New User Here Seeking Advice About My Cushings Boxer

[arjones0918]

I have been reading some threads on the site and decided to create a user so that maybe I could pick some of you more experienced folks brain. I'll try to sum this up the best that I can..... My 9 year old boxer Dozer had to have surgery 2/1/22 to remove a blockage from his stomach but prior to that was normal. When he came home from surgery I started noticing him peeing in his sleep and having accidents in the floor which he has never done he has been very good since he was housebroken. I also started noticing he would walk around the yard peeing multiple times like little bits at a time. So I contacted the vet and they thought it was a UTI so put him on antibiotics, but he did not get any better. They then suggested to me that we test for Cushing's disease since he was also drinking a ton of water. They did a blood test which took all day I believe they had to do like 3 different samples, and they called when the results came back saying that he had Cushing's. He at this time weighed about 78 pounds so they put him on Vetoryl dose 70mg per day. He was on this same dose until I would say some time towards the end of May, but I just noticed he was losing muscle mass drastically, and he never really got any better with the drinking and peeing. He now has to wear belly band because he cannot control his urine at all. They tried putting him on Proin for incontinence, but that made him very sick he would not eat or anything. So he was taken off that medication, and I just do the belly bands. In the weeks following that he just seemed to not have much interest in anything, his appetite was not very good, he would still walk around trying to pee multiple times, and sometimes it was like he was confused if he was needing to pee or poop like he would squat to poop, but he would be peeing. I let the vet know all of this and they had me take him down to 60mg per day. He was on that dose for a couple of weeks, but I took him back in because he was looking very thin to me and just not seeming like himself. They had not been able to fill my Vetoryl so he had been without it for about 2-3 days whenever I took him into the vet and they wanted to do some blood work. They said his cortisol levels were out of wack and they felt like he needed to go back to the 70mg even though I explained they had not been able to fill his medicine for a couple days so he had been without it. So I did go ahead and follow their advice and put him back on the 70mg. He is now down to 71lbs, I can see almost his whole skull, his spine, and his hip bones. His muscle loss is just unreal to me... He also does not have a very good appetite, still drinks and pees like crazy(sometimes waking me up 5 times a night), and doesn't seem to have much interest in anything at all. He is scheduled for an abdominal ultrasound tomorrow, but I just am feeling very discouraged as I have had him on this medicine and have spent a lot of money on it and the testing, and there has been no improvement. Have any of you experienced anything like this? I do understand that he is now 10 so some of this could be aging, but I just find myself being so blown away that I took a normal healthy happy dog in for a surgery in February and here we are now almost to July and he is a totally different dog. It is almost like he is worse since he has been on the medicine, I did read that it does have some side effects. Everybody's reviews that I read about this medicine are so positive though and I have not had that luck at all. I am just hoping somebody has some input or advice, or maybe has had a similar experience.

[labblab]

Hello and welcome to you and Dozer! I’m so sorry he’s having such a rough time, and I share your worry that there may be something going on here aside from, or in addition to, Cushing’s. I want to take the time to carefully read through your post and give it more thought before adding a more detailed reply of my own. So it may be tomorrow before I make it back here again, but I wanted to have the opportunity to quickly welcome you and Dozer to our family.

So do stay tuned, and in the meantime, we’re so glad you’ve joined us.
Marianne

[Squirt's Mom]

Hi and welcome to you and Dozer!

Please stop the Vetoryl. I am highly suspicious of the diagnosis to start with, thinking he has been misdiagnosed. This can happen very easily....I've had two misdiagnosed. ;) Cushing's does NOT come on suddenly. This is a disease that moves at a snail's pace, causing most parents to think their baby is simply aging. None of of the signs start suddenly. So the fact that you say he had no issues at all before the surgery tells me something is very wrong with the diagnosis of Cushing's. Second his reaction to the Vetoryl....if he had Cushing's we would expect to see improvements by not, not worsening.

So your homework is to get copies of all the testing done to diagnose Dozer - the blood work that shows things like ALP, CHOL, BUN, T4, etc. We only need to see the values that are too high or too low. And the CBC that shows things like eosinophils and monocytes. Also the ACTH and/or LDDS test(s). We need to see all the numbers on these two tests. If Dozer had an abdominal ultrasound we need to see all the comments from that test.

Has he had an ultrasound since the surgery to be sure there was no damage incurred or anything else that might be causing this? That might be my first step...have him checked out thoroughly since this started right after the surgery. But please do stop giving the Vetoryl for now. And when you can, share those test results with us if you don't mind. That will help us give you better feedback.

I am very glad you found us and look forward to learning more soon!
Hugs,
Leslie

[arjones0918]

Thank you both for the warm welcome! :)I do actually have his lab results that are on my computer at work so I will put those up tomorrow and share those. He has his abdominal ultrasound tomorrow but this will be the only one he has ever had he has only ever had X-rays on his abdomen before when he was having some stomach issues due to eating strange things! He has always been a gobbler of the strange lol I will share the results of the ultrasound and I really do appreciate you all even taking the time to read through all of this and give me some insight!

[Joan2517]

Hello and welcome from me, too. I agree with Leslie. Please stop the Vetoryl. Stopping won't hurt him, but continuing it could. That starting dose was high to begin with, if he does indeed have Cushing's, which I also question.

[arjones0918]

Good Morning All,

I dropped Dozer off this morning for his ultrasound so hopefully I will know the results of that this afternoon or tomorrow. I did pull up his lab work is there a way to put a PDF attachment in here or do I just need to type it out? I have looked and looked to see if I can do an attachment, but am not seeing it. I could just be totally blind lol

[Squirt's Mom]

I know it's a bit of a PIA but typing out the results is usually best. From the blood work it would look something like this -

EXAMPLE ONLY:
ALP 660 ug/dl 100-300

This will give us the results as well as the units of measurement and normal ranges for each abnormal value.

The ACTH and LDDS are typically 2 and 3 numbers respectively...again with the little letters that follow (ug/dl, mnol/l, etc) and the normal ranges from that lab. Different labs use different normal ranges and different units of measurement. Comments from the ultrasound will be just that...words about each organ that was seen and sharing those will be helpful as well.

Best of luck on the US and let us know how it went!
Hugs,
Leslie

[arjones0918]

Okie Dokie Here it goes....

Starting 2/17/22

ALT 96 normal range 12-118 IU/L
AST 27 normal range 15-66 IU/L
Alk Phosphatase 494 normal range 5-131 IU/L (this one flagged as High)
BUN/Creatinine 16 normal range 4-27
Glucose 86 normal range 70-138 mg/dL
Sodim 152 normal range 139-154 mg/DL
Potassium 6.1 normal range 3.6-5.5 mEq/L (this one flagged as High)
NA/K RATIO 25 normal range 27-38 (this one flagged as Low)
PrecisionPSL 246 normal range 24-140 U/L (this one flagged as High)
CPK 26 normal range 24-140 U/L (this one flagged as Low)
Lymphocytes 19 normal range 12-30 %
Monocytes 5 normal range 3-10 %
Eosinophils 1 normal range 2-10 % (this one flagged as Low)
T4 3.5 normal range 0.8-3.5
Free T4 (Dialysis) 59.0 normal range 8-40 (this one flagged as High)

2/21/22 Cortisol Serial 3 DEX
Cortisol Sample 1 "Pre" 2.9 normal range 1.0-5.0 mg/dL
Cortisol Sample 2 "Post 4" 3.9 normal range 0.0-1.4 mg/dL (this one flagged High)
Cortisol Sample 3 "Post 8" 1.5 normal range 0.0-1.4 mg/dL (this one flagged High)

4/5/22 Cortisol Serial 2 ACTH---- (This was his check up after being on initial 70mg dose of Vetoryl for about a month)
Cortisol Sample 1 "Pre" 1.8 normal range 1.0-5.0 mg/dL
Cortisol Sample 2 "Post" 5.0 normal range 8.0-17.0 mg/dL(this one flagged Low)

6/6/22

ALT 171 normal range 12-118 IU/L (this one flagged High)
Alk Phosphatase 959 normal range 5-131 IU/L (this one flagged High)
Glucose 95 normal range 70-138 mg/dL
Sodium 161 normal range 139-154 mEq/L(this one flagged High)
Cholesterol 184 normal range 92-324 mg/dL
PrecisionPSL 514 normal range 24-140 U/L(this one flagged High)
CPK 71 normal range 59-895 IU/L
Monocytes 7 normal range 3-10 %
Eoosinophils 2 normal range 2-10
Lymphocytes 15 normal range 12-30
T4 2.5 normal range 0.8-3.5 mg/dL
Free T4 (Dialysis) 42.1 normal range 8-40 pmol/L(this one flagged High)

6/6/22-- This was taken when he was out of Vetoryl for about 2-3 days because they could not fill my prescription and I took him in to the vet because I was complaining about his appetite etc
Cortisol Serial 2 ACTH
Cortisol Sample 1" Baseline" 10.6 normal range 1.0-5.0 (this one flagged High)
Cortisol Sample 2 "Not Stated" 17.1 normal range 8.0-17.0 (this one flagged High)


I know this is a lot of information! :l I did hear on his ultrasound this afternoon and they are stating that he has "lesions" on his liver they said it could be a couple of different things, but cancer being one of them. They said his bladder and everything else looked fine. So they asked if they could do an xray of his chest and lungs and all of that to see if there were signs of anything in those areas. So I did agree to that, I did not give him the Vetoryl yesterday. I am hoping that will help him to perk up and have better appetite. He was down to 66lbs though when I took him in this morning. Granted he had to be fasted, and did not eat really great last night. That is nearly 5lbs from when he was weighed last Monday.

[labblab]

Thank you so much for taking the time to type out all this info!!! I apologize to be so slow to get back with you, but I've just had some stuff come up that's kept me away from the forum for a couple of days. Not bad stuff, but just busy stuff! I'm still scratching my head a bit after seeing these labs, so I'm afraid I'm still not ready to put together a substantive reply. But I've not forgotten you and Dozer, and I'll definitely be back with my thoughts ASAP.

Marianne

[arjones0918]

Thank you for taking the time to look at it and touching base! I can understand the being busy for sure! He has been off his Vetoryl now since Monday and the vet that did his ultrasound Monday agreed with him being off it for now. (His regular vet did not do his ultrasound) Just to update too, the X-rays came back good as in they did not see anything that looks abnormal in his chest and all of that. Just the ultrasound causing some concerning “lesions” and she also called them “nodules” in the liver. They gave him an appetite enhancer to see if we can get him eating better, they are also hoping being off the Vetoryl will help the appetite. Eating just seems to exhaust him though it’s so strange he will just pant like crazy when he is done eating, it’s almost like he has to stop eating at a certain point because he just pooped out. Again thank you for reading and taking time out of your life to hear my stuff.

[labblab]

OK, finally I’m back again! Once again, thanks so much for providing all this helpful information. I know Dozer had several abnormal lab results, but I’m going to focus on the ones that stand out the most to me. Before doing that, let me caution you that I’m not a vet, so my thoughts are based on what I’ve learned over my years on this forum as opposed to professional training. But these are things that have raised questions in my mind.

First, elevated liver enzymes — especially high Alk Phos levels - are characteristic of Cushing’s. Also, changes in the appearance of the liver itself are commonly viewed on ultrasound. So those abnormalities would be consistent with the disgnosis. However, here are my concerns about the diagnosis. First and foremost, just as Leslie wrote earlier, Cushing’s is typically a syndrome that gradually worsens over time. The sudden onset of Dozer’s symptoms immediately subsequent to his surgery raises a huge red flag for me. Not that I’m accusing the vets of anything improper with the surgery itself, but I do have to wonder whether there was any internal trauma, inflammation or infection that lies behind the sudden onset of these symptoms. And if Dozer was/is suffering from any other type of systemic issue, this could easily result in a “false positive” on his diagnostic LDDS test (noted as “Cortisol 3 Serial Dex” on your report). Any illness, injury or stress can raise cortisol levels in the same manner as Cushing’s. That’s why the complete medical history and constellation of symptoms are an important part of the diagnosis.

It is the third cortisol reading on that test that is diagnostic for Cushing’s. Dozer’s third reading was 1.5, which was *barely* higher than the normal cut-off value of 1.4. The fact that he was only slightly out-of-range doesn’t give me a lot of comfort in the Cushing’s diagnosis, especially if you know he was outwardly acting unwell at the time the test was performed.

Adding to my concern are two other abnormally high readings at the time of his test. The first is the Precision PSL reading of 246. I believe a level that high would be considered diagnostic of pancreatitis, which can be an extremely painful and disabling condition, definitely affecting appetite. In addition, his Free T4 reading was quite high, as well, which would indicate hyperthyroidism if it was a valid and ongoing elevation. Here are symptoms of hyperthyroidism, several of which correspond with Dozer’s behavior:

Depression.
Diarrhea.
Enlarged thyroid gland.
Excessive thirst.
Forced breathing.
Heavy, rapid breathing.
Increased appetite.
Increased energy.
Increased urination.
Nervousness.
Rapid heart rate.
Shaggy hair texture.
Vomiting.
Weight loss.

The increased appetite and energy don’t correspond with what you’re seeing in Dozer, but he may be suffering from multiple issues that are combining to present a particular set of problems. For instance, when we move ahead to the June labwork, his Precision PSL has jumped clear up to 514. So perhaps he may be suffering from a smoldering chronic issue with his pancreas. At this point his Free T4 thyroid reading is much lower, but still a tiny bit above normal.

All in all, I definitely agree with holding off on giving him any more Vetoryl for the time being. I’m just not yet convinced about the accuracy of the Cushing’s diagnosis in the face of these other abnormalities. And I would specifically question your vet about the appearance of his pancreas on the ultrasound, as well as the significance of the elevated Precision PSL and thyroid levels. My concern here may be unfounded, but these are issues that do raise big questions for me. And no matter what, please do keep us updated.

Marianne

[labblab]

Just wanted to come back to add a link to a helpful article re: symptoms and testing for pancreatitis. As you’ll see, “garbage eating” may be a possible trigger (I’ve always had Labs and am *really* familiar with that tendency!). This article is focused on acute attacks of pancreatitis, but I know that it can be a chronic issue as well.


Dogs with subclinical or mild disease can display nonspecific signs such as intermittent anorexia and weakness with no gastrointestinal signs.
Anyway, hopefully this may help you develop questions for your vet.

https://todaysveterinarypractice.com/hepatology/diagnosing-acute-pancreatitis-in-dogs/

[arjones0918]

Wow! Thank you so much for the thoughtful response. I have some good takeaways to ask about at his next appt
They have never mentioned anything to me about anything of the other elevated levels on his bloodwork. I really am wondering about the Cushing’s diagnosis myself, because yes this has all seemed so sudden and the Vetoryl did not help at all. I am starting him on some home cooked food that I looked up saying it was good for the liver not making it work harder than it needs to so he will start that tonight but all week he has been eating Hill Digestive I/D food that the vet gave him. I have a check up appointment on Tuesday with the vet that did his ultrasound and found the spots in the liver. They had me to start him on Milk Thistle so he has been on that for a couple days now. His appetite is doing a lot better and I have not given him the appetite enhancer yesterday or today just because I want to see id it’s truly better being off Vetoryl. However today he is not doing so well, it started in the middle of the night just pacing and panting and peeing. He did eat pretty good this morning but has just not been right. He will not lay down and just keeps pacing around almost in circles and then squats to pee like literally a couple times every minute or two. He has probably peed 100 times today not even exaggerating I have never seen anything like it. He is also panting quite hard still. I called my usual vet(that gave cushings diagnosis) since he was on call this weekend and he is telling me it’s because he’s off the Vetoryl and would need to get back on it! He has been off of it since Monday and this has not happened at all in this time! So I was peeved that was the only suggestion for him. He seems quite uncomfortable I’m afraid he is in pain and it’s very hard to watch. He has lost so much muscle mass, and has such weakness in his back legs he is barely able to hold himself up to pee or especially poop, but today it’s especially bad with the weakness. Also another thing I have noticed over the last couple weeks is the massive decrease in his stool when he goes the amount is very little compared to what it used to be? Any ideas or could that be normal with the lower food intake he has been having ? Thank you again for your time and thoughts

[labblab]

Gosh, I’m so sorry that Dozer is having such a hard time. I know this must be so hard for you, too, seeing him so uncomfortable! And of course, this has to happen on a holiday weekend — in our house, it always seems like the crises come on a weekend or a holiday…:-(((((

I’m glad you’ll be seeing the new vet on Tuesday because I’m guessing he may be a specialist of some kind since he’s the one who did the ultrasound. Dozer’s situation seems complex enough at this point that I’d welcome some fresh eyes and some new thoughts. Cushing’s remains a possibility, but even if so, the Vetoryl seems to be creating as many problems as it might be helping. I’m still wondering about an unresolved UTI. The incredibly frequent urge to pee accompanied by discomfort could certainly be caused by a UTI. Has your vet continued to test his urine? Originally, did your vet ever actually run a culture on a urine sample to try to identify a specific bacteria, or did they just give you a broad-spectrum antibiotic to try? If they didn’t run an actual culture, Dozier might be suffering from a bacteria that the medication didn’t address in the first place.

Also, as far as his food right now, if he was eating the Hills I/D food, you might not want to mess with success. I know the ingredients in it sound pretty awful, but dogs do seem to like it and it has really helped my own dogs at times. My current Lab girl has had recurrent episodes of diarrhea of unknown cause, and that I/D food has been the one thing she could eat that seemed to normalize things during an upset. I would home-cook chicken/rice, etc., and nothing settled her stomach as much as a temporary course of that food. So if Dozer doesn’t eat as well on the new food you’re cooking, it might be best to stick with the I/D food for now. And as far as the lesser quantity of stool, that may well be due to the different composition and fiber content of the food he’s eating right now.

I sure hope you can make it through until your appointment tomorrow. I’ll be thinking of you guys today and hoping for the best.

Sending big hugs across the miles,
Marianne

[arjones0918]

I thought I would check in and give an update on Dozer.. last weekend was pretty rough, but he did a little bit better last week. We had an appointment with the newv vet on Tuesday and she feels it to be very important to try and manage his Cushing's disease as she feels a lot of his symptoms were coming from that. She wants to start him on a lower dose though because she said if the 60 and 70mg were giving him problems it could just be too much for him. She is having it compounded so that he can have 20mg 2x daily. She said she has seen evidence to support 2x a day dosing is helpful in controlling the symptoms. She also has prescribed him Adequan injections to help with his back legs. He is very slow and stiff and has a very difficult time squatting to go to the bathroom so she wants to see if that will help him get some mobility back and help with discomfort. I am hoping these come in the mail today, I had to order them to be shipped, I am ready to get him started on the medicines to see if he can get some relief. She really feels that the spots in his liver given all of his other clinical symptoms ( severe muscle wasting, weight loss, cognitive issues) that it very well could be cancer in the liver. She feels the biopsy to find out for sure would be much too hard on him given his current state and she says our main concern should be getting him feeling better and lessening his symptoms for the time being. He was also started on Milk Thistle and she may be prescribing him some Ursidlol for the liver inflammation. He is basically 100% incontinent now, but she feels that is because of some issues with his spine. He had an xray 2 years ago and showed some signs of intervertebral disease, he did not really have symptoms then so they did not do anything to treat it. I have him in belly bands, but now that he is sleeping a bit better at night if he goes 2-3 hours sleeping without getting up he has soaked through them and pee has run all over his side. So been trying to waterproof things as much as possible and trying to order some products to help with this. Also having to give him a little bath in the mornings to get the pee off him :( He is loving the homemade food I have been making and is eating good. He has not lost anymore weight since 6/28 when he had his ultrasound he was 66.8lb and he has stayed in the 66lbs since then. I was hoping to see a little gain of weight, but I was happy to see no loss considering previous to that he had lost 5lbs in a week. I am just trying to make him as healthy and happy as possible right now, if any of you have any experience with other things I can try or have dealt with these similar things and things that worked for you I would love to hear them. I know his time is on the horizon, but I can still see some life and fight in him so I am going to try everything I can for him. Thank you all so much!