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Thread: New User Here Seeking Advice About My Cushings Boxer

  1. #11
    Join Date
    Apr 2009
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    Georgia
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    14,959

    Default Re: New User Here Seeking Advice About My Cushings Boxer

    OK, finally I’m back again! Once again, thanks so much for providing all this helpful information. I know Dozer had several abnormal lab results, but I’m going to focus on the ones that stand out the most to me. Before doing that, let me caution you that I’m not a vet, so my thoughts are based on what I’ve learned over my years on this forum as opposed to professional training. But these are things that have raised questions in my mind.

    First, elevated liver enzymes — especially high Alk Phos levels - are characteristic of Cushing’s. Also, changes in the appearance of the liver itself are commonly viewed on ultrasound. So those abnormalities would be consistent with the disgnosis. However, here are my concerns about the diagnosis. First and foremost, just as Leslie wrote earlier, Cushing’s is typically a syndrome that gradually worsens over time. The sudden onset of Dozer’s symptoms immediately subsequent to his surgery raises a huge red flag for me. Not that I’m accusing the vets of anything improper with the surgery itself, but I do have to wonder whether there was any internal trauma, inflammation or infection that lies behind the sudden onset of these symptoms. And if Dozer was/is suffering from any other type of systemic issue, this could easily result in a “false positive” on his diagnostic LDDS test (noted as “Cortisol 3 Serial Dex” on your report). Any illness, injury or stress can raise cortisol levels in the same manner as Cushing’s. That’s why the complete medical history and constellation of symptoms are an important part of the diagnosis.

    It is the third cortisol reading on that test that is diagnostic for Cushing’s. Dozer’s third reading was 1.5, which was *barely* higher than the normal cut-off value of 1.4. The fact that he was only slightly out-of-range doesn’t give me a lot of comfort in the Cushing’s diagnosis, especially if you know he was outwardly acting unwell at the time the test was performed.

    Adding to my concern are two other abnormally high readings at the time of his test. The first is the Precision PSL reading of 246. I believe a level that high would be considered diagnostic of pancreatitis, which can be an extremely painful and disabling condition, definitely affecting appetite. In addition, his Free T4 reading was quite high, as well, which would indicate hyperthyroidism if it was a valid and ongoing elevation. Here are symptoms of hyperthyroidism, several of which correspond with Dozer’s behavior:

    Depression.
    Diarrhea.
    Enlarged thyroid gland.
    Excessive thirst.
    Forced breathing.
    Heavy, rapid breathing.
    Increased appetite.
    Increased energy.
    Increased urination.
    Nervousness.
    Rapid heart rate.
    Shaggy hair texture.
    Vomiting.
    Weight loss.

    The increased appetite and energy don’t correspond with what you’re seeing in Dozer, but he may be suffering from multiple issues that are combining to present a particular set of problems. For instance, when we move ahead to the June labwork, his Precision PSL has jumped clear up to 514. So perhaps he may be suffering from a smoldering chronic issue with his pancreas. At this point his Free T4 thyroid reading is much lower, but still a tiny bit above normal.

    All in all, I definitely agree with holding off on giving him any more Vetoryl for the time being. I’m just not yet convinced about the accuracy of the Cushing’s diagnosis in the face of these other abnormalities. And I would specifically question your vet about the appearance of his pancreas on the ultrasound, as well as the significance of the elevated Precision PSL and thyroid levels. My concern here may be unfounded, but these are issues that do raise big questions for me. And no matter what, please do keep us updated.

    Marianne

  2. #12
    Join Date
    Apr 2009
    Location
    Georgia
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    14,959

    Default Re: New User Here Seeking Advice About My Cushings Boxer

    Just wanted to come back to add a link to a helpful article re: symptoms and testing for pancreatitis. As you’ll see, “garbage eating” may be a possible trigger (I’ve always had Labs and am *really* familiar with that tendency!). This article is focused on acute attacks of pancreatitis, but I know that it can be a chronic issue as well.

    Dogs with subclinical or mild disease can display nonspecific signs such as intermittent anorexia and weakness with no gastrointestinal signs.
    Anyway, hopefully this may help you develop questions for your vet.

    https://todaysveterinarypractice.com...titis-in-dogs/

  3. #13
    Join Date
    Jun 2022
    Posts
    7

    Default Re: New User Here Seeking Advice About My Cushings Boxer

    Wow! Thank you so much for the thoughtful response. I have some good takeaways to ask about at his next appt
    They have never mentioned anything to me about anything of the other elevated levels on his bloodwork. I really am wondering about the Cushing’s diagnosis myself, because yes this has all seemed so sudden and the Vetoryl did not help at all. I am starting him on some home cooked food that I looked up saying it was good for the liver not making it work harder than it needs to so he will start that tonight but all week he has been eating Hill Digestive I/D food that the vet gave him. I have a check up appointment on Tuesday with the vet that did his ultrasound and found the spots in the liver. They had me to start him on Milk Thistle so he has been on that for a couple days now. His appetite is doing a lot better and I have not given him the appetite enhancer yesterday or today just because I want to see id it’s truly better being off Vetoryl. However today he is not doing so well, it started in the middle of the night just pacing and panting and peeing. He did eat pretty good this morning but has just not been right. He will not lay down and just keeps pacing around almost in circles and then squats to pee like literally a couple times every minute or two. He has probably peed 100 times today not even exaggerating I have never seen anything like it. He is also panting quite hard still. I called my usual vet(that gave cushings diagnosis) since he was on call this weekend and he is telling me it’s because he’s off the Vetoryl and would need to get back on it! He has been off of it since Monday and this has not happened at all in this time! So I was peeved that was the only suggestion for him. He seems quite uncomfortable I’m afraid he is in pain and it’s very hard to watch. He has lost so much muscle mass, and has such weakness in his back legs he is barely able to hold himself up to pee or especially poop, but today it’s especially bad with the weakness. Also another thing I have noticed over the last couple weeks is the massive decrease in his stool when he goes the amount is very little compared to what it used to be? Any ideas or could that be normal with the lower food intake he has been having ? Thank you again for your time and thoughts

  4. #14
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,959

    Default Re: New User Here Seeking Advice About My Cushings Boxer

    Gosh, I’m so sorry that Dozer is having such a hard time. I know this must be so hard for you, too, seeing him so uncomfortable! And of course, this has to happen on a holiday weekend — in our house, it always seems like the crises come on a weekend or a holiday…:-(((((

    I’m glad you’ll be seeing the new vet on Tuesday because I’m guessing he may be a specialist of some kind since he’s the one who did the ultrasound. Dozer’s situation seems complex enough at this point that I’d welcome some fresh eyes and some new thoughts. Cushing’s remains a possibility, but even if so, the Vetoryl seems to be creating as many problems as it might be helping. I’m still wondering about an unresolved UTI. The incredibly frequent urge to pee accompanied by discomfort could certainly be caused by a UTI. Has your vet continued to test his urine? Originally, did your vet ever actually run a culture on a urine sample to try to identify a specific bacteria, or did they just give you a broad-spectrum antibiotic to try? If they didn’t run an actual culture, Dozier might be suffering from a bacteria that the medication didn’t address in the first place.

    Also, as far as his food right now, if he was eating the Hills I/D food, you might not want to mess with success. I know the ingredients in it sound pretty awful, but dogs do seem to like it and it has really helped my own dogs at times. My current Lab girl has had recurrent episodes of diarrhea of unknown cause, and that I/D food has been the one thing she could eat that seemed to normalize things during an upset. I would home-cook chicken/rice, etc., and nothing settled her stomach as much as a temporary course of that food. So if Dozer doesn’t eat as well on the new food you’re cooking, it might be best to stick with the I/D food for now. And as far as the lesser quantity of stool, that may well be due to the different composition and fiber content of the food he’s eating right now.

    I sure hope you can make it through until your appointment tomorrow. I’ll be thinking of you guys today and hoping for the best.

    Sending big hugs across the miles,
    Marianne

  5. #15
    Join Date
    Jun 2022
    Posts
    7

    Default Re: New User Here Seeking Advice About My Cushings Boxer

    I thought I would check in and give an update on Dozer.. last weekend was pretty rough, but he did a little bit better last week. We had an appointment with the newv vet on Tuesday and she feels it to be very important to try and manage his Cushing's disease as she feels a lot of his symptoms were coming from that. She wants to start him on a lower dose though because she said if the 60 and 70mg were giving him problems it could just be too much for him. She is having it compounded so that he can have 20mg 2x daily. She said she has seen evidence to support 2x a day dosing is helpful in controlling the symptoms. She also has prescribed him Adequan injections to help with his back legs. He is very slow and stiff and has a very difficult time squatting to go to the bathroom so she wants to see if that will help him get some mobility back and help with discomfort. I am hoping these come in the mail today, I had to order them to be shipped, I am ready to get him started on the medicines to see if he can get some relief. She really feels that the spots in his liver given all of his other clinical symptoms ( severe muscle wasting, weight loss, cognitive issues) that it very well could be cancer in the liver. She feels the biopsy to find out for sure would be much too hard on him given his current state and she says our main concern should be getting him feeling better and lessening his symptoms for the time being. He was also started on Milk Thistle and she may be prescribing him some Ursidlol for the liver inflammation. He is basically 100% incontinent now, but she feels that is because of some issues with his spine. He had an xray 2 years ago and showed some signs of intervertebral disease, he did not really have symptoms then so they did not do anything to treat it. I have him in belly bands, but now that he is sleeping a bit better at night if he goes 2-3 hours sleeping without getting up he has soaked through them and pee has run all over his side. So been trying to waterproof things as much as possible and trying to order some products to help with this. Also having to give him a little bath in the mornings to get the pee off him He is loving the homemade food I have been making and is eating good. He has not lost anymore weight since 6/28 when he had his ultrasound he was 66.8lb and he has stayed in the 66lbs since then. I was hoping to see a little gain of weight, but I was happy to see no loss considering previous to that he had lost 5lbs in a week. I am just trying to make him as healthy and happy as possible right now, if any of you have any experience with other things I can try or have dealt with these similar things and things that worked for you I would love to hear them. I know his time is on the horizon, but I can still see some life and fight in him so I am going to try everything I can for him. Thank you all so much!

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