Please help-dog stopped breathing and went limp last Saturday-thought was dead.

[Widgetsmom]

Hi, new here. My 12 y/o Boston terrier girl, widget was diagnosed about a month and a half ago after she had two episodes we are guessing were seizures, though we only witnessed after effects. The vets told us she had a clear chest X-ray and bloodwork and no heartworms. She has the symptoms of breathing issues, pendulous stomach, shedding, increased thirst and peeing, more bumps cropping up. We have her on 30 mg of vetoryl (she’s about 18 lbs )which worked well....till this past sat night she was acting weird and my vet said if this happens to skip a dose so I did. That night, she lost consciousness suddenly, seemed to stop breathing and we thought she died. Then, after a few minutes, she came back and was fine for a day. The vet said to stop her Meds till further notice but he wonÂ’t Be back from vacation to see her till Thursday. We are not sure she had a seizure or if it could have been a heart attack or something but we are afraid to leave her for even a moment. She has been mostly lethargic till about a day ago. I started giving her tums because my vet thinks she might have an ulcer (orangey-poop). Also, I gave her half a capsule two nights ago. The next day she seemed better and better still after I decided to do 2 smaller meals a day vs 1 larger meal. That is till tonight when she was acting weird again-not wanting to play but trying to get attention -for something. Also, she is licking and sniffing around more than normal. And a couple nights ago we noticed a new fatty lump/lipoma (I am guessing) on her torso about the size of a quarter. Right now, she is breathing at 32 breaths a minute.

If someone could help me figure out how to insert pics or docs, I could include her numbers from her tests.

Thank you!!

[Joan2517]

Please don't give her any more Vetoryl until your vet returns and has a chance to see her. 30mgs may is too much for her. The recommended starting dose is 1mg per pound. AND never open the capsule to half it. She should have an ACTH test done at the 14 day mark and 30 day mark. You never raise the dose until the 30 day mark because the cortisol continues to lower over 30 days.

Please post the results of the tests she had done to confirm Cushing's and any blood work with just the HIGHS and LOWS with the reference ranges.

I hope she is doing better today and that you can get her in to see the vet.

[Squirt's Mom]

Hi and welcome to you and Widget!

I agree with Joan...do not give any more of the Vetoryl for now. The loose stool and lethargy are both signs that the cortisol has gone too low which is a life-threatening situation. The 30mg was too high for a starting dose so the cortisol dropping below a safe level is certainly a possibility. At Widget's weight I would want no more than 15mg to start with. The rule with this very powerful drug is to start low and go slow with increases. ;) So for now, just forget about giving the Vetoryl. When her vet gets back I would want an ACTH run asap....and if the cortisol come back elevated AND her signs are strong again then I would insist on a much lower dose - 10-15mg. 5mg Vetoryl is available tho you may have to search for it. A compounded version is also an option which could be made into a 15mg dose. A compounded liquid makes it very easy to adjust doses without getting a new prescription every time.

It would help us help you if you could get copies of all the testing done to diagnose the Cushing's in the first place. Did she ever display a ravenous appetite? This is one of the hallmark signs of Cushing's but I don't see that you have mentioned that in your post. Copies of all the monitoring tests done since she started the Vetoryl would be very helpful as well. Be sure to ask for test results and not invoices.

I'm glad you found us and hope your sweet girl is feeling a bit better today.
Hugs,
Leslie

[Widgetsmom]

She did have a very ravenous appetite during the 2 first supposed seizure episodes. Yesterday, she ate in the morning but at dinner time left her food for a couple hours before eating her 2nd meal at around 7pm. However, that girl is always on the lookout for treats, and anytime we get up she thinks she is getting one (read-vetoryl pill or joint tablet wrapped in cheese) even if she is completely lethargic beforehand. When she does it, she runs out to the living room sometimes spitting little bits of kibble as she goed-this is not something she used to do.

Again, if someone can tell me how, I am happy to post both the diagnostic and the follow up test.

[Squirt's Mom]

To post test results simply post the abnormal values on the test, sometimes called a super chem, that shows things like BUN, CHOL, ALP, T4, etc. Be sure to include normal ranges and the little letters that follow. It would look something like this -

ALP 1500 mnol/L 150-300
CHOL 250 ug/dl 100-200

We don't need to see values that are normal, just the ones that are too high or too low.

For the LDDS, if Widget had this test, it will have 3 results and we need to see all three results. The ACTH, if she had this test, will have 2 numbers and we need to see both of those numbers. The monitoring ACTH will also have 2 numbers. If she had an abdominal ultrasound, seeing all the comments about the organs seen would be helpful, especially the comments about the adrenal glands, liver, and kidneys.

Hope this helps!

[Widgetsmom]

This is the follow up test.

Endocrinology
6/30/20 (Order Received)
6/30/20 4:01 AM
TEST
Cortisol - Pre ACTH
Cortisol - Post ACTH
(Last Updated)
RESULT REFERENCE VALUE
3.8 μg/dL
3.9 μg/dL
a TUBE ORDER AND LABELED DRAW TIMES RECHECKED RESULT VERIFIED BY REPEAT ANALYSIS
a
b
b ACTH Reference Range:
Canine: Feline 2-6 0.5-5 6-18 5-15 18-22 15-19 >22 >19
<2 <0.5 1-5 n/a
1.5-6 1.5-6 therapy
Pre-ACTH (resting) cortisol Post-ACTH cortisol
This is the follow up test results after the first diagnostic done s month prior. They sent in cut/passable form.

Equivocal post-ACTH cortisol Post-ACTH cortisol consistent with
hyperadrenocorticism Post-ACTH cortisol consistent with
hypoadrenocorticism
Desired pre- and post-ACTH cortisol on
lysodren* therapy
Desired pre-and post-ACTH cortisol on trilostane*

[Widgetsmom]

Here’s the original diagnostic done 6/5. Thanks!

TEST
Cortisol - Baseline
Cortisol - 4 hr Post Dex
Cortisol - 8 hr Post Dex
(Last Updated)
a
a Low-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hours 8 hours Interpretation ----------------------------------------------------------------------
RESULT REFERENCE VALUE
7.0 1.0 - 6.0 μg/dL H
1.2 μg/dL
1.9 μg/dL
<1
1.0-1.5
>1.5 and >50%
of baseline
<1.5 or <50% of baseline
<1.5 or <50% of baseline
>1.5 or >50% of baseline
<1
1.0-1.5
>1.5 and >50%
of baseline
>1.5 and >50% of baseline >1.5 and <50% of baseline >1.5 and <50% of baseline
Normal
Inconclusive
Consistent with hyperadrenocorticism
Further testing required to differentiate adrenal tumor from pituitary-dependent hyperadrenocorticism (PDH)
Consistent with pituitary-dependent hyperadrenocorticism (PDH)
Consistent with pituitary-dependent hyperadrenocorticism (PDH)
Consistent with pituitary-dependent hyperadrenocorticism (PDH)
High-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hour 8 hour Interpretation ----------------------------------------------------------------------
<1.5 or <50% of baseline >1.5 and >50% of baseline
<1.5 or <50% of baseline >1.5 and >50% of baseline
>1.5 and >50% of baseline
<1.5 or <50% of baseline <1.5 or <50%
of baseline >1.5 and >50% of baseline
Consistent with pituitary-dependent hyperadrenocorticism (PDH)
Consistent with pituitary-dependent hyperadrenocorticism (PDH)
Consistent with pituitary-dependent hyperadrenocorticism (PDH)
Further testing required to differentiate PDH from adrenal tumor.

[labblab]

Hello and welcome from me, too! I’m so glad you found your way here to begin posting. Thanks for adding those test results. From what I’m seeing, her initial diagnostic LDDS results were consistent with the pituitary form of Cushing’s. And the subsequent monitoring ACTH stimulation test shows a cortisol level that was within desired therapeutic range at that time. However, cortisol levels can continue to drift downward over time, even when Vetoryl levels are left unchanged. So it’s possible that Widget’s cortisol has now dropped too low for her comfort or safety. Therefore, I have to agree with the others that I would hold off on any more Vetoryl at all until your vet returns and Widget can be examined.

Another reason for this is because, in addition to lowering cortisol, Vetoryl can also lower the level of another adrenal hormone, aldosterone. Aldosterone controls the proper balance of sodium and potassium in the body. If that balance is thrown off, there can be serious consequences such as heart arrhythmias, and I believe that could even trigger a seizure-type episode. So in addition to having her cortisol level rechecked, you’ll want to make sure that her basic blood chemistries are also OK before resuming the Vetoryl.

I’m so sorry you’re having these problems. Please do keep us updated, OK?
Marianne

[Widgetsmom]

Hello,

Lots has happened since I last posted. In short, I got another Cushing test by the same vet, he insisted she had Cushing’s. More importantly, I asked for yet another chest X-ray when I read there was a lot of overlap in symptoms with heart issues and, low and behold, after three chest X-rays within 6 months, the last just a couple months before with the same vet, I was told she has an enlarged heart and fluid in her lungs-before I had been told she has a mild murmur and that it’s very common so I was never advised to do anything. This time, I was told to see a cardiologist. This is my report from the cardiologist.

Diagnosis
Patient Details Name Widget
Species Canine
Age
Sex Referral
12 years 4 months Female Spayed
Dr —
Moderate degenerative valve disease
Moderate mitral valve regurgitation causing heart murmur
Moderate to severe left atrial enlargement
Moderate left ventricular enlargement with normal heart muscle function
Moderate tricuspid regurgitation with mild pulmonary hypertension (high pressure in the lungs)
Concurrent conditions:
Episodes of collapse Cushing's disease
Medications
Start pimobendan (Vetmedin) 5 mg tablets: Give 1/2 tablet by mouth twice daily.
This medication improves heart function and helps delay the onset of heart failure.
This medication is only available from veterinarians or pharmacies that carry veterinary prescription drugs.
Start enalapril 5 mg tablets: Give 1/2 tablet by mouth twice daily for 4 days then 1 tablet by mouth twice daily.
This medication decreases the workload on the heart.
Have on hand furosemide (Lasix) 12.5 mg tablets. If you note symptoms of congestive heart failure, e.g. coughing, labored and/or fast breathing at rest, please give 1 tablet twice daily and notify CVCA on the next business day. If you do not see improvement in 1-2 hours, please seek veterinary care.

This is my most recent Cushing test (from July 25th)
Resting cortisol 1.4
Post ACTH. 7.8
Trilostain best cortisol levels 1.6 resting and post
Post ACTH consistent with Cushings would be over 22
So we should hold off a bit more before restarting the trilostane.
I do recommend a cardiologist ultrasound of Wigit’s heart - the heart murmur is very clear now when I listen with my stethoscope.

My cardiologist did not check her lungs (no one has aside from the chest X-rays/listening with a stesthescope) but disagrees with the vet that she has fluid but said to just check her breathing and if issues/over 35 breaths a second or a wet crackly sound to give furosemide. I got a follow up done at another vet as told by my cardiologist to check her blood, liver, electro lights etc and to see how the meds were effecting her and both this vet and the cardiologist said to keep things up with her heart meds as her numbers were good.

The new vet did not run another stim test but disagrees with the vetoryl or Cushing’s treatment -I forwarded all recent stim tests to him. He said her symptoms donÂ’t warrant it as her only Cushing symptoms are the ones that cross with the heart issues-the breathing issues, lethargy namely. She does not have the skin and coat issues he would expect with CushingÂ’s and could be in danger of addisons. I have not taken her back to the original vet for CushingÂ’s but he last time we spoke said we should decrease the vetoryl to about 15 mg a day. She is breathing generally at around 30 a minute while sleeping sometime More sometimes less but not over 35. She gets little bursts where she wants to play but otherwise sleeps all day and night. She isnÂ’t in pain per the vet -she had ear issues which we treated and she seems a lot better there. I am to go back to the cardiologist in 4 mos.

Any advise, as always, appreciated

[Squirt's Mom]

Hi,

Good to hear from you again!

If I were in your shoes I would forget about Cushing's for now and concentrate on her heart and lungs. My last dog that was diagnosed with Cushing's was misdiagnosed due to similar health issues. She had COPD VS heart problems. But the thing is.....ANY stress, internal or external, can and does cause the cortisol to rise naturally in response to the stress. My baby did show many of the cush signs and tested >50 on the ACTH test but her necropsy proved what I had believed from the beginning - she never had Cushing's. It was the stress of her health issues that caused that astronomical result. In addition, the brochure from Dechra that comes with Vetorly (Trilostane) states:


Angiotensin converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-
lowering effects which may be additive, impairing the patient’s ability to maintain normal electrolytes, blood volume and renal perfusion.

Potassium sparing diuretics (e.g. spironolactone) should not be used with VETORYL Capsules as both drugs have the potential to inhibit
aldosterone, increasing the likelihood of hyperkalemia.

Both Enalapril and Vetmedin are ACE inhibitors and Lasix is a potassium sparing diuretic. So I would simply forget about Cushing's for now.

Please keep us updated on how Widget is doing!
Hugs,
Leslie

[Widgetsmom]

Is there a better way to tell if she has fluid in her lungs besides counting her breaths while sleeping? I have been told to only give her furosemide if her breathing is 35+ or her breathing in labored or if she is coughing. Sometimes I can’t tell if she is coughing or just clearing her throat or sneezing or if her breathing is “labored” as she is a Boston and her breathing is loud in general-sleeping anyway. I find her noises are hard to gage.

[labblab]

I’m very sorry but I just don’t have enough knowledge about heart and lung issues to advise you about this. I’d encourage you to call back to the cardiologist and tell him that you’re having a very hard time judging when to give the medication. Hopefully he can clarify his instructions about this, and I think he’d be the best one to do so.

I can imagine how stressful it must be for you to be constantly monitoring Widget’s breathing. I’d be exhausted, myself, if it was me!! I sure hope the vet can give you some better tips about this. Do let us know, OK?

Marianne