@ my wits end !!

[Rosie230404]

Bit of a long winded read.
BUT was hoping to hear a few other people's experiences & views.
Rosie is our 9yr old boxer, who we've had from a puppy. We resided in the USA ,till 2 yrs ago when she made the journey back with us to the UK. We first noticed about a few mths after trip, her having accidents around the house ( urine dripping from her without her even realising.)
Firstly we put it down to maybe just anxieties, from the move & flight.
So took her To be examined.
She also had hair loss on both flanks ,so Vet decided to test for a thyroid problem.
After few visits to vets ,in which time we've tryed drops & then tablets ,designed to help strengthen her bladder controlling muscles.)
There wasn't any change ,so then had Rosie tested & diagnosed, as positive for cushings a few months ago now.
She has been on a dosage of 120mgs of vetoryl, ever since & Inc. after 3 more tests results.
We are very concerned reg. the side effects since the treatment started.
ie. noddy head, shakes, spasm/epilepsy looking actions & irregular breathing pattern whilst asleep or relaxing) , to which i was told these aren't a side effect of the vetoryl tablets.
(But now after reading thru some other people's experiences online....that doesn't seem to be the case).
& of course ,wanting to know whether she is in any pain at all.
Due to all of this. ,we're becoming very concerned & disheartened as ,to her quality of life or more the fact ...the lack of.

Another concern I've had is ...
After her 1st ATCH retest the vet wanted to up dosage to 150mg ,which I didn't agree with due to side effects ,her deameanor & on observation of the weight(kg)to medication (mg) graphs ,that i've read, that made me feel the dosage figures didn't add up.
Was then told ,after the vet went to check blood results again, to just keep her on 120mg's & without no explanation?
I now am doubting ,if the meds are helping at all .as 3 months on ,Rosie still drinks & urinates excessively & not the canine she was before.

I Mentioned to Vet on last visit a week ago, that i was considering stopping her meds ,as am finding it difficult to be seeing her like this.
But was advised not too ,as too high a risk of internal infection & kidney failure ).
?????
Rosie's gone from being ,socially living around the house with our family to now living in the kitchen on a Lino floor ,as it is easier to clean up after her. We also have a 15 mth old baby running & crawling around that loves to pet her ,but he also loves to grab & pull at her bedding, which you can imagine ,is impossible to keep clean from 1hr to the next.

Like I said .... @ my wits end, what path to take.

[Harley PoMMom]

Hi and welcome to you and Rosie,

So sorry for the reasons that brought you to us but very glad you found your way here.

It would help us a great deal if you could round up copies of all tests that were done on Rosie and post any abnormalities that are listed with the reference ranges and units of measurement...e.g...ALT 150 U/L (5-100) Thanks! We would especially be interested in any Cushing tests that were done so if you could post the results of all ACTH stim tests with their timelines, that would be great too.

The dose that Rosie is on seems very high to me. Usually a dog is started at a dose of 1mg per pound, how much does Rosie weigh? Was diabetes ruled out? Is Rosie taking any other herbs/medicines/supplements?

How is Rosie's appetite? Is she vomiting or does she have diarrhea?

Sorry for all the questions but the more we know about your sweet girl the better our feedback will be, ok?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[NoonelovesmelikeNorman]

Hello Rosie's mom!

I am too new at cushings myself but if you post Rosie's lab results, the group has many who have a great understanding of this awful disease on our pups...Your in good hands...Wishing Rosie a speedy leveling and decrease in symptoms.

Love and (((hugs))),

Sharon and Norman

[addy]

I am so sorry you and Rosie are having such a hard time but I am glad you found us. Hopefully we can help try to sort things out. You don't have to try to figure it out by yourself anymore. We are to help in anyway we can.


As Lori mentioned, it is easier for us to have the test results so we can help decipher things so we really need to see the test results. Did your vet ever mention if it was adrenal or pituitary hyperadrenocorticism? How much does Rosie weigh?

Usually when a dog is urinating without realizing it we tend to think of incontinence but it sounds like you tried meds for that and they did not work? Sometimes they develop diabetes, or diabetes mellitus and sometimes their pu/pd just doesn't resolve. Every dog is different. That remark used to drive me crazy when I heard it but it is so true.

Also, some dogs may develop neurological problems due to an enlarging tumor see quote below:


Neurological
•neurological signs may develop secondary to mass effect of pituitary macroadenoma
•clinical signs include inappetance, dullness, disorientation, pacing, head pressing, ataxia, loss of learned behavior, seizures, visual deficits, anisocoria, and Horner’s syndrome

Now I don't want to scare you having said that, so don't panic on me;)

We need to really start with the recent ACTH tests to see just where Rosie's cortisol is.


We look forward to learning more about you and Rosie. Hang in there and remember to breathe. Being at your wits end for extended periods of time is not a good thing:):)

hugs

[milosmom]

welcome rosies'mom and your most precious furbaby.i can say you have definitely found the right place to help you with all your questions and try to get a clear picture of what might be going on with rosie.as you see there are lots of tests results that are needed here for those knowledgeable to help you.and then there are the rest of us that also go through this process with you sending you and rosie hugs.kisses,love and understanding.remember you are never alone,there will always be a set of eyes on you here...sending you warm wishes and hugs...patty(milo)meka xoxox so happy you found us

[Trish]

Gosh is it just me or do we seem to get a lot of Boxers on here! Welcome to you both and glad you found us. I bet once you pop up the lab results these experienced people will be able to help you to sort this out and put a plan in place. You poor thing though, really feel for you trying to do the best for everyone. Hope I will be reading of an improvement for you all soon.
Trish xxxxxxxxxxxxxxxx

[Rosie230404]

Thankyou all for taking time to reply.
I will later today ,contact my vets & see what lab results they can fwd to me.
Her weight, is a concern.
3 months ago she was a stocky & muscular looking dog,
weighing in at 60lbs.
But Since shes been on the vetoryl ,she's lost over 10&1/2lbs

In Ref. to the neurological side of things, our vet had said due to side effects ( & ??? not being the vetoryl) it could be neurologic & prescribed her some tablets to take for a week, which had no effect whatsoever ,so now on different drips ,which after a week,have still not seen any signs of improvement but we're monitoring her 24/7
I'm @ wk most of day, so the real angel is my wife.
She has her hands full with our lil boy, but still manages to take care of Rosie.

again ,Thanks all

[addy]

Could you find out also the names of the other drugs that Rosie has been given, if possible when you call for the test results?

[molly muffin]

Hello and welcome. You have really be in one side and out the other with what is going on with Rosie.

Diabets, thryoid, kidney problems can all mimic the same cushings symptoms.
If we are looking at cushings here then it needs to be determined if it is adrenal or pituitary based. Has an ultrasound ever been done?
We'll be interested in seeing not only the cushings specific testing, but all tests, T4, glucose, lipase, etc.
Depending on what your test results show, an ultrasound might be of real value to you in figuring this out.
Has her urine been cultured to check for a UTI? Do you know if it is dilute?
One of the main things that I think we have all learned is that knowledge is the most powerful thing you have when dealing with the vets. You'll know what questions to ask, what dosages would be right, symptoms and their possible causes and what results you want to see on test results, optimal ranges during treatment, etc.

Having said all of that, hopefully we can help you move from "at your wits end" to somewhere more like "driving me nuts today", because we all have some days like that. :)

Sharlene and Molly Muffin

[Rosie230404]

Hi again.

Been awhile since able to update my post here.
I have now managed to get results & history of tests carried out on Rosie.
Wondering which test results you were needing to look thru, as there are many abbreviated names ,I'm unable to make sense of.

Rosie's been back for another test since & been told the 120mg is adequate for the levels she's at & that their happy with the prescribed dosage till her next test in 5 mths time.


I Asked as we are still concerned about her twitching & her breathing pattern (heavy abdominal reaching) since starting vetoryl.
But like the vets said before ,they dont believe its a side effect of the drugs & that its more likely due to age (9) ,as a neurological or spinal movement/pressures ,that are the cause of this & the urinating.
They prescribed her with " Urilin " which is taken with food 3 times a day.
Due to this ,we was hoping her weight loss would decline.
It doesn't seem to be as drastic as the 10 lbs she's lost ,since shes been on vetoryl, but still....
in the few wks since last test ,she has dropped a further 1 & half lb.
Also her water intake is more.
To the point she's constantly nudging her bowl to be filled & then literally doesn't stop till its empty ???
We were given some other meds. Previously that are in the history notes ,that didn't seem to make any change.
The only change since on Urilin is ,much less of the dripping but now finding pools of urine on floors during sleeping hours & what with our lil boy waking for milk & me being up early for work.:cool:
Rosie is barely left unattended for more than 2 hrs & now seems uncapable of holding it in now.( not a previous prob )


Wouldn't say at our wits end but
Feel it's a case of 1 step fwd ,2 steps back.

Is there a way I could fwd you the PDF that was sent to me ,as it will give you everything needed to look thru.

Thank you all ever so much for your help.
Andy

[lulusmom]

Hi Andy,

You can send the PDF to me at gpomerantz@hotmail.com and I'll post the results for you.

Glynda

[Rosie230404]

Hi again.

Been awhile since able to update my post here.
I have now managed to get results & history of tests carried out on Rosie.
Wondering which test results you were needing to look thru, as there are many abbreviated names ,I'm unable to make sense of.

Rosie's been back for another test since & been told the 120mg is adequate for the levels she's at & that their happy with the prescribed dosage till her next test in 5 mths time.


I Asked as we are still concerned about her twitching & her breathing pattern (heavy abdominal reaching) since starting vetoryl.
But like the vets said before ,they dont believe its a side effect of the drugs & that its more likely due to age (9) ,as a neurological or spinal movement/pressures ,that are the cause of this & the urinating.
They prescribed her with " Urilin " which is taken with food 3 times a day.
Due to this ,we was hoping her weight loss would decline.
It doesn't seem to be as drastic as the 10 lbs she's lost ,since shes been on vetoryl, but still....
in the few wks since last test ,she has dropped a further 1 & half lb.
Also her water intake is more.
To the point she's constantly nudging her bowl to be filled & then literally doesn't stop till its empty ???
We were given some other meds. Previously that are in the history notes ,that didn't seem to make any change.
The only change since on Urilin is ,much less of the dripping but now finding pools of urine on floors during sleeping hours & what with our lil boy waking for milk & me being up early for work.
Rosie is barely left unattended for more than 2 hrs & now seems uncapable of holding it in now.( not a previous prob )


Wouldn't say at our wits end but
Feel it's a case of 1 step fwd ,2 steps back.

Is there a way I could fwd you the PDF that was sent to me ,as it will give you everything needed to look thru.

Thank you all ever so much for your help.
Andy

[Rosie230404]

Oops !! Resent by mistake.

[Rosie230404]

Thanks Glynda,
Will get them on there way to you ASAP
Andy.

[lulusmom]

Hi Andy,

I am so sorry for the delay in posting Rosie's test results. It was nice to have a complete history of what has been going on since August, 2010. There is too much information to post but will try to summarize so that members get a really good idea as to the progression of Rosie's issues. How is Rosie doing now? What kind of symptoms are you seeing? Are you still dosing with Vetoryl?


Initially saw the vet after relocating to the UK in August 2010 where in vet was advised that Rosie has a history of passing small amounts of urine when asleep or relaxed. Appears Propalin was prescribed.

Rose saw vet in April 2011 for bilateral lat abd hair loss. T4 was normal and member was asked to bring in urine sample. Rosie seen again in June, 2012. Urine results all normal. Cushing's was discussed with member but vet is doubtful as Rosie presents well and alopecia, based on member's description, seems to be seasonal flank alopecia. No change of opinion at visit to vet in October 2012 but after seeing low USG, vet feels leakage may be due to something other than muscle tone/sphincter. Member reports that Rosie is now drinking more but vet notes that leakage has been going on for some time. Bloodwork normal except elevation in GGT 62 (normal 0 - 7.0) and slight lymphopenia.

In December, 2012 member reports to vet that PU/PD still ongoing and seems to be getting worse. Vet notes bladder small/empty on palpation and patchy alopecia with melanotic skin lesions on flanks and hind limbs but this could just be hair growing back. ACTH stimulation test was done and Rosie was diagnosed with Cushing's Syndrome based on the results. Pre 160 nmol/L (5.8 ug/dl) and post 671 nmol/L (24.32 ug/dl). Given 120mg Vetoryl to be given once a day with directions to return in 10 days for an acth stimulation test.

Rosie returned to vet on December 18 for acth stim test. Rosie is now lethargic with signs of drowsiness while at rest. I only have one result for this stim and since the notes indicate Synacthen was injected, I assume the 189 nmol/L (6.95 ug/dl) is the post stimulated draw. Vet gave member 30mg capsules and directed dose now to be 150mg once daily. Vet decided against that increase after watching a video of Rosie's lethargy; however, vet did not believe her behavior is due to cushing's. :confused: It was also noted that Rosies weight on December 3 of 26.1kg (57.42 lbs) is down to 24.5kg (53.9 lbs) on December 18.

Visit to vet on December 31 shows Rosie not drinking as much but still incontinent, twitching in sleep, more lethargic and reduced appetite. Gave Vivitonin Tabs 50mg for dullness and lethargy and told to continue dosing with Vetoryl.

Visit to vet on January 18 shows Rosie URINATING EVERYWHERE, breathing with abdomen and neurological problems. On January 21 smelly urine - smell like a fish with PU/PD present. ACTH stim tests done but I see no mention of urinalysis/culture. Vet noted that neurological signs are probably due to elderly dementia and bone changes like spondylosis, intervertebral disc calcifications changes. Results of acth stimulation test is 131 nmol/L (4.74 ug/dl). Vet thinks this number is good but because Rosie is still dripping urine, this proves point of looking at the dog as neurological case....dog is hypersensitive over spine. Urilin prescribed for incontinence. Weight on February 18 is now 22.6 kg (49.72 lbs).

I hope I got all the important info on the table now and invite others to comment. I would like to know if your vet ever talked to you about doing an abdominal ultrasound to validate the acth stimulation test and to determine what form of cushing's Rosie has. The twitching or tremoring you are seeing when Rosie is at rest could be a side effect of Vetoryl. Dechra, the manufacturer or Vetoryl, does list this as a side effect. Did your vet do a urinalysis when Rosie's urine smelled fishy? If so, what were the results? Were antibiotic's prescribed. I'm not sure this was ever done as I don't see it in the vet's file notes. What were the actual neurological problems your vet noted? Are you still seeing neurological signs?

Glynda

[Rosie230404]

Thanks Glynda for looking thru Rosie's case.

Our vet did want to do an abdominal ultrascan,
But due to financial difficulties @ the time ,I asked " which out of the two ( ab. Scan or ACTH test) ,would give them better diagnosis for the symptoms she was showing.
We also don't recall our vet doing a urinalysis test ,as nothing else was said reg. fishy smell (which by the way, tamed down somewhat ,but does now seem ,to have returned over the past week or two).
We've never had any antibiotic's prescribed either.
Vet said reg. the neurological problems,that
they can't honestly say if its old age / or some pressure caused by adrenal gland inflammation etc.
Yes, we're still seeing all the same neurological signs which is the hardest part of this condition to deal with
It is honestly now, like we own a different dog ,cause this isn't the Rosie we all know.

If this is a vetoryl side effect ,which they insist it isn't.
What harm would we be putting onto Rosie ,if we stopped her meds.?
& the only reason for this, is we're tired of seeing her look like she is in discomfort & any sort of pain.

Of course when asking the vets.
We were told discontinuation of vetoryl would leave her
Exposed to things like liver failure & kidney infections.

Were just so uncertain now as to which path to take as.
There is no doubt that whatever medication ,has been prescribed
for Rosie.
Her health ,quality of life & well being has steadily deteriorated.

Thanks Andy

[lulusmom]

Hi Andy,

It sounds like Rosie has a urinary tract infection which should be treated. Cushing's progresses very slowly and if a dog is otherwise okay with no other underlying conditions, it takes a very long time to cause the internal organ damage your vet mentioned. An expanding macroadenoma (pituitary tumor), however, can destroy a dog's quality of life rather quickly. I have to be honest with you about my feelings and hope others will chime in if they think I'm off the mark but it's very possible that Rosie could have an enlarging pituitary tumor that is causing the neurological problems you are seeing. Boxers seem to be particular predisposed to these and there is good evidence showing that treating with Vetoryl can hasten growth of a tumor. If Rosie were mine, I'd probably stop treatment. If it is the tumor that is causing her problems, by letting cortisol rise, it will help with swelling and inflammation and you should see some improvements. Treating is about improving, not destroying, quality of life so if Vetoryl is causing the problem, you'll will know rather quickly.

As I was reading through Rosie's medical history, I kept seeing your vet's comment on her lively and happy disposition. I'm sad that Rosie isn't that happy girl right now and I'm hoping that you see a glimmer of her former personality come through soon. I have chronically ill small dogs so am no stranger to doggie diapers. Have you thought about diapers for Rosie?

Glynda

[Rosie230404]

Its a relief to hear other peoples veiws & opinion ,on this illness.
When @ the vets I find it hard to take in what there explaining to me.
1. Cause some of the explanations, too technical &
2. Of course Going there, in the hope to hear news.
that the tests & results show a glimpse of improvement ,
in my case " hoping "....they'd realised Rosie was over-medicated which would explain her severe side effects since the 1st week in her system.

I have been contemplating taking her off the vetoryl for a while now, Glynda & appreciate your honesty reg. Rosie.

I have 10 (days) tablets left ,from her last prescription so at least they give me a little lee-way, Just incase she shows any other signs of decline or illness ,once taken off them to re-administer them ,if required.

Again thank you.

[lulusmom]

Hi Andy,

I'm not a big gambler but I would bet that you'll see some improvement in Rosie after stopping treatment. Have you given diapers any thought. They can make your life so much easier and they are a lot cheaper than Vetoryl. :D

[Rosie230404]

Ohh for sure they'd b cheaper.
Just not sure whether Rosie would like em.
I'd say right now ,we would get away with her wearing them.
But if she ,after stopping meds shows half the signs of energy she had before, she'll have them off within 5 seconds of putting them on.

I think right now , I could put up with the leaks if ,
just to see Rosie , happy & alert again.
Will keep you updated.
:) Day 1 off them tomorrow.
Not sure whether to continue with Urilin prescribed ??????
Guess mayb on its own & not having the toxicity of vetoryl in her system ,it may do something.

Thanks

[lulusmom]

I'm a rescuer and most dogs that come through my door are not housebroken so I have to keep water proof hospital pads on the floor. I use diapers on some, usually males who will lift their leg right in front of me. They usually hate them initially but do get used to them. Of course I have small dogs so there is a big difference between them and Rosie in determining if they or the diaper wins. ;)

Please keep us posted on how Rosie does after withholding the Vetoryl. Praying that your precious girl perks up.

Glynda

[molly muffin]

The thing about vetroyl is that you Can stop it and see what happens. However, I want to second what Glynda mentioned, as very important. If no culture for a UTI was done, then get one done, especially with the fishy smell. This needs to be treated with antibiotics and also could help with some of the symptoms that you have seen.

Sharlene and Molly Muffin

[SoggyDoggy]

Hi, haven't stopped by before but i would like to give you a big beltaed welcome!

I too however would question whether Rosie has a Urinary Tract Infection? The increase in drinking, peeing and smell could be symptomatic of that, as could the incontinence and though I am not sure about dogs, I do know that an untreated UTI in humans can cause neurological issues (temporarily, they resolve when the infection clears), especially if there is some form of dementia already present. (Maybe one of the experts could comment on this?) If this hasn't been tested, I would certainly follow it up. If it is a UTI, treatment with antibiotics may resolve some of the neuro issues you have seen. It's worth investigating at least.

As for the vetoryl, I too would withhold at this point. As has been seen here in the past, sometimes our babies do better with test results in the higher numbers (lower dose) than the lower. Rosie may be one such example and is feeling lousy with the lower cortisol.

Good luck though, let us know how she is going.

[Concernedmom]

Hi Andy
I'm fairly new to the site as of December. I'm sorry your Rosie is having such a terrible time. I just wanted to say I also think the right decision is stopping treatment of the vetoryl. My Maltese almost 13 years old was on it for 2 months when I discontinued treatment. After about 6 weeks into it he began to have shivers every day and then a couple of days he began panting something awful like he couldn't catch his breath. He could barely walk and when he did it was with his head down. He wouldn't let me touch him as though he was in pain. He just didn't seem like himself so we made the decision to stop and the next day he was walking, playing, stopped panting. So I honestly believe he had a reaction to it. We are the only ones that see them every day and in our gut we know when something just isn't right. I am now treating through a holistic vet because we didn't want to go the conventional route with lysodren. We don't know if this will work or not only time will tell but this was the choice we wanted to make for our pup. I hope your Rosie feels better soon and your family can breathe a little easier