HELP 13 yr old dog walking in circles, pacing, shaking and can't chew

[Lemarph81]

I have a 13(ish) yr old red healer Dog who just 2 months ago was diagnosed with Cushings. We started Veterol 60 mg/day at that time. The first month, we saw drastic improvement. No more panting or eating everything in sight and her fat butt lost about 5 pounds. Then she started panting a little more and getting hungrier again. Then all of a sudden she started having major balance issues and was dragging her back legs. She keeps falling over and swaying when standing up. She also started shaking a lot, kind of like full body tremors. And now she is unable to hold pee for longer than 3 hours (she never had any issues before). To top things off she is now having a lot of issues chewing where food falls out of her mouth. She seems to have panic attacks at night where she will get up from her bed, walk in a circle and sit down like 50 times while panting heavily and eyes darting all over the room. She is still going for walks outside and the only noticible difference outside is she is slower. She is also on Rimydal and Tramadol for her legs.

Does anyone else have any previous experience that is similar?

[Squirt's Mom]

Hi! Welcome to you and your baby girl!

First can you tell me how much she weighs?

Next when was her last ACTH and what were those results? Your vet should be happy to give you a copy of that test. While you are asking for copies, please get copies of all the testing done to diagnose her Cushings - the LDDS, ACTH, abdominal ultrasound and/or wellness exam that shows things like BUN, CHOL, ALKP, T4, etc. We would like to see all those results but on the wellness exam only post those that are too high or too low and include the normal ranges please.

I am concerned that she is on Rimadyl (Carprofen). That drug is VERY hard on the liver and in a cush pup the liver is already under a great deal of stress so it is never recommended in our cush babies, in fact we do our utmost to avoid all NSAIDS in our cush babies. Here is a link about this and other NSAID drugs:

http://srdogs.com/rimadyl-and-other-nsaids/

A link about Rimadyl:

https://www.drugs.com/pro/carprofen.html

Is her appetite ok? Does she want to eat but is having trouble with the function or is her appetite less than it was? What about her stools - any loose ones or diarrhea lately?

In general, we say anytime a pup seems to be sick it is best to stop the drug for a bit. If this were my baby that is what I would do starting today. The next thing I would do is have an ACTH done immediately unless one has been done very recently and was within range for a dog on Vetoryl. I would also consider looking for an IMS, Internal Medicine Specialist, to have a look at her soon. Some of what you are describing could come from the Vetoryl as well as many other things, including some rare complications of Cushing's like myatonia/pseudomyatonia or a macroadenoma. For those things I would want an IMS on board. Another thought I had reading your description was doggy Alzhiemer's. 13 seems a bit young but it is still a consideration in my mind for now. But first I would want an ACTH immediately and if she has not had an abdominal ultrasound I would that asap as well.

I am sure others will along soon to share their thoughts with you as well. Meanwhile you have some homework - get copies of all those tests I mentioned and post the results here. Then tell us all you can about your baby - any past health issues, meds she is taking, etc. The more we know the more meaningful feedback we can offer.

I'm glad you found us and am looking forward to hearing from you again.
Hugs,
Leslie

[Joan2517]

Hi and welcome! Has she had an ACTH test done since she started the Vetoryl? Could you send the results of the test that confirmed Cushing's? And any blood work done with just the highs and lows along with those reference ranges? How much does she weigh? Others will be along to welcome you, too. They will ask more questions and want to see the results of those tests.

[labblab]

Welcome from me, too. I just want to reinforce what Leslie and Joan have already asked — it is critically important that your dog’s cortisol level and blood chemistries have been checked since the onset of these problems. Given the average weight that is listed for your breed of dog (around 35 pounds), 60 mg. would be a larger starting dose than is widely recommended. A safer starting formula is 1 mg. per pound. Also, your dog’s cortisol level and blood chemistries should have been checked at least twice since beginning treatment. This is to make sure that the Vetoryl is not oversuppressing your dog’s adrenal function. Both cortisol and also aldosterone, another adrenal hormone can be driven too low by the medication, and some of the problems you are describing can result.

So please do let us know about any recent monitoring testing, as well as the results. Thanks so much!
Marianne

[Lemarph81]

Thank you everyone for the quick reply. She was started on the meds after blood panel and urine test and she had every symptom of cushings. She never had an ultrasound so i will request the reaults of whatever tests were performed and post back once i get them. The vet is in surgery now. As far as dosage. She is super chubby at 55 lbs as she was eating everything in sight, including chicken feed, acorns and even fire ants. I got her about 4 yrs ago so i dont know complete history. She was a stray in terrible shape. She had heart worms, intestinal worms, and sores on her. So she had a rough recovery period initially. But has been in excellent health since until about a yr ago when she started drinking like crazy and eating more. We chalked it up to being old and fat but her panting got worse so i asked her vet to run some bloodwork and we found out she had cushings.

We did not do any follow-up blood work due to her having panic attacks when in a cage (not sure what her history was like) but she will about give herself a heart attack and poop all over herself if put in a cage. I think those tests are like 6 or 8 hours waiting.

She is still hungry but quits due to falling over when eating. She tried to chew but gets unsteady and falls in her bowl. There is no yelping and she doesn't look in pain, just looks dizzy. When she stands up she leans her body on my leg to not fall over but she sways. This only in past week or 2 and it happened over night.

I will definitely ask my vet about the rimadyl. We tried other anti inflammatory meds but she started throwing up and diarrhea once started. She still has loose stool now. But no accidents as far as poop in the house. But she needs to pee every 3 hours.

When you suggest stopping all meds in interim, do you mean Veterol as well? Any suggestions on meds to help her back legs instead of Rimydal?

This dog is by baby and she goes everywhere with me so this is so terrible watching her like this!

QUOTE=Squirt's Mom;209536]Hi! Welcome to you and your baby girl!

First can you tell me how much she weighs?

Next when was her last ACTH and what were those results? Your vet should be happy to give you a copy of that test. While you are asking for copies, please get copies of all the testing done to diagnose her Cushings - the LDDS, ACTH, abdominal ultrasound and/or wellness exam that shows things like BUN, CHOL, ALKP, T4, etc. We would like to see all those results but on the wellness exam only post those that are too high or too low and include the normal ranges please.

I am concerned that she is on Rimadyl (Carprofen). That drug is VERY hard on the liver and in a cush pup the liver is already under a great deal of stress so it is never recommended in our cush babies, in fact we do our utmost to avoid all NSAIDS in our cush babies. Here is a link about this and other NSAID drugs:

http://srdogs.com/rimadyl-and-other-nsaids/

A link about Rimadyl:

https://www.drugs.com/pro/carprofen.html

Is her appetite ok? Does she want to eat but is having trouble with the function or is her appetite less than it was? What about her stools - any loose ones or diarrhea lately?

In general, we say anytime a pup seems to be sick it is best to stop the drug for a bit. If this were my baby that is what I would do starting today. The next thing I would do is have an ACTH done immediately unless one has been done very recently and was within range for a dog on Vetoryl. I would also consider looking for an IMS, Internal Medicine Specialist, to have a look at her soon. Some of what you are describing could come from the Vetoryl as well as many other things, including some rare complications of Cushing's like myatonia/pseudomyatonia or a macroadenoma. For those things I would want an IMS on board. Another thought I had reading your description was doggy Alzhiemer's. 13 seems a bit young but it is still a consideration in my mind for now. But first I would want an ACTH immediately and if she has not had an abdominal ultrasound I would that asap as well.

I am sure others will along soon to share their thoughts with you as well. Meanwhile you have some homework - get copies of all those tests I mentioned and post the results here. Then tell us all you can about your baby - any past health issues, meds she is taking, etc. The more we know the more meaningful feedback we can offer.

I'm glad you found us and am looking forward to hearing from you again.
Hugs,
Leslie[/QUOTE]

[Joan2517]

With the ACTH tests, I bring my dog, Gable in for the first blood draw 4 - 6 hours after he eats and takes his Vetoryl, bring him home, then bring him back for the second part two hours later. It is less stressful for both of us this way.

With my first cushpup Lena, I would sit with her in the waiting room for the two hour wait. She was fine with that and would nap or just look out the window.

[labblab]

Bless you for adopting your girl, and thanks so much for the additional info. I’m so sorry she’s so fearful at the vet. But the monitoring blood testing is really crucial for a dog taking Vetoryl. The ACTH stimulation test takes one hour to perform. A baseline blood draw is taken, and a stimulating agent is injected. A follow up blood draw is taken an hour later. Given her panic at being caged, I would hope your vet would allow you to just take her back into your own custody during that intervening hour. Or if even that approach seems too stressful, a lot of information can be gained from just one single blood draw: blood chemistries to check the functioning of her liver and kidneys, the balance of potassium and sodium in her body, and the resting cortisol level. The ACTH gives you more complete info about her cortisol profile, but a resting cortisol is better than nothing.

Under these circumstances, I’m hoping your vet will tell you to bring her in ASAP for at least a single blood draw. I don’t believe it’s safe to give her any more Vetoryl until you know the results of some blood testing.

Marianne

[Squirt's Mom]

If she were mine I would insist on an ACTH today. It is not the day long test and you can take her out of the clinic between draws for a walk, to sit in the car, or even go home if you live close enough. They will take a blood draw then give her an injection and then she will have another blood draw in a few hours. So get that done asap. That is the most critical. Once that test is done I would not give any more Vetoryl until that result is in myself. As for the Rimadyl, I would also stop that for good.

[Lemarph81]

Thanks everyone for the concern and quick reply. I got my baby in but hr couldnt see her until closing time. He took one look at her and the list of symptoms I was describing and he took her off all meds and has me doing a 4 day prednisone therapy to counteract the veteroyl. He strongly felt it was either an adverse reaction to the meds or when her body settled it was too much. So he wants to see how she is after a couple days with no meds and then take bloodwork and possibly restart Veterol at a lower dosage and do the tests as you guys described once she starts back up 2 weeks after begining again to see where her levels are at. She actually seems to have improved greatly just from not taking any meds today. What are ypur thoughts on course of action? Should I get a new vet? He is so carinh and supportive when we have issues that I hate to switch but if he isn't diligent enough then I need to.


If she were mine I would insist on an ACTH today. It is not the day long test and you can take her out of the clinic between draws for a walk, to sit in the car, or even go home if you live close enough. They will take a blood draw then give her an injection and then she will have another blood draw in a few hours. So get that done asap. That is the most critical. Once that test is done I would not give any more Vetoryl until that result is in myself. As for the Rimadyl, I would also stop that for good.

[Lemarph81]

Also she has a lot of stress when separated from me. Not just at the vet but even at home. She wont eat or drink if I am not at home and will not leave the house to walk without me. So that is part of the concern with the tests. He was concerned that her cortisol levels would show high regardless due to how stressed she naturally is. Ahe is a very neurotic dog due to her past. Is this an actual factor in the testing? Please tell me if this is BS so I can insist on it anyway!

[labblab]

Also she has a lot of stress when separated from me. Not just at the vet but even at home. She wont eat or drink if I am not at home and will not leave the house to walk without me. So that is part of the concern with the tests. He was concerned that her cortisol levels would show high regardless due to how stressed she naturally is. Ahe is a very neurotic dog due to her past. Is this an actual factor in the testing? Please tell me if this is BS so I can insist on it anyway!
Your vet is right that stress can elevate cortisol levels on these tests. I had meant to comment on that earlier, because your dog’s extreme anxiety does need to be taken into account when looking at the test results — especially if only a resting cortisol level alone is taken. You might falsely think that a Vetoryl dose needs to be increased due to a higher resting cortisol level, when it’s actually stress that is raising the baseline. Even on a full monitoring ACTH, both of your dog’s test results may come out higher due to stress. But I think it still has to be checked so that baseline levels can be established for your dog. And from a safety standpoint, our concern is whether the cortisol has dropped too low from the medication as opposed to being too high. If this has happened, I don’t think even stress will be able to force the adrenals to produce as much cortisol as is necessary to return a normal result. So I think you do need to perform the monitoring testing, while taking your dog’s anxiety into account. Also, her blood chemistries also need to be regularly checked, and I’m unaware of stress being a factor with that.

I’m relieved to hear that your vet has told you to stop all medication for the moment. As long as your girl continues to look better to you rather than worse right now, the plan going forward sounds reasonable to me. Do be aware, though, that your dog will need to be “off” the prednisone for at least 24 hours prior to any cortisol testing, because prednisone will also elevate the test results. So do keep us updated, and we’ll hope that things quickly straighten out for you two.

Marianne

[Squirt's Mom]

I am SO glad her vet told you to stop the meds and put her on Pred for a few days. The fact that she seems better already is great and I pray she remains so once the Pred course is finished. I second what Marianne said - just keep in mind that her natural stress may cause her cortisol to test a bit higher. It is a GOOD sign that her vet recognizes this fact! Elevated cortisol is much better than those levels going too low so that fact that her vet understands the role her extreme stress can play should help in her ongoing treatment.

You are an angel for giving her a home and loving her so much. She lucked out when she met you!

Stay in touch and let us know how your sweet girl is doing.
Hugs,
Leslie

[Lemarph81]

Great news! Blondie has been off all meds for 2 days and she is like her old self! Still a little slower but she is able to walk, eat (like a pig...wants everything in sight), no more accidents in the house and just looks all around much better. She doesn't appear to have any more dizziness and was actually trying to herd the chickens again yesterday (we have 100 chickens and she's a cattle dog). Lol

What a relief that is! Now, only concern is how long should I keep her off meds and how to control it properly this time. I didn't get the numbers on past levels yet but the second visit we had, he had said the levels were higher than the initial levels but she had improved so much that he felt we were getting false positives due to her panicking. So boy and I glad that we didnt imcrease it then! The first time we went, I brought my other dog along for emotional support for her and they were lower so I may try that next time.

What are your thoughts on going back on the meds and a better course of action?

Btw....sorry I didn't reply in 2 days but i just now noticed that there is a page 2..... Lol I just thought no one else replied to my last comment. * I'm very new here.



Your vet is right that stress can elevate cortisol levels on these tests. I had meant to comment on that earlier, because your dog’s extreme anxiety does need to be taken into account when looking at the test results — especially if only a resting cortisol level alone is taken. You might falsely think that a Vetoryl dose needs to be increased due to a higher resting cortisol level, when it’s actually stress that is raising the baseline. Even on a full monitoring ACTH, both of your dog’s test results may come out higher due to stress. But I think it still has to be checked so that baseline levels can be established for your dog. And from a safety standpoint, our concern is whether the cortisol has dropped too low from the medication as opposed to being too high. If this has happened, I don’t think even stress will be able to force the adrenals to produce as much cortisol as is necessary to return a normal result. So I think you do need to perform the monitoring testing, while taking your dog’s anxiety into account. Also, her blood chemistries also need to be regularly checked, and I’m unaware of stress being a factor with that.

I’m relieved to hear that your vet has told you to stop all medication for the moment. As long as your girl continues to look better to you rather than worse right now, the plan going forward sounds reasonable to me. Do be aware, though, that your dog will need to be “off” the prednisone for at least 24 hours prior to any cortisol testing, because prednisone will also elevate the test results. So do keep us updated, and we’ll hope that things quickly straighten out for you two.

Marianne