No... I haven't fallen off the face of the earth. Things have been a little crazy around here lately. And not a lot of fun. The most recent misadventure... our beloved dog, Hobey, was diagnosed with Cushing's disease a few weeks ago. If you're not familiar, it's basically a condition where the body produces too much cortisol. Approximately 85% of canine cases are caused by a benign pituitary tumor, and that's what Hobey has been diagnosed with: Pituitary-dependent Cushing's Syndrome.
Hobey never displayed any of the classic clinical symptoms... increased thirst, increased urination, increased appetite, etc. Our vets noticed elevated numbers in his routine bloodwork. A lot of further testing confirmed the diagnosis, though fortunately it's a borderline case and we caught it pretty early. We started treatment with Vetoryl (Trilostane) about five weeks ago.
What the Vetoryl does is inhibit the production of cortisol by the adrenal glands, to prevent the body's level from getting too high. Too much cortisol can cause all sorts of problems. The opposite of Cushing's Disease or Syndrome is Addison's Disease, where the body doesn't produce enough cortisol. Not enough cortisol can be life-threatening.
Treating Cushing's can be tricky, because if the dose of medication is too high, it can cause an Addisonian reaction. So when starting treatment for Cushing's, you have to keep a close eye on your pet and watch for symptoms that would indicate his cortisol levels are too low. You also have to get an ACTH stim test performed two weeks after beginning the meds, then 30 days after that, then 90 days after that, then every six months to monitor the cortisol levels and adjust the meds if necessary. It ain't a picnic, and it ain't cheap. Hobey's vet and medication bills have been about the same as a luxury car payment for the past few months! But he's my furry son, and I don't need a new car, so I'm thankful I'm able to provide the treatment he needs.
As I said, we started treatment a little over five weeks ago. Hobey's numbers were good at his two-week follow-up ACTH Stim test. He didn't seem to be having any side effects other than an increase in his arthritis stiffness, which we expected. Because it's a natural steroid, elevated cortisol levels can mask arthritis and other inflammatory problems. When you bring the cortisol levels back down to normal, the arthritis symptoms will become more obvious. We did see a gradual increase in Hobey's arthritis symptoms... he was slower in getting up, didn't run as fast or as long, and hesitated to jump up on the bed or in the car... but it wasn't drastic or extreme.
Then late last week, we noticed he was suddenly struggling a lot more to get up from lying down. He also seemed to tire out much more quickly than usual. He didn't run to his friend's mom (a.k.a. the cookie lady) when he saw her in the park like he's always done. And he was really slow walking back home from the park that morning. We thought maybe he was just having an off day. That night after work, we noticed a spot on the rug by the back door where he had apparently thrown up. And Mr. RM told me he had to help him up when he got from work that day.
We decided that if he still seemed off the next day, I'd call the vet. I was concerned that he might be heading toward that dreaded life-threatening Addisonian reaction... weakness, lethargy and vomiting are some of the symptoms. The next day, he was still struggling to stand up without help. He was okay once he got his legs under him, but he had a hard time getting there, and he still seemed to be walking much slower and tiring easily. So I skipped his meds that morning, called the vet and left a message with one of the techs about what was going on. I had to go to work before the vet called back... I'm in the process of hiring a new "minion" (that story may be another post), and had someone scheduled for a 10:00 interview. When the vet's office called later that morning, they said to bring him in so the doc could check him out.
When I got back home to get Hobey, he was still lying in the hall where he'd been when I left earlier, and he hadn't eaten the treat I left for him. I called to him, and he tried to get up. He couldn't even get his front legs under him, let alone his poor arthritic back legs. He just slipped around on the wood floor, almost flopping like a fish. I can't begin to tell you how badly that absolutely crushed me. It's horrible to see your four-legged son struggling like that. I went to him and helped him up, and even with me supporting him he struggled to get his feet solidly under him. I half carried him to the rug, and he was finally able to stand up. We went outside, and he was wobbly, but getting steadier. Mr. RM met me at the house and we loaded Hobey into his car to ride to the vet's office.
Dr. H checked his electrolytes... the meds can knock those out of balance too, which can cause problems. They all came back okay. He felt his legs and hips... legs seemed fine, but said Hobey's hips were "cracking" under just the pressure from his thumbs. He said we should increase his Carprofen (like doggy ibuprofen) from one pill every other day to one and a half pills every day... one in the morning and a half one at night. He also said to suspend his Cushing's meds and go ahead and do his 30-day ACTH stim test the next day, a week earlier than scheduled, to see where his cortisol levels were. Like us, he was also concerned that Hobey could be becoming Addisonian.
We got the test results back today. Thankfully, his levels were within normal range. They should be between 1.5 - 9, and he was at a 3. Now, that's a bit low for my complete comfort... I'd be more at ease if they were around a 5, but Dr. H said he was pleased and as relieved as I was. He said to restart the Cushing's meds (the Vetoryl) at the same dose, but to go ahead and do another ACTH stim test in 4-6 weeks to make sure things are still okay.
In the meantime, we're to continue the increased dose of Carprofen for two weeks, and hopefully that will get Hobey's mobility back to what it was. If it doesn't, we'll be looking into other options. Our vet recently began offering stem stell therapy for joint problems, and we were eager to sign up before Hobey's Cushing's diagnosis. Now we're not sure he's a good candidate. It might be okay, but my fear is that because the Cushing's is caused by a tumor, the stem cell treatment could possibly cause the tumor to grow and begin causing other problems. They won't perform stem cell therapy on dogs with active cancer for that reason, but there's not a lot of info on how it might affect pituitary-dependent Cushing's dogs. Dr. H agrees that we should hold off on that in favor of caution. So if the Carprofen doesn't do the trick for Hobey's arthritis, we'll probably try injections of hyaluronic acid, steroids, or Adequan.
So far, we've seen improvement in Hobey's mobility with the increased Carprofen. He's moving around a lot easier the past few days. Still slow, and still seems to tire quickly, but he's able to stand up on his own, even from lying down on the wood floors. We try to get him to lie down on the rugs or on the carpet in the bedrooms, but he LIKES lying on the wood floors... they're cooler I guess.
I also built some doggy stairs for him this weekend, to help him get up and down on the bed, and in and out of the car. I found several instructions for building styrofoam pet steps on tha interwebz, and I'll share how I built Hobey's here.
I got one 8'x4'x2" styrofoam insulation panel from Home Depot, and I cut it into four 2'x32" panels and four 2'x16" panels.
Then I stacked the four 2'x32" panels, and glued them together with Liquid Nails to form the base step, and then did the same with the 2'x16" panels to form the top step.
Once the two step pieces were done, I attached the top step piece to the base step piece with the Liquid Nails, like so. I tried to smooth out the sides a bit, but because it was making a bit of mess, I opted to leave them a little rough. It doesn't look perfect, but the rough sides don't affect the function anyway. I didn't have time to be a perfectionist about it.
After letting the completed structure set for while, I covered the steps with outdoor carpet, again adhering it with Liquid Nails. I weighed the carpet down with some heavy stuff just to help ensure it would lie flat while the glue set.
Then, it was just a matter of teaching Hobey how to go up and down the steps. He's familiar with steps and generally doesn't have a problem with them, but we don't have any in our house, so he wasn't quite sure what to make of these. We got him to climb up the steps onto the bed with a little coaxing and a couple of chicken chips, but he had trouble coming back down. He didn't want to do it, and it took quite a bit of bribery with more chicken chips to get him down. He preferred to do sort of a slide maneuver, and finally ended up coming down a bit cockeyed, but not a bad first effort. The fairly strong adhesive fumes may have had something to do with it! We'll keep working with him to get him used to going up and down the steps. The great thing about them is that they're lightweight, so they're easy to move about. This will be a big help with getting him in and out of my RAV4! I can carry the steps out to the car, load Hobes into the back seat, then stow the stairs in the cargo space until we get to our destination. Assuming, of course, that we can get him to be comfortable actually using them!
If you'd like to make some pet steps, Google "build pet steps" or "homemade pet steps" or something similar... there are lots of helpful instructions out there, and you can find something that will work well for your situation. Here's a tip... styrofoam can be really messy to cut! It looked like it snowed in July on my patio after cutting the panels! And if I make another set, I think I'll spend the extra money on the Liquid Nails that's specifically for foam. I got the regular project kind, and it worked okay, but it did "melt" into the styrofoam a little bit. Our house is also still very fragrant from the adhesive fumes. Our Florida summer thundershowers have prevented me from leaving them outside to air out.
And so, armed with doggy anti-inflammatories, extra floor coverings and portable steps, we're ready to combat Hobey's arthritis issues and help him get back to his old self... or at least as close as a nearly-12-year-old dog can get to his old self. And we'll be keeping a close eye on his Cushing's. He's truly the greatest dog in the world, and we'd like to keep him healthy, happy and comfortable for another few years. Even if it seems like he's trying to put his mama in the poor house. Totally worth it. Totally!