We need help - Ben has passed

[Raluca]

This will be a long post so please be patient. My name is Raluca,I am from Romania and I have a 12 year old amstaff, with Cushing's. He was diagnosed last year and received Vetoryl 60mg. He had 34kg that period. Months passed and he began to develop muscular weakness,lethargy and lose weight fast. We took him to the Vet,did bloodwork,repeated his ACTH and started on 30 mg. He has diarrhea from everything we feed him. It's like a rule, every 3 days he has diarrhea. We did also his poop analysis and had clostridium and e.coli so he received treatment.currently we took him off Vetoryl and other pills because we don't want him to be poisoned anymore. His bloodwork is ok but his body is not doing well and we don't find a logic explanation. He's now 25kg. We only give him supplements for joints, food: beef, fish, sweet potatoes,rice,horse(yep, tried it)turkey. I don 't understand. It's like his body doesn't accept nothing. We did everything and more. I also quit my job so I can be with him every day. We're out of funds, it's nerve wrecking. We can't find a explanation!!

[Joan2517]

Hello and welcome, Raluca. Wow, you sure have a lot going on. Others more knowledgeable than I am will be along shortly. They will want to see his blood work, just the highs and lows along with the reference ranges and ACTH results, so if you could post those, that would be great. What is your dog's name?

[Squirt's Mom]

Hi and welcome to you and Raluca!

For now I have one question - has his blood sugar been tested since he started losing weight? If not have that done ASAP....like TODAY! He could have developed diabetes and that can be quickly life threatening. It can also come on seemingly overnight so please have him tested today if he has not been tested very recently for diabetes.

Glad you found us!
Hugs,
Leslie

[Raluca]

I'm sorry I forgot to mention his name. It's Ben. And he is my rock and my everything. He has been tested for diabetes too but in january. For now we're broke as really bankrupt :( i can't download his papers here anybody knows why? I would have loved you all to meet him

[Squirt's Mom]

ahhhh! Sorry about that! :o Tho being called my dog's name is not nearly as bad as some of the names I've been called! :D:D:D

Diabetes could have easily come on since Jan. I would call BEN's :D vet and ask how much they would charge you to just test his blood glucose. Also ask if they will work on payments with you....some will but many won't. However it doesn't hurt to ask. One of our vets has let me sweep floors, walk dogs, clean cages and bowls, and other little things to pay off my bill. But I would have never known they would if I hadn't asked if there was some way for them to help me with the costs. ;)

As for his "papers" - I assume you mean test results? If so, you will have to type in the abnormal results and any comments or notes. We will want to see all info on the LDDS, ACTH(s), and ultrasound if he has had one. The other labwork like the one that shows things like BUN, CHOL, ALP, etc. - we only need to see those that are too high or too low. Please include the little letters and normal ranges for each value. It will look something like this -

ALP 325 150-300 ug/dl
BUN 13 9-21 mnol/l

Thanks for setting us straight on the names! :D

[Raluca]

ACTH -T1cortisol-1.92
T2cortisol-3.16
Glucose-90mg
GPT-74IU/L
ALP-279IU/L
BUN-12mg
Creatinine-1.2mg
Proteine-5.6g

[labblab]

Hello Raluca, and welcome to you and Ben, although I'm so sorry he is doing so poorly right now. Thanks very much for posting those test results. I do have a question that will help us better understand how he was handling the Vetoryl. Can you tell us when the ACTH test was done that you've listed above? What dose of Vetoryl was he taking at the time of the test, and for how long a time did he take the lowered dose of 30 mg. before you stopped the Vetoryl altogether?

It does sound as though he may have some sort of gastro-intestinal problem that is separate from the Cushing's, but is causing all these additional problems as well. But the tough part, as you already know, is trying to figure out exactly what that may be. We'll try to keep thinking of suggestions for you, but first, it'll help if we can find out more about his history with the Vetoryl. Also, during this past year has he had any internal x-rays or ultrasound images to rule out cancer or any obvious problems with his internal organs? I realize the cost may not allow that to be an option for you right now, but I'm just wondering whether any imaging was done in the past.

Thanks in advance for any additional information,
Marianne

[Raluca]

The ACTH was done last month. When we realised that he is not doing well with 60mg, I called his internist and he told us to do his bloodwork to determine if the dose could be lowered and based on them he said we could give him 30 mg. 2 months later we did the ACTH(last month) wich said that we should continue the 30mg. Also last month we did ultrasound and it was ok. X-ray was in january and revealed that his spine had issues (we knew that already )and that the heart is a little bigger. He always been tummy sensitive but now it's extreme. 2 nights ago he threw up in the bed and then diarrhea all night long and day. I realise this is another reason for his weight loss and lethargy. We asked our vet what should we do and I think he's sick of us always calling and taking Ben there and he told us that he's an old and senile dog and we have to take it day by day until it's over. His internist told us the same but nobody tells us what we could do to stop this diarrhea and vomiting only to give him metronizadole and Oralade. We're tired and I know he is tired too. I can't go even to the market and leave him alone. We're going out at least 10 times/day to pee,he's not drinking much but his bladder is weak. His eyes are different,his whole body is different,he became wobbly and disoriented. We tought of letting him go because we tought that he suffers but we can't do it. He's still eating and walking and we can't. But it's so consuming for me. I can't sleep at night and neither at day. Somebody told yesterday to walk the vet'svet' s dog and clean up there in exchange for Ben's checkup. I tried to tell them and it's not possible because it's a big clinic and they have staff there and also are very strict in payments. I asked the vet if he is suffering I said look at him how he's standing up and look at this eyes he's watching me like he doesn't know me,I didn't saw his tail wag for 4-5 months! And he said he's just old and he has back pain and behind legs also and he sent us home. What should I do now? :(
Last year in june my dog had nothing. He was jolly and playful- he wasn't bothered so much by the back pain and now he's like 7 years older and I can't understand why :(

[Raluca]

In addition to those above I have to say that since january we had to take Ben to my parents as we couldn' t handle his needs and us being at work all day long but it was like trips every month to take him to the vet until I had enough and tought I will lose him. I tought that he thinks I abandoned him and that's why he's so sad and decided to bring him home and he will be ok. But it wasn't. Nothing changed. He's like he was at my parents. I know I may not think clear now but I can't go on like this and can't stay at home. I have to find a job,We live on rent and we can't handle only one income. If I will go to work 8 or 12 hours Ben will be alone all day long and this is not ok for him so I'm thinking to take him back to the parents for his good. What do you think?

[labblab]

Oh my goodness, I’m so deeply sorry to read about all the struggles you, your husband, and Ben have been going through. You have sacrificed so much to take care of Ben, and I know you are willing to sacrifice even more if it would only help him. But since you’ve asked what I would do, as impossibly hard as it may seem, I think the time may have come for you to release him from his tired sick body. Something is terribly wrong with Ben, and it seems as though you are beyond the point where there is any medical help left. Even though the vet did not tell you that Ben is suffering, from what you’ve told us it seems to me as though you all are suffering. And this is not good for any of you. Here are some of the things you’ve described for us.


He has diarrhea from everything we feed him. It's like a rule, every 3 days he has diarrhea.

We did everything and more. I also quit my job so I can be with him every day. We're out of funds, it's nerve wrecking.

He always been tummy sensitive but now it's extreme. 2 nights ago he threw up in the bed and then diarrhea all night long and day.

We're tired and I know he is tired too. I can't go even to the market and leave him alone. We're going out at least 10 times/day to pee,he's not drinking much but his bladder is weak. His eyes are different,his whole body is different,he became wobbly and disoriented.

But it's so consuming for me. I can't sleep at night and neither at day.

I asked the vet if he is suffering I said look at him how he's standing up and look at this eyes he's watching me like he doesn't know me,I didn't saw his tail wag for 4-5 months!

In addition to those above I have to say that since january we had to take Ben to my parents as we couldn' t handle his needs and us being at work all day long but it was like trips every month to take him to the vet until I had enough and tought I will lose him. I tought that he thinks I abandoned him and that's why he's so sad and decided to bring him home and he will be ok. But it wasn't. Nothing changed. He's like he was at my parents.

One of our beloved and very wise members who lives in The Netherlands has spoken about a “dog-worthy” life, and I always think about her especially at times such as this. You know Ben better than anyone else — even your vet — and if you can see that there is no joy left in his life, if he is merely “existing” from meal to meal, then it seems to me that the merciful decision is to help him go peacefully, at the end of a long life that was so well-lived before this terrible illness.

Here are some thoughts written by Moira Anderson Allen, M.Ed.


Some pet owners reject euthanasia as “unnatural.” Nature, some say, has a timetable for every life, and by artificially ending a life, we’re disrupting nature’s plan. While charming, this belief overlooks the fact that by providing treatment, surgery, medication, or any other form of care for a sick (or injured) pet, we are already extending that pet’s life far beyond what would occur if matters were left in the not-so-tender hands of “nature.” Euthanasia is often not so much a question of “artificially ending” a life, but of determining when to cease artificially extending that life...The painful truth is that if your pet is terminally ill, and especially if it is suffering and unable to function, it will die; the decision you must make is not whether its life will end, but how, and how much discomfort, you are willing to allow it to endure. Stefanie Schwartz, DVM, sums up the issue in one vital question in her book,Canine and Feline Behavior Problems: “Which choice will bring you the least cause for regret after the pet is gone?” Unfortunately, “no regret” is often not an option.

I know these are such hard things to think about. And it may be the case that you and your husband will continue to feel as though euthanasia is not the right decision for yourselves and Ben. But since you’ve asked for our own thoughts, I felt as though I had to give you my honest ones. Once again, I’m so sorry for all you are going through, and we’ll stay with you no matter what you do end up deciding. Please feel free to return and discuss this all as much as you wish.

Sending many hugs to give you strength and comfort,
Marianne

[Raluca]

We can't do it. We just can"t do it. As long he eats and walk by his own we can't. In my opinion he still wants to be with us. In the morning we had 1 hour walk,this is amazing. It was slow and with pauses but he wanted to have a long walk like in the past. I will never let him suffer. I know his quality of life has dropped but it's not zero. Who am I do decide for his life... Believe me,I would like it to happen naturally but I don't know what the future will be. It's a hard struggle and very much mixed feelings and emotions.
I'm sure that the weather is an influence for him,it's very hot here. We will go on until he will tell us it's over. Crying right now. :(

[labblab]

Well then, we’ll stay right here with you as well. We will not leave any of you.

Here’s a couple more thoughts. If Ben’s GI problems have not shown any improvement since stopping the Vetoryl, you might want to go ahead and start back up with it. At least that might help control the excessive urination and other Cushing’s symptoms.

Secondly, I’ll come back later and give you information about specialized dogfood that can sometimes help ease GI problems in dogs that have extreme food sensitivities. Depending on the type of sensitivity, this special food can make it much easier for dogs to digest their meals without causing irritation or inflammation.

Lastly, if Ben truly does not seem to really recognize you any more and your parents are able to take care of him capably, then you may need to return him to them so that you can once again begin working, yourself.

As I say, though, I’ll be back later with more information about that food, and we can talk more about everything, OK?

Marianne

[Raluca]

Since we stopped the Vetoryl,for now everything is ok. He doesn't drink much,he only eat a bit more and that's ok because when we were on Vetoryl the appetite was really low. I don't know if the drinking problem will return but I'm willing to order another box of Vetoryl but now of 10mg not 30. Urinating is the issue here. He began having accidents since neutering. Now we have to go potty at max 3 hours. Am yes please,I would absolutely love some recipes for tummy sensitive dogs. We don't eat kibble anymore. My parents love him. It's very hard to take care of a dog in this stage but they also do everything for him.
Ben knows I'm around and he stays with me all day long but something changed. I know this stupid disease +Vetoryl causes depression. Thank you Marianne for your support. It's good to have someone to talk to.

[flynnandian]

ACTH -T1cortisol-1.92
T2cortisol-3.16
those are actually pretty good numbers. shouldn't go much lower, but was this on 30 mg vetoryl?
may be the vetoryl and cushing's are not his main problem, but the gi tract issues or ibd are.
it looks like he has a lot of problems health wise. and all this together may be too much for his old and sick body.
it is heart breaking to have to say goodbye to our old and/or sick dogs, but their quality of life should come first.
we all know on this forum how hard it is to make the decision; enough is enough.
we really do understand what you are going through right now.
they are such a big part of our life.

[Joan2517]

Just because we have the option, doesn't mean we can choose it. I always wait too long. I swear that the next time I won't, but I can't do it either. I should've put Lena to sleep that last night at the ER. I told my husband before I left that I was going to, but I could't...and I should have. I would've been with her like I promised her I would be, and I wasn't. I am still tormented by it. It's that little glimmer of hope that they will get better. I feel for you, I truly do.

[labblab]

OK, here is some of the information I was hoping to give you about food. Actually, I’m going to direct you to a reply written by the Dutch member I was telling you about. One of her dogs had awful GI problems that were caused by food sensitivity. Her dog was helped greatly when he was switched to a prescription Royal Canin food. Here’s what she wrote about the food:


I would suggest then that you use Royal Canin Hypo Allergenic. This food was especially designed for dogs that have an allergic reaction to all proteins. So what they did is, they "cut up" the proteins in such small pieces, the body doesn't recognise them anymore as being proteins :) It's called "hydrolysed".. So, no matter what protein source, Annie's system wouldn't recognise it as a specific protein she had before :) (I used this for my Sogno, with good succes)
Royal Canin also has a product named Sensitivity Control and in this product as well, the the meatproducts (fish and liver) are hydrolysed, again meaning the proteins are being made so small that they won't be recognised by the body. Another advantage for either of these is that "small proteins" are more easy to digest wich will help the actual foodabsorption and thus gaining weigth. At least the Sensitivity Control comes in both dry kibble and canned food. The Hypo Allergenic one has just dry kibble as far as I know. (but it has been a few years so maybe they have canned now too).

Hope this was of some help...

Sas and Yunah :)

ps forgot to mention that perhaps you are able to feed Annie 3 till 4 times a day, smaller portions, this may help getting more food in her more easily...

I checked, and Royal Canin is still making this food as well as a couple of other specialty formulas for dogs with food sensitivities. I do believe Royal Canin foods are available in Europe as well as the U.S. Here’s a food listing from their website.

https://www.royalcanin.com/products/vet/food-sensitivity

I know you are trying to steer away from kibble right now, but sometimes commercial prescription food can really be helpful for certain specific problems.

Marianne

[Raluca]

He began drinking like crazy again. He was off Vetoryl almost 2 weeks. What should I do? Can I split the pills in two and give him only a half in the morning and one in the evening? I will order a new box of Vetoryl but I don't know what mg,10...15? Any advices please?

[Raluca]

Thank you so much :(

[labblab]

Unfortunately, it is not safe for you to open up the capsules and split them. If taken out of the capsule, the powder may not be metabolized properly by Ben, and humans should not be exposed to the raw powder, themselves.

Ben’s ACTH result after taking the 30 mg. capsules for two months was actually quite good. But if you’re fearful that the full 30 mg. in the morning is making him too lethargic and depressing his appetite, here’s a couple of thoughts. You could buy a box of 10 mg. capsules and try giving him one in the morning and one in the evening. Some studies have shown that dogs who are dosed twice daily end up maintaining the same cortisol level on a lower daily total of the medication. So 20 mg. daily total might keep his cortisol under good control, but with less of a peak-and-valley effect. The downside is that this dosing regimen will be more expensive for you. But you might try one box and see how things go for a couple of weeks.

One other option might be to give him the 30 mg. at dinner time rather than with breakfast. The normal recommendation is to dose in the morning, for a couple of reasons. First, the medication is having its greatest effect during the waking hours when owners are hoping to see the greatest symptom relief. And secondly, that allows the ACTH testing to be easily done 4-6 hours after dosing. But in Ben’s case, I am thinking that if he takes the full 30 mg. with dinner, you all may have a more restful night with him being sleepier and drinking/peeing less overnight. In humans, I think the natural daily cycle of cortisol production is such that cortisol is lowest during the first half of the night, and then increases towards early morning when it peaks. If it works the same with dogs, dosing with dinner might mimic Ben’s natural cycle a bit more. Again, you might want to give that a trial run as an alternative. Either way, you are so well tuned to Ben’s behavior and habits that I think you’ll soon know whether either alternative helps or instead makes things works.

And hopefully other folks here may have some other thoughts and suggestions, as well!
Marianne

[Squirt's Mom]

Personally, there is no way I would restart the Vetoryl at any dose. It has always been a hard, fast "rule" that you never ever give these powerful drugs to a sick dog. I would not force him to spend what could be his last months taking a drug that can make him even sicker, that requires him to be poked and prodded at the vet's often. I just couldn't do it. When my Squirt started showing signs of aging and all that comes with aging, I stopped her treatment (Lysodren in our case), I stopped everything that was not absolutely required and promised her no more vet visits unless necessary. She had been thru enough and I just wanted her last days to be as carefree as possible....and they were. For about another year we simply lived our days, preparing for what was inevitable. And she was no where near as sick as your baby boy - she was simply old. So these are my thoughts - enjoy your baby boy as much as you can; give him any and everything he wants; do anything with him he is able to do and enjoys doing; touch him often; talk to him constantly; tell him all the things you want him to carry with him to the other side, all those things that bind the two of you together; let him find as much comfort and joy in each day as possible. And remember we are here with you all the way.

Hugs,
Leslie

[labblab]

I’m glad Leslie has posted her thoughts about this, too, so that you’ll have a different perspective to consider. And in view of what she’s written, I do want to clarify my earlier reply about restarting the Vetoryl. Normally I agree that I would not give Vetoryl to a dog who is acting unwell. But in Ben’s case, my hope is that restarting the Vetoryl might actually make him more comfortable during this final time. Excessive thirst and urination such that none of you are sleeping and he’s having to pee at least ten times a day seems really stressful to me. Plus, sometimes lowering cortisol levels can ease intestinal irritation rather than inciting it. So if restarting the Vetoryl can give you some restful time together without worsening the GI issues, that seems like a positive to me.

Leslie’s comment about the poking and prodding is well taken, though. And in that vein, since I consider Ben now to be living out his final days, I’d actually probably abandon the monitoring blood testing and base my Vetoryl dosing on my direct observation of his outward behavior. If he seems to be better while taking the Vetoryl, I’d keep giving it. If he seems worse, I’d stop it. As simple as that. My goal is pretty much the same as Leslie’s — to give you all the greatest amount of comfort as Ben’s life winds down, with the least amount of stress. If the Vetoryl can help, that will be great. If it doesn’t help, then by all means I would stop it. And if the thought of restarting it causes you even more worry, then as Leslie suggests, you need not restart it at all.

Marianne

[Raluca]

Thank you both Marianne and Leslie for being here for us and trying to help Ben and me also. I always tought it would have been easier for him and me if we lived at a house with a backyard and doggy door but we are in a 2 room apartment at the 2nd floor.
I wanted to stop the Vetoryl forever and also promised him it's over with poking, pills,supplements,etc.
Until he started drinking again. We went potty 18 times today. Great! I have 18 pills of Vetoryl and I want to sell them they are 60mg.with those money i could buy a box of 10 mg like Marianne said. I hope I will be able to sell them.
Next friday he will go to my parents :(
I feel useless,he will think again that I abandoned him.
And Leslie, every day he is hugged,kissed,I tell him stories (like "do you remember how happy we were when I found you" do you remember those nikes you chewed? ":)))) and so on). Most important-if he wasn't him in my life I would have never met the pitbull rescue- I try to rescue pitbulls and "dangerous" breeds from public shelters and dogfighting and I try to rehabilitate them if possible and find them the perfect home and it's the best feeling ever.absolutely the best. For that,I thank you,Ben.

[labblab]

I want to let all our K9C family know that Ben has just passed, and Raluca has started this new memorial thread for him. Please join us there to offer our support, always in loving memory of sweet Ben.

http://www.k9cushings.com/forum/showthread.php?8988-We-lost-our-baby-(

Marianne