will help if she is having any pain and maybe help her relax.

I dont want to be inhumane but its sooooo hard to think about euthanizing a dog who is so alert and still enjoying things and acting normal when she starts moving around. Ugh!!!!

Laurie

[judymaggie]

Laurie --just a thought -- I know you have been giving tramadol sporadically. What about giving it to Charlotte on a regular basis to see if that helps with the tremoring, especially if it is pain related? Might be something worth talking to your vets about. I give Abbie tramadol two-three times a day on a regular basis. Only problem I have with it is that it is seriously bitter if broken in half and Abbie gets 1/2 pill each time. For her weight, she could get a whole pill but that makes her too groggy.

[labblab]

Laurie, if this is a macrotumor, I suspect you will see some pretty definitive changes before long that may make your decision more clear-cut. Things like what happened for us -- not eating or drinking at all, for instance. If you reach a crossroads like that, then you would have to start direct intervention to prolong life and that may force your hand. Even if not that dramatic, there may be other changes that make it obvious that Charlotte's good times are far outnumbered by the bad times. And that may make your decision clearer.

In the meantime, I encourage you to make as many good memories as you can. Savor the good walks and the good moments. And continue to smother her with love, as I know you are doing already. I was so worried and upset and anxious in the days before we lost Barkis, that I was unable to stay calm enough to spend many quality moments with him at all. I will regret that forever. So my best advice is to stick with that mantra of "one day at a time." Each new day will give you the opportunity to evaluate the path forward. If the changes keep coming, I think you will have fewer doubts about when it is time.

Marianne

[LaurieS]

Laurie --just a thought -- I know you have been giving tramadol sporadically. What about giving it to Charlotte on a regular basis to see if that helps with the tremoring, especially if it is pain related? Might be something worth talking to your vets about. I give Abbie tramadol two-three times a day on a regular basis. Only problem I have with it is that it is seriously bitter if broken in half and Abbie gets 1/2 pill each time. For her weight, she could get a whole pill but that makes her too groggy.

I think you are right Judy. We were giving Charlotte tramadol twice daily for several days, up until yesterday because she was doing so well. She gets 1 1/2 tablets so we have the same problem with the bitterness. But at this point she wont take any pills at all so we have to put them down her throat anyway. :(

Laurie

[LaurieS]

Laurie, if this is a macrotumor, I suspect you will see some pretty definitive changes before long that may make your decision more clear-cut. Things like what happened for us -- not eating or drinking at all, for instance. If you reach a crossroads like that, then you would have to start direct intervention to prolong life and that may force your hand. Even if not that dramatic, there may be other changes that make it obvious that Charlotte's good times are far outnumbered by the bad times. And that may make your decision clearer.

In the meantime, I encourage you to make as many good memories as you can. Savor the good walks and the good moments. And continue to smother her with love, as I know you are doing already. I was so worried and upset and anxious in the days before we lost Barkis, that I was unable to stay calm enough to spend many quality moments with him at all. I will regret that forever. So my best advice is to stick with that mantra of "one day at a time." Each new day will give you the opportunity to evaluate the path forward. If the changes keep coming, I think you will have fewer doubts about when it is time.

Marianne

Thanks for the advice Marianne, i know you are 100% right. Its so hard to do though, im just a mess with worry and anxiety. She is sleeping well now so i think we have decided to keep her on the tramadol regularly, even if she isnt seeming to need it. The lapse yesterday seemed to take its toll.

She is drinking a normal amount but we are still having a hard time with food. I offer her a variety and go with whatever she wants at this point. Right now she is loving canned salmon but wont eat too much at one time. Its so odd since she used to always be such a piggy.

We will try our best to enjoy this time with her. I sometimes wonder why i keep getting dogs and putting myself through this. But i dont know how to live without them!

Laurie

[Budsters Mom]

Buddy never stopped eating. He ate eagerly till the end. I knew that Buddy's happy, pain free days were limited and would only get fewer and farther between. I had a plan in place for him. Easy to plan, but very difficult to implement. He was being treated for an aggressive probable pituitary macro tumor. He experienced head tremors, rear leg weakness and his front legs would collapse on him without warning. This would most often occur when he was walking or running and he would end up going down face first on the concrete. Quite often, he had difficulty getting up at all. He would often be very restless at night, but could still get up and function pretty normally during the day. As long he could continue to chase lizards, bark at birds invading his air space and guard his family, I would let him continue to do that for as long as possible. However, as soon as he was no longer able to do what he loved, what made him happy, it was time to release him to fly. Unfortunately, that day arrived much too soon.

No fur baby should be left to suffer because we are not strong enough to help them cross over when their life becomes too painful. When what makes them who they are, has been robbed from them. It is the ultimate act of love. A large chunk of my heart flew with Buddy that day, but he was happy and did not suffer.

As Marianne said, if Charlotte does have a macro. You will notice more neurological symptoms soon enough and will guide the path you ultimately take. Right now, love on her with every ounce of your being, while she's still with you.

Kathy

[LaurieS]

Buddy never stopped eating. He ate eagerly till the end. I knew that Buddy's happy, pain free days were limited and would only get fewer and farther between. I had a plan in place for him. Easy to plan, but very difficult to implement. He was being treated for an aggressive probable pituitary macro tumor. He experienced head tremors, rear leg weakness and his front legs would collapse on him without warning. This would most often occur when he was walking or running and he would end up going down face first on the concrete. Quite often, he had difficulty getting up at all. He would often be very restless at night, but could still get up and function pretty normally during the day. As long he could continue to chase lizards, bark at birds invading his air space and guard his family, I would let him continue to do that for as long as possible. However, as soon as he was no longer able to do what he loved, what made him happy, it was time to release him to fly. Unfortunately, that day arrived much too soon.

No fur baby should be left to suffer because we are not strong enough to help them cross over when their life becomes too painful. When what makes them who they are, has been robbed from them. It is the ultimate act of love. A large chunk of my heart flew with Buddy that day, but he was happy and did not suffer.

As Marianne said, if Charlotte does have a macro. You will notice more neurological symptoms soon enough and will guide the path you ultimately take. Right now, love on her with every ounce of your being, while she's still with you.

Kathy

Thank you Kathy, I have tears in my eyes reading what you said about Buddy. In comparison, Charlotte has fewer symptoms at this moment. Although she has lost muscle, especially in her back legs, she is still strong enough to run and chase things when she is feeling well enough. It's so weird to see her laying around then go outside, see a squirrel and hit top speed in seconds to chase it through the yard and up a tree. She has only fallen once and that was a week ago when we took her to the ER for weakness and vomiting. It's the tremoring that seems to be causing her the most problems. Whether it's painful or just highly annoying, I know it's getting to her. She is confused and looks at us like she is asking us to stop it.

I have lost many dogs over the years but Charlotte will most likely be the youngest. Some of my babies have died from old age problems and some from illness like cancer, but I think I always did a good job of helping them cross over the bridge when it was time. We have a great vet who comes to the house whenever possible so they don't have to leave or be in a strange, unpleasant environment when it's their time.

We just got back from another short walk. She went at her own pace and never really asked to stop. She is now very tired and sleeping next to me as I type this. Tremoring but not too badly.

My heart breaks for everyone who has had to go through this horrible disease. I believe, and I hope I am correct, that one day we will be reunited with our furbabies for eternity.

Laurie

[Budsters Mom]

Yes, Buddy was aware of his head tremors too. :p He would stare at me in much the same way that you describe of Charlotte. He would stare with frightened, soulful eyes. His ended up being partially caused by hypoglemic fluctuations in his blood sugar. He was not diabetic, but did have periodic tremors. A little Karo syrup on his gums often ended them within a few minutes.

[Whiskey's Mom]

I'm so sorry for everything you all are going through. Poor Charlotte. I know how hard it trying to find something to entice them to eat. You said she always was a piggy which makes it even harder. I'm Going through this with Whiskey so when I find something he likes I go with it for as long as he eats it. Up until last year he inhaled his food & treats without so much as a sniff. Now he inspects everything before making a decision. Hope your sweet girl is feeling better.
Annie & Whiskey

[molly muffin]

I went through the lack of appetite thing with my molly too and it sure can drive you bonkers trying item after item after item, often in the same day to entice them to eat.

They can be amazing can't they and nothing like a squirrel or something to perk up their interest.

I remember for Kathy's Buddy it was lizards that did it for him. LOL He was our mighty lizard hunter. Charlotte might be the mighty squirrel chaser. :)

[LaurieS]

I wanted to share something good that happened today. Charlotte had a peaceful day, slept a lot but with very little tremoring. We went on a short walk that she seemed to enjoy but wasnt very energetic. After dinner i let her outside to potty and when she was done she just started running towards me and bouncing through the long grass like she used to do. It was so cute! I forgot how that looked and never appreciated it when she was healthy. I havent seen her do that in months. The only thing she has moved quickly for is a squirrel but today she had a little burst of energy and happiness!

Thanks Annie and Sharlene for your posts. Its so frustrating dealing with trying to feed her, its always nice to hear from others who understand. Charlotte used to be a doggie garbage disposal, she would wolf down anything without hesitation. She loved her veggies too! Always was in the kitchen begging when i was chopping veggies, there wasnt much she didnt like. Now she turns her nose up at almost everything. Tonight she only wanted the spaghetti sauce i made for dinner. Silly girl didnt even want the beef without the tomato sauce.

Laurie

[labblab]

...but today she had a little burst of energy and happiness!
YAY for Charlotte and YAY for you, too, Laurie! :o :) :)

Thanks so much for sharing this. Reading this is such a sweet way to start off my morning.

[Whiskey's Mom]

Wow really great news! I know exactly what you mean. Wish we could bottle up those bursts of energy for them and the wonderful feeling it brings for us. :)
Whiskey was always my "assistant chef", I never had a bit of food on my floor. Now he doesn't really come around so much while I'm
Cooking, and he sniffs whatever falls on the floor and takes or leaves it depending. It's a huge victory these days when he eagerly empties his bowl and we have just a few favorite treats left on our list. But it's ok-we do what we can to keep them happy!
Hope there are many more bursts of happiness for your sweet Charlotte. ;)

[Squirt's Mom]

What a wonderful moment for you both! Thanks for sharing!

[LaurieS]

From a good day to a bad day...

Charlotte is very lethargic again and hasn't wanted to eat or drink. I finally got her to take a few bites of food and drink some bone broth. Her local vet wants to give her another dex injection since that bounced her back last time. He also said he would give her another injection of Cerenia in case she is nauseous. He said at this point it's like treating a hospice patient, so sad. My husband isn't ready to let her go yet and I understand how hard it is but if it were my call I may decide differently. But Charlotte was his dog and I told him I would let him make the decision....

[labblab]

I'm so sorry for this turn of events, Laurie. I can only imagine how rough this roller-coaster must be for you, and also for your husband. One day at a time, and we'll see what the injections do. If they don't help as much this time, maybe the path forward will seem clearer for your husband, too. The drinking, especially, may end up being the deciding factor. Animals can go quite a while without eating, but that is not true for drinking. So we'll all see what tomorrow brings.

Sending still more hugs your way,
Marianne

[LaurieS]

Thank you Marianne. She perked up a little in the car on the way over, looking out the window and being more alert. After the injection of the dex and the cerenia she seemed very sleepy never even got up off the back seat until we made her get out of the car. I can't compare the immediate effects from last time to this time because last time she couldn't even walk when we took her in. But I do know that last time she slept for several hours then got up and started walking around and then went uphill from there. So I'm hoping she will get up and drink and maybe eat later tonight. I was so worried about over doing the meds that I almost didn't take her in today. But I didn't know what else to do.

I'll update in the morning. Thank you all for caring so much!

Laurie

[labblab]

Thanks so much for adding this update, Laurie. I hope you all get some rest tonight, and that the up-beat effect of the dex will wait until daylight to kick in :o. I'll surely be checking back in the morning.

[LaurieS]

Just wanted to post an update. The dex shot worked just like last time. If you visited my home right now you would never know there was anything wrong with Charlotte. She chased a cat out of the yard at full speed last night. She did keep us up most of the night walking all over the house and wanting to go in and out, but we expected that. She has been drinking plenty of water but still isnt interested in food. We got a little down her last night, she wanted the chicken casserole i made for dinner. Ill try some tasty treats this morning. Hopefully she will have a good day today.

Laurie

[LaurieS]

A question for those of you who have gone through the steroid usage with your pups... The vet wants to give Charlotte another dex shot tomorrow (actually Friday because I won't be available to take her tomorrow) and said maybe we should not do the pred anymore. He said he could give us the dex injections to give her at home. He feels that's what is working best for her I guess. I'm fine with that but we had her on a relatively low dose of pred (20 mg a day) and I remember he told me that to reduce inflammation of a tumor she would need more like 40-50mg a day. So maybe we just weren't giving her enough pred? Does it even matter which steroid she gets at this point? I'm just a little confused on what's best to do. She had a few really good days on the pred but was just slowly getting more lethargic. But the pred didn't cause her to be on such a high. She was relaxed, sleeping better and hardly tremoring at all.

Laurie

[LaurieS]

I'm back again to share some happy news. After being a bit "wired" all night from the dex injection yesterday, Charlotte has had a great day today! She even initiated play with her "brother" Lido this afternoon for the first time in many months! And we found a canned dog food she likes too! I'm heading back to the store after work to grab a few more cans. I don't know how long this will last but I'm enjoying it while it does!

Laurie

[Harley PoMMom]

Yes!!!! Way to go Charlotte!!!

[Whiskey's Mom]

Yay!!! Such great news! :D

[DoxieMama]

That's wonderful! What a bright way to start my day. :D

[LaurieS]

Charlotte ate almost normally last night and this morning! She ate a mix of canned and kibble and then came begging for some of my toast at breakfast like she used to do! Other than some minor tremoring she is acting almost normal. It's been 2 days since the dex and she had no tramadol at all yesterday.

My question is... Her vet wants to give her another dex shot tomorrow afternoon. I kind of feel like we should be giving them as needed rather than just scheduling them regularly. I sure don't want to let her get to a point of being bad again before giving her one but I think we will know when she is starting to slide backwards a little and then go get her one. Does that make sense? I will be talking to the vet today. I trust him but he doesn't see her daily like we do and I think he may want to give her more than I feel is needed. Thoughts?

Laurie

[labblab]

I wish I knew how to advise you about this, Laurie, but I really don't. The one thought that does occur to me is that, at least this time around, you might want to go ahead and get the injection in advance of the weekend. It is so wonderful to hear how Charlotte is rebounding, and it might be a good idea to give her the best shot for some continued relief over a period of several days, especially if you don't have access to your vet 24/7 throughout the weekend. Then on Monday, you could take stock of things and regroup if necessary. You had mentioned possibly getting trained on giving the dex injections at home, so maybe that's something you could pursue further next week. If you actually had the dex on hand, yourselves, then it might be easier to hold off on the injections until you see some slight changes -- knowing that you could give her the dex immediately if it looked as though she was needing it...

Marianne

[Harley PoMMom]

So maybe we just weren't giving her enough pred? Does it even matter which steroid she gets at this point?

Dexamethasone is approximately 5 to 10 times more potent than prednisone and can stay in a dog's system for up to 48 hours. So it may be that the Prednisone dose just wasn't high enough to help her for a extended period of time.

It is quite the balancing act in getting Charolette's dex dose right, just as you mentioned, too long between doses and she will feel poorly but too close an array of other issues can pop up.

One thing I do want to reiterate, ONLY YOU know Charolette best. And I am confident that you will make the best decision for your girl.

Hugs, Lori

[Squirt's Mom]

So good to hear Charlotte is acting so much better! I pray the trend continues with whatever help is best at this point. I think in your shoes I would have the vet give this shot and talk to them about how the dex works - how long it lasts, do you wait til you see signs it's wearing off to give the next shot or is it best given at regular intervals to keep levels even, side effects, alternating injection sites, and any thing else you can think of before you take over injections. Remember what Lori said - you know your girl best. You are doing a great job!

[molly muffin]

This is good news. Any time that we hear that Charlotte is having fun, and being herself is good.
So the Dex helped more than anything it seems. I think what the others said is a good recommendation. Talk to your vet about just doing the Dex and how often to do it.

[LaurieS]

Thanks Marianne, Lori, Anne and Sharlene! That is exactly what I'm going to do. I have an afternoon appt tomorrow and he will give her dex and cerenia injections like last time and then send us home with dex injections, some more cerenia (which she hasn't needed) and some baytril because he said since dex is an immune suppressant he wants her on antibiotics. I'm not real happy about that as I'm a "don't give it unless they need it" kind of person but if he feels it's important then we will give it to her. I will speak with him about frequency. I'd like to give as needed rather than on a schedule but we will see what he says about that.

Today she is doing so well. You would never know she is sick unless you see her tremble a little when she lays down to relax. It's really amazing. We haven't seen her like this since long before she was diagnosed. I hope it lasts awhile, we aren't ready to let her go yet!

Laurie

[Whiskey's Mom]

Aw that's really great to hear that she's doing so well! Pretty sure the antibiotics need to be given on a daily basis for them to work properly, but I could be wrong. Hope they keep the nasty stuff away from her as she heals & feels better every day!
Annie

[LaurieS]

Aw that's really great to hear that she's doing so well! Pretty sure the antibiotics need to be given on a daily basis for them to work properly, but I could be wrong. Hope they keep the nasty stuff away from her as she heals & feels better every day!
Annie

I think you are right Annie, I'd just rather not give them at all. But if it's important then of course we will.

[Budsters Mom]

Antibiotics are used to eradicate infections. That's why they are usually dosed for the full course if treatment (until gone). Check with your vet before stopping them just to make sure. ;)

[LaurieS]

Antibiotics are used to eradicate infections. That's why they are usually dosed for the full course if treatment (until gone). Check with your vet before stopping them just to make sure. ;)

We actually never started them. She had been on them before but finished the dosage she was given and now they basically want her on them all the time, since the dex is an immune suppressant. I see the point but then I hate to do more meds than needed.

Charlotte had her dex injection yesterday afternoon and is dong well this morning after waking me up numerous times last night. But that's a small price to pay to see her feeling well!

[labblab]

I'm actually kind of with you on this, Laurie, in terms of having reservations about the antibiotic. Antibiotics can sometimes cause GI upsets and loss of appetite, and while I do understand the rationale of her being immunosuppressed due to the dex, I'd hate to see her backsliding again in terms of appetite. If we are talking strictly palliative care, we are wanting her to be as comfortable as possible for as many days as possible. But in a hospice situation with humans, instituting antibiotic treatment is one of the interventions that may be decided against in terms of end-of-life treatment decisions, when nature is allowed to take its course. In other words, in the face of a known terminal diagnosis, one may opt out of what would otherwise normally be life-prolonging measures.

One of the wild cards with Charlotte, however, is that we still don't know exactly what's causing her problems, although we assume it's the enlarging tumor. So I guess one option might be to start the Baytril with the knowledge that you could discontinue it if it seems to affect Charlotte adversely. That might be the route I'd take in this circumstance, although I can't disagree with not starting it at all as long as you're aware of the possible risks of infection.

Marianne

[LaurieS]

We are noticing that when Charlotte is on the dex she tremors quite a bit but yet her appetite is better and she seems more normal and active. As the dex wears off she tremors less but starts to act more lethargic, a bit confused and stops wanting to eat and drink. We waited about 3 1/2 days between dex injections this time and that is about as long as we would want to go without having her back slide quite a bit. We gave her 6mg (3ml) vs 10mg (5ml) that she was given at the vets office in hopes the lesser amount will work well enough without making her pace for hours and tremor so much. We will see what happens.

Im wondering if any of you know why the tremoring gets worse on the dex while everything else gets better? Then when the dex wears off the tremors almost go away. I assume its the enlarging tumor that is causing the tremoring so why does it get better off the dex?

I hope that made sense. Its very late and i get so little sleep these days.

Laurie

[LaurieS]

I forgot to mention we decided not to start her on the baytril right now. The dex alone seems to be doing well but we have the baytril and can start her on it if we feel she needs it. We also havent been giving her the Cerenia. Although its an anti-nausea medication she seems to have a better appetite when we dont give it to her. So right now its just the dex every 3-3 1/2 days along with tramadol if needed (which she hasnt seemed to need for pain and doesnt seem to help the tremors).

Laurie

[molly muffin]

I hope the baytril isn't needed. That stuff makes Me feel nauseous!
Hopefully the dex shot will continue to work and she'll feel good and more herself long term.

[LaurieS]

We didn't have a very good day yesterday after lowering the dex from 10mg to 6 mg. She didn't eat well and was more lethargic. This morning she is acting a little confused so I assume the tumor is causing this. We gave her a cerenia pill last night and she ate a little a few hours later. We may try that again today. We haven't given her any Baytril.

I sleep on the couch so she can sleep with my husband. Her tremors stop when she is in a deep sleep and she sleeps best snuggled with him. She was his road dog (he is a truck driver) and she always slept in his sleeper bed with him. We are doing everything we can think of to make her feel comfortable. I'm physically and emotionally exhausted but right now she is my biggest priority and I hope she can stay with us awhile longer.

Laurie

[Joan2517]

The poor little girl...how sweet that she was your husband's road buddy. She must feel so safe when she is with him.

It is so exhausting, especially when you don't know what to do to make them feel better...then there is the constant worrying, which is also exhausting.

You are doing everything you can for Charlotte, Laurie. She knows...

Joan

[LaurieS]

The poor little girl...how sweet that she was your husband's road buddy. She must feel so safe when she is with him.

It is so exhausting, especially when you don't know what to do to make them feel better...then there is the constant worrying, which is also exhausting.

You are doing everything you can for Charlotte, Laurie. She knows...

Joan

Thanks Joan. I wasn't as bonded with Charlotte before she got sick, she was such a daddy's girl. But I handled all her vet appointments and now she and I have a closeness that I almost wish I didn't have. I know that sounds bad but she has become so special to me now that my heart is breaking every day. We are still praying for a miracle but our first priority is making sure she has quality of life. I wish she could talk!

Laurie

[Harley PoMMom]

Im wondering if any of you know why the tremoring gets worse on the dex while everything else gets better? Then when the dex wears off the tremors almost go away. I assume its the enlarging tumor that is causing the tremoring so why does it get better off the dex?

I hope that made sense. Its very late and i get so little sleep these days.

Laurie

High doses of prednisone can cause tremors so I would gather that dexamethasone could cause tremors too, I believe it has some kind of effect on the nervous system.

Sending huge and comforting hugs your way, Lori

[Joan2517]

Thanks Joan. I wasn't as bonded with Charlotte before she got sick, she was such a daddy's girl. But I handled all her vet appointments and now she and I have a closeness that I almost wish I didn't have. I know that sounds bad but she has become so special to me now that my heart is breaking every day. We are still praying for a miracle but our first priority is making sure she has quality of life. I wish she could talk!

Laurie

When they're sick, they always go to Mom...it's very hard being the caretaker. It does break your heart every day, but the closeness is special because they know you're trying to make them feel better and it does comfort them.

My guys always come running to me when they are hurting or not feeling well, even my husband's teacup Chihuahua, who is nasty. But when she wants me to make her feel better, she's a completely different dog. They know who Mom is.

[LaurieS]

High doses of prednisone can cause tremors so I would gather that dexamethasone could cause tremors too, I believe it has some kind of effect on the nervous system.

Sending huge and comforting hugs your way, Lori

Thanks Lori! I can see that, as it wears off they get better but never go away. And she had tremors, although not as bad before she was diagnosed with Cushings and then while she was on Trilostane they got worse. So I realize it very well may be the neurological signs of a tumor but was just wondering if it could be caused by something else. Without further tests I guess we won't know. But sometimes even with the diagnostics they don't figure it out.

Laurie

[LaurieS]

When they're sick, they always go to Mom...it's very hard being the caretaker. It does break your heart every day, but the closeness is special because they know you're trying to make them feel better and it does comfort them.

My guys always come running to me when they are hurting or not feeling well, even my husband's teacup Chihuahua, who is nasty. But when she wants me to make her feel better, she's a completely different dog. They know who Mom is.

So True Joan!

[Whiskey's Mom]

I've been thinking of you & Charlotte & hoping for the best. You're caring for her with such compassion and kindness and she loves you for it. Joan is right...they know.

[LaurieS]

I've been thinking of you & Charlotte & hoping for the best. You're caring for her with such compassion and kindness and she loves you for it. Joan is right...they know.

Thanks Annie!

[LaurieS]

Charlotte had a nice day today. We went to a RV show and she walked quite a bit. She even got frisky when she saw other dogs. Then on the way home we got her a In-n-Out burger which she scarfed down! Shes a tired puppy now but i think she enjoyed getting out. Its been raining here so much and it was our first sunny day in the 60's so a beautiful day for an outing.

Laurie

[labblab]

Oh Laurie, that sounds just lovely :). I am so proud of you for the way you're handling things at such a difficult time! No matter what happens in the future, you are making memories that will last forever. Good job. Truly a good job!

Marianne

[molly muffin]

Awww, how wonderful to hear that she had a good day. Wonderful news!

[Whiskey's Mom]

Yes that sounds like a fabulous day for all of you! So happy :)

[LaurieS]

We had another great day on Valentines Day. It was a beautiful sunny day and we went to the lake where the dogs could be off leash with nobody around. We spent about 2 hours there and she explored and even got in the water. We got some nice pictures i will post here in her album.

But after every good day there are a couple of not-so-good days. A down day after a good day, followed by a dex shot which creates a day of unease, where she cant relax and keeps us awake all night. Im thinking of switching back to the prednisone. It wasnt working as well but we may have been giving her too low a dose. The dex she gets is 3ml (6mg), every 3 days. However, the third day she is very lethargic and it has clearly worn off. The pred dose was 10mg twice daily. I know dex is much stronger and i love that she feels so good on that 2nd day but she also seems to tremor more on the dex than she did on the pred. The 20mg a day of pred seemed to keep her tremors under better control but also kept her very lethargic. We still arent seeing any major cushings symptoms coming back. She drinks more on the first day of the dex shot but nowhere near what she was drinking before. Her appetite is low, we still have to encourage her to eat and give her what she wants or she wont eat at all. But her skin is still thin and her hair hasnt grown back. Not sure where her cortisol level is at this point but both vets said not to put her back on Trilostane until her symptoms returned.

So what to do??? Pred or dex? Does anyone know if its detrimental to switch back and forth? Try one then try the other, depending on how she responds? And what is the pred equivalent of 6mg of dex? I just feel bad keeping her on this dex roller coaster. Suggestions anyone?

Laurie

[molly muffin]

Okay so this is the great thing about the forum. You can go back and using it as a diary see how Charlotte was doing at any given time. I did that and here are a couple things that jumped out at me.

Lori's answer about dex:
Dexamethasone is approximately 5 to 10 times more potent than prednisone and can stay in a dog's system for up to 48 hours. So it may be that the Prednisone dose just wasn't high enough to help her for a extended period of time.

It is quite the balancing act in getting Charolette's dex dose right, just as you mentioned, too long between doses and she will feel poorly but too close an array of other issues can pop up.

and looking back at jan 26 when Charlotte was on the pred:
Dexamethasone is approximately 5 to 10 times more potent than prednisone and can stay in a dog's system for up to 48 hours. So it may be that the Prednisone dose just wasn't high enough to help her for a extended period of time.

It is quite the balancing act in getting Charolette's dex dose right, just as you mentioned, too long between doses and she will feel poorly but too close an array of other issues can pop up.

and just after that
The pred is 20mg tablets and instructions from her local vet was to give her 1 tab in the morning and a half tab at night the first 2 days and then back off to a half tab every 12 hours. So you are right on with your thoughts Marianne. He told me that to reduce inflammation in a macrotumor it would be 20-25mg twice daily but if it was a addisonion type crisis it would be much lower, about 5-10mg per day. Of course we dont know for sure but we are assuming its a macro so she will most likely need more than the 5-10mg but we dont want to over do it either. So today she starts a half a tab twice daily which will be 20mg a day.

She slept a lot yesterday, kept me company in bed while i was recovering from my oral surgery. She hardly tremored at all. Her appitite is a little better this morning but still picky and wont eat her dog food alone without treats. Overall the tremors are definitely better from a couple of days ago but still bad when she is resting. She isnt as perky this morning but moving around quite a bit and drinking well.

So it appears that she had to have a heft dose of the pred already to keep things in check.

Read back through during those dates, before you switched to the dex and see what you think.

You know Charlotte best and know how she was doing on any given dose of the pred and the dex. See what you think.

[LaurieS]

Thanks Sharlene. From what ive read 6mg of dex is about equal to 40mg of pred. So the 20mg she was on seems too low. Now maybe she simply responds better to the dex but i dont think we can know that unless we have given her comparable doses.

We are currently also giving her a natural supplement that is highly anti-inflammatory and high in antioxidants in hopes to support her immune system and maybe even help shrink the tumor some. So after a while on the supplement maybe we will even be able to reduce the dose of the steroid, only time will tell. Of course her comfort is top priority but we hope to get some benefits from the supplement in case she is able to live longer than predicted. Its all just trial and error i guess.

Laurie

[LaurieS]

We had a rough night last night. When I got home late yesterday afternoon Charlotte seemed to be in pain. She was very lethargic, hadn't eaten since her breakfast and when she would walk she held her head very low and also kept twisting around to look at her back end. She was due for her steroid shot so my husband wanted to give it and wait a few hours to see if she would respond. He held her for a couple of hours to keep her calm. After that she got up on her own and came into the kitchen like she was hungry. We offered her several things that she turned down and finally she decided she wanted a grilled hamburger patty which she gobbled down. She then started her restlessness, which we are used too after a Dex injection, but this time she was actually running around and acting like she was in pain. But this lasted only for about 10 minutes and then she settled down in her bed like nothing was wrong. My husband gave her a tramadol and stayed up with her til about 3am. I got up with her at 5am and finally got her to eat some scrambled eggs with bread and cheese at 7am.

So this morning, it's 10am as I type this, she is acting normal. Well her version of normal anyway. She urninated this morning but we haven't seen her have a bowel movement for awhile. The weather has been bad so we haven't been going out with the dogs every time they go outside to potty but of course we will be now. I'm now starting to think there could be something else going on in her hind end. Cancer maybe? Or possibly she has a bladder infection or is constipated. Everything seems to be aggravated and elevated when she is on steroids, or coming off of them, so it's hard to tell if she is uncomfortable, in pain or just really wired up and wigged out from the dex.

One of us will be with her all day today so we will watch very closely to see if she is able to poop and if she displays any of the same actions she did yesterday. She is so finicky I can't get her to eat anything that might help with constipation so I'm thinking of asking the vet for a laxative if she doesn't poop by this afternoon. We also started her on antibiotics (Baytril) last night in case she is dealing with a bladder infection. We are just so broke and are trying to do this without more vet visits and expensive diagnostics. But just when we think it is time to let her go she starts acting so responsive and happy. This is by far the hardest time I've ever had with a dog. Usually I have been pretty clear on what to do, but she is fighting so hard it's very difficult to know what to do.

Sorry this was so long, and thanks to all of you for being here!

Laurie

[Joan2517]

Not knowing is the hardest. She does sound like she's fighting though.

And yes, the vet bills are killers! I am still paying off some of Lena's bills from last year and hoping and praying that none of the others get sick until I clear that CareCredit card. I don't know how we would've managed without that card.

Hopefully, Charlotte just needs to poop and will feel a little better.

[LaurieS]

Thanks Joan! Yes I'm hoping it's something simple like just being constipated. Although nothing is simple at this point. She is so skinny and not really eating enough to put weight back on, if that is even possible at this point. I need to go to the store and get her some ground beef, that seems to be what she wants now. I was thinking of making a patty with some grated veggies mixed in and hope that will help her get regular. She actually ate a couple of bites of asparagus this morning but she turned down chicken!

And yes, thank God for the Care Credit card! Although my local vet doesn't accept it I did use it at Davis for the things the Cushings study didn't cover. But I have about $3000 of credit card debt now and my husband isn't working right now so it's been a real struggle. I'm like you, hoping nobody else gets sick until we can get back on our feet!

Laurie

[LaurieS]

We believe Charlotte is constipated. Ive put a call into the vet but havent heard back yet. Her eating is extremely limited right now, she wont eat pumpkin or anything that might help. Do anybof you have suggestions? Im thinking a very mild laxative but i dont want to cause diarrhea either. Have any of you used over the counter meds for constipation in dogs?

Laurie

[lulusmom]

Hi Laurie,

You may want to consider slippery elm bark as it is wonderful for dogs who are refusing to eat and or experiencing diarrhea or constipation. I have had amazing results in my own dog with irritable bowel problems, colitis and recovering from severe pancreatitis. I've provided a link to some good information on this very natural supplement which can be found in most health food stores and some pharmacies. I personally prefer the gruel which I make by opening six capsules and stirring into 8 ounces of boiling water. I let it cool, suck up in a large syringe and slowly plunge in the side of the mouth. This can also be a meal replacement as it has lots of good stuff in it. My dogs are smaller breeds so I give them 1 to 2 tbls. You can find more complete dosing information, using the link below.

https://draxe.com/slippery-elm-for-pets/

I hope this helps.

Glynda

[LaurieS]

Hi Laurie,

You may want to consider slippery elm bark as it is wonderful for dogs who are refusing to eat and or experiencing diarrhea or constipation. I have had amazing results in my own dog with irritable bowel problems, colitis and recovering from severe pancreatitis. I've provided a link to some good information on this very natural supplement which can be found in most health food stores and some pharmacies. I personally prefer the gruel which I make by opening six capsules and stirring into 8 ounces of boiling water. I let it cool, suck up in a large syringe and slowly plunge in the side of the mouth. This can also be a meal replacement as it has lots of good stuff in it. My dogs are smaller breeds so I give them 1 to 2 tbls. You can find more complete dosing information, using the link below.

https://draxe.com/slippery-elm-for-pets/

I hope this helps.

Glynda

Thank you Glynda! I have some! My husband takes it all the time. We have lozenges and capsules. I just wasnt thinking about this for her. I'm texting him right now to let him know as I'm at work and wont be home til late. Hopefully he can get some in her and it will help! Thank you so much!!!

Laurie

[molly muffin]

Oh i do hope the slipper elm bark will do the trick for her!

[LaurieS]

No pooping so far but she just ate about an hour ago and i gave her about a Tablespoon of the slippery elm after her dinner. She ate quite a bit, including some veggies, so im hoping she will be able to go tonight or by morning. She had a nice walk today too. This is one tough girl. She is fighting so hard.

Laurie

[Whiskey's Mom]

Poor Charlotte! You are doing such a great job caring for her with such love. Whiskey has been really picky too & as of now his favorite thing is meatloaf. I made him his own version without onions-I added eggs, oats, some very chopped up green beans and some ketchup. He really loves it.
Hope Charlotte goes soon & glad she ate the slippery elm. We are thinking of you.

[Squirt's Mom]

Go easy on the veggies...you may not want to bulk up the poop right now so check each one and make sure it contains high soluble fibers. Giving her some mineral oil may help move things along, too. But don't give it when you feed or give other meds - give it alone. If she balks at taking it, mix it with a little something she likes to get it down. Plain pumpkin can also work...but it is a double-edged sword. Too much will make the situation worse so try something like a tablespoon. Be sure it is NOT the pie filling kind - just plain old pumpkin. ;)

[LaurieS]

Thanks Anne, I've tried the pumpkin but she won't eat it. She eats very few things these days and takes a long time to pick through them to make sure there is nothing added. Right now she is liking hamburger. A few days ago she wanted chicken. But if I add anything to it she walks away and won't eat at all. Meat is all she is wanting right now, and occasionally she will eat a few bites of broccoli or asparagus (her old favorites). It's a long drawn out process every day trying to get her to eat. I literally get up an hour early to take that time with her to find something she will eat in the morning.

We have put the slippery elm down her throat with a syringe twice now (last night and this morning) and I'm hoping it will help. I guess we could do the same with a little mineral oil. I never heard back from the vet about a possible laxative pill that would be safe to give her so I'm just trying to deal with this the best I can. I haven't seen her even try to go in the past 24 hours, very weird.

Laurie

[LaurieS]

Poor Charlotte! You are doing such a great job caring for her with such love. Whiskey has been really picky too & as of now his favorite thing is meatloaf. I made him his own version without onions-I added eggs, oats, some very chopped up green beans and some ketchup. He really loves it.
Hope Charlotte goes soon & glad she ate the slippery elm. We are thinking of you.

I'm going to try that tonight, making a meatloaf for her and adding some chopped up greenbeans or zucchini for some fiber. I hope she will eat it! Thanks for the idea!

Laurie

[LaurieS]

We have poop! Yay! But there still seems to be something painful back there so ill be taking her to the vet tomorrow afternoon to have them take a look. She took a nice long walk today and trotted part of the way. She ate her hamburger enthusiastically tonight and is resting very peacefully now. Today was a really good day for her with hardly any tremoring. Hopefully we all can rest well tonight.

Laurie

[Joan2517]

Yay! Nothing better than a good poop!

[DoxieMama]

Yay! Nothing better than a good poop!

This. One hundred percent! (Though I must admit your post made me laugh Joan... it's true but still. :D)

[LaurieS]

Yay! Nothing better than a good poop!

Lol Joan!

She ate well this morning and actually ran out the door with our other dog. She also slept all night and didnt seem to be tremoring as much. This is her second day on prednisone instead of dex. We shall see how it goes....

Laurie

[molly muffin]

Good luck! Poop patrol still going strong.

I'll be back next week to check in on how she is doing.

[LaurieS]

Well we are right back with the extreme lethargy while on the Prednisone. We gave her 20mg yesterday afternoon and it was hard to get her out of bed this morning. Once up she moved around well and ate well but went right back to sleep. Today we started with 20mg this morning and tonight gave 10mg which is what we were instructed to do, and then taper down to 10mg twice daily. Unlike the dex, she isnt tremoring as much or acting restless. Her appetite is better than its been in a long time, and she is so skinny im happy to see her eat well again. But she isnt interested in much else. She just wants to sleep. We did give her first 2 doses with Famotidine and i read that the latter can possibly cause tiredness. Tonight i gave her just the 10mg of pred alone to see if maybe the Famotidine is causing some of this lethargy. We continue to give her a tablespoon of slippery elm twice daily so im hoping that will help with any tummy upset or acid reflux caused by the pred.

My question to those of you who have experience with the steroids is...would you say her tiredness is caused by too much pred or not enough? She wasnt lethargic while on the dex but would get that way when it wore off. So its confusing to me to see her on what i feel is a fairly high dose of pred and acting like she did when the dex was worn off. I really dont want to go back to the dex injections. Its tearing up her skin and also it increases her tremoring and makes her crazy the first day she is on it. Any suggestions?

***UPDATE***
This morning Charlotte woke me up at 6:30am. She had to go pee and was hungry. Huge difference from yesterday when I had to force her out of bed. The big difference seems to be the Famotidine. She ate well and is now in bed with Daddy sleeping with no tremors at all. I gave her slippery elm with her breakfast but haven't given any pred yet. So still trying to figure out what is best but so far today seems better than yesterday when she was just so lethargic.

Laurie

[LaurieS]

For awhile now i have felt Charlotte is dealing with more than one problem. She definitely had, and still has, many of the symptoms of cushings. The ravonous hunger is gone and she is no longer drinking more water than normal but her skin is so thin and she has sores we are treating. The lethargy has remained but she never really gained weight or had a pot belly and now she is so skinny. Her weight loss and lack of appetite make me think about cancer. Even on steroids she just isnt eating well. Some days are better than others but she no longer has much interest and has to be really pushed to eat. With all the bloodwork, xrays and ultrasounds they never found anything other than cushings but a couple of vets felt like she had more than one thing going on. Its so hard to treat something if you dont even know what it is! But we could spend thousands (which unfortunately we dont have) and still not know what we are dealing with.

This morning she didnt want to get out of bed again. I made her get up and got a little food in her so i could give her the pred. She is now back sleeping again. Today is the first day on 10mg pred twice a day. One day at a time. But i still wonder if its the cushings taking her down or something else???

Laurie3

[Squirt's Mom]

When was the last time her blood glucose was checked? It would probably be shown as GLUC on the lab work.

[LaurieS]

When was the last time her blood glucose was checked? It would probably be shown as GLUC on the lab work.

Bloodwork was done last about 4 weeks ago but i dont have a copy of it. Not sure if they checked glucose level but it was normal in the first few panels that were done when we were first trying to figure out what was wrong with her. We probably need to have more bloodwork done but each time its been relatively normal. Its been so frustrating because her bloodwork has always looked much better than it should for such a sick doggie.

Laurie

[Harley PoMMom]

She wasnt lethargic while on the dex but would get that way when it wore off. So its confusing to me to see her on what i feel is a fairly high dose of pred and acting like she did when the dex was worn off. I really dont want to go back to the dex injections. Its tearing up her skin and also it increases her tremoring and makes her crazy the first day she is on it. Any suggestions?



I wonder if her system is becoming resistant to prednisone and because the dex is so much more potent that this is the reason she does better on it. And to make it easier on the skin dex does come in a liquid suspension, but I have no idea on how to alleviate the tremors she gets from the dex. :(

Hugs, Lori

[labblab]

Hey Laurie, this may already have been mentioned to you, but I have seen the recommendation made to avoid giving slippery elm within two hours of other medications. This is because the slippery elm may interfere with proper absorption of meds through the GI tract. Since the Dex was an injectable, this wouldn't have been an issue with it. But for oral prednisone, the interference might occur. Just a thought as to a possible explanation for decreased effectiveness.

Marianne

[LaurieS]

I wonder if her system is becoming resistant to prednisone and because the dex is so much more potent that this is the reason she does better on it. And to make it easier on the skin dex does come in a liquid suspension, but I have no idea on how to alleviate the tremors she gets from the dex. :(

Hugs, Lori

Good thoughts Lori but actually she has been on pred for less time than the dex. This time around its only been a few days and last time was also only about 4 days before we went back to dex. So im not sure what is best but i do know the dex makes her crazy the first day. I dont like putting her through that. Today she is doing well so it seems to be day to day. Ugh, i wish i knew what she was feeling!

Laurie

[LaurieS]

Hey Laurie, this may already have been mentioned to you, but I have seen the recommendation made to avoid giving slippery elm within two hours of other medications. This is because the slippery elm may interfere with proper absorption of meds through the GI tract. Since the Dex was an injectable, this wouldn't have been an issue with it. But for oral prednisone, the interference might occur. Just a thought as to a possible explanation for decreased effectiveness.

Marianne

Thanks Marianne, yes i knew that so we give the pred about 2-3 hours before the slippery elm. 😊

[LaurieS]

Looks like Charlotte now has CC. Its on her back so she cant really get to it and we have been applying neosporin. Her vet wants to put her on Baytril but im wondering how much that will help? Besides keeping it from getting infected, is it going to make it any better? Ive been reading through some of the threads here and have seen many dogs have cleared up on trilostane but Charlotte isnt on that anymore.

My understanding is that CC is caused by high cortisol levels, which im sure she has due to the prednisone she is on (currently 10mg twice daily). Her skin is very thin, her hair has thinned a lot and now we have the CC. The initial cushings signs we noticed, excessive thirst and ravonous appetite have not returned and the lethargy is still there but the last few days not as bad. She is more animated and interested in things than she has been in quite a while.

So it seems we have traded some old symptoms for some new ones and im not sure what we should do at this point. Her local vet doesnt think she can handle the trilostane and her Davis vet said we should put her back on it when she started showing signs of being cushinoid again. So im confused. She is doing well right now so i hate to mess with anything. Yet i sure dont want to see the CC get worse. Suggestions?

Laurie

[Gracie123]

Hi!

I thought I would jump on this thread instead of the thread about Abbie. So your dog is on 10mg of pred because of the lack of appetite? How much does your dog weigh? That large of an amount can make your dog feel bad.

I'm in your same boat trying to figure out why Gracie is so lethargic. It's a sign of too much pred as well as too little. Gracie (19lb) is on .5mg pred right now and is tired most of the time. I've tried a little .2mg booster, but it just makes her tremors worse with no increase in her energy. So, I don't know.....it could be the pred or it could be the pituitary tumor causing the lethargy and tremors.

[LaurieS]

Hi!

I thought I would jump on this thread instead of the thread about Abbie. So your dog is on 10mg of pred because of the lack of appetite? How much does your dog weigh? That large of an amount can make your dog feel bad.

I'm in your same boat trying to figure out why Gracie is so lethargic. It's a sign of too much pred as well as too little. Gracie (19lb) is on .5mg pred right now and is tired most of the time. I've tried a little .2mg booster, but it just makes her tremors worse with no increase in her energy. So, I don't know.....it could be the pred or it could be the pituitary tumor causing the lethargy and tremors.

Charlotte weighs 60 pounds and is on 10mg of pred twice a day. She was dianosed with pituitary cushings and put on 60mg of Vetyrol but after 6 weeks almost died so we took her off of it completely. She was put on dex then we switched her to pred and she is doing better now than she has been in a long time. She is still more lethargic than normal but much more alert and interested in things than she has been. She still has tremors but they are also less severe. Her appetite has increased a little but we still struggle getting her to eat. The big problem we are having now is calcinosis cutis. She had a few small spots on her back we were freating with neosporin but tonight while she was left alone for about 10 minutes she scratched them into a huge bloody mess. Im a bit freaked out and not sure what to do. We will have her wear a tshirt or her sweater tonight while we sleep and hopefully she wont make it worse. Ill be talking to her vet tomorrow and hopefully we can get this under control.

As far as the pred goes, id love to get her off of it or at least reduce it drastically but right now i hate to make any changes since she seems to be feeling and acting so much better. Its really such a tricky balance. We definitely felt like 30mg a day was too much but will 10mg be too little? I guess we wont know until we try.

Laurie

[Gracie123]

Does the vet think your dog has become Addisons? My dog is typical Addison's now. Her adrenal glands were destroyed. She takes both pred and has her monthly percorten shot.

[LaurieS]

Does the vet think your dog has become Addisons? My dog is typical Addison's now. Her adrenal glands were destroyed. She takes both pred and has her monthly percorten shot.

Were Gracie's adrenal glands destroyed by trilostane?

Charlotte's last ACTH stim test was done about 5 weeks ago and she was right where they wanted her to be. Two days later she almost died. She couldnt walk and our local vet only gave her a 10% chance to make it through the night. He gave her a dex shot, cerenia, iv fluids and sent her home with a subq. She bounced back but we struggled to keep her from drifting off. As the dex shots wore off she would become so lethargic she didnt even want to get up or eat or drink. They dont believe she had an addisonian episode but suggested she had a macro tumor that was putting pressure on her brain. Our local vet also felt there may be something else going on, like cancer somewhere that we havent found. She has lost a ton of weight and now we have the calcinosis cutis to deal with.

The past week she has been on the pred only. We switched from the dex injections because we felt they were too strong. The amount we have her on (20mg a day) seems to be working well for her lethargy problem. She is acting much more like a normal dog, more active and appetite is a little better. But she still has mild tremors and now the CC. Obviously we need to find a balance of the meds but everytime we have lowered the steroid dosage she goes back to not eating and being extremely lethargic.

Laurie

[Gracie123]

Yes, Gracie is permanently Addisons. Her previous vet said Gracie was well controlled on Vetoryl for 2 months even though her symptoms of extreme thirst and panting never subsided. I did make the mistake of giving the next dose a few hours earlier and down she went. She was only on 10 mg. (Half the recommended dose for a 19 lb dog).

We had the ACTH performed 2 weeks post crisis.....close to 0 cortisol. And, her k continues to increase when the percorten starts to wear off. Did your vet check the electrolytes? Gracie was in the ER for 3 days straight on IV fluids.

Just got the results from her latest blood work.... UTI. Could be why she's been so tired lately....

[LaurieS]

Poor Gracie! Charlotte was on 60mg per day (30mg twice daily) for 6 weeks. She was tested 2 weeks post trilostane then again 4 weeks later. Her excessive drinking and urination stopped almost right away but she remained lethargic and her appetite went from wanting to eat all the time to barely eating at all. Her hair continued to fall out and her skin continued to thin. Her ACTH stim at 6 weeks was pre 1.6 and post 3.1. They were very happy with those numbers but 2 days later she vomited and colapsed and we ended up in emergency. Her cortisol hasnt been tested since then but i have a feeling its back up again. We see her local vet tomorrow. Not sure what he will suggest. I dont think he will want her back on the trilo.

Laurie

[LaurieS]

So we saw Charlottes local vet yesterday and he doesnt think her skin condition is calcinosis cutis. He gave me some spray for her sores and has put her back on Baytril to avoid infection. He wants us to start gradually reducing the pred to see if she can handle it. He feels at this point her body should be producing enough cortisol so she doesnt need steroids, unless she had a macroadenoma that needs the anti-inflamatory properties she is getting from the pred. Since we dont know what we are dealing with we are going to hope for the best.

He called this morning with the results of her bloodwork and said overall he was very pleased. Her liver enzymes were a little higher than last time but he expected that after 6 weeks on steroids. The only other concern was her white cell count was slightly elevated but he thinks that could be from her skin problems or even from the steroids. So we will move forward with our plan to see if she will be able to handle slowly weaning off the pred. We have added the Baytril and a probiotic as well as some herbs to support her system. Ive also been feeding her home made bone brogh daily. She is still super finicky about food but is eating more of what she likes so she has put on a little bit of weight. She is still only 58 pounds (before cushings she was 75-80 pounds) but she looks better now than she did even a week ago. She is also acting more like a dog. She actually dug a hole in the yard on Thursday. I never thought id be happy about that but i was thrilled!

Laurie

[Squirt's Mom]

What herbs are you using?

[Harley PoMMom]

She is also acting more like a dog. She actually dug a hole in the yard on Thursday. I never thought id be happy about that but i was thrilled!


So happy to read that she is feeling better and doing doggy stuff!

[LaurieS]

What herbs are you using?

The herbs we have started her on is a blend called Ophiopogon Formula. It contains a number of chinese herbs that our vet feels might help Charlotte. I was also using curcumin, quercitin and boswellia but ive stopped that for right now since i didnt know how those might react with this new herbal blend.

Yesterday was the first day Charlotte had only 10mg of pred. We gave it at about noon and its now 8:30am and she is still sleeping. Prior to yesterday she was getting a morning and evening dose (10mg each) and had me up several times a night and early in the morning. But now im worried she is lethargic again. We will see how she is acting when she gets up. Im hoping and praying we can wean her off of the steroids!

Laurie

[molly muffin]

I cannot for the life of me remember, did they do a biopsy to diagnose that the skin issue was calicinosis cutis? That is if there is any question, the only true way to know for sure. It is also not unheard for cc spots to become infected.
The steroids could cause the cc if that is what it is at this point.

I am super happy to hear that she is enjoying things around her again and getting to be her happy self. It's hard to see a boxer who isn't jumping around being a lovable dork, so I'm sure that really was a worry.

[LaurieS]

I cannot for the life of me remember, did they do a biopsy to diagnose that the skin issue was calicinosis cutis? That is if there is any question, the only true way to know for sure. It is also not unheard for cc spots to become infected.
The steroids could cause the cc if that is what it is at this point.

I am super happy to hear that she is enjoying things around her again and getting to be her happy self. It's hard to see a boxer who isn't jumping around being a lovable dork, so I'm sure that really was a worry.

No he didnt do a biopsy but we will keep a close eye on it. She is on Baytril to prevent infection and we have a topical spray that seems to have helped some.

The first day on reduced steroid wasnt good. She was extremely lethargic and wasnt interested in much. It breaks my heart because i want so badly to think this isnt a macro tumor but her symptoms point towards it being just that. This is a quality of life thing and as much as i want to reduce the pred it may not be possible.

[molly muffin]

Steroids make the feel better and reducing and taking her off it might make her feel down for a bit. What you want to check for in the case of macro is whether she starts looking dazed, getting stuck in corners, rubbing her head and pressing it, not able to drop her head to the food bowl, that sort of thing. Those are all symptoms associated with macro tumors.

[LaurieS]

Steroids make the feel better and reducing and taking her off it might make her feel down for a bit. What you want to check for in the case of macro is whether she starts looking dazed, getting stuck in corners, rubbing her head and pressing it, not able to drop her head to the food bowl, that sort of thing. Those are all symptoms associated with macro tumors.

Thanks Sharlene, I will be on the lookout for those signs for sure. So far the tremors are the main symptom we see other than the lethargy. A few times she has acted dazed and like she doesn't know how to eat or drink but she has only acted that way when we gave her large amounts of the steroids. She would act strangely for the first 4-8 hours then settle down to more normal behavior. It was particularly bad with the dex injections.

I think we will be a bit more gradual in reducing the pred. We will continue with the morning dose of 10mg and instead of nothing in the evening I think we will try 5mg so she has some amount in her system all the time. I'm not sure how long to wait with that dose to see if it's going to work for her? I hate seeing her so lethargic and not wanting to eat much. I sort of freak out when I see her get that way and then go back to the larger amount so she feels better. She has finally started to put weight back on, I don't want to see her lose again but maybe I need to give her more time on the lower dose to see what happens?

The vet said he was pleasantly surprised when he saw her liver enzymes, he thought they would be much higher. I still want to have her on as low a dose of the steroids as possible though because eventually her liver will be in trouble. I forgot to ask if any of the herbs in this blend we are giving her will support her liver. I have given Milk Thistle supplements to dogs with liver problems in the past but will have to ask if that is something I can give her along with these herbs.

Laurie

[LaurieS]

Charlotte's skin is really itchy. Not just the areas on her back where her sores are, but all over. Im starting her on a product called Licks today that has worked really well for my sister's dog who has allergies and im hoping it helps but im very worried about Charlotte scratching herself to the point of bleeding when she is alone. Up until now someone has always been with her but my husband has to go back to work and now she will be alone at home 4 days a week. I do come home for lunch on those days so i can check on her but obviously it doesnt take long to do damage. And i especially dont want her opening up the sores on her back again. Any suggestions?

Laurie

[Harley PoMMom]

I wonder if a soft e-collar would work, different types are shown here: https://www.chewy.com/b/dog-288?query=dog+cone&gclid=Cj0KEQiAuonGBRCaotXoycysvIMBEiQAcxV0nG-aHRLhH8LOV-wGcHnSWWTQ1Ct9bY23yvMgeVbpspkaAuMF8P8HAQ&gclsrc=aw.ds when I did a search for soft e-collars another product came up called "Cover Me by Tui" : https://www.tulanescloset.com/?gclid=Cj0KEQiAuonGBRCaotXoycysvIMBEiQAcxV0nO52_UO Eyacq5yF4i5jUxVe0AhMo5CCC1EI8bOy6a1kaAs-58P8HAQ

Hugs, Lori

[Joan2517]

I got one at Petco for Sibbie after she was spayed and it worked great...she even used it as a pillow!

[Carole Alexander]

Laurie, I also wonder if a coat would help. Even a thin. one that just covers her back might keep her from chewing or scratching.

[LaurieS]

Thanks for the suggestions Lori and Joan. An e-collar isnt going to work because her sores are on her upper back and neck. She cant reach them with her mouth. She cant reach all of them with her back feet either and has been rubbing on low bush branches outside. I also thought of a coat/tshirt Carole. She is used to wearing a sweater in the winter so i was thinking a lighter weight shirt that is really soft might work. I dont want it to rub and make her more uncomfortable but im thinking it might help keep her from rubbing and scratching.

Im hoping this new supplement will help the itching. It has worked wonders for my sisters dog who had been on several prescription drugs and quite a few other supplements with no luck until she found this for him.

Laurie

[labblab]

Hey Laurie, I'm just reposting the second link that Lori offered out: it's for a soft cotton onesie rather than an e-collar:

https://www.tulanescloset.com/?gclid=Cj0KEQiAuonGBRCaotXoycysvIMBEiQAcxV0nO52_UO Eyacq5yF4i5jUxVe0AhMo5CCC1EI8bOy6a1kaAs-58P8HAQ

They've got them sized so that they'll fit even very large dogs. Might be worth a try!

Marianne

[LaurieS]

Oh im so sorry i missed that Lori! And thank you Marianne for reposting it! I was busy trying to get dinner and clearly didnt read it well. Those look very interesting and might be the perfect thing for her right now!

Laurie

[LaurieS]

Charlotte had a pretty active day yesterday. We went for a long walk in the hills behind our neighborhood and she even ran a little. She ate well when we got home so we were very encouraged. We are down to 10mg of pred in the am and 5mg in the pm. Last night she paced around for about an hour before she finally settled down and went to sleep. Not sure if this is from the pred or could be due to a macro tumor. She continues to deal with the tremors daily, sometimes worse than others. But here is a strange thing I don't think I've mentioned here before. When she is resting/sleeping she often likes her head to be lower than her body. She will hang her head off of the couch or the bed for 15-20 minutes sometimes. It seems to me that if she has pressure or pain from a tumor in her head keeping it lowered like that would send blood to that area therefore increasing the pressure. Maybe I'm wrong but I know if I have a headache it makes it worse to send blood to my head so keeping my head elevated feels better. Any thoughts on this?

Laurie

[LaurieS]

The past couple of days Charlotte has been pacing around a lot. The weather is good here so we left the back door open and she goes out and circles the yard then back in and around the living room and then back out again. This concerns me because it makes me think that a macro tumor could be causing the pacing. But yet she is now eating better, she's more alert and much more interested in things. She has expression back in her face and she carries her head higher and is much more attentive. We went for a walk again today and although she was clearly tired on the way back she almost pulled my arm out of the socket trying to go after a rabbit that crossed the street in front of us. I'm not sure what to think, and I know that nobody can really tell me, but on one hand she seems to be doing so much better and yet she does these odd things like pacing and hanging her head off the bed or the couch when she sleeps. I sure wish I knew what was going on with her!

Laurie

[Harley PoMMom]

I sure wish I knew what was going on with her!

Laurie

I know that feeling of helplessness when you just can't figure out what's going on. I so wish they could talk to us. :( I'm sending huge and comforting hugs your way.

Lori

[LaurieS]

Thank you Lori! Yes i soooooo wish they could talk!

[molly muffin]

Talking would be extremely helpful!! LOL

Molly always liked to hang her head too, every since she was a puppy so I know it had nothing to do with cushings or tumors. I think a macro dog wouldn't necessarily hang their head upside down like that as even their bowl being too low can cause difficulties. Just my thoughts.

[LaurieS]

Thats what i was thinking Sharlene. Of course i could be wrong, but hanging her head makes me rethink the macro tumor being the cause of all of her problems.

Today was my husbands first day back to work since Charlotte has felt better and she was pretty upset when he left. He is a truck driver and she was his travel companion. She lived for going in that truck. When he left she went into her bed and started tearing it apart. I had to get her mind off of it by getting her to chase a fake lizard! She settled down but it was kind of nice to see that she still wanted to go. Maybe she will get well enough for some short trips soon. I just worry...

Laurie

[molly muffin]

Awww, she didn't like being left behind. I think that is a good sign. She wants to go and has a snit because he left her. Poor girl. Hopefully she can make some short trips with him as it seems to be something she loves.

[LaurieS]

Tonight Charlotte has been pacing a lot and so i decided to see if she would run around putside for a few minutes to get some of that nervous energy out. I opened fhe door and said "go get the squirrel!" and she and my other dog went running out the door. Instead of going around the 2 foot tall flower pot she jumped and cleared it! Then she came in and jumped up on the bed with me! She hasnt been able to jump in a long time! Love seeing this, it gives me hope. :)

Laurie

[Carole Alexander]

That is terrific and it should give you hope after so many days and nights of so much misery and worry. I know you are on the one day at a time plan, as am I, but it is wonderful to have great moments and great days with them. I hope they continue for a very long time. Thanks also for the cost estimates from UC Davis; they are about what I expected. Skippy took himself off of Vetoryl yesterday; he is not eating and I suspect it is the diarrhea; he has been sleeping pretty much since yesterday afternoon and is still asleep this morning so I will figure out what to do next shortly. Best to you and Charlotte.

[Harley PoMMom]

Instead of going around the 2 foot tall flower pot she jumped and cleared it! Then she came in and jumped up on the bed with me! She hasnt been able to jump in a long time! Love seeing this, it gives me hope. :)

Laurie

You go, Charlotte!!!!

[DoxieMama]

Woo hoo! Get that squirrel - and don't let any ol' flower pot stand in your way! :D

[LaurieS]

Thanks Carole, yes it's so nice to have good days especially after wondering if she would still be with us at this point. The vet really thought she only had about 3-4 weeks to live and that was 7 1/2 weeks ago. I'm not sure what to expect at this point. She seems to be improving since we put her on the herbal supplement but she is also still on the pred. Her skin is looking horrible so it sure would be nice if we could get her off of the steroid, if that is indeed what's causing it.

So sorry to hear that Skippy isn't doing well, I hope his diarrhea clears up soon!

Laurie

[LaurieS]

Overall Charlotte seems to be doing better. She is down to 12.5mg of pred daily and although she is still picky about food she is eating enough to maintain and her water intake is normal. She seems to be tremoring less and is also more alert and interested in life. Now my huge worry is her skin. I'm going to post a picture in her album of what it looks like right now. It continues to spread and it's really scaring me. Her vet doesn't think it's calcinosis cutis, he thinks it's from the steroids. We haven't done a scraping to find out for sure but from what I've read and the pictures I've seen it sure looks like it to me. He gave us a spray for it but I almost think it makes it worse because it dries it out and makes her itch more. I've been putting neosporin on it and also some lavender essential oil with colloidal silver and apricot oil. So far nothing seems to be helping although the supplement I have been giving her the past week (Licks) may be helping her comfort level as she doesn't seem to be trying to scratch as much. I'm wondering if I should make an appointment with a dermatologist? I'm an Esthetician and I deal with skin all day long but never this kind of problem!

Laurie

[labblab]

I'm so glad Charlotte is better, overall, but so sorry about her skin!! I've seen your pic, and it does indeed look like CC to me, too. I'm hoping your vet is aware that supplemental steroids can cause calcinosis cutis in exactly the same manner as does elevated natural cortisol. So when he/she says, "it's the steroids," I'm not sure what is meant. Steroids usually help most other inflammatory skin conditions, not cause them. :confused:

That being said, it would take an actual tissue biopsy to definitively diagnose CC -- a simple skin scraping won't do it. Since I know finances are a big consideration, I don't know whether it's worth an actual biopsy or not. To me, it seems very likely that CC is the culprit, and in that case the only real help will be continuing to decrease the prednisone. In the meantime, here's a copy of a post made by another member who battled CC for quite some time. Maybe it can give you some suggestions.


Hi and welcome. I am so sorry that you are dealing with CC. My pug was first diagnosed with CC in Oct of 2013. Before it was all said and done, she had open lesions from the top of her head to the base of her tail. She is now what I would call in 'remission'.

First, I'll just put this right out there - there is NO cure for CC other than bring the cortisol into proper therapeutic range and keeping it there long term. The proper range is a post of below 5 ug/dl. And, when I say long-term, I mean staying in range for months or for life. My pug stopped her meds for about a month during a bout of pancreatitis. In just 3 weeks, I saw lesions recurring.

There are things you can and should do to help manage the CC, but none of these items will cure it. They can help, that is all.

CC lesions are very susceptible to secondary infection, so I do suggest you run a course of abx on occasion, especially if things are looking particularly bad. In combination with the abx, I also suggest you add a high quality probiotic.

I did use tramadol for pain, as needed. I think they are painful. Or, at least they were painful for my pug.

You may be told that DMSO is a treatment. My personal belief is that it does nothing and is an outdated treatment. But, that is only my opinion, and there are those that have reported good results using DMSO. It will not cure the CC though, so don't think it will. It smells horrific and you'll need to wear gloves when using it. I used it on my pug for about 2 weeks then stopped. I could see it was doing nothing but making her uncomfortable and making my other pugs treat her like she had leprosy.

What I did find helpful for topical treatment was using tea compresses. Not tea tree oil! Just tea bags, like lipton or chamomile tea. I did clip the hair around the areas as well, to keep them open and exposed to air, and I did peal away the scabs that were ready to come off, otherwise they just rotted over the skin. I never covered the lesions up, although I understand covering them may be necessary to prevent your dog from itching them.

Another CC mom, Dawn, had success using a spray she purchased on amazon. I cannot recall the name, something like cetochlor? I think this helped keep infection down.

Some people have used weekly medicated baths. I'm not opposed to this. My personal choice was not to bathe my pug until her lesions were in a significant stage of improvement. I didn't think the sores needed anymore moisture and I didn't want anything else topical on them to irritate the skin more.

I actually think some time in the ocean may not be a bad idea, especially if the sores are crusty right now. If they are open and oozing, then I would not recommend it.

The lesions will bleed, crack, ooze, peel away, look raw and angry, then eventually start to dry out. When they begin to flake and dry out, I believe they are on their way to getting better. Also, keep in mind, they will get worse before getting better, and even as you bring the cortisol down, the lesions that are below the surface will continue to bust through and break open. This went on for about 6 months for us. Hopefully they will not be as angry as the ones that you may be dealing with now though.

Sorry I've typed so much. I'm working a lot right now, so I am not on all the time, but I always watch the CC threads.

[Carole Alexander]

Hi Laurie,
Cushing's, the disease full of unwanted gifts that just keep on giving. Skippy has not been beset with CC, yet, so I can't offer anything meaningful. I do wonder how you can reduce or stop the pred without Charlotte's symptoms increasing. So maddening and I'm thinking of you.

[judymaggie]

Hi, Laurie -- just when things seem to to be staying consistent, you and Charlotte get hit by something else. I would think that, if a biopsy is not affordable, then a skin scraping might give you some answers, at least with regard to what the condition will respond. Hang in there!

[molly muffin]

Looks like cc to me too. Biopsy will tell you for sure, a scraping might be able to tell you also. :( Keeping it dry and the hair around it cut back helps, but yes, the dry makes it itch but if it is too moist then it can get bacterial infection. It's never easy with cc for sure.

[LaurieS]

Thanks Marianne, Carole, Judy and Sharlene for your comments on my latest post about cc. I agree completely with what you said Marianne and i think our vet just isnt very experienced with this condition. I read the post you quoted and feel fortunate (and i should probably knock on wood while stating this) that her lesions have never ozzed or opened up except for when she scratched them and made them bleed. But they are definitely slowly spredding and im afraid of never being able to get the cortisol levels under control since we are worried sick about going back on the trilostane.

I sooooo agree with you Carole, this cushings is the gift (NOT) that keeps on giving. Just when we think we have one thing under control something new pops up!

Im not sure if a scraping or even a biopsy is going to help much since there isnt much we can do if its cc other than continue to try to wean her off of the pred and hope that the chinese herbs will help keep her cortisole level down. Her local vet says he has had success with herbs for treating cushings, but he is willing to use drug therapy too so hes not one of those woo woo crazy holistic docs that only see things one way. Im all for a mix of holistic (eastern meds) and western meds. Me personally, i dont handle drugs well so i always look for alternative treatments when possible and recommend the same to my clients. For instance ive seen clients go through numerous prescriptions for minor skin infections only to find that lavender essential oil cleared it up in a matter of a couple of days.

Yesterday i started putting lavender EO mixed with Apricot kernal seed oil on her sores. Ill give it a few days and see how it looks. I will also be using my LED machine on her as it kills bacteria and stimulates collagen and elastin production and promotes healing. This all may be futile but it makes me feel like im at least trying!

Laurie

[Carole Alexander]

Hi Laurie,
I hope the lavender is soothing Charlotte's sores and I am most interested in whether the herbal treatments help to naturally lower the cortisol. You are such a great mama to her and I know she loves it. I too am likely to resist reintroducing Vetoryl for all of the same reasons. Take a look at Mojo's post (new) regarding another dog with a macro. I just wrote a diatribe that I will refrain from posting now as I may be in one of those seven stages of grief - anger! Best to you and Charlotte.

[LaurieS]

Thank you for your kind words Carole and i can totally identify with your seven stages of grief! I read Mojo's thread and its so frustrsting to hear about the trials and tribulations of this awful disease. At this time i cant say what the herbal blend is doing for her cortisol levels and unfortunately we cant even test them as long as she is on the pred. In some ways she is doing a lot better and in others she is not. Its terribly confusing. As ive said in prior posts, we have suspected a macrotumor for awhile now and after reading Mojo's thread it sounds all too familiar. However there is one thing that keeps confusing me and that is Charlotte's desire to have her head lower than her body. She seems most comfortable hanging her head a couple of inches or more below the level of her body when she rests and sleeps. That seems so backwards to me! If she has swelling and pressure in her head from a macro it seems like it would be more painful or bothersome to her to lower her head like that.

Alas, without further diagnostics we cant know what exactly we are dealing with so we just move forward doing the best we can with what we do know. We have increased the herbs and lowered the pred over the past week. She is doing a little better in my opinion. The only other things she is getting are Licks (supplement for itching) and slippery elm. Her skin seems to be about the same, no better no worse. But she doesnt seem as itchy and bothered by it as she was a week ago so im not sure if its the Licks or the oils that are helping, maybe both. Im so glad Skippy hasnt had to deal with cc, its terrible to have to manage that along with everything else! Right now my biggest frustration is her anorexia. Its exhasting trying to figure out, day to day, what she will eat. I know so many here on this forum are dealing with the same thing and that helps me a little, knowing im not alone. We just keep plugging along!

Laurie

[LaurieS]

After a week of feeling like we were seeing improvement, the last 24 hours have been hard for Charlotte. She is not eating much and is wandering around aimlessly, like she is confused. She is still responsive but is acting distant. And when she is laying down she acts like she cant use her back legs and will pull herself with her front legs. But yet when she gets up she walks fine, and easily got in and out of the car today when i took her for a short ride. Im going to raise her pred back up a little and see if that helps. Last time we got the steroids too low she would just crash, she was so lethargic she didnt want to move. This is totally the opposite but the only thing i can think of to do is play around with the pred and see if it helps. My heart is breaking.

***Update*** How quickly things change. 7pm tonight i gave her pred a little earlier than normal and she continued her pacing but at 8pm she finally ate about 1/4 pound of meatloaf. She also started running around the house while i was playing with my other dog, although she wasnt actually playing it was like she sort of wanted too. Then she ran outside when i opened the door and was bouncing as she ran. Then into the bedroom and jumped up onto the bed, which she was too weak to do earlier today. She wimpered a little, which always scares me, then jumped down and paced for another 10 minutes and then back up on the bed and within minutes was sound asleep and snoring. I really think this is anxiety but not sure whats causing it!

Laurie

[Harley PoMMom]

What a roller coaster ride you and dear Charlotte are on, hopefully you will be able to find that sweet spot with the pred.

Hugs, Lori

[LaurieS]

Thanks Lori. Today she ate a little bit of meatloaf but only what i fed her by hand. She wont eat from her bowl. She has slept a lot and when she gets up she is moving very slow. So different from yesterday when she would hardly relax and was anxiously walking all over the place. She finally fell asleep in my arms after midnight last night and only woke me up once. Oh how i wish we could take this awful disease away from our babies!

Laurie

[Squirt's Mom]

Have you tried raising her bowls, food and water? If she is hurting in her legs or back or neck then bending down to the bowls may be an issue that raising them might help. Just a thought.....

[Squirt's Mom]

My Brick had hydrocephalus and it was very hard on him to put his head down to eat or drink so his bowls were raised up and that helped him a great deal.