New Member - Gertie recently diagnosed with Cushing's

Hello, I have read a lot of posts on this forum over the last month and have found so much helpful information so I am joining in. I apologize in advance for how longwinded this is!

My 10-year-old rescue dog Gertie, white bulldog/pittie/shar pei mix who has been with my almost 9 years successfully underwent two surgeries for removal of two types of skin cancer over the last year that luckily were contained and did not spread. After her second surgery, I requested an oncology referral to try and stay ahead of the cancer. At the initial visit/eval, one of the things mentioned by her oncologist was suspicion of Cushing's, and to f/u with fam vet. Gertie's vet brushed it off when I mentioned it and since he has been seeing her for about 8 years, I trusted him and I had never heard of Cushing's or knew the symptoms, so I accepted and moved along.

Fast forward five months to now, out of the absolute blue, Gertie woke up with a giant sack of fluid in her lower right abdomen a month ago. She looked rough... It was pretty jarring because just a mere 12 hours prior, she went on her 30 min nightly walk, no issues. I applied the same ointment I apply to her belly every night, no signs of anything. I got her in to see her vet that day, he completed labs and said they looked good, didn't know what it was, possibly a hematoma. Gertie was given Tramadol for pain, and I as told to keep an eye on it. It continued to progress over the next two days, the fluid migrated up to her chest and down to her right hind leg. Things were getting worse, I got her in for another emergency appt, her vet said it might be time to euthanize Gertie. He was positive that her cancer returned internally. She had ultrasound/xrays/labs/etc recently done with oncology that came back totally clean, but I know cancer can appear suddenly and be very deadly.

I set up an onco appt to be sure I as making the right decision. Onco agreed, it was probably cancer, but also prescribed antibiotics and Gabapentin. The next to days, she got worse and I had to make the difficult decision to schedule with a vet for at-home euthanization, she was declining fast. The day of Gertie's scheduled at-home goodbye, she seemed to be doing better, not great, but better. I cancelled the appt. Then she had a major turnaround three days into the antibiotic. She was active and playing again. It was really exciting because I thought this was all just some infection that needed to be treated. Though she was doing better, she continued to experience excessive bloating and panting. Prior to all of this, Gertie experienced bloating and hunger that had gotten worse over the years. I cut her diet, but she couldn't lose weight. Every visit to her vet, Dr. said her labs, thyroid, etc. looked great and it was just Gertie. I had also noticed she was quicker to panting spells in the last year, but it was usually after walks or when exposed to heat or anxiety so I just thought she was getting older.

When Gertie finished her antibiotics, she was doing well, but three days later, the infection returned and she started to decline again. I got her in for an emergency onco appt to prescribe more antibiotics and request a Cushing's test. By that time, I had done my research and realized Gertie had almost every single symptom of the disease, and, in fact, she has likely had this disease for 4-5 years, when the hunger and bloating started. We decided on the UCCR test, I did not want to put Gertie through the stress and trauma of an all-day visit in her condition. In the meantime, I started proactively treating Gertie for Cushing's with natural remedies that were safe to take with her meds last week while waiting on her urinary cortisol‐creatinine ratio results. I started Melatonin first and instantly saw a huge improvement in her symptoms re: panting and discomfort. A few days after, I started her on Prana and Adrenal Harmony Gold - can't say that I notice a difference, but the melatonin is definitely a lifesaver. She was able to go on walks for a few nights too. Though, my hope was that we could get the UCCR results and start her on Vetoryl before the second round of antibiotics were done. I requested that the onco office email me results as soon as they arrive, I received them on 6/21/24 with results - I had collected her urine first thing in the morning when she was very stable and doing well. The ratio came back at 66 with anything above 26 being consistent with Cushing's. I tried contacting onco to take next steps, hopefully start her on meds. No call back. Monday, I called her vet, but he was out until 6/26. Onco called me that day, said she couldn't treat it, I'd need to go to her vet or internal med. She spoke disparagingly about Vetroyl when I asked about it and said "Some dogs do too well on that medication, until they suddenly don't." In my head, I was thinking she was referring to the cases that were prescribed too high of a dose/not carefully monitored and had gone into Addison's crisis.

Waiting for 6/26 to come was brutal. Gertie finished her antibiotics on 6/24 and by 6/26, I could see signs of the infection sneaking back in. I sent a desperate email to her vet and called them right when they opened, pleading for help. He called me that afternoon, prescribed a third round of antibiotics, set her up for ATCH on 6/27 and allowed me to stay with Gertie for the entirety of the testing because I was worried that the anxiety of a drop-off would flare up a panting episode. Vet said he would call me today 6/28 with results (still waiting but will attach once received). We talked about dosage and he allowed me to take the Vetoryl home and wait until he called to start the med - I didn't want to have to wait for him to call in a script and pick it up with the weekend approaching. He agreed about starting low and said he usually starts at 0.5-1mg/kg. Gertie weights 65 lbs. so he said we will start at 20mg BID; however, the more I have sat with this and with all the research about large dogs doing better with smaller doses, I feel safer starting at 10mg BID.

So basically, Gertie's increased Cushing's symptoms over the last year have been overlooked and chalked up to cancer. I read that Cushing's makes dogs more susceptible to infections, which is what I think is going on right now. I am worried she will not be able to fight the infection after this THIRD round of antibiotics and the Cushing's untreated so my hope is to get the vet's phone call with ACTH results and the go ahead to start Vetoryl, but if not, I fear Gertie may be in trouble. I am very tempted to start the treatment at 10mg tonight if I don't hear back. I just feel like every second this goes untreated with an active infection is another second her body is deteriorating and becoming weaker. I'm also worried that vetoryl treatment might be too late with the active infection. She is currently stable, but still experiencing panting episodes that look very much like a panic attack to me that often occur around 5-6pm and are barely managed with Trazadone PRN. She is pretty miserable and detached, starving all the time. She doesn't even seem to enjoy eating at meal times, she miserably scarfs down her food and it's never enough. She constantly looks to me with "please feed me" eyes and lays around all day long. She barely wants pets or cuddles anymore and sometimes moves away when I sit next to her and give her pets. This whole thing has been the most heartbreaking rollercoaster nightmare I have ever experienced. To have gotten to multiple points of thinking I needed to be responsible for my best friend leaving this world to spare her suffering, moments of hope quickly crushed by moments of backsliding. I am not sleeping well, I have lost a lot of weight, and I have put my job in jeopardy over the last month. It is unbearable to see Gertie like this and feel so helpless to make her feel better and protect her.

Attached are Gertie's UUCR results from 6/21 and labs from 5/31 that were described to me as perfectly normal and healthy, though I disagree and you can see some red circles and text in the doc that I have left some notes on certain labs that, to me, indicate Cushing's. Also, ultrasound completed by onco in March said "“\The adrenal glands are within normal limits bilaterally. Gertie's adrenal glands were normal in size on abdominal ultrasound today. This finding does not exclude Cushing's disease as a cause for her symptoms, and we recommend discussing additional diagnostics, if indicated, with Dr.******." so I think these clean adrenal results mean that she leaning toward pituitary-dependent hyperadrenocorticism.

Any advice would be so cherished and appreciated... really about anything, but especially about Verotyl starting dosage for a 65 pound dog and would it be wrong to start treatment tonight if I don't hear back from her vet? The UCCR and labs coupled with Cushing's symptoms seem pretty dang conclusive to me and I hate sitting on this medication that could be helping Gertie already.

https://drive.google.com/file/d/1D_u...ew?usp=sharing - labs
https://drive.google.com/file/d/1n4t...ew?usp=sharing - uccr

**************EDIT: ACTH Labs just came back, confirmed Cushing's, and we are starting 10mg BID tonight!

https://drive.google.com/file/d/1J95...ew?usp=sharing