New Member: Otto ~ Otto has passed

[emacd33]

Hi Everyone,

I’ve spent the last few days reading through so many of your posts. While I still have a million questions about what is going on with my dog, I think the emotional support that comes from this forum is really what I need.

My 9 year old 77lb German Shepherd, Otto, was diagnosed with pituitary-dependent Cushing's in August 2023. Leading up to that we had noticed increased panting, excessive drinking and peeing. Unfortunately around that time our other dog was diagnosed with and passed from hemangiosarcoma so we were admittedly a little distracted and feel guilty that we maybe didn’t catch symptoms sooner.

We have spent much of the last year attempting to find a vetoryl dosage that works. Every dose we have tried seems to work for 1-2 weeks and then slowly he’ll lose interest in food and eventually stop eating. With two different vets (we moved across the country two months ago) we have tried 6 different dosages. Most recently we had him on just 10mg once a day with the same results. We’ve stopped the vetoryl for now and will readdress with the vet again in about a week.

For 3-4 months we had him on Pranapets melatonin and lignans. Looking back now I feel like that may have been working ok. He’s never grown his fur back from his ultrasounds almost a year ago but if that was the only Cushing symptom I think we’d be ok.

The issue is that he has a host of other health issues so we’re struggling to figure out what is being caused by the Cushings and what is unrelated.

He has also been diagnosed with arthritis. He no longer runs, doesn’t like going for walks, and has a hard time standing up on his own (and can’t stand up from any type of smooth surface). He also won’t lay down on his own. He’ll either stand until he falls to the ground, or we have to force him to the ground and then he’ll settle. I think the worst symptom I associate with the arthritis is that he no longer wags his tail. I hope internally he is not miserable, but the lack of tail wags just makes it seem like he is forever unhappy. We’ve had him on gabapentin for a while and our new vet also put him on carprofen and chondroprotec injections. 



The main reason why we started trying vetoryl again is because of the above symptoms. He definitely has arthritis but some of them we hoped could be fixed with vetoryl. He also seemed to be very restless at night, getting up and roaming a bit so we aren’t sure there if there is some amount of cognitive decline. Lastly, and maybe the weirdest symptom that we can’t figure out, is that he has basically become agoraphobic. He just does NOT want to step outside. We moved to a place with only three stairs so I don’t think it’s pain related but really don’t understand the cause of it.

I’ve been tracking all of his lab results in this doc. The test the vet seemed most surprised by was that his potassium/sodium ratio was low before being on vetoryl (normally associated with addisons). That dropped further when he went on vetoryl.

He’s now been off vetoryl for about 5 days now. Initially his appetite started to come back but just yesterday and today he’s suddenly not interested in food again.

I just wish I could pinpoint the cause of each of the issues and give him whatever he needs to feel better. I really just want to see him wag his tail again.

[Harley PoMMom]

Hi and welcome to you and Otto!

First let me extend my sympathy to you and your family on the passing of your other dog, I am so sorry for that loss, it is very painful losing our furbabies so my heart goes out to you and your family.

Thank you for sharing the wealth of information on Otto, taking a look at his blood work I have a few questions. I see that there is a Cortisol 1 and Cortisol 2 test done, I'm assuming this was an ACTH stimulation test, correct? And if so when was this performed, and were there any other ACTH stimulation tests done? If so, could you post the dates and the results? What test/s were performed to diagnose his Cushing's, and could you post those results too?

If monitoring ACTH stimulation tests were done, was the Vetoryl given with a meal and the test performed 4-6 hours after the Vetoryl dose? It is vital that Vetoryl be given with a meal so it can be properly absorbed. I'm sorry for all these questions but the more we know the better our feedback will be.

Again, welcome to you and Otto and please know we will help in any way we can.

Hugs, Lori

[emacd33]

I see that there is a Cortisol 1 and Cortisol 2 test done, I'm assuming this was an ACTH stimulation test, correct? And if so when was this performed, and were there any other ACTH stimulation tests done? If so, could you post the dates and the results? What test/s were performed to diagnose his Cushing's, and could you post those results too?

If monitoring ACTH stimulation tests were done, was the Vetoryl given with a meal and the test performed 4-6 hours after the Vetoryl dose?

Hi Lori,

Thank you for the kind words.


Yes, he had an ACTH Stim test done on 5/17/24. The Vetoryl was given with his breakfast and the test was performed 4 hours later. He's had a LDSS test and at least one monitoring test done previously at our old vet. I've reached out to them to get copies of his records. I do have notes from his ultrasound that was done last August that states "Recently diagnosed with Cushing's but LDDS unable to distinguish pituitary vs. adrenal origin. Pertinent Laboratory Findings: CBC/Chem12 was normal in March (note ALP was only 10.) UA at that time has USG 1.104, otherwise normal. On 7/26 a Urine Cort/Cre was 312. LDDS on 8/18 had cort levels of: Pre (7.0), 4H4 (6.78), 8Hr (7.0)." The ultrasound did not find any adrenal mass.

I've updated my sheet with that limited information but will add more as soon as I get the older test results from the other vet!

[labblab]

Hello and welcome to you and Otto! I'm very glad you've joined us, but very sorry about the problems that you guys are experiencing right now. I also send you my sympathy on the loss of your other dog. This has surely been a difficult year for your family, and it's clear that you've been doing your very best to deal with a lot of painful decisions. At the time that my own Cushpup was struggling the most and probably would have benefited from additional testing, my mom suffered a heart attack and my attention ended up being focused primarily on her. I've always regretted that I wasn't as available for my dog, but I was doing the best that I could back then, as I know you've done for Otto. He's very lucky to have you!

I must admit that his situation is quite a puzzle, though. Given his LDDS result, we wouldn't have been surprised had the ultrasound indicated the existence of an adrenal tumor. But none was seen. And given Otto's response to the Vetoryl, two thoughts come to my mind. I wonder whether the Cushing's diagnosis is actually accurate. Since both the LDDS and ACTH can return "false positives" in the event of other illness or bodily stress, it's possible that something else may have been elevating his cortisol on those tests. However, you do explain that he has suffered from several observable symptoms that are classically consistent with Cushing's. So I do understand that the diagnosis certainly didn't come out of thin air.

There is one other possibility that I hesitate to mention since I don't want to cause you even more stress. But if Otto does indeed suffer from a pituitary tumor, it may be enlarging and placing pressure on his brain that is resulting in neurological changes. Lack of appetite, restlessness, changes in cognition and coordination can all be caused by swelling and inflammation in the brain. Unfortunately, the only way the presence of an adrenal "macroadenoma" can be confirmed is via expensive imaging of the head. So I apologize for raising a concern that cannot easily be ruled out. But my own Cushpup started exhibiting neurological symptoms consistent with such a tumor, so I do worry, myself, when I read about similar symptoms in other dogs.

No matter what the issue is right now, I think it's definitely wise to withhold the Vetoryl altogether. It's possible that the Vetoryl may be overly suppressing the production of another adrenal hormone, aldosterone, which is central to maintaining the appropriate balance of sodium and potassium in the body. As your vet noted, it's interesting that Otto's balance was "off" even prior to the Vetoryl. So perhaps there is something key that is going on with him that is actually linked more closely to the aldosterone than to the cortisol. At any rate, I do think the vacation from the Vetoryl is best.

I wish I could be more helpful, and I do indeed apologize if I'm worrying you further about the pituitary tumor. But I just felt as though I should throw out that possibility, perhaps to discuss further with your vet. And I'll try to do some more brain-storming, as well.

Once again, best wishes to you and to your sweet boy.
Marianne

[emacd33]

Unfortunately we unexpectedly had to say goodbye to Otto last night. As expected, after coming off the vetoryl his appetite came back, but only for a couple of days and then it began to wane again. We've never experienced this so we quickly made a vet appointment. Our vet wasn't able to do an exam that day but the vet tech did some labs. The tests came back roughly consistent with what we had seen from him when not on vetoryl. He didn't eat yesterday morning but did go out for his bathroom trip without an issue. The vet suggested an anti nausea med, Cerenia, and Denamarin to address the high liver enzymes. He recommend trying to give it to him for lunch but he was sleeping soundly while I worked so I didn't bother him (nothing out of the norm).

Around 5:30pm I decide it was time to get the anti nausea med in him so we could hopefully get him to eat dinner. I forced him to sit up and he fought the pill as he normally would but I eventually got it down. He immediately dropped his head back down. My husband came home shortly after and we realized Otto had a weird hitch in his breath or a shiver in his body. We force him to his feet (again, fairly normal after he's been in a deep sleep) to go out to the bathroom. He seemed EXTRA unsteady on his feet. He kind of bumped into the walls and we had to guide him out. He did immediately go pee but when we went to come back inside he couldn't get his back legs up the step (not normal). My husband came out to help and when he got in he kind of face planted on the carpet. He's done this a couple of times before but he would try to catch himself. This time he just went down and stayed down.

I got on the phone with the vet while my husband sat with him. He tried putting a pillow under his head and said it was just completely dead weight. We decided to take him to the emergency vet since ours wouldn't be able to see him until the next day. At the time I felt that he probably just needed some fluids and get some food in him to feel better. We got him out and down the stairs but it became clear that he couldn't control his legs (he's often stubborn when we take him out and plants his feet, but in this case there was a lot of curling under and trying to walk but failing).

My husband carried him to the car and into the vet when we arrived. They quickly got him in and hooked up to a million machine and got blood drawn. It was only around then that I realized that was more serious than I thought. He had almost no reaction to the pokes and prods and even the rectal temp (because of arthritis and a fused tailbone he HATES anyone touching his tail). (Side note: this was an open concept ER so we could stand with him the whole time. I've never experienced that before but I was so grateful for it).

They said he was in shock and was tachycardiac. They had a machine (not sure if it was an ultrasound but it was looking at his abdomen). They saw a mass and fluids (I think?) and mention hemangiosarcoma, which of course was terrible to hear considering that's how we lost our last dog, Mac. After further scanning, blood results, and x-rays the vet concluded that he was experience acute liver failure. The mass he was seeing was a "gallbladder full of sludge". His GI tract was full of gas. His liver enzymes had jumped another 100 points since his bloodwork the day prior and the Citrated Partial Thromboplastin Time (PTT) was over 300 seconds. The worst thing to hear was that he was encephalitic. He just had no reaction to anything going on. He was not improving with the fluids they were giving him.

Everything was moving so fast. I really obsess over research and looking at the numbers and learning what every test result is saying but we had to trust the vet in this instance. He said he could be hospitalized but would need a significant amount of work and even with that the prognosis was very poor. We decided to wait for the x-ray results but I don't actually remember what they said... the implication of them did not give us hope.

Otto has not been himself in many months. We know he's in pain. We know cognitively he's just not all there anymore. He hasn't wagged his tail in months. We decided it was time to say goodbye.

I knew our time with him was limited but I still had hope that we'd find something that would make him feel better.

Marianne - I think you were right in your guess that there was something more going on here. I'm not sure if the Cushings was a misdiagnosis, but it is very likely there was something else going on. I'm still not even sure what exactly (maybe liver cancer? something with the gallbladder?) but I think it was his time.

We spent this morning looking at pictures and watching videos of him from the last nine years. He had such life and personality and we could see that disappear over the last 9 months. I hate that we couldn't figure this out in time but I'm grateful that he's not in pain anymore. And I hope he's been reunited with Mac.

[Joan2517]

I'm so sorry for your loss. It's heartbreaking when we have to make the decision to let them go, even knowing that it is time.

Many, many hugs...
Joan

[Harley PoMMom]

I am so sorry for your loss, losing our precious furbaby is indeed very heartbreaking and we understand the pain you are feeling. My heart goes out to you and your husband, I wish so much that there was some way that I could ease your pain right now. If you would ever need a comforting shoulder or support, please do come back and talk to us.

I have added Otto to our "In Loving Memory" forum and if you want, we would be honored if you would want to provide us with a photo which we can link to his memorial line.

If you have an album you can upload it to there and then we can copy the photo, or you can email it to us at k9cushings@gmail.com.

Again, I am so very, very sorry.

Love and hugs, Lori

[labblab]

Oh my. I join Joan and Lori in telling you how very sorry I am to read this news. What a horrible shock to have everything spiral out of control so quickly. And on the heels of losing your dear Mac, as well. It just doesn’t seem fair in any way. But you were very brave in realizing that for Otto, the mercy was in giving him release from his tired ailing body. That was the last gift you could give him, and it was the right thing to do. But I’m just so sorry now for your own pain and loss.

I know you’ve only had the chance to be with us for a short time, but as Lori has written, Otto will now forever be remembered as a part of our family. If you’d like to come back and tell us more about your lives together, or just how you’re doing yourself, we’re eager to listen and to share stories of our own. Everything may feel too raw right now, but we’ll always be here at any time. Please do extend my sympathy to your husband, as well.

Always in loving memory of sweet Otto, who is surely wagging his tail wildly once again as he romps with his bestie, Mac.

Many hugs, Marianne

[mytil]

I too am very sorry, especially with this rapid decline. We understand this heartache.
Always remembering your Otto!
Terry

[fernanda.menda]

I am so sorry for your loss. My baby Lucy just passed 4 days ago…. But a lot of what you said was just what happened to her. She was not herself for the lest couple of months, every so often she would lay down on the floor and I would call her and she wouldn’t even lift her head… I thought I could write more, but I can’t it’s all too recent. I guess I’ll add Lucy’s album to the list of loving memories…