My Son... Bentley. How can I help my boy? ~ Bentley has passed

My son, Bentley was diagnosed with Cushings a few years back. He is a male maltipom of 13 years. I love him more than I could ever express. He has been with me through thick and thin and I can imagine my life without him.
https://photos.app.goo.gl/g4iwF6tRQUbbpJp47

His hair is thinning everywhere, especially on his tail and neck area. He is about 15 lbs and does have a little potbelly.

He drinks a lot of water at each sitting. We feed him Fromm reduced activity senior dry food.

He likes to chew on thin/skinny bully sticks.

His vet put him on Vetoryl (5mg capsules) years ago. Twice a day, but we only give him one a day as it's so expensive and two didn't seem to be making any difference.

I also give him 3mg of melatonin at night since I give him the Vetoryl in the morning.

He is active, still plays and is lively, but I don't feel that his Cushings is under control.

What can I do to help my boy? I just feel helpless and know he could be doing better.

Thank you!

Welcome to you and Bentley! I’ll come back later to write a lengthier reply, but I didn’t want to waste any time telling you that your membership has now been approved and that you can continue to post at any time that you wish. We’re very glad you’ve found us, and we look forward to learning more about your precious little boy.

Once again, welcome!
Marianne

OK, here I am back again. Once again, welcome to both you and Bentley. It’s clear that you love him very much, and we’ll do everything we can to be a help to you. In order to be the most helpful to you, though, it’ll help us if you can give some additional background information. It sounds as though Bentley was initially diagnosed and started the Vetoryl quite some time ago. From your description, he does exhibit some outward symptoms of Cushing’s, but did abnormalities in his labwork and diagnostic blood tests also support the Cushing’s diagnosis? Also, has he had periodic monitoring blood tests in order to see what effect this dosage of Vetoryl is actually having on his cortisol level? Any specific numerical testing results that you can give us will be much appreciated.

In the meantime, it sounds as though his thinning coat and excessive thirst are his major issues. Otherwise, he sounds as though he’s generally doing well. At age 13, I’m guessing that we can consider Bentley to be in the midst of his senior years? If so, my own thought is that our main goal with Cushing’s treatment is to ease any symptoms that are making him uncomfortable at this stage of his life. You are the best judge of his comfort level right now. If overall he’s doing well, then perhaps you don’t want to rock the boat at all right now. But if you think he could be feeling better and if Cushing’s has been confirmed to be the cause of those symptoms, then the key question is whether or not his current dose of Vetoryl is optimal. For the sake of both safety and effectiveness, this will require blood testing.

If it turns out down the road that a higher dosage of Vetoryl is required, we can offer you some cost-saving tips. Oh, and also, is Bentley currently getting his daily Vetoryl dose along with breakfast? In order to be metabolized properly, that medication must be given with food. Please do tell us as much as you can about Bentley’s health and testing history, and then we can brainstorm some more.

Marianne

Thank you so much for reaching out.

Yes, he has had blood tests and was officially diagnosed with Cushings. He had a blood test recently and showed he was within levels. I will have to see if I can get the numbers from that test and provide them.

He seems to be pretty good, but his thinning coat really concerns me. Is there anything that can help with that? I do give him his Vetoryl with a piece of a hot dog to help him metabolize. Is that enough or does he need more food with it? He just grazes his food throughout the day and I hide the pill in the piece of hotdog for him to take it.

I have tried giving him 3mg of Melatonin at night as well. Not sure if that helps, but I have read it possibly can.

I've also noticed over the past week or so he has developed Kennel Cough (kind of coughing like a seal) and he's breathing rapidly using his stomach muscles.

He's also been trembling a bit which concerns me.

Another thing that I wonder is his Trifexis something that could cause problems? Does he even really need this? He is super clean and never around other dogs. We live in Oregon and have never had issues with fleas or ticks.

Feed him a full meal, then sneaking the pill with the hotdog would be better. I was lucky with my Gable. He would gobble up any people food and never even knew there was a pill in there. And dosing should be at the same time every day. Otherwise testing won't be accurate.

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Originally Posted by Tenacious--M

Thank you so much for reaching out.

Yes, he has had blood tests and was officially diagnosed with Cushings. He had a blood test recently and showed he was within levels. I will have to see if I can get the numbers from that test and provide them.

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We would really appreciate it if you would post his latest ACTH results! Thanks!!

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Originally Posted by Tenacious--M

He seems to be pretty good, but his thinning coat really concerns me. Is there anything that can help with that? I do give him his Vetoryl with a piece of a hot dog to help him metabolize. Is that enough or does he need more food with it? He just grazes his food throughout the day and I hide the pill in the piece of hotdog for him to take it.

I have tried giving him 3mg of Melatonin at night as well. Not sure if that helps, but I have read it possibly can.

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As Joan mentioned, giving his Vetoryl with a meal is recommended, a snack might not be enough to metabolize his Vetoryl. If he seems off his food you may try topping it with something yummy like tuna or parmesan cheese.

What is the dosage of Melatonin you are giving?

As far as his thinning coat, improvements in that area can take a long time, as much as 6 months.

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Originally Posted by Tenacious--M

I've also noticed over the past week or so he has developed Kennel Cough (kind of coughing like a seal) and he's breathing rapidly using his stomach muscles.

He's also been trembling a bit which concerns me.

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We have seen on the forum that some dogs do have trembling issues after starting Vetoryl. The kennel cough definitely should be brought to the attention of his vet.

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Originally Posted by Tenacious--M

Another thing that I wonder is his Trifexis something that could cause problems? Does he even really need this? He is super clean and never around other dogs. We live in Oregon and have never had issues with fleas or ticks.

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I've never used Trifexis so I really don't know, with my own dog I decline to use any flea/tick treatment but that's just me!

Thank you for responding! I can't thank you all enough. I do give him his does the same time each day, but I will try to get it in a full meal and see how that helps.

I give him 3mg of melatonin a day.

The Trifexis is also for heartworm. Is it worth him taking? I just hear a lot of bad things about side effects from Tick/Flea/Heartworm medication and was hoping you could steer me on that. I don't want to have him on anything that could be making things worse.

I forgot to add, in addition to his thinning coat, I have also noticed that he has a few random hard pimple like bumps in a few places. They are white and kind of hard, they don't do anything if you lightly squeeze them. Is that something that is related to Cushing's or something else?

I will see tomorrow about getting his ACTH results. He has an appointment with the Vet for his Kennel Cough and labored breathing in the morning.

Hello again from me, too, to follow up with a couple more thoughts and questions. I absolutely agree that it would be best if Bentley could be given his Vetoryl along with an actual meal in order for him to best metabolize the medication. Can you tell us what time of day you’re giving the med? When given once daily, the makers of Vetoryl recommend giving it in the morning alongside breakfast. There are likely two benefits to this timing. First, since Vetoryl has a short life in the body, this way the medication is having its greatest effect during the day when Bentley is awake and active. Secondly, the monitoring ACTH test should be performed around 4 hours after giving the Vetoryl (along with food) on the day of testing. If the Vetoryl is only given at night, this proper testing time window is difficult if not impossible.

For sure, we’ll be interested in finding out his most recent ACTH results. And also, was he tested when he was still taking the medication twice daily, or after you had dropped back to the single daily dose? I do have to wonder whether his current dose is too low, given his worsening hair loss. Also, high cortisol can definitely cause prolonged panting episodes in dogs. I’m not aware of coughing being directly related to high cortisol, so something else may be causing both Bentley’s cough and rapid breathing. That’s very good you’re having that checked out. But my own Cushpup did pant almost constantly before we got his cortisol lowered.

As far as the white bumps, definitely have the vet check them out, too. There is a specific condition called Calcinosis Cutis that can arise in dogs with Cushing’s. This condition arises when calcium deposits form under the skin and push their way outward. The deposits can cause the surrounding skin to become very inflamed and painful, and the necessary treatment, once again, is to effectively lower the cortisol level. For all these reasons — hair loss, rapid breathing, skin issues — I do think it’s important to determine whether Bentley’s current Vetoryl dose is high enough to sufficiently control his cortisol. Once again, we definitely understand the financial burden of Vetoryl. But if Bentley does need a higher dose to be effective, we can give you some cost-saving suggestions. For instance, giving him a single 10 mg. capsule once a day might be less expensive than giving the 5 mg. twice daily.

Last but not least, I have no personal experience with Trifexis. But if you’re worried about possible side effects from the combined ingredients, you could talk with the vet about maybe switching to one of the simpler meds that only targets heartworm alone. Personally, I would never want to risk exposing a dog of mine to heartworm. And unfortunately, I see from the Oregon Veterinary Medical Association that you do have heartworm in Oregon:

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Cases of heartworm are regularly reported throughout the state of Oregon, and all dogs are at risk, even pets that live primarily indoors.

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All in all, I’m very relieved that Bentley will be seen by the vet today, and we’ll be very anxious to hear what he/she has to say.

Marianne

As Marianne has mentioned, those bumps could be Calcinosis Cutis, to properly diagnose Calcinosis Cutis it is usually necessary to have a skin biospy done of the infected area.

You're doing a great job!!

Hi Tenacious, welcome to you and your sweet Bentley!

At 15 lbs, 5mg may not control the cortisol. Treatment is based on weight only in the beginning. Then it is numbers PLUS signs. Cushing's is a sign-driven disease so the signs (symptoms in humans) are just as important as the numbers very often. Seeing the ACTH results will help in that area. Sadly, we have too often seen vets who didn't know how to read the test results so that is why we like to see the actual numbers. Plus it helps keep you busy so you might not worry quite so much. :D

As long as Bentley isn't diabetic the melatonin should be fine. It won't have much if any impact on the cortisol but it can help with sleep, noise phobias, hair and nail regrowth.

That's all I have for today but I am looking forward to seeing those test results. I am very glad you found us!
Hugs,
Leslie