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

There is a lot so let me start with the beginng.

Our son, has been in the ER since Friday and is now in ICU. He has massive adema in his lungs and they think he could have bleeding in his lungs and or a pulmonary embolism. He also has blood in his urine. His red blood cell count is low and they are pushing for a transfusion.

To top it off the vet told us on Friday morning that they think Bentley has congestive heart failure. Then right after we got home from that we had to take Jake to the hospital.

The vet did prescribe the following medications to help Bentley.

Clavamox tablet 62.5mg for infection
Gabapentin solution 250ml / 5ml for anxiety/pain/rest
Denamarin Advanced small/medium canine for elevated liver
Remain on current Vetoryl dosage

Jake's friend Soda (who Bentley loves and has known since he was a pup) was helping us out by checking on Bentley a couple times a day and giving him his medications while we have been here in the ICU with Jake. He even stayed overnight with Bentley last Sunday to give him love & company.

My wife and I went home Sunday night to shower and resupply. Before leaving I held his face, pulling his fur up around it like a little lion 0and told him how much I love him and what a good boy he is. I his a few bully sticks throughout the house for him to chew on and he gingerly took one from my hand hand and sauntered over to his blanket in front of the sliding glass door. The last time I saw him was him on his bed with a treat in his mouth like a cigar. I told him how much I love him, we will miss him, be a good boy and we will be back soon. He looked at me with a smile and started chewing his treat, holding it with one paw like he does. I closed the door and left to go back to the hospital to be with our son.

Then Tuesday January 25th, 2023 @ 6:25am I was awoken in the ICU room by this text.
https://imgur.com/a/f8qtxa5

Soda was crushed to, @ 6:14am, find my lil boy curled up in his round snuggle bed with his chin resting on the side. Just like he always slept. He had passed sometime that night. Soda took him to the Tualatin Vet Emergency where he is now awaiting cremation.

The hardest thing was going home Tuesday afternoon. There was no bark after opening the garage, no greeting at the door. No clicking of his nails on the hardwood. The house feels void. I keep wanting to talk to him but realize he's no longer at my feet. His food bowl was there with kibble on the floor and his little bed next to where I sit on the couch was empty. A partially chewed treat sits on his blanket. I'm devestated. I dropped to the floor trying to smell him in his bed sobbing. I didn't get to say goodbye or even see him again. I don't think it's wise for me to go see him now that they have his body on ice. I know he's in heaven and that's just a body now. I'm just torn up. They get is making us a ceramic paw print, ink pawprint, nose print and a lock of his hair. We are also getting a private cremation and his ashes so we can bring him home soon. It gives me peace knowing he is layed to peace and his remains will always be home with us.

Thank you for all your prayers for us during this extremely difficult time with our son and the loss of our precious little boy, Bentley.

I am so sorry to hear your son is in the hospital and he will be in my thoughts and prayers. I'm, also, so terribly sorry for the loss of beloved Bentley and my heart goes out to you at this most painful time. Please know that we are here for you and always will be.

With Heartfelt Sympathy, Lori

I join Lori in my prayers for you and your family. I cannot think of enough words to tell you how sorry I am about losing Bentley and your worry over Jake. As Lori says, we'll be right here should you wish to come back and write more. I lost my own dog last month and my heart joins yours in your grief over Bentley. I can't imagine having to also cope with Jake's illness at the same time. It is so much to bear. If we can support or comfort you in any way, please come back and keep writing. Sending all the healing energy within my power to Jake, and hugs of strength across the miles to you.

Marianne

This is so, so heartbreaking for you, I know. With everything you were dealing with I think Bentley died peacefully in his sleep to save you from more trauma. Others on this forum have had to suffer through their beloved babies struggling with CHF.

My heart goes out to you...we just lost our beloved chihuahua on New Year's day and are still grieving. It is never easy.

I hope Jake recovers and you are able to find some peace...

Dear Tenacious,

I sit here with tears rolling down my face reading your post. I can see you falling to your knees at Bentley's bed in utter anguish. :( Please know you did nothing wrong. You took every step possible to help him both before your son got so sick and certainly while you were with him in the ICU. That is where you belonged even tho I know your heart is torn. Bentley left this life knowing he was oh so loved. He carried that love with him and will hold it close til he can give it back to you one day when your job here on Earth is done. Til then, Bentley will be watching over you just as you watched over him with such devotion.

My prayers join Lori's and Marianne's for your precious son, his medical team, and all who love Bentley.
My deepest sympathies,
Leslie

Tribute to a Best Friend
By Unknown Author

Sunlight streams through window pane onto a spot on the floor…
then I remember,
it’s where you used to lie, but now you are no more.

Our feet walk down a hall of carpet, and muted echoes sound…
then I remember,
it’s where your paws would joyously abound.

A voice is heard along the road, and up beyond the hill,
then I remember,
it can’t be yours — your golden voice is still.

But I’ll take that vacant spot of floor and empty muted hall,
and lay them with the absent voice and unused dish along the wall.

I’ll wrap these treasured memories in a blanket of my love,
and keep them for my best friend until we meet above.

Your family remains in my thoughts this morning, and I just wanted to stop back by in the hope that this new day will bring more healing to Jake. You may still be there at the ICU, and if so, I pray that everything is going as well as it possibly can.

If you are back home, I know that Bentley’s absence must still feel like a bottomless hole in your heart. Sitting alone in the quiet, empty house is such a sorrow. As you’ve written, whereas once your homecomings were filled with the joy of reunion, now they’re a constant reminder of what you’ve lost. It has been six weeks for me, and still I dread the quiet homecomings the most. Each and every time it still hurts so much.

Right now, though, I’m guessing you are spending most of your time in the hospital with your focus necessarily on Jake. I know you would have willingly done anything within your power to take care of Bentley, too. But as Joan has said, CHF can present a lot of challenges. And difficulty with breathing can be very scary for humans and animals alike. Although you are suffering such pain in losing Bentley, he himself will be spared any future struggles that were likely to come. Bentley peacefully left this world cradled in love. As Leslie wrote, love was your lifelong and everlasting gift to him. What a lucky little boy. And now, *his* parting gift to his big brother Jake is to allow all of your attention and concern to be focused on Jake in the days ahead. It sounds as though it may be a rough journey, and we are here to continue to walk alongside you should we be able to ease your burden in any way. In the meantime, please know that Bentley will always be remembered and honored by his family here on K9C.

Sending many more healing wishes your way,
Marianne

Thank you all for you kindness and sincere care for my lil boy Bentley. Your kind words, prayers and thoughts mean so much to our family.

One thing that I concerned with is the vet gave him this medication two days before he passed. Is this a proper dosage for him?

I've attached a picture of the syringe where they marked it in red for his dosage. Is this a safe, low dose?
https://imgur.com/a/2MhL9aA
Gabapentin solution 250ml / 5ml for anxiety/pain/rest

Unfortunately we’re not able to see your photo. But in order to judge the actual size of the dose, we’d also need to know how many mg. of the medicine are in the 5 ml. amount. A milliliter is simply a liquid measurement — it doesn’t tell us the strength of the dose of the medication that’s been dissolved in the liquid. Perhaps the label tells you how many milligrams are in each milliliter? If it turns out that Baxter’s dose was 5 mg., that is a very conservative dose from what I just read. Also, it sounds as though damaging overdoses of gabapentin are very rare in dogs. Apparently dogs can tolerate quite high doses with not much ill effect. I hope that may give you some comfort.

Marianne

Thank you for reaching out.

Gabapentin solution 250ml / 5ml for anxiety/pain/rest

Label says: Gabapentin 250mg/5ml Solution (per ml). Give 1.3 mls every 12 hours for 14 days.

I have a picture of the bottle and syringe but I don't see a way to attach any files.

If you’re unable to attach a photo to your reply, here are a couple other suggestions. You can create a personal photo album here, and hopefully upload your photo to that album where we all can view it. If you have trouble with that, too, you can email a copy of the photo to our forum gmailbox and we staffers can try to load it here for you: k9cushings@gmail.com.

Here’s a link that will give you instructions re: creating a photo album here: https://www.k9cushings.com/forum/faq...faq_vb3_albums

In the meantime, I’m still trying to gather more info about gabapentin dosage. What I’m finding is that there is a very wide range of acceptable doses. Here’s one specific quote I found:

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Dosages can vary, but commonly gabapentin is dosed in dogs at 5-30 mg/kg up to three times daily, though in our own patients we have used 10-40 mg/kg up to three times daily as well. Gabapentin has also been used on an as-needed basis to achieve anxiolysis at 30-60 mg/kg one to two hours before an anticipated stressful event, such as a veterinary visit.

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https://www.dvm360.com/view/use-gaba...y%20as%20well.

Since Bentley weighed around 15 pounds, that would translate into approximately 7 kg. Using the formula above, this means he typically could have received a dose anywhere between 35 - 280 mg. up to three times daily (even up to a 560 mg. dose given right before a stressful event). So this is a *very* broad range indeed. I’m still having trouble making out the exact dose he was receiving based on the labeling that you’ve typed in. But *if* it means that 250 mg. are dissolved in 5 ml. of solution, then Bentley’s dose would have been 65 mg. per each 1.3 ml. mouthful, given only twice daily. If this is accurate, then that is firmly in the lower end of the range. Also, given this very broad dosing range, I see why it’s said to be very hard to seriously overdose a dog on the medication. Again, I hope this may give you some comfort.

Marianne

Thank you. That does help.

So it looks like even if he received a full syringe he would be in the safe range as that would be 250mg and he could have received up to 280mg x3 a day?

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Originally Posted by Tenacious--M

So it looks like even if he received a full syringe he would be in the safe range as that would be 250mg and he could have received up to 280mg x3 a day?

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Yes, I think that’s exactly right. We’ve received your photos in our gmailbox, and I’ll see if we can’t get them posted. But based on just looking at them myself, I think we have this figured out correctly.

Edited to add: Another one of our staffers, Lori, has now had the chance to view your photos, too, and we both agree about our interpretation of the dosing. But if you’d still like for us to post them publicly here on the forum, just let us know, OK?

No thank you. I appreciate it though. I'm glad to hear the dosage was correct.

You are very welcome. We’re surely hoping that Jake is showing some improvement, and we continue to send our healing wishes to your family.

I too am so very sorry about the loss of your sweet Bentley and my thoughts and prayers are with your son.
These coming days and months will feel so empty and my heart goes out to you and your family!!!! Know we are all here - and many know what you are going through.
Healing ((((hugs))))
Terry