Ellie 9 year old boxer dog

[Ellieboxer]

Hi all

I am looking for advice on our family dog Ellie. She has been showing different signs of cushings for a while now which we had been putting down to old age. I am in no doubt now that this is what she has. She has been taking incurin to help control her bladder as the first problems started when she began urinating in the house.

Actually looking back she was diagnosed a few years back with seasonal flank alopecia and I half wonder if that was wrong but was very early stages of cushings 🤔

Anyway so recently Ellie has had an increase in accidents despite still being on the incurin. She also has the increased thirst and hunger. The thirst is constant. She has now started barking at first light to be let out and often she goes straight to the outdoor water bucket. By doing this she is waking the whole house at 5.30am so by tea time I have very tired and groggy children.

She has scabs and extreme hair loss and one of the scabs is beginning to look infected which I am planning to take her to the vets for.

She often trembles as if she is cold and has a pot bellied apperance.

Her back legs have been weak for a while now and we have to lift her in and out of car. She enjoys a walk but not like she used to she will walk very slowly and seems to want to go home again relatively soon. She also is not interested in being outside and barks to come in even if the children are outside with her.

The problems I have with diagnosing are these...

Ellie is 9 I know that boxer dogs on average live to about 10. I also know that Cushings is difficult to diagnose and also difficult to get treatment dosages/types right. As she is old for her breed I struggle to justify the financial cost of this for potentially such a short space of time when I have two small children at home to look after.

Aside from the financial side as I have young children I already struggle with the urine accidents this is a big issue to me. So potentially introducing drugs which have common side effects of vomiting and poo accidents in the house is a massive problem.

I am beginning to feel that given the side effects she already has from the (most likely) Cushings and her age and what the options are for treatment that the kindest and best option for our family would be euthanasia. I feel terrible about it as I feel selfish as I am putting our human needs high up there as well as considering Ellie. I think if i didnt have the children the hygiene issues wouldn’t be such a massive problem but as my youngest if 3 it is a big deal to me.

Does anyone know of any treatments which don’t have the awful side effects? Am I completely thinking worst case scenario here?

I am waiting for a call back from my vet and will discuss with them but now I have been thinking it over for so long I’m getting 8mpatient for the answers to my questions. I don’t want to start down an expensive and distressing journey for everyone if she only realistically would live a few more months.

Please be kind it’s been hard admitting how this is all feeling to me

[labblab]

Hello and welcome to you and Ellie. I have only a moment to type right now, but I will return later to write more. Most importantly, though, I want you to know that we understand the nature of your concerns and we will do our very best to support you regardless of what path you end up taking. Of necessity, you have the welfare of your entire family to consider. It may turn out that you’ll wish to pursue some testing and an initial attempt at treatment for Ellie. But as I say, I’ll return later to offer you some of my thoughts re: the pros-and-cons. But in the meantime, I’m very glad you’ve found us. It’s very painful to be faced with such difficult decisions about our sweet companions, and as I say, we’re here to walk alongside you.

Marianne

[Ellieboxer]

Hello and welcome to you and Ellie. I have only a moment to type right now, but I will return later to write more. Most importantly, though, I want you to know that we understand the nature of your concerns and we will do our very best to support you regardless of what path you end up taking. Of necessity, you have the welfare of your entire family to consider. It may turn out that you’ll wish to pursue some testing and an initial attempt at treatment for Ellie. But as I say, I’ll return later to offer you some of my thoughts re: the pros-and-cons. But in the meantime, I’m very glad you’ve found us. It’s very painful to be faced with such difficult decisions about our sweet companions, and as I say, we’re here to walk alongside you.

Marianne



Thanks Marianne I look forward to hearing from you.

Just an update as we had worked ourselves up so much we managed to get Ellie into the vets today she is going in tomorrow for a ACHT simulation test I think it is called? Two blood tests 5hrs apart?

They said it looks obvious she has cushings and if is positive she will need to start vetoryl which apparently is simple and causes next to no side effects. The vet said she would be unlikely to vomit or have diarrhoea. If you have any experience with this drug it would be much appreciated to hear your thoughts.

Thanks

Rebecca

[labblab]

OK, here I am back again. Once again, I’m very sorry that you are confronted with these worries about your girl. Cushing’s can be a cruel disease, indeed. From what you are describing, Ellie does exhibit a number of classic Cushing’s symptoms. So in her case, establishing the diagnosis actually may not be all that difficult. I am thinking the harder decision may be the one related to treatment.

Let’s start with the diagnosis, however. Typically we would expect to see a standard panel of blood and urine testing in order to look for abnormalities consistent with the disease. Cushpups often have elevated liver readings, high cholesterol, low thyroid, abnormal white blood cell patterns, and very dilute urine. They can also experience kidney changes that result in elevated levels of protein in the urine. If you combine Ellie’s external symptoms with some or many of these lab abnormalities, then you’d move forward to one of two blood tests that are specific for Cushing’s — the ACTH stimulation test or the LDDS.

However, in Ellie’s case, there is one other “wild card” that could lead you pretty directly to a diagnosis. From your description of her skin problems, it’s possible she may be suffering from a particular disorder that is directly linked to Cushing’s: Calcinosis Cutis. Given all her other classic Cush symptoms, if you were to discover via biopsy that her skin problem is indeed CC, I think you’d have your answer right there. Our experience here on the forum is that boxers and bulldogs seem to be especially vulnerable to this problem, and it can prove especially challenging to control. It can rapidly spread and drastically worsen. So in terms of quality of life decisions, the presence of widespread CC can be a significant deciding factor. We have seen dogs here for whom the disorder has been successfully managed over time. But it always requires lowering the cortisol level into a specific therapeutic range via Rx medication, and can also include medicated bathing and topical treatments. Sadly, for some dogs, the disorder never responds sufficiently to treatment and their lives become so miserable that euthanasia becomes the compassionate decision.

I may be putting the cart ahead of the horse here, and Ellie may simply have a skin infection. But I wanted to specifically talk about CC, because if your vet thinks it is a possibility, I believe I’d even make a skin biopsy my very first diagnostic step. If it is “positive,” you may eliminate the need for certain other diagnostic testing.

If we cast aside the possibility of CC and return to the more typical diagnostic progression, though, we’d move forward with the lab tests. If Ellie comes up positive on that testing, then the next step is the decision whether to treat. From what you’ve written, I’m guessing you’re in the U.K. If so, the medication used to treat Cushing’s is Vetoryl (trilostane). My own dog took trilostane, and we have many, many members who are successfully treating with this medication. As is true with so many medical treatments, though, the results can be variable. Some dogs do very well right off the bat, with quite amazing and rapid improvement in many outward symptoms. Other dogs have a more difficult time adjusting to the drug. Unfortunately, there’s no way to predict in advance how things will go for any individual dog. However, one thing we’ve discovered is that, overall, negative side effects can be reduced by starting at a low dose and working upward if needed.

Given Ellie’s age (and assuming she doesn’t have CC), it seems to me that your primary goals with treatment would be to reduce her excessive thirst/urination and to halt the progression of her muscle weakness and exercise intolerance. Vetoryl treatment can successfully treat those problems in many dogs. So it may be the case that you’d want to give it a try. Treatment can always be halted at any time if the results don’t warrant continuing. If Ellie does have CC, then controlling the progression of the skin lesions would likely catapult to priority number one.

I see that I have written a book here, so I hope I haven’t confused you even more than you were to begin with! But returning full circle, if Ellie were mine, I believe the very first thing I’d do is consult with your vet about the nature of the skin problems. Specifically ask your vet whether they can be Calcinosis Cutis. A general practice vet may not even be familiar with this disorder, and you’ll want to make sure the diagnosis is being considered in Ellie’s case. And from there, then you can consider the other testing, as well.

Marianne

[labblab]

Hi Rebecca, I see you were posting your own reply while I was running on and on with my very lengthy answer! I think that’s fine that you’re moving forward with the blood testing tomorrow since I agree that Ellie seems to be a pretty classic case. But truly, make sure the vet knows you’re wondering about Calcinosis Cutis.

Also, if Ellie does test positive on the Cushing’s test, ask your vet not to start at a dose any larger than 2 mg. per kilogram. As I wrote earlier, starting at a lower dose can really reduce any ill effects from the medication! I’ll come back and add a link for you to refer to and share with your vet.

OK, I’m back with a link to the dosing info:

http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1251#post1251

[Squirt's Mom]

Hi and welcome to you and Ellie! :)

I wanted to add a note - the medication Ellie is taking for incontinence has increased drinking as one of its side effects. ;) Some of the other possible side effects are the same as we would see if the cortisol dropped too low - vomiting and loss of appetite. So I would want to talk with the vet, or preferably a pharmacist, and make sure the Vetoryl and Incurin will be alright together IF you decide to treat. Either way, we will be with you both all the way. You and Ellie are now part of our little family here.

Hugs,
Leslie

[Ellieboxer]

Wow thank you o both of you for taking so much time to respond you have been so helpful!

I have been advised by a family friend who used to work at a vets that if she tests positive (which we all know she will!) to ask the vet to provide us with a 12 moth forecast of the costs involved in treatment as they would know how many blood tests they would expect to carry out etc.

I think that’s going to be a good starting point and will give us an idea of whether we can afford the treatment. I think her age is a big factor in the cost as I think I would be a bit less reluctant if she were much younger.

Will report back Friday when we get her results.

Marianne I will also mention the CC when she takes a closer look at the lesion on her leg thanks for the heads up ��

[molly muffin]

I just want to pop in and say hello and welcome also. It does sound like Ellie may have cushings, and a cost forecast can be helpful. Keeping in mind that how she responds to treatment can cause an adjustment in those costs. Better or worse.

We look forward to hearing what your vet has to say and what the test shows.

Welcome again

[Ellieboxer]

Thank you molly muffin I am just awaiting it all now so I can get the cost forecast it’s really stressing me out!

Will check In When I get results x

[Ellieboxer]

Hi all

We have had Ellie’s results back which came back negative. We were really shocked including the vet. The results are as follows

Cortisol pre ACTH 137.0
Cortisol post ACTH 406.0

The bio chemistry results were

Total protein 57.3
Albumin 23.9
Globulin 33.4
Ag ratio 0.72
Urea 5.3
Creatinine 40.0
ALT (SGPT) 37 degrees c 260.0
Alkphosphatase 37 degrees c. 1131.0
Gamma gt 37 degrees c. 21.0
Total bilirubin 2.8
Cholesterol 10.91
Inorganic phosphorus 2.11
Calcium 2.11
Glucose 3.1

The vet initially said that her liver looks like it might have problems from these results and as they don’t show cushings we should have an ultrasound. We had booked this in but ....

Now she has called to say she has spoken to a senior colleague who agrees she still seems like she has cushings so we should have another test which is similar but takes 3 blood tests and is a Lower dose? She the said if this still didn’t show cushings then we would just treat her for liver disease.

Does this sound right to you? My concern is that we would be paying out for medication to treat something which might not even be treatable? Ie a tumour etc. I know by not having further tests could save money but in the long run is it actually a good option?

I know it’s short notice but if any of you are able to get back to me tonight that would be fantastic as I have to take her in at 8am tomorrow for this test

We have already spent £185 on this test and treating her sore where she just has such thin skin that she had made it infected by licking so much. The test they are giving tomorrow is £100. The ultrasound would have been £65. So am concerned at how quickly this could spiral out of control financially.


Thanks

Rebecca

[labblab]

Hi again, Rebecca. The blood test you’ve got scheduled for tomorrow is likely the Low Dose Dexamethasone Suppression test (LDDS). It is known to return fewer “false negatives” than the ACTH. What this means is that if a dog truly has Cushing’s, the LDDS is less likely to miss making a “positive” diagnosis. So I believe I understand why this test is now being recommended for Ellie. In honesty though, depending on the results, you may still end up wanting an ultrasound, as well. But beyond that (and perhaps also a biopsy of her skin lesion), you should then have the information you need to make an informed decision. I know it is a burden to perform these tests upfront, but that way you should know what you’re dealing with.

If you have the time, can you add the normal reference range for those biochemistry results? That will allow us to see whether, and by how much, Ellie’s results were abnormal.

Thanks so much!
Marianne

[Ellieboxer]

Hi marianne

Thank you for getting back to me so quickly! The only page the vet showed us was the one with this information of and it says page 2 of 3 at the bottom which is annoying.

The albumin, creatinine, calcium and glucose are all in blood showing low under the alert column.

The ALT, ALK, GAMMA GT, CHOLESTEROL & Phosphorus are all in bold and show high in the alert column.

The pre ACTH is also in bold under high alert.

Does that help at all?

Thanks

Rebecca

[labblab]

Yes, that does help. Significant elevations in ALK along with milder elevations in the other liver markers can be found with Cushing’s. Elevated cholesterol is also common. So let’s see how the test turns out tomorrow, and we’ll go from there. Definitely let us know!

Marianne

[Ellieboxer]

Thank you that is really reassuring as we don’t have a massive amount of confidence in our vet to be honest. Will report back in a few days to bring the results ��

Feeling much more supported just from having you guys to talk to.

Thank you xx

[molly muffin]

Hi, just checking in to see how the testing went. :)

[Ellieboxer]

Hi molly muffin!

So yes the test results showed that Ellie has cushings. She has been prescribed vetoryl 50mg and has been asked to go back for a blood test in two weeks. Does that sound right?

How long would you usually expect it take to know whether she will respond to the medication?

[Squirt's Mom]

A 50mg dose is appropriate for a 50 pound dog. I looked back but didn't see where you have told us how much Ellie weighs - would you mind telling us her weight?

[Sullivan'smom]

I just wanted to send a quick note that I understand what you're going through. My boxer Sullivan is 13 1/2 and was just diagnosed. Thinking of you.

[Ellieboxer]

Sorry my reply didn’t post before! I can’t remember what they said her weight was but it’s 2mg a kilo I think and it’s 60mg not 50 I was wrong!

No improvement as yet 5 days in. She’s shivering a lot more too

[Harley PoMMom]

No improvement seen in drinking or hunger?

[Ellieboxer]

I think now she has slowed a bit on the drinking. I guess time will tell!

[Harley PoMMom]

Any amount of decrease in a symptom is a good sign! Keep us updated!

[Ellieboxer]

How do I upload pictures on here? 8m hoping to show you some pictures of Ellie’s skin to see if u think it’s calculis cutis?

[Squirt's Mom]

Go to the second post in this thread and you will find directions for adding pics to albums. Pics don't do well in the thread themselves.

http://www.k9cushings.com/forum/showthread.php?8321-How-do-I-add-a-picture-to-my-post

[Ellieboxer]

http://www.k9cushings.com/forum/album.php?albumid=1231

Let’s hope this works! Let us know the verdict! ��

[molly muffin]

One of our members mentioned her dogs lesions were doing well with using aloe vera on them, maybe give that a shot. Not sure that it really looks like cc, and I don't think they did the dermatology test for that right? But a skin biopsy would definitely show what is going on with those areas.

[labblab]

The black spots don’t look like Calcinosis Cutis to me, either. I think that hyperpigmentation can be caused by both Cushing’s and/or low thyroid, though, and perhaps that’s what’s going on with Ellie. If so, I think the issue is mainly just cosmetic, though, which is good news as compared to the discomfort caused by CC.

Marianne

[Squirt's Mom]

That didn't look like CC to me either and I agree with the hyperpigmenation for the dark spots on the belly. That is very common in our cush babies. NOT saying this couldn't be the very early stages of CC but it just doesn't look that way to me. I would seek out a derm vet if one is available in your area for an exam with then. Meanwhile here is a link that shows CC in detail - warning, it is not pleasant to look at some of the images but it gives a clear picture of what that condition looks like so you can compare.

https://www.google.com/search?q=calcinosis+cutis+dog&client=firefox-b-1&tbm=isch&tbo=u&source=univ&sa=X&ved=0ahUKEwi066vO86raAhWIslkKHWkRDOIQsAQIcQ&biw=1366&bih=603

[Ellieboxer]

Thanks guys! I found a Facebook groups for cc and they all said the same as you which basically tells me that we are not dealing with cc. Another lady said it looked like a MRSP bacterial infection that her dog had had and I looked it up and it does look similar so I think we will have to have another trip o he vets.

The money side of things is really getting me down now. We are paying a fortune in tests and medication for Ellie. I have two little girls 6 and 3 and it’s hard knowing all this money is gone which I could have spent doing things for them when considering her age and the fact she can hardly get up when you ask her to go out for a wee Ellie is unlikely to be here this time next year. I know it sounds really harsh I do feel terrible feeling like it - confessional over! ��

[molly muffin]

Don't worry, we've all been there were the money is tight and the guilt is great, if you spend it you feel guilty on what it could have been spent on and if you don't spend it, then you feel guilty for not doing so It's a no win situation, so best thing is to not think about that too much.

HUGS