Nightime Panting and accidents

[crohrs]

I'm wondering if anyone has suggestions on how to handle the excessive panting during the night. My dog, Rosie, has been on vetoryl for cushings for about three months now. The vet has increased her dosage several times but we are still dealing with very loud panting episodes in the middle of the night that wakes me up from a sound sleep. Also, because of accidents I have often needed to take her out during the night to pee. We tried giving her acepromazine which did make her drowsy but she was still panting. The panting and drinking continues during the day as well but she can calm herself eventually. I'm desperate for a good night's sleep! Thanks for any helpful advice!

[LauraA]

Do you have a copy of the last ACTH Stim test you had done? There is a wide range that is considered 'normal' so it really comes down to symptoms as well as numbers :) At 3 months on the meds you would be due another test. If the post number is between 3-5 then I would look at splitting the dose between AM and PM since you are seeing symptoms returning in the evenings. So if you were doing 30 mg once a day for example then you would split that to 15 mg morning and night (with food of course) and this should help keep the cortisol more level over a 24 hour period.

[Harley PoMMom]

Posting her monitoring ACTH stimulation tests would really be helpful to us, and could you also tell us what symptoms Rosie displayed that led the vet to suspect Cushing's. Also, what tests where performed that diagnosed her Cushing's and would you post those results as well. Did she have a CBC and chemistry blood panel done, and if so, would you post any values that are marked abnormal with the reference ranges and their units of measurement...thanks! What dose of Vetoryl is Rosie taking?

The panting is very common with our cushpups, with my Harley I found that spritzing his pads and belly with water helped a little along with keeping the house really cold.

Lori

[crohrs]

I will need to get a copy of the ACTH Stim tests....she has had several and the dosage of vetoryl has been increased gradually to 40 mg twice a day. She weighs 60lbs so this seems like a pretty strong dosage but she is still panting a lot and also drinking a lot even during the day. It's easier to deal with during the day but at night it wakes me up.

[crohrs]

I will try to get the results of the many tests she has had in the last few months. I was actually the one who suspected Cushings after my own research online. Her main symptoms were the excessive panting and drinking. The vet thought the panting was due to pain but agreed to test her for cushings which turned out positive. They also did a blood panel to check her thyroid as she has been on medication for low thyroid for a while. Rosie is a rescue who came to me with severe separation anxiety and has also been on prozac and trazodone for her anxiety. I've had her for five years now and I think she may have had the cushings for a while but we were treating her for anxiety (and all the other issues). I've never had a dog with so many health issues. I ended up changing vets recently because I didn't think the first one really knew much about cushings. I love my new vet but still am concerned that the vetoryl is not improving her symptoms. Thanks for the idea of spritzing her pads and belly with water....I will try that. I do try to keep the house cool as well.

[Harley PoMMom]

Increased drinking/urinating can be caused from an UTI, has this been ruled out with an urine culture?

[crohrs]

Yes she had a urine test done recently and does not have a UTI. I believe the cushings is the cause but the vetoryl is not helping so far. I will be talking to her vet tomorrow to find out what our next step should be.

[Bobo09]

Hi,
I noticed you say the vetoryl is not helping so far and just wanted to let you know that Bo my bichon frise has been on vetoryl for 3 months. It has lowered her cortisol level to the accepted range however her symptoms all remain. I changed vets just over a month ago and he is now treating her for proteinuria too (old vet just shrugged her shoulders and didnt know what to do about proteinuria).
We are trying twice a day vetoryl dose just now but he and i both feel this is as good as its going to get for Bo, some dogs just dont seem to lose the symptoms. I read the paper that was done on pre vetoryl testing at Glasgow Vet School and there were several on the trial that still had symptoms.

Not much help to you but just wanted to share as all i read are great stories about vetoryl changing a dogs life but sadly it hasnt so far for Bo (or myself who has a starving dog pestering her for food all day long).
Its so hard at times, i think she has had this for a couple of years and symptoms put down to other things but its been a tough couple of years.

[Harley PoMMom]

I will try to get the results of the many tests she has had in the last few months.

Please do get the results of all tests that were done and post them here for us as this will give a better picture of what is going on with your sweet girl.

[crohrs]

Today I got the results of her recent tests on August 13 with my new vet. From what I can tell everything was in the normal range on her blood test and urinalysis. Her thyroid results were in the normal range as well so she's taking the right dose of thyro-tabs. The numbers for the ACTH were: Cortisol - Pre 4.1 and Cortisol -Post 6.9. After this test her dosage of vetoryl was increased from 60 mg a day (split) to 80 mg a day (split). My vet told me that it could take up to a month to see if her symptoms improve.

[crohrs]

Thanks for sharing....I had hoped that the vetoryl would would change things for us as well. Rosie doesn't have the huge appetite ( in fact sometimes I have to put treats on her food just to get her to eat so I can give her the medicine.) But for us the hardest has been the constant panting and drinking, especially at night. It has been quite a challenge, both financially and emotionally.

[Squirt's Mom]

Has your baby had an abdominal ultrasound? If not I would want that done asap on a high resolution machine so they can see more of the internal organs clearly. It is possible something is pushing on the diaphragm making it more difficult to breath. I would also want to rule out ADH, the adrenal based form of Cushing's in which a tumor is growing on one or both adrenal glands. This form is more difficult to control so it helps to know whether that is in play or not and an US will show that - if it's done on a high resolution machine. ;)

The ACTH shows that the cortisol is still too high which can account for the signs still remaining. Has she had an LDDS to diagnose the Cushing's or only an ACTH? The reason I ask is because with a dog who has as many health issues as you say she does and who is already anxious the ACTH can often come back positive when the dog does not actually have Cushing's. Any stress, internal (such as a tumor on the spleen or other organs) or external (stress from going the vet or riding in a car) can easily cause the cortisol to rise in natural response to the stressor. My second dog diagnosed with Cushings' had a host of other conditions and illnesses and I always questioned the cush diagnosis as a result. After she passed I had a necropsy (autopsy for animals) performed and it proved she never had Cushing's. It was the other issues that caused false-positives on her testing. My first cush pup also tested positive on 5 different tests but the US found a tumor on her spleen and once it was removed her cortisol returned to normal. She did develop Cushing's a few years later but when she was originally diagnosed she did NOT have it - she had a tumor on her spleen which caused the cortisol to rise in response which caused the tests to show positive. So I am always nervous when a dog is treated based solely on an ACTH. :o

Something to keep in the back of your mind - if the increase in Vetoryl dose doesn't help you might consider switching her to Lysodren. Some dogs can't take Vetoryl or don't respond to it; others can't take Lysodren or don't respond to it. In both cases switching to the other drug can help. Do NOT let anyone pr anything you read scare you about Lysodren. BOTH drugs have the exact same risk factors; both drugs are very powerful; BOTH drugs are life-savers. So just keep that in mind if this dose change does not help.

Do let us know how things are going!
Hugs,
Leslie

[crohrs]

Thanks for your response Leslie. Rosie has not had an abdominal ultrasound but I will ask my vet about that. She did have the LDDS when she was diagnosed back in June at my former vets office. I don't have the report but I remember them telling me that she definitely had cushings and that it was the adrenal form rather than the pituitary form. I'm pretty sure she has cushings and since she's been on the vetoryl her coat has improved greatly. She's never had such a soft and fluffy coat since I adopted her. Next week she will have another ACTH and I'm hoping that her new vet will again increase her dosage. If it doesn't help with the panting and drinking we may need to consider trying the Lysodren. I will keep you posted.

[crohrs]

I know it's been a long time since I posted anything but wanted to finally report that Rosie is now on the right dosage of vetoryl (60 mg twice a day) and seems to be doing much better. We are still dealing with her anxiety issues which causes some panting but she calms down much faster. It has been quite a journey but I'm glad to see some good results!

[labblab]

We’re so glad to hear that things are going well! Thanks so much for updating us, and please continue to do so ;-).

Congrats to you, and a big pat to Rosie.
Marianne

[crohrs]

I know it's been a long time since I have been active on this site but I am struggling right now with the cost of medication for my Rosie. She was diagnosed with cushings last year in June and after many costly tests she is now thriving on 140 mg of vetoryl daily. I am still paying off credit card bills for her care and she needs another ACTH stim test next month ($350.) The cost of her vetoryl is about $350. monthly. Does anyone know of any financial help that is available? Thank you!
Carolyn

[Joan2517]

Yes, the financial struggle is real. Have you tried Care Credit? They were a godsend to me when my Lena was hospitalized a few days before she died. I have another Cushpup and I use that for most of his bills. In fact, I have four dogs and use it for all of them. I'm over the limit right now, but I know that if I ask, they will raise it.

[labblab]

Welcome back from me, too. You’ll see that I’ve merged your new post into your original thread about Rosie — this way, all her info is consolidated in one place. I’m so glad to hear that she is doing well, but like Joan says, I surely understand the stress of the costs. Joan’s suggestion about Care Credit is an excellent one. In addition, I’m going to give you a link to a thread on our resource forum that lists some other cost-savings measures.

As far as Rosie’s Vetoryl, I’m assuming she’s taking 70 mg. twice daily? If so, probably in the form of one 60 mg. capsule and one 10 mg. capsule morning and evening? I just now quickly price-checked that combo on one of the Internet pharmacies listed on the link, and came up with a monthly total of a little less than $250. Still a lot of money, but a bit of a savings for you. And if you check other pharmacies listed on the link, you may come up with even a better price. Another med option that you’ll see discussed on that link is a compounded form of trilostane. If your vet will consider it, compounded trilostane will definitely be much cheaper than brand name Vetoryl.

Also on that link, you’ll see the possibility of substituting a less expensive alternative monitoring test for the ACTH: taking a “pre-Vetoryl” baseline cortisol level. Again, your vet may or may not feel it’s a reasonable and safe substitution for Rosie right now. But it’s an option you may want to discuss.

So here’s the link to the thread with all this info. Look it over and just let us know if you have questions.

https://www.k9cushings.com/forum/showthread.php?9066-Cost-Savings-for-Owners-of-Cushingoid-Dogs

Marianne

[ritaamorris]

https://iheartdogs.com/cant-pay-for-your-pets-needed-care-these-12-programs-can-help/

[Squirt's Mom]

http://www.tipper-squirtcushingfund.org/

[crohrs]

Thanks for all the suggestions....I plan to do some research!:)

[crohrs]

Rosie is actually taking two 30 mg and one 10 mg. twice a day. Maybe it would be less expensive to get the 60 mg. capsules instead of the 30 mg. I will check into it and see if my vet will change the prescription. She was originally started on the compounded form of trilostane (which was certainly much cheaper) with my former vet but unfortunately it was not working for her. I also have recently connected with the rescue group she came from and it looks like they will be able to help with the cost of the upcoming ACTH. Thanks for your help!

[Squirt's Mom]

I'm so glad the rescue will help out! That is wonderful news!

[labblab]

I agree, that's great news about the rescue! Also, yes, I think you'd definitely save money by switching to the 60 mg. capsule strength. Two boxes of 60 mg. will be less than the cost of four boxes of 30 mg. So if Rosie seems stable enough that you'd not need to be backing down to a lower dose again, I'd indeed request a prescription change. And do check out some of the pharmacies on that link in terms of competitive pricing.

Marianne

[crohrs]

I'm pleased to report that I was able to get Rosie's prescription changed and the two boxes of 60 mg each month is much less expensive than the four boxes. My cost is now less than $200. a month. Thanks! She's now on 70 mg in the morning and 60 mg in the evening. I am a little concerned with some symptoms that have returned so it's possible that dosage could be increased. She is losing a lot of hair and her back legs have become very weak. It's hard for her to jump into the car so I have ordered a ramp from Amazon. Next month she will have another stim test so we will see.

[Squirt's Mom]

Keep us updated if things continue to change for your sweet girl. I am so glad you were able to find a way to lower the cost a bit! That is ALWAYS nice! Hope things remain fairly steady thru the coming weeks!
Hugs,
Leslie

[crohrs]

Again it has been a long time since I have been on this thread but I wanted to update what's going on with my Rosie. Her last ACTH test was good so she has stayed on the same dose of vetoryl for several months. It's now time to retest and I'm concerned about her recent symptoms. She does not have much strength in her legs and has a hard time getting up and down. She is drinking a lot more water and she has regular times of heavy panting, day and night. I will be talking to my vet but at this point I'm wondering about her quality of life and don't want her to be in pain. It's so hard to know what is best for both of us. I believe that she had the cushings when I adopted her 6 years ago. When she was diagnosed last year and put on the vetoryl her coat changed completely with soft fluffy fur and darker in color as well. She had an early shed this year in February and then grew it back again. Now she's shedding again. I'm wondering if this is due to the cushings. Anyway, I'm taking her to have the ACTH test today. (hopefully I can get her in the car....she's a big girl!) I would welcome any advice about deciding when it's time to say goodbye. Thanks!

[Squirt's Mom]

What you are describing could easily mean the dose needs to be adjusted again so don't think too hard about "the end" until she sees the vet and has the cortisol checked.

As for when it is time, I think our babies will let us know by their behaviors. One thing you can do now is make a list of the things she still enjoys - foods, certain treats, games, toys, walks, etc. Then as she loses interest in the things she has loved check them off the list once you are SURE nothing medical is causing the changes. When my babies got down to having only one thing left they enjoyed I knew the time was close and I started listening to them carefully. We each know our babies best of all so you will know when the light in her eyes changes, when she seems tired beyond normal for her age and situation, and so on. Experience has taught me that it is best for my babies that I let them go a day early rather than a day late. I had rather take any pain on myself than risk they should suffer. I believe you will do the same for your sweet girl or you wouldn't be here asking this very difficult question. Know we are with you every step of the way and will support your decision, knowing it is made out of love.

Hugs,
Leslie

[crohrs]

Thanks for your sensitive response. The results of her ACTH showed that the cortisol level had gone too low so we are decreasing the dosage on her vetoryl. So I will be waiting a couple of weeks to see if this change makes a difference. I will be watching for the things you mentioned as well. So far she still has some life in her but she's very wobbly and not as active as usual. She did manage to get up the ramp into the car but it wasn't easy. She does still love her walks but we don't go as far as we used to.

[labblab]

Hi again from me, too! I’m very glad to hear that Rosie has had her cortisol checked, but I am concerned about the specifics of her situation since you say that she is still acting very wobbly and less active. Please ask your vet for the actual numbers of her ACTH test results. Depending upon exactly *how* low they were, it may be safest to totally discontinue the Vetoryl altogether for a while, as opposed to simply reducing the dose. Some dogs who are overdosed on Vetoryl rebound quickly. But for other dogs, the functioning of their adrenal glands may remain oversuppressed for quite some time. If that’s the case, you don’t want to continue giving the medication at all until the adrenals have recovered and are back to producing sufficient amounts of the necessary hormones on their own. Some dogs even require active supplementation of those oversuppressed hormones during the time period that the adrenal glands are recovering.

Since your vet has told you to just reduce the dose, I’m hoping that means that Rosie’s cortisol level didn’t actually fall below the lowest level of the desired therapeutic range. But the only way to know for sure is to find out the actual test results. I’m hoping that her basic blood chemistries were also checked, especially her potassium and sodium levels. In addition to cortisol, a Vetoryl overdose can also affect the adrenal hormone that controls the balance of those two “electrolytes.” Serious problems can result from that, as well.

So please do check on those actual test results and let us know, OK?
Marianne

[crohrs]

I was able to check online and her pre test result was 1.6 ug/dl and her post test result was 1.8 ug/dl. She has been on a dose of 60 mg twice a day and he said to lower it to a dose of 60 mg and a dose of 30 mg each day. They did not check the potassium and sodium levels.

[labblab]

Thanks so much for getting back so quickly with that info! OK, so Rosie’s level did not fall below Dechra’s base therapeutic range of 1.45 ug/dL. But yes, her cortisol level was definitely low enough to justify a dosing decrease. Hopefully, this will do the trick for her, and she’ll soon show more improvement. If not, you still may want to consider a basic blood chemistry panel in order to see whether there’s anything obviously amiss there.

Please do keep us updated, though. I cannot improve upon Leslie’s thoughtful earlier reply, and I surely do understand how the issues of old age and illness can become intertwined and so difficult to unravel. We are always here for you as a sounding board and a support.

Take care, and please give Rosie some big pats from her family here.
Marianne

[Squirt's Mom]

If Rosie were mine, based on those ACTH results I would give a her break from the Vetoryl then restart on the lower dose. Sometimes even tho the numbers aren't in the actual danger zone according to the papers, it is in the danger zone for THAT dog. So while 1.8 ug/dl isn't technically too low it may well be too low for Rosie and making her feel pretty bad. So I would give her adrenal glands a chance to rebound a bit then start the lower dose. If the electrolytes are out of whack that will really make her wobbly and feel just awful. Completely stopping the med for a bit should allow the electrolytes to stabilize too. I would watch for an increase in appetite and thirst then put her on the 30 mg.

I did a quick scan of Rosie's thread here and didn't see where you have told us her weight. It was a quick scan tho and I may have missed it. But looking at her pic I am thinking she is a medium to medium large dog. If that is the case then even the 30mg may be too much for her. Recent studies have shown that larger dogs need a much much smaller dose that originally thought - 0.5mg per pound VS the 1-3mg per pound stated in the literature. So if she continues to have issues on the 30mg I would ask for an even lower dose...something like 15mg to start.

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

[crohrs]

Thanks for your suggestions. I haven't weighed her recently but her weight has usually been just under 60 lb. Lately however I think she has lost some weight since she hasn't been eating as much. She has always been a very picky eater since I adopted her. It is frustrating, especially early in the day, to get her to eat something since I know the vetoryl should be taken with food. I've tried adding some cooked rice and chicken and other meal mixers but she will just look at it. The vet office suggested adding some meat flavored baby food which she seems to like but it doesn't always work (and those little jars are expensive!) Any suggestions?

[labblab]

Hi again from me! If Rosie’s appetite remains “off,” I can’t argue with Leslie’s recommendation that you stop giving the Vetoryl entirely for at least a couple of days as an experiment to see whether her appetite improves. I know you said she’s always been picky, but this is perhaps being made even worse by a cortisol level that’s running too low for her comfort. I don’t want to encourage folks to make medication changes without notifying their vets, so if it was me, I’d call the vet to discuss with him/her what I was doing. But I don’t see how temporarily withholding the Vetoryl will cause any great harm, and it may help you determine whether or not it’s playing any role in the appetite suppression.

In the meantime, a couple of suggestions that I’ve seen offered by our members is to add some “fishy” water from a can of tuna to Rosie’s food, or try shaking some Parmesan cheese over it. It seems as though adding something with a strong smell may help entice picky dogs. I don’t know why they like this and it’s not smelly, but my dogs have been eager to eat some scrambled egg when I’ve added it to their food when their appetites have been wonky. Hopefully other folks will be by with even better suggestions, too.

Marianne

[crohrs]

Thanks....I'll try some of those things. The first thing she does is smell the food so I think something smelly might get her more interested in eating. I really don't think the vetoryl is causing her eating problems since it has been an issue for years. She didn't eat anything at all for the first week after I adopted her! She's a very nervous dog and it affects her eating. She lived outside by a freeway offramp for a year before she was rescued.

[labblab]

Omigosh, the poor baby :-(((((. Bless you for rescuing her!!!

OK, I understand things better now. And hopefully adding something smelly will be more likely to tempt her.

Good luck, and do let us know.

[crohrs]

Thanks again for all of the suggestions. I've tried shaking the parmesan cheese over her food and she seems to like that. I talked to the vet and he decided to do a blood test to see if anything else was going on. The results were mostly pretty good but her thyroid was too high so we are lowering the amount of thyroid medication. Also, she has been on carprofen for pain and he said that could affect her tummy so he's switching her to a different medication that is easier on the stomach. Hopefully all of these things are going to help with the digestive issues. She does need to gain some weight....she's only at 51 lbs. right now.

[crohrs]

Update on Rosie....The changes in her medications have made a big difference in her appetite and I believe she is gaining some weight. However she continues to drink and pant excessively. I'm not sure if this is due to her cushings or her anxiety issues. At night her panting and pacing wakes me up several times. I'd appreciate any suggestions on how to calm her at night. Thanks!

[Squirt's Mom]

I'm glad to hear she's gaining some weight and eating better! Do you have the results of the latest ACTH or PVC monitoring test? That might explain the continuing panting and restlessness.