12y/o JRT/Spanish Bodeguero - Sweet Maggie has passed

[Abettyb]

Hi All,

New to the forum. We have a 12 year old Spanish jack Russell type little lady, we adopted her 8 years ago and recently she's been diagnosed with Cushing's. Her symptoms were excessive hunger, weeing lots, drinking lots and back leg weakness. She was eating well but losing weight. She's been on vetoryl for 10 days now and is seeming a bit brighter but is still losing weight.

I know weight gain is an expected symptom... Anyone else experienced weight loss? On vets suggestion we are going to switch to a higher calorie food in the hope it will help but if not she will be having an abdominal scan to see if anything else is going on.

Thanks in advance for any help/guidance.

Amy and Maggie the doggie

[labblab]

Hello Amy, and welcome to you and little Maggie! You are exactly right that weight gain is the far more common Cushing’s symptom. However, my own Cushpup, a Labrador retriever, was also an exception to that rule. Prior to his diagnosis, he had a ravenous appetite but was steadily losing weight. Along with excessive thirst/urination, hair loss and hind end muscle weakness, it was actually his weight loss that also prompted our diagnostic vet visit. After beginning trilostane treatment and a food change, the weight loss ended. So all that I can figure is that his metabolism had been drastically altered by the excessive cortisol, and since we never gave him extra treats or table scraps, he was unable to support his previous weight level on the food we were giving him. So even though weight loss is unusual, it can happen. Having said that, there is always a lot of helpful information that can be gained from an abdominal ultrasound. If nothing else, it can indeed give you peace of mind that there is nothing else involved.

Also, we’d love to learn a bit more about Maggie and her treatment. How much does she weigh, and what dose of Vetoryl is she taking? Did her initial diagnostic testing help differentiate between a pituitary vs. an adrenal tumor? If not, that could be another benefit to having an ultrasound done. Vetoryl is appropriate to treat Cushing’s caused by tumors in either location, but surgery can also sometimes be an option for adrenal tumors.

Anyway, once again, welcome and we look forward to hearing more about your little girl.
Marianne

[Abettyb]

Dear Marianne,

Thank you for replying and explaining about your dog's experience. Hopefully the meds and diet change will help Maggie too.

In answer to your questions Maggie is currently 6.3kg and is on one tablet a day (10mg). The vet hasn't mentioned a type of Cushing's - just that Cushing's is the diagnosis. Her initial blood test showed liver concerns and then the 8hr test confirmed Cushing's.

Today she seems to be quite shaky, wondering if that's a side effect of the meds or just another symptom? Other than that she is much the same as she has been - a sad a lethargic version of our doggy.

Amy

[Harley PoMMom]

Hi Amy,

I belated welcome to you and Maggie, I am sorry for the reasons that brought you here but glad you found us and we will help in any way we can.

Could you post those results from that 8 hour test which, more than likely, is the low dose dexamethasone suppression (LDDS), this type of test has the ability to differentiate between the pituitary and adrenal form of Cushing's.

Maggie's starting does is well within the endorsed guidelines of 1 mg per pound of a dog's weight but that doesn't mean that adverse effects won't happen. If you should see any diarrhea, vomiting, or Maggie just not acting herself than stopping the Vetoryl is recommended as this is a sign of cortisol dropping too low.

Please know we are here for you both and if you have any questions, ask away!

Lori

[Abettyb]

Hi Lori, thank you for the confirmation about Maggie's dose. She is continuing to be shaky and sleeps a lot but when awake she is wagging a little more and the ravenous hunger seems to have eased.

She was previously scoffing the tablets without question and now is doing her best to spit them back out!

We got the results for the test from our vet
Baseline 206
4hrs 166
8hrs 260

Any insight into what these numbers tell us would be greatly appreciated

Amy

[Squirt's Mom]

Hi Amy! Welcome to you and Maggie!

Just FYI - trembling is one of the side effects of Vetoryl so I wouldn't be overly concerned about that just now. Do watch for those other signs Lori posted that indicate the cortisol has dropped too low. That is a life-threatening condition and you will want to stop the Vetoryl immediately if you see any of those things. Hopefully as Maggie adjusts to the Vetoryl the shakes will subside a bit.

Hugs,
Leslie

[Harley PoMMom]

Hi Amy,

Unfortunately Maggie's LDDS test results do not differentiate between the adrenal or pituitary form of Cushing's because for a diagnosis of pituitary dependent Cushing's there has to be at least 50% cortisol concentration suppression present at the 4 or 8 hour time points. Maggie's results are indicative to a dog with the adrenal type of Cushing's, however, approximately 25% of dogs with the pituitary form demonstrate a lack of suppression with LDDS test. In cases like Maggie, either an endogenous ACTH or ultrasound is performed to try to distinguish between the adrenal or pituitary form of Cushing's.

As for her spitting out those Vetoryl capsules, you could try putting them in cream cheese or peanut butter, also there is a product called pill pockets that are made specifically to hide those pills: https://www.greenies.com/products/dog/pill-pockets

Lori

[Abettyb]

Thanks Lori and Leslie,

I gave Mags the tablet with a really tiny bit of ham this morning and she took it no problem. Hurrah!

Lori- is adrenal the more serious type? The vet mentioned perhaps a liver ultrasound before the LDDS but we asked them to do the LDDS instead as we didn't want her to go through too much and they suspected Cushing's anyway. There's been no mention of any other tests or scans but there is a follow up blood test in a couple of weeks I think to check the meds are working.

Would the meds still work for either type of Cushing's?

I'm quite confused now...

Amy

[Harley PoMMom]

The Cushing's medications work for either the pituitary or adrenal form. The goal of treatment is to improve clinical symptoms and to get that elevated cortisol stabilized.

The most common cause of Cushing's disease (80 - 85% of all cases) is a benign tumor of the pituitary gland; it is rare for these tumors to be malignant.

With the adrenal form of Cushing's, there is a tumor on one or both adrenal glands, and unfortunately about 50% of adrenal tumors causing Cushing’s disease are malignant. However, if it is the adrenal form of Cushing's and the dog is a good candidate for this type of surgery than an adrenalectomy is a cure but this is a very serious and very expensive surgery which only a well seasoned surgeon should perform.

Hope I'm not confusing you more, if you have any questions do not hesitate to ask them! So glad to hear that she took the Vetoryl with ham...YAA!!!

Lori

[Abettyb]

Hi Lori,

Thank you for explaining. I understand now. Sorry for the confusion!

I don't think we would choose to put Maggie through surgery even if it is an option. She's 12 officially but as she is a rescue we dont know for sure and we always suspected she might be quite a bit older. Other than the shakes the meds seem to be going well, hopefully at her next check her weight will have stabilised!

She's sat next to me on the sofa, which is a lovely change as for weeks she has hidden herself away in the kitchen. Hoping this is a sign of her feeling a little better too ��

Amy

[Abettyb]

Maggie's shaking seems really extreme today. She's been sick this evening so we won't be giving her the tablet in the morning and will give the vet a call. She managed to eat something from the grass on her evening walk so we are hoping the sickness is just her clearing whatever that was out...

[labblab]

I’m surely hoping that Maggie is feeling better today, but I think your decision to hold her medication and consult with the vet is very wise. The trembling and vomiting can both be signs that her cortisol has dropped too low, and it’s always much better to be safe rather than sorry. We’ll be anxious to hear an update whenever it’s convenient for you to let us know.

Marianne

[Abettyb]

Thank you Marianne,

Maggie has had no more sickness and the shakes have eased a little. We've paused the vetoryl for now and the vet is running some more blood tests. The only positive is Maggie has not lost any further weight but nor has she yet gained any back.

Will post results when we have them.

Amy

[labblab]

I’m so relieved to hear that Maggie has been feeling better! I think you and the vet are doing exactly the right thing by pausing the Vetoryl and checking her labwork. Good job! And please do continue to check in with us...

Marianne

[Abettyb]

Hi again,

Blood results suggest the sickness wasn't due to a drop in cortisol from the medication. Vet suspects something else is going on in addition to the Cushing's but we are continuing to hold off on the medicine for now.

Vet is recommending an abdominal ultrasound that would be looking for possible cancer. We are not sure what to do.. the ultrasound requires some sedation and would be looking for possible cancer. If cancer was found we wouldn't be up for surgery or chemo for Maggie at her age so not sure if it's better just not to have the scan!

She seems ok ish today, there have been some tail wags, but she seems to be drinking quite a lot again.

Poor Maggie, we just don't know what is for the best,

Amy

[Squirt's Mom]

Personally I would do the US. It may not be cancer but something that is treatable. Also, I would want to know if something is causing her pain right now, pain that could be treated and relieved....or not. Even if it is cancer, knowing what kind will let you and the vet(s) know what to expect, if there are things that can help (or harm), and give you an idea of when enough is enough, as terribly difficult it is to wrap our heads around such a thought. Regardless, we are with you and Maggie every step of the way.

Hugs,

Leslie

[Abettyb]

An update on Maggie:

Today we have had the abdominal ultrasound. It has confirmed adrenal cushings but also picked up an enlarged liver that is an unusual colour. No sign of additional tumors but we've agreed to further x-ray and blood tests to check out her chest too and are waiting for the results.

We will be restarting meds I think to manage Cushing's. However she has lost a little more weight again which is concerning. We are waiting to hear the other results and what our options are. My heart breaks for our little girl,last night she lay on her side miserable and shaking and there was nothing we could do to help her.

Amy

[Abettyb]

Other results are back and no other issues have been found.

Her adrenal tumor is quite large, but given her age we are choosing not to operate and to manage with meds so Maggie is going back on the vetoryl. Vet thinks liver issues are linked to Cushing's but we are going to keep monitoring. We are increasing her food to try to address the weight loss issues. We are also going to try her with some daily calpol to see if some of the issues are pain related (possibly linked to arthritis)

Amy

[labblab]

Dear Amy, thanks so much for this update although I know the news about the adrenal tumor is a worry, especially in view of Maggie’s weight loss and other issues. Under the circumstances, I think you are taking the best care of her that you possibly can, and it will all come down to facing each day as it comes. I’m surely hoping for some more good days for you all. Please do continue to let us know, OK?

A gentle hug for sweet Maggie, and some big hugs for you all.
Marianne

[Abettyb]

Thank you Marianne,

Today we are having some incidents of Maggies back legs failing her completely. I'm wondering if the weight and muscle loss has just become too much.

Amy

[Abettyb]

https:https://photos.app.goo.gl/XNjJhnETU3gaPKoMA

Maggie (left) a few weeks ago with our other dog Diefenbaker.

[Squirt's Mom]

awwww what precious babies! Thank you for sharing that with us!

You are doing a great job in a difficult situation, Mom. Know that we are with you all the way and that your sweet Maggie girl knows she is in the very best hands possible, loved to the nth degree.

[Abettyb]

We made the very sad decision to put Maggie to sleep yesterday. Among other health issues, her knees had given up on her, she was uncomfortable and struggling to get herself up and lie down. She was very sad and wasn't getting any joy from life anymore. It was the right decision but we are heartbroken and words cannot describe how much we already miss her.

Thank you for your kind words and advice everyone.

Xx

[labblab]

Oh Amy, I’m so very sorry for your loss. Thank you so much, though, for telling us what’s happened. Maggie has now joined our other sweet angels on our special memorial thread of honor, and we will always remain here for you, as well.

https://www.k9cushings.com/forum/showthread.php?9161-Remembering-All-Who-Have-Left-Us-(2019)

If you’d like for us to add a photo link to her memorial line, it would be our privilege to do so. At any time, you can send a photo of your choice to us at k9cushings@gmail.com, and we’ll take it from there.

I had so hoped that you’d be gifted with at least a bit more quality time with your girl. But sadly, it was not to be. Faced with her increasing debilitation, I totally understand that this was the time to release her spirit. She’s now forever free from pain, but at such a cost to your own heart. Truly, we’ll always remain here by your side should you wish to return and tell us more — about anything. Your lives together, special memories, how you’re doing on any given day. From my own losses, I can easily imagine how painful this first morning after must be for you.

So I’m sending many hugs to you from across the miles, and please know that sweet Maggie will always be remembered and honored here by her K9C family.

Marianne

[Joan2517]

I'm so sorry for the loss of your sweet girl. I wish that I had been strong enough to put my precious Lena to sleep that last night. Instead she died without me and I regret that every day.

[Abettyb]

Thank you both. My heart is aching and I can't stop crying. I miss her so much.

X

[Joan2517]

It never stops hurting, but it does hurt less with time. I still cry a lot, but not all the time like I did after she left me. It will be four years in February. There isn't a day that I don't think of her, but I do smile when I remember certain things.

There's no end time to grieving...

[Squirt's Mom]

Dear Amy,

I am so sorry to hear about your precious baby girl but I know you made the right decision. You took away her pain and gave her the greatest gift we ever can - freedom from a body that could no longer supply her needs or wants. Today she is running wild and free in the Rainbow Fields, chasing butterflies and rabbits with all her new friends who were there to meet her as she crossed the Bridge. I believe all our babies here are at that bridge every time one from here crosses, there to show them the ropes while they wait for us to join them. We are never ready regardless but we put ourselves aside for them. One of our members once said that we take their pain so they can be free of it.

Grieve as long as you need in any way that you need as long as no harm comes of it. There are no other rules to grieving. All those tears and sobs are an expression of how much we love our babies, a way we honor that love we shared with them. Know we are always here to talk should you ever want or need - we DO understand.

My deepest sympathies,
Leslie



I give you this one thought to keep –
I am with you still – I do not sleep.
I am a thousand winds that blow,
I am the diamond glints on snow,
I am the sunlight on ripened grain,
I am the gentle autumn rain.
When you awaken in the morning’s hush,
I am the swift, uplifting rush
of quiet birds in circled flight.
I am the soft stars that shine at night.
Do not think of me as gone –
I am with you still –
in each new dawn

~~ Author Unknown ~~

[Abettyb]

Thank you.

We continue to miss her every day.

She hated fireworks and there are lots at the moment. Our other dog is mostly deaf so doesn't seem to notice them much. He's a bit of a monster, and has been shredding things more since Maggie has been gone. I think he misses her too.

She was such a sweet dog, there was nothing bad in her. She loved everyone and even none dog loving folk would end up with her curled up next to them and stroking her happily. I still can't believe she's gone.

X

[labblab]

Hello again, Amy, and we so appreciate you coming back to talk with us some more. What you’ve said reminds me so much of my own sweet girl, Peg. She was a big black Lab who looked like a bear cub, but who had a heart of gold. She had not one cross bone in her body. She loved everybody and everybody loved Peg. When we had to release her, there were many more tears shed over her than just our own. That was over three years ago now, and yet I’ll never, ever forget or stop missing her. That’s the power of the love we share with these precious spirits. Our hearts ache so badly when they’re gone, but we never forget how it feels to love them. Love is forever. It is perhaps our only comfort from the pain, at least during the early days, before happier memories begin to return again. But hearing how sweet Maggie was with everyone is indeed a very dear memory to share. I can now picture her in my own mind’s eye, snuggled up and spreading her love. Sweet, sweet girl.

Thank you for sharing her with us, Amy, and please continue to stop back by whenever the mood may strike. Your family here sends many hugs your way, today and every day.

Marianne

[Squirt's Mom]

This loss is still so fresh and new the rawness is ever present. After my Squirt had to leave I walked around my house for weeks on end sobbing and often a scream would tear out of me with no warning. The pain was just too much to bear silently. She's been gone since 2014 but I still cry because I am missing her so but the screaming has stopped. In time you will smile with the memories of your life with Maggie instead of crying but for now crying is what you are supposed to do. To me, all those tears are a way I honor Squirt and remember the love she shared with me. I don't ever want to forget so I will always be glad for the tears. In time the pain you feel today will lessen and come sporadically instead of being a constant. There is an old saying that says - "time heals all wounds". I have found that is a fallacy. Time hasn't healed my wounds at all but it has allowed me to learn to live with them, to bear them, in all their rawness at times, yet keep putting one foot in front of the other. I believe time will also allow you the same. For now, grieve as long as you need in any way that you need. There are no rules to grief other than to do no harm. Know you have a safe place to fall here when you need. We DO understand and we do care.

Hugs,
Leslie

[Joan2517]

Yes, it is hard to believe that they are gone. I can't believe we are coming up to four years since Lee left me. Sometimes it seems like yesterday, and then others it feels like a lifetime since I held her in my arms and she would sigh and lean her head against my heart; or how I would kiss the underside of her ears; or pick her up and kiss her potbelly. She was my heart and soul dog and I miss her everyday. Halloween was hard, she loved to sit outside on the stoop with me and greet all the trick or treaters. Every year she got her picture taken with so many kids. We loved it. It was one of our special times. This year I didn't cry, I just remembered...