13 year old dog with "Cushings Light" (words the vet used)- Jackson gained his wings

[jaxr0806]

Hi, I am Julie and my dog is Jackson. He is most likely a Corgi/English Bull Terrier mix but we don't know for sure. He will be 13 in May.

A year ago this past December (Dec '17)while getting a pre-op check prior to a dental cleaning he was diagnosed with elevated liver enzymes. I believe his ALP was over 1000. The vet postponed the procedure and we started him on Denamarin. It seemed to me that shortly after starting the supplement he started drinking more water. The vet did not think this was related to the Denamarin so he remained on the supplement and it did bring the enzymes down a bit. In June of this past year Jackson urinated in the house while my husband and I were away. We took him to the vet the next day thinking and praying it was a urinary tract infection and not something more serious. There were no sign of a UTI so they did an ultrasound to check out his organs and I believe at that time the vet saw a few nodes on his liver and said that was not unusual for a dog his age. The vet was leaning towards Cushings at this point so shortly after we had the LDDT completed. This is when she diagnosed him as "Cushings light" saying that his cortisol was elevated but did not stay elevated consistently so she did not want to start him on medication as it could push him to other way towards Addisons. We agreed to monitor him with a specific gravity test on his first AM urine every 4-6 weeks. The past two tests weren't where she would like him to be and he has urinated in the house twice in the past two weeks so we are going to have the LDDT re-done.

I just reached out to the vet's office today to request all of his lab/test results since December of '17 and will share those once I get them. I guess for now I just need some moral support as I know this is not going to be an easy road ahead.

Thank you.

[labblab]

Hello Julie, and welcome to you and Jackson. We will do our very best to answer your questions and, for certain, we’ll be here to offer our support!

That’ll be great if you can post Jackson’s test results. You don’t need to list every single number — what’s most important for us are any numbers that are abnormally high or low, along with the range of what’s normal for that particular value. Also, in addition to the excessive thirst and urination, are you seeing any other abnormalities with Jackson? Other common Cushing’s symptoms include excessive hunger, bilateral hair loss on the sides and/or haunches, hind-end muscle weakness, seeking out cool spots to lie down, and pot belly. Last but not least, has Jackson had any other significant health issues prior to this?

It’s true that the medications for Cushing’s must be monitored carefully. But we’ve seen many success stories here, and we’ll definitely be here to coach you every step of the way if Jackson does end up starting treatment! But first things first, so let’s see how these test results turn out.

In the meantime, once again, welcome!
Marianne

[jaxr0806]

Hi Marianne,

Jackson has always been very food motivated but there are times now when he is almost frantic around food. I would say he is a little pot bellied and I don’t know if I am noticing hind end weakness per se but sometimes a hind leg will quiver when he lays down. His only other health issue is hypertrophic cardial myopathy. He takes atenolol daily.


Thank you for welcoming me to the group and I will post his abnormal labs as soon as I get them.

Julie

[jaxr0806]

Hello,

It's been about a month since I've been out here. I was just on the phone with Jackson's vet. He had a follow up LDDS on Monday. She is still hesitant to start him on any meds and consulted with an internist who is leaning the same way. She feels that based on his results we would be walking a very tight line with the medication at this point. Here are his LDDS levels from June 2018 and March 2019

June 2018 - baseline 1.8, 4 hr 1.9 and 8 hr 2.2
March 2019 - baseline 3.8, 4 hr 2.5 and 8 hr 2.2 (it shows he is suppressing but not to within the normal range)

His ALP in June was 1058 and his ALT was 82.

I expressed to her that I definitely don't want to start him on meds if there is too much risk but I told her that he drinks and pees a lot. She suggested we measure his water intake over a 48 hour period and if it is in the excessive range for his weight we can discuss putting him on a very low dose of Trilostane. I would really like to improve the drinking and peeing as my husband and I both work outside of the home and while Jackson has had a few accidents in the house he really does a great job of "holding it" and I feel horrible about that.

I know I've seen this info somewhere but I am wondering what Trilostane costs (Jackson weight about 48 lbs.) and if it will provide enough relief from the drinking and urinating to justify the cost if he's not quite ready for meds.

Thanks!

[Harley PoMMom]

Was an UTI ruled out as the cause for the increased drinking and urination? Also, does he have a low urine specific gravity?

One thing you may want to think about doing is having an ACTH stimulation test performed to see if his body is producing excessive amounts of cortisol. I really would recommend not starting the Trilostane until a diagnosis of Cushing's is confirmed, which the ACTH stimulation test can help do.

Lori

[labblab]

Hello Julie, and welcome back to you and Jackson. I agree with Lori that it's always helpful to continue to rule out the presence of a UTI when excessive thirst and urination are present. But if there still is no UTI present now, just as there was not one last summer, then I'm very puzzled as to why your vet is minimizing the LDDS result as somehow being borderline or "Cushing's Light." For symptomatic dogs without other known/suspected illnesses, the LDDS is the "gold standard" in terms of canine Cushing's diagnostics. And Jackson has now tested positive twice on that test. Not "sort of" positive -- but positive. That is all the LDDS is designed to do. The result does not tell you how severely compromised a dog may be, or predict how he/she will react to medication — it just tells you whether or not the result is consistent with Cushing's, in general. And Jackson's result, twice, has been positive.

For some dogs, the LDDS is also able to give another piece of information. Depending upon the pattern of results, a pituitary tumor can be determined to be the likely cause of the Cushing's symptoms. However, in Jackson's case, either a pituitary or adrenal tumor could produce the results we've seen. That being the situation, an abdominal ultrasound probably would be the most helpful next step in terms of diagnostics. For dogs with pituitary tumors, frequently both adrenal glands show enlargement. If there's instead an adrenal tumor, you'd expect to see a lump or thickening one one of the glands, and the other gland may atually be smaller than nornal size. But Jackson has already had an ultrasound, and apparently there were no abnormalities seen related to the adrenal glands? Can you double-check the ultrasound report in order to see how the adrenal glands were actually described? Also, was the ultrasound performed at your regular vet's office? The reason why I ask is because the adrenal glands can be very difficult to see clearly using basic ultrasound equipment. Sometimes it takes high resolution equipment -- such as the equipment found in specialty practices -- to be able to visualize the adrenal glands clearly.

Additionally, as Lori says, you can certainly request an ACTH stimulation test in order to measure Jackson's actual cortisol reserves. If that test is also positive, that can give additional confidence in the diagnosis. However, one drawback is that the ACTH is more likely than the LDDS to give a "false negative" even if a dog does have Cushing's. It is especially vulnerable to false negatives for dogs who are suffering from an adrenal tumor. However, if nothing else, the ACTH will give you a baseline reading of the dog's circulating cortisol status, and this can be very helpful prior to starting treatment. The ACTH is the test that is given periodically to monitor medication effectiveness, and it can be helpful to know what the cortisol level is before giving the medication.

In summary, you may indeed wish to pursue a few more diagnostics. But since Jackson exhibits both symptoms and two LDDS results that are consistent with Cushing's, I think it's reasonable to expect that he truly has the disease (and not some "Light" version, whatever that means). If so, the question then shifts to whether or not you want to start treatment. The cost is not insignificant. Current recommendations for trilostane use are to begin dosing at a formula that doesn't exceed 1 mg. per pound. And it's certainly OK to start even lower. The rationale for this is that it is both safer and probably gentler on a dog's system with less risk of unwanted side effects to start at lower doses and work upwards if necessary, rather than vice versa. If you were to start with only a 30 mg. dose of brandname Vetoryl, the cost could be around $50 per month from select veterinary pharmacies. However, compounded versions of trilostane would be even less expensive. The monitoring blood testing must also be factored in. However, that is more frequent at the start of treatment and tapers off once a dog is stabilized on a specific dose.

Given Jackson's age, your treatment considerations may be largely focused on his quality of life. For younger dogs, you want to halt the progression of systemic damage that uncontrolled high levels of cortisol can cause. But for older dogs, my personal opinion is that you are weighing the discomfort of the symptoms vs. the risk of medication side effects, and the stress that may be associated with the need for frequent vet visits and monitoring tests. And, of course, the costs for the owner. In the case of my own older Cushpup, his Cushing's symptoms made him so uncomfortable (ravenous appetite, excessive thirst/urination, panting, muscle wasting, hot all the time, couldn't climb stairs or tolerate even short walks), that treatment was a no-brainer. But if Jackson doesn't appear to be suffering very much, then you may indeed choose to hold off on treatment for now, or forever. That is really a judgement call that you are the best one of all to be prepared to make. So please do continue to ask us any questions that come to mind as you continue to sort through your options.

Marianne

[jaxr0806]

Lori and Marianne - thank you for your replies.

I hope we didn't jump the gun (based on your suggestions to retest for a UTI, which we did not do) but we started Jackson on Trilostane this morning. After measuring his water intake over a 48 hour period Sat AM to Mon AM (he is 47-48 pounds and drank 170 oz of water) the vet recommended we start him on the Trilostane. He also had another accident in the house on Friday while we were at work. She prescribed 50 mg once a day and it is a liquid suspension formulation that a compounding pharmacist filled for us.

Marianne - to answer a couple more of your questions...Jackson did have an ultrasound of the adrenal glands at his regular vets office and there was some enlargement but no tumors. As for him suffering, I know most dogs are pretty stoic when it comes to illness so I don't really know how much he is suffering but he does pant and spends a lot more time laying on the hardwood or tile floor than in his bed which I attribute possibly to him being hot. I think I commented in an earlier post that he has always been very food motivated but he is now frantic around food. I timed how long it took him to eat his breakfast the other morning and it was just over 1 minute. We may end up buying one of the slow feeding bowls. The most prevalent symptom is the drinking/urinating. He is up drinking multiple times during the night and I know this because I am a light sleeper and I wake up and hear him. Some times it sounds like he is drinking his entire bowl and then I toss and turn wondering if I should get up and take him out to go to the bathroom. My husband sleeps very soundly and doesn't hear any of this so it impacts me more than him.

We are committed to giving him the best possible life for as long as we can so we are hopeful that the meds will give some relief from the drinking and urinating, panting and his ravenous/frantic behavior around food.

We will be monitoring him for any side effects and have an ACTH scheduled in 12 days.

Julie

[labblab]

Julie, thanks so much for updating us. Given Jackson’s total symptom profile and two “positive” LDDS results, I do agree that Cushing’s seems likely and we’ll certainly be wishing you guys good luck with his treatment. The 50 mg. dose sounds good for a 48 pound dog, as does the ACTH testing in 12 days. So I think you’re off to a good start! I know you’ll be watching carefully for any side effects, and with the liquid suspension, you can easily adjust his dose if it ends up being warranted.

Just a couple of tips... I want to make sure you’ve been instructed to give the trilostane along with breakfast. The medication must be given along with food in order to be metabolized properly. This is also the case on the day of the ACTH test — Jackson should not be fasted on the day of the test, and the testing should take place 4-6 hours after eating/dosing. Here’s a helpful link that summarizes some of this same information:

https://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)

So once again, good luck and please let us know how you are doing!
Marianne

[jaxr0806]

Newbie here - trying to figure this all out.

So I called the vet's office to schedule Jackson's ACTH at 12 days but they won't schedule it on a Saturday so I am thinking of moving it up a day. I would rather get the results earlier than later if there is any chance of him being over-medicated. I was told to drop him off before work and pick him up after work. I said I did not want to leave him there all day and that I was under the impression that if he had breakfast at his usual time of 6AM that he should be done by noon at the latest. The receptionist spoke with a tech who said the first blood draw would be 4-6 hours after he took his meds and then an hour later would be the second blood draw. If they wait until 6 hours to do the first draw then the second draw is 7 hours later - isn't that too late? Also, I thought the draws were supposed to be two hours apart not one hour.

Please set me straight. Thanks.
Julie

[Katy1]

Hey Julie, It’s me Karen. I know I ‘m knew to all this too but my advice would be to take one for the team and leave Jax at your vet for the day if you can to really obtain an accurate level. With the low dose test, they do administer the stimulant and do a first draw after 4 hours—- then they do another draw after another 4 hours. So yes Jax will have to be there all day. It’s really worth it if you can do it because it will give you and your vet the most accurate reading, especially if it is his first. My only question is, has he reached his fully “loaded” level and now you’re on a maintenance dose? Annie is on Lysodren and I won’t even pretend to know anything about Trilostane.

Listen to the others here before me. There is a lifetime of experience to learn from. I’m rooting for you because you’re basically a neighbor I haven’t yet met. Blessings. Karen

[labblab]

Hi, Julie. You are correct in your understanding that for dogs being treated with trilostane, the monitoring ACTH test ought to be completed within a time frame of 4-6 hours after dosing with breakfast. So I see no reason for Jackson to be stuck at the vet’s office all day. Just to clarify, though, the test only takes one hour to perform in the U.S. In Canada, readings are taken at both the 1-hour and 2-hour marks. But here in the U.S., there is only one hour between the baseline cortisol blood draw and the second blood draw subsequent to the injection of the stimulating agent.

Since you seem to be getting questionable information from the vet tech, this is a situation where I would insist on talking directly with your vet prior to the test. This test is too expensive and too important to be performed incorrectly. And there’s also no need to put Jackson through unnecessary stress by extending his length of stay at the vet’s.

Karen, I think what you’re referring to is an initial diagnostic LDDS test. That test does indeed take eight hours to perform and involves a full day at the vet’s. However, once treatment has begun with either Lysodren or trilostane, the monitoring test is the ACTH stimulation test. So when Annie is tested, it will also only involve a one-hour test for her, as well. However, since she’s taking twice-weekly maintenance Lysodren as opposed to ongoing daily doses of trilostane, that 4-6 hour testing window after dosing is not applicable. With Lysodren, I think you can test at any time of any day that suits your schedule.

Marianne

[Katy1]

Hi Marianne, Thanks for providing Julie with the correct information for her pup. I always learn from my mistakes and one of these days, I’ll learn to keep my thoughts to myself especially when I keep realizing just how much I DON’T know about this disease.

Sorry Julie if I made your anxiety worse! My own anxiety tends to trigger the ‘over-zealous’ part of my personality. I know you are doing everything you can for Jax and these great people here willl guide you in the right direction. I told you I was a worrier and over-thinker. I promise from now on, I’ll just worry and over-think about my own little baby. Karen

[labblab]

Karen, there’s no need at all for you to just stick to talking about Annie — the mutual support we get from joining other members’ conversations is what makes a forum like this so helpful! We all have the chance to expand upon or clarify info in replies. Trust me, I’ve had to come back and correct or update plenty of information of my own. Truly. But there’s always mutual learning that comes out of the process. And for another member, just knowing that you cared enough to take the time to add a reply can mean the world. So don’t “clam up” on us, girl! We welcome your replies everywhere ;-).

Marianne

[jaxr0806]

Hello wonderful K9C friends. Just sharing an update on Jackson because it helps me process everything. He has had six doses of Trilostane so far. It does seem like he is drinking less - is it too soon for that to be happening? That is my stress, wondering if the dose is too high. His poop was bit soft today but not diarrhea. He is scheduled for his ACTH on Friday so I am just praying he stays stable until then. I’m sure it is wishful thinking but it would be great if this was his right dose and we don’t need to play around with it.

Have a great week everyone.

[lulusmom]

Hi, Julie, and a belated welcome to you and Jackson.

I just wanted to mention that a peer reviewed study and the vast experience of renowned veterinary teaching institutions across the globe suggests that larger dogs (>44 lbs) can be more sensitive to the drug and require much smaller doses to effectively control cortisol. For instance, UC Davis California, Zurich University and University of Utrecht would have prescribed much lower starting doses for Jackson, none of which would exceed 30 mg. Most general practice vets are unaware of this and unfortunately Dechra US confirmed that they have no active submissions to FDA to revise their dosing recommendations, despite this science based evidence. My concern for Jackson is that you are noticing mushy stool and this could be a sign that 50 mg may be too much for him and cortisol could be dropping too low. Please keep a close eye on your boy and if his stool gets worse or he starts to show any disinterest in food, I recommend you stop treatment and contact your vet. Hopefully he just had a bad one off bowel movement and things will go smoothly until the acth stimulation test on Friday.

Glynda

[jaxr0806]

Hi Glynda. Thanks for expressing your concern. I did read somewhere about the lower dose in bigger dogs but I thought it was a weigh range higher than Jackson’s but I’m sure I am misremembering. Today on his AM walk and his PM walk his stool was perfectly normal. He still has a very hearty appetite. My husband and I have always said that when he doesn’t eat we will know something is very wrong. Counting the days until Friday.

Thanks again! Julie

[Katy1]

Hi Julie, Annie and I will be thinking of you guys the rest of this week. Annie gets a much needed groom in the morning, and I'm stressing about that! I've also been doing the poop check on a regular basis with her. I just feel so paranoid most of the time! Good luck, well wishes and good thoughts are coming your way. Let us all know how it goes on Friday. Karen

[labblab]

Hi Julie! I’m really glad to hear that Jackson returned to normal again, and I surely hope that remains the case. We’ll all be anxious to see how the testing turns out on Friday, and I’m hoping you’ve been able to straighten out the testing protocol with your vet: testing to be completed 4-6 hours after dosing with breakfast. One other advance comment about the testing — unless Jackson’s dose seems to be too high and needs to be lowered, current recommendations are to leave the trilostane dose unchanged for the remainder of the first month of treatment. This is because cortisol levels often continue to drift downward during that first month, even on the same dose. Therefore, it’s usually better to hold off on any dosing increases until the second monitoring ACTH is performed and there’s greater confidence that the cortisol level has truly stabilized.

I do want to comment on the issue of larger dogs often needing smaller doses of trilostane to maintain effective control. Like you, my reading had led me to believe that the weight “cut-off” that was cited in the research study is heavier than Jackson’s weight. I had seen >66 pounds cited, which is why I felt comfortable with Jackson starting off at the 1 mg. per pound formula. But Glynda’s point remains very well taken, that any time an adverse reaction is seen in a dog taking any dose of trilostane, there is cause for caution. And I’m reaching out to her to see whether perhaps the >44 pound guideline represents a newer revision in the research findings.

In the meantime, I hope that all is going well for you guys, and that you may even be seeing increasing improvement in Jackson’s symptoms. You had asked earlier whether six days was too early to see improvement in his drinking, and the answer is “no.” Improvements in thirst, urination, and hunger can be the earliest symptoms to show improvement. So we’ll hope the trend continues. Do let us know!

Marianne

[jaxr0806]

Hello and Happy Monday! The first ten business days of every month are my super busy time at work so I haven't had time to be on-line for anything not work related.

So Jackson had his ACTH back on 3/29. That morning started out traumatic for both of us. I was dropping him off by myself in the AM and my husband was picking him up in the afternoon. Well, Jackson did not want to get out of the car. If I opened the door on one side he would go to the other side of the car. Then he managed to jump from the back seat to the front seat (remember he is part Corgi so he is vertically challenged) and when I opened the front passenger side door he jumped over the console to the drivers side seat. He has never responded this way to getting out of the car. I went into the vet and got some treats and I eventually got him out of the car but it was upsetting to both of us.

The test was on a Friday and the vet called on Saturday when I was in the car driving so I wasn't able to write down his results. They were supposed to be e-mailed to me and I have yet to see them. The vet dropped his dose from 50mg to 40mg and asked us to monitor his water intake again that weekend and call with the results on Monday. His consumption was definitely down from before he started the meds. I am a bit frustrated as I have yet to talk to the vet since providing her with the water results (a week ago). I played phone tag with a tech last week and in one of the messages she indicated that the vet had reached out to a specialist and would call me after she was able to speak with the specialist. I am a bit frustrated right now.

Jackson seems to be doing ok. He still has his appetite and is drinking less but we've noticed some whimpering that we can't relate to anything specific.

Sorry if I am rambling but honestly I feel like this is my first opportunity to collect my thoughts around this since the morning of the ACTH.

[Harley PoMMom]

Please get those test results and post them, the fact that the vet dropped his Vetoryl dose has me worried that his cortisol has dropped too low.

[Katy1]

Hi Julie,

It was so good to see your post just to know you guys are hanging in there. I have been through the "dog doesn't want out of the car" scenario a couple of times and I really felt for you!

I can't really add any med advice since our pups are on different drugs, but I can send you all the virtual hugs in the world. You must feel soooooooo frustrated in not being able to talk to your vet in person. I hope you get some answers soon.

Anyway, as long as Jackson is eating and drinking ok, maybe you can tell yourself it's been mostly a good day, or a better day. Blessings to you and your family. Karen

[jaxr0806]

Hello friends. I am finally getting a chance to sit down and share the ACTH results for Jackson.
Pre - 0.4
Post - 3.3

When I finally was able to speak with the vet I was in a store and was writing notes on an envelope from my purse and now I can’t find the envelope. UGH! I do remember that she said to keep him on 40mg and we would redo the ACTH in 6 weeks but to definitely watch for the side effects.

I think Jackson is experiencing senior anxiety and we aren’t getting much sleep. This is not new it just seems a bit worse recently. He licks everything and recently he developed a small wart on the top of his foot which he is now licking obsessively. We talked to the vet’s office last night and until we can get him in (which might be today or could be Monday) they suggested putting a cone on him so now he is banging around the house in a cone looking miserable.

I know you can all sympathize with me but I am just feeling tired and overwhelmed right now. And it is hard to know what is age related and illness related in Jackson. Sigh!

[labblab]

Hello friends. I am finally getting a chance to sit down and share the ACTH results for Jackson.
Pre - 0.4
Post - 3.3

Hi Julie, and thanks so much for posting these results. However, they have me concerned. If I’m remembering correctly, Jackson had been taking the trilostane for only about ten days when this test was performed. The “post” number is right within desired therapeutic range, but the “pre” or resting cortisol number is very, very low. If his resting cortisol keeps consistently running that low, it would not be at all surprising to me if Jackson’s daily behavior is altered in a negative way.

Since the test was performed after only ten days of treatment, we can assume that even had the dose remained unchanged, Jackson’s cortisol would continue to drop through the first month of treatment. Your vet has made only the very modest dosing drop down to 40 mg. from 50 mg., so I’m worried that this is still too high a dose for Jackson’s comfort and safety. Our staffer, Joan, just received almost identical monitoring ACTH results for her Cushpup, and the specialist with whom her vet is consulting recommended that the trilostane be halted entirely for the moment.

If Jackson were mine, I would want to lower the dose more dramatically — down to no more than half what you were giving previously. Also, the next monitoring ACTH should not wait for six more weeks. Virtually all specialized clinicians as well as the manufacturer of brand name Vetoryl state that a monitoring test should be performed at the 30-day mark after treatment has begun. In Jackson’s situation, given these ten-day results, I think it’s imperative to retest again at that time, rather than later. When you go in to the vet today or Monday, I think it’s important to discuss both the dosing and the testing timeframe in more detail with your vet. It is always better to err on the side of caution if the risk of cortisol dropping too low seems more likely.

Marianne

[Harley PoMMom]

I agree with Marianne, those results are low for a dog taking Trilostane for only 10 days, and as Marianne mentioned, the cortisol can continue to drift downward for the first 30 days of treatment. If this were me, I would definitely want the Vetoryl dose lowered to 20 mg once a day and have him retested in 2 weeks.

Lori

[jaxr0806]

Hello,

I’m sorry I haven’t been out here updating in quite a while. Hope everyone is doing well. I am hoping to get caught up on everyone’s threads this weekend.

Things on the Cushings front are going well but we’ve been dealing with some other issues with Jackson. Jackson’s last ACTH results were pre=1.7 and post 3.2. His thirst and urinating are back to normal but he picked up giardia at the end of April/beginning of May and it has wreaked havoc on his intestines. He did two rounds of antibiotics before the parasite was gone but now he is on a probiotic because the good and bad bacteria are out of balance. Hopefully we have him on the mend but it’s been an uphill battle.

Have a good weekend everyone.

[labblab]

So good to see you guys back again :-), but I’m so sorry about Jackson’s giardia :-(. I know that can be a bear to treat. Not only from the bug itself, but also from the antibiotics. My nonCushing’s girl was on a week of protective antibiotics after a dental cleaning a couple of weeks ago, and her poops have been “off” ever since, too. The probiotics are a good idea — I probably should think about getting some for my girl.

Meanwhile, though, those ACTH results are great! So hopefully once you get the GI issues cleared up, Jackson will be feeling a whole lot better.

Do keep the updates coming!
Marianne

[Katy1]

Hi Julie,

I just wanted to jump in here to say hi. So sorry to hear about Jackson's latest struggles but hopefully he's on the mend. I know this hasn't been easy for you either. Just wanted you to know I have been thinking about you guys and sending healing thoughts your way. Blessings, Karen

[jaxr0806]

Happy New Year everyone.

It has been quite a while since I’ve been on the forum. When I look at the date of my last post I know why. June is the month my dad was diagnosed with mouth cancer. He had surgery to remove the spots on his tongue. It had not spread anywhere else and he is doing well. Then there was some stuff going on with my nephew and then the holidays. But I am glad to be sitting here now with my cup of coffee, reading the forum and getting caught up.

Jackson is doing well for an almost 14 year old Cushings pup. There has been a lot of playing around with his Trilostane dose as his potassium was elevated. He is currently on a pretty low dose but it is still controlling the drinking and urination and his potassium is coming down. It’s been a cycle of changing dose, waiting 3-4 weeks, go in for tests, changing dose, waiting 3-4 weeks, go in for tests. He will have more labs in a week or two and I’m hoping his potassium is normal and we can stay at the current dose. Other than that he is doing pretty well. He does have some aches and pains in his back legs but we started him on Galliprant and the legs seem to be doing better.

Have a great Sunday everyone and I’ll be checking in again soon.
Julie

[labblab]

Julie, thanks so much for your update! Gosh, I’m so sorry for all your worries during these past months. But it’s so good to hear that Jackson is holding his own. Yay!!

Please do continue to let us know how things are going for you guys, and Happy New Year!
Marianne

[jaxr0806]

Hello everyone! Hope you are all well and are getting by ok in this bizarre COVID world we now live in. Luckily my husband and I are both still working and haven’t been impacted in that regard other than being remote. Jackson is still doing well on his Trilostane but his musculoskeletal system is starting to fail and I believe he has some doggie dementia. He turned 14 in May. Our vet mentioned a drug called Anipryl for the cognitive issues. I’m wondering if anyone has an experience with the use of that medication in their senior dog. Also she mentioned laser therapy, acupuncture and some hydro therapy for his back and legs. I’m torn about doing all of that and my husband says straight out “no”. We would have to take him to therapy twice a week which is at his vets office and he is frantic when he gets in the building. My husbands says why would we stress him out like that. And I get that but I feel if we can relieve some of his discomfort it would be worth it.
Looking forward to the experienced words of all the great members of this group.

[Katy1]

Hi Julie! Good to hear about Jax but sorry to hear he is having problems. I haven’t posted on the the site for months, only because Annie has been stable and I guess I didn’t want to jinxed it. I hope you guys are ok in Chicago. We are just holding our breath here in Spring Valley. Blessings, Karen

[jaxr0806]

Hi Karen. So good to hear from you and to hear that Annie is doing well on her meds. I searched through posts yesterday to see if I could find a recent post from you and see how Annie was doing. Jackson is my first dog as an adult and I will be honest, I am struggling watching him age and wondering if I am going to know when life becomes too hard for him. I have a lot of cries just anticipating that awful day. Ok, that is too much heavy stuff.
I’m surprised to hear you are still in Spring Valley. I thought you were planning on moving back closer to grandkids.

[Squirt's Mom]

Hi Julie,

Good to hear from you and Jackson again!

My Squirt developed dementia in her latter years and it was heartbreaking to watch. The worst was when late afternoon and evening came. She had what in humans is called "sundowners" which caused her to be extremely restless and disconnected. She would pace for hours on end even tho I could see how badly it hurt her to keep moving....she simply couldn't stop until she was exhausted. Then often as not, she'd rest a bit and be back at it for a few more hours. I couldn't reach her at all during this either, it was like she couldn't see or hear me. She was 15 when this started. We did use Anipryl and it helped a little bit but what really worked was an OTC product that is sadly no longer available called Novifit. It was a stable SAMe, meaning it could be taken with food for one thing. I called the company and asked them what made their product different from regular SAMe and they explained that it had to do with the molecules. I sat on my end of the phone and nodded "sagely" but didn't understand a word other than it was something about the way the molecules were arranged that made it different from the typical SAMe. I just googled to get some info on it for you and find that the company that makes it, Virbac, has kept the trademark current and some sites are saying it is available only thru a veterinary prescription now. But others still say it is unavailable. It is referred to as Novisame now too so hopefully these small changes mean something positive. I would contact Virbac and talk to them. It was a miracle for my Sweet Bebe! I will tell you that it did not work for all dogs tho. But I used it in two of mine and in both it worked like a charm. So it is worth looking into. I would also ask Jackson's vet if they know anything about it or would see what they could find out about it. Here is a link that give contact info:

https://www.drugs.com/vet/novifit-s.html

I also gave a product called PS100. Here is some info on it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966935/

As for the therapy for muscle improvement, I would check and see if there was something available in your area that could do hydro especially that was not in a vet setting. Some place that he wouldn't associate with the vet at all. Some areas have these sort of spas for dogs I guess you could call them that do offer hydro, massage, and other things that might help without causing him added stress. We were lucky in that we had an above ground pool we could use and it did help. Squirt hated it but it did help quite a bit to build up a little mass and help her have better control. I would carry her to the far side of pool, let her go and do my best to beat her to the other side where we would start all over. :D

Let us know how he's doing and especially if you learn anything about the Novifit/Novisame!
Hugs,
Leslie

[jaxr0806]

Leslie, thank you so much for the info. I will definitely be looking into the meds. I believe Jackson is experiencing Sundowners as well. He gets very anxious in the early evening and paces and whimpers for what seems like an eternity. I do feel Jackson would benefit from some therapy so think I will also see if there is an alternative to therapy that won’t be at his vets office.
Thank you again. This is such a great group to be a part of. I know I will always get knowledge and kind words.

[Katy1]

Hi Karen. So good to hear from you and to hear that Annie is doing well on her meds. I searched through posts yesterday to see if I could find a recent post from you and see how Annie was doing. Jackson is my first dog as an adult and I will be honest, I am struggling watching him age and wondering if I am going to know when life becomes too hard for him. I have a lot of cries just anticipating that awful day. Ok, that is too much heavy stuff.
I’m surprised to hear you are still in Spring Valley. I thought you were planning on moving back closer to grandkids.


Hi Julie

OMG! You just took the words right ought of my mouth! Annie is 12 now,by the grace of GOD, but she has been through the worst of it and she still wants to go for rides in the truck with her dad to Starved Rock.
I “m so glad you posted your fears because those are what I think of every day.

Annie also has cataracts and will see her eye doc in Elgin,Il next Mon. I’m hoping for the best, which is stable. I won’t go because of COVID. When Jerry gets there, he phones in and they will pick Annie out of the truck and bring her back when she’s done .


We are still planning on moving back to Kansas City when it is safe. I just cannot get my head around this virus stuff. We are so safe it’s laughable. Yesterday Jerry was working in the garage and he had a phone call on our home phone. Well I put on my mask, hand him the phone with gloves on , and he just looked at me like I was an idiot-which I was. I’ll own it.

Anyway, back to Jax, you mentioned a med I never heard of and I wrote it down to ask my vet—I have noticed trembling in her hind legs. I’m just like you Julie—Blessings to you and your family. Karen

[jaxr0806]

Hi Everyone -

I've been struggling to sit down and write this post but I am hoping it will be cathartic. Our little Jackson gained his wings on 2-14-21. He would have been 15 in May and we had him for 14.5 of those years. We helped him pass at home in his bed on his favorite blanket. That day and the day before we ate cheeseburgers and ice cream and gave him as much love as we possibly could. It was as peaceful as the worst day of my life could be.

Life was getting harder for him which was making his anxiety worse. His sight was going, we don't think he could hear much and his back legs were SO weak. He had been using a ramp to get in and out of house since late summer because he no longer could navigate the stairs. He started declining more rapidly in December. His legs now couldn't support him long enough to finish his meals. It was really hard for him to get up and out of his beds. He would fall and then panic and howl when he couldn't get himself back up. He was starting to lose control of his bowels and would occasionally poop in his bed when he was sleeping. He also had canine cognitive dysfunction which the vet wasn't really treating because his liver was too compromised for most meds. We did our best with CBD and melatonin but it wasn't very effective. Most mornings he was up between 3 and 4:00 and there were many nights when he would pace, pant and whimper for hours on end. It was hard to see him struggle but I wasn't ready. My husband and I were having the hard conversations but it took a trip to the vet for a previously scheduled senior check up to snap me out of my denial.

Due to coronavirus, a tech came out and got Jackson along with a long list of items written on a piece of paper, that I wanted to talk to the vet about. We stayed in the car waiting for the vet to call us when she was with Jackson. The tech came out fairly quickly after taking Jackson in and she said the doctor wanted us to come in. When we met her in the exam room she said she wasn't going to put Jackson through any type of exam, blood draw or anything else that was going to stress him out more than he already was. She said there was no reason to. There was nothing medically that was going to bring back his quality of life. I started crying (ok, lets be real I was bawling). My husband inquired about in home euthanasia, she recommended we start tracking the number of good days versus the number of bad days, but honestly that day is a blur.

We gave ourselves a few more weeks with our little guy but when the bad days started to outnumber the good we didn't want to see him suffer any longer. I am definitely struggling since his passing, feeling guilty and questioning if there was more we could have done but I know deep down in my heart that we gave him the best life possible and it was time.
I apologize for any missing words or typos. It's hard to see the screen through my tears which have been falling since I typed the first word.

I am so grateful I found this group when we were trying to figure out Cushings. It is a wonderful source of information, love and compassion. I can't thank you enough for guiding us through the tests and trials of living with a Cush pup. I'll still be out here following along with everyone's journey and prayer for the well being of all the pups and those of us who love our pups beyond words.

[Joan2517]

I'm so sorry, Julie...I'm crying reading this. You did everything you could for Jackson and he knew you loved him, that's what matters more than anything. Making that decision is just so hard and when you were ready, you let him go.

[jaxr0806]

Thank you for the kind words Joan. Every day I feel like my heart heals a bit.

[Joan2517]

That's good...you will be able to remember and smile. It took me years, but I can. I still cry for Lena a lot, but it has gotten easier. Sometimes it's harder, but I've gotten used to missing her. There are days when it still hits me so hard that I can't talk about her, but then there are others where I want to talk and hear what everyone else remembers about her. She was a huge part of my life and I will always love her.

[labblab]

Oh Julie, I’m so sorry, too, for your loss! We so appreciate you coming back to tell us, though, and I do hope that having the chance to write to us may have brought you at least a bit of comfort. When I lost my two babies through my years here, I know that coming here to share my grief was one of the few things that did help me to ease my burden of sorrow and regret. So I hope the same will be true for you. I don’t think it’s humanly possible not to feel regret and not to second-guess our actions. But as Joan has said, all your decisions for Jackson were made out of your love for him, and you were doing your very best to keep him as happy and healthy for as long as you could. No doggie could ever ask for more.

Although his passing is so sad, we are grateful to be able to join you in honoring Jackson here on our special memorial thread of honor:

https://www.k9cushings.com/forum/showthread.php?9294-Remembering-All-Who-Have-Left-Us-(2020-2021)

If it would please you, it would be our privilege to add a photo link to his memorial line. Whenever you might wish to do so, you can send us a photo at k9cushings@gmail.com, and we’ll take care of the rest.

In the meantime, I truly hope your loving memories will keep Jackson forever alive in your heart and in your mind’s eye. Now that his spirit has been released, I hope the picture you’ll always envision is him running strong and free, healthy and whole.

Sending many hugs to you from across the miles, Julie. Thank you so much for all of your kind words about our group. And please know that we’ll always be here for you, any time you want to talk.

Marianne

[Harley PoMMom]

Dear Julie,

I am so sorry for the loss of your beloved Jackson and my heart goes out to you and your family. Please know we are here for you and truly do understand the pain you are feeling. Sending tons of loving hugs your way.

With Heartfelt Sympathy, Lori

[jaxr0806]

Marianne,

Thank you for the kind words of support. I know so many of us here know the pain of losing a much loved pet. I recently started going through pictures so I can memorialize him at home and I will definitely find a favorite to send to share on this site.

Keep doing what you guys do. It is such a valuable resource.

Julie

[jaxr0806]

Thank you so much Lori. I felt like I was coping a bit better last week but my husband left to go out of town last night. It is my first long stretch of time in the house alone without my boy and it’s really quiet and lonely. I do truly appreciate this site and everyone’s support. I know time will heal my heart and my tears will become smiles when I think of my Jackson.

[Harley PoMMom]

It does take time to heal one's heart after losing your furbaby, please do not ever feel that you have to rush your grieving. We are here to listen and to virtually hold your hand. Come talk to us whenever you want.

(((Hugs)))
Lori

[Katy1]

Hi Julie,
I haven’t checked this site for maybe over a year and was so sad to read of Jax’s passing. I know how hard it was for you and your husband and I hope the wonderful memories of your “boy” will replace these painful days soon. We are still in Spring Valley and Annie is still with us. Take care and Blessings to your family. Karen

[Squirt's Mom]

Dear Julie,

I am just so sorry to learn of our precious Jackson's passing. He had such a wonderful life with you, one he could not have had with anyone else I am positive. You gave him the safe place he needed and a love that will last thru eternity. My beloved Squirt has been gone almost 7 years and at times I still go thru those terrible "what ifs", questioning nearly everything I did and didn't do over her 16 years and more times than not finding plenty to feel guilty about even tho in my heart of hearts I know it's not deserved. Those thoughts and times are part and parcel of grief and for me they ebb and flow always. Please don't let those thoughts get the better of you either; you deserve that no more than I. Jackson knows you did all you could for him and he left this life carrying the love and security you gave him in his heart. One day you will see him again, I firmly believe this, and when that day comes the two of you will never again be parted.

Please know we are here anytime you need to talk....we do understand.
My deepest sympathies,
Leslie


TAKE JOY IN.....OLD DOGS

Their joys are simple. A soft bed. A scrap fallen from the table that the younger dogs missed. The memory of a treed squirrel. A stormless night.

White whiskered faces and legs crooked as question marks.

Old Dogs…their sweet Buddha bellies hang over crossed legs as they fall asleep in a coveted patch of sun. Dreaming of out-racing their shadows down long, shady lanes.

Once they danced by your side. The very definition of joy unleashed. A perfect poem caught in shining eyes and wagging tails. They have followed you faithfully for years. And would plunge into fires, untamed wildernesses, raging waters if you asked.

Now, they struggle to catch up. Their pace slow but their hearts still valiant.

Their cloudy eyes are starting to dim and go distant, tuning in to some invisible world. Just beyond your reach.

Don't go you say, as you scratch the tender part between their ears. Stay longer. I can't imagine a world without your fur pressed close to my cheek. There are still so many roads we haven't explored.

And they look up at you with a wisdom that just slays you.

Their backs are bent, not from the weight of years, but from the invisible wings they are growing

That will soon take them to a place where once more they are warriors of speed

Drunk with the sights and scents of a thousand meadows.

Able to leap high enough to touch the wing of the tiniest butterfly.

A place where they will now wait for you to catch up.

by Donna Swajeski

[jaxr0806]

Karen, good to hear from you and so glad to hear Annie is doing well. Thank you for your kind words. I am still struggling with Jackson’s loss. My logical side knows that he wasn’t living he was just existing but then I question if there was more we could have done for him. I don’t think our vet was very knowledgeable about Canine Cognitive Dysfunction (CCD). I found a Facebook group for CCD support and I now know there are more prescriptions and supplements we could have tried but who knows if his liver could have handled all of that. I need to stop beating myself up. Any additional time we would of had with him still wouldn’t have been enough or made that final day any easier. Take care and give your little Annie some extra love from me.

[jaxr0806]

Leslie,

Thank you for sharing that beautiful ode to “old dogs”. It is all so very true and touching. And thank you for all the words of support. I finally dreamt of Jackson last night. In the dream he wasn’t old, frail and grumpy. He was spry and happy and we were walking at the church that is across the street from our house. I was hoping and praying he would come to me in a dream and I am so glad he did but it stirred up all sorts of emotions today. I know it’s a process and some days are easier than others. Thanks again. I’ll be out here, following along with all the Cush pups and their loving and devoted families.