Lulu, 12.5 year old Bichon Frise treating with trilostane, updates

[Lulu's Dad]

Hi everyone,
It is the first time that I have posted here.
My beloved Lulu has been diagonalized with cushings this April.
Lulu is a 12.5 year old Bischon Frise and she is the joy of our life. In addition to cushions Lulu has a grade 3 heart murmur and has hypothyroidism. The vet did a Low dose suppression in April and the suppression was not too bad so she decided to treat for the heart murmur and hypothyroidism and retest for cushings in August. We found out from her results that she definitely needed to go on medication and we talked about Lysodern , but before going any further the vet wanted to do a profile on her..... we just got the results for her profile and I will put in the ones that are not in the normal range
Total protein 74.7 ( range is 50-74)
AST 167 - very high ( normal range is 15-66)
ALT 611 very high ( normal range 12-118)
Alkaline Phoshpates 756 ( normal range 5-131)
BUN 10.7 ( normal range 2.14-9.8)
Potassium 5.6 ( normal 3.6- 5.5)
Sodium potassium ratio low 26 ( normal 27-38)
Cholesterol 12.88 ( normal 2.38- 10)

On going through these levels today the vet said the liver is definitely the problem , the catch 22 here is the lever enzymes could be caused by the cushings itself, or it could be caused by somthing else.
When Lulu was ultra sounded in May her liver was enlarged but there were no masses. The vet is not comfortable to put her on Lysodern as if it the elevetation of her liver enzymes are non cushings thie would lead to organ failure and death....

I have now booked a consult with a vet who also a herbilist for this wednesday and will see what he says......but the general prognosis is grim if we can not treat Lulu for cushings as her levels are very high.

Any thoughts????

[rhodesian46]

Liver enzymes are generally high on a cush pup when first diagnosed. If this was my dog I would see an Internal Medicine specialist being that he has hypothyroidism and possible cushings.Has your vet treated any dogs with Cushing? Most general practice vets don't treat a lot of cases. What are the results from the ultrasound?It is important that your vet know what type of Cushing your dog has because this will determine how to treat it. Can you post them? Also was a Urine cortisol:creatinine ratio test done? If this test comes out normal your dog most certainly doesn't have cushings disease.This is one of the first tests a vet does along with a chem panel.Is your dog showing any clinical signs of cushings? Such as pendolous abdomen,excessive urination and excessive drinking. Has he been tested for diabetes? It would be under glucose on your blood work. There are many cush pups that have liver enzymes in the 2000's. Your dog isn't that high. I am sorry to ask so many questions here. NOt trying to freak you out or anything,

I am not familiar with the LDDS test. There are many here that are. Can you post the results? I used Trilostane( Vetoryl) for my dog not Lysodren.

I am a bit confused as to why take your dog to a herbalist for a cushings diagnosis? A specialist deals with these endocrine diseases all of the time and in the long run it would save you money because a definitive diagnosis could be made and in turn your dog can start to be treated.

[Squirt's Mom]

Hi and welcome to you and Lulu! :)

Don't know what to do, huh? Well, you are exactly where you are supposed to be for the moment! And you have come to the best place to learn. :)

First, while Lulu's liver values are elevated, we have seen much, much higher levels - ALKP in the 1000's! But, with the proper treatment, these levels come on down to a more normal range, tho they don't always return to within the norms.

While elevated liver enzymes are a clue to Cushing's, they cannot be used to diagnose, as you know, because those values can elevate in response to numerous things. You have had the LDDS, correct? Could you post those actual results along with the units of measurement (ug/dl, mnol/l, ect) and the normal ranges for that lab? This will help us get an idea of where Lulu is. Also, on the ultrasound, were they able to see the adrenals and, if so, what were the comments concerning their size? The adrenal glands are the organs that can tell about the possibility of Cushing's VS the liver.

The next step in diagnosing would be either another ultrasound to look at the adrenals if they were not checked on the prior one and the HDDS, or the ACTH. Another test that is very, very important to Lulu, since she is one of the Nordic breeds, is the full adrenal panel from the Uni of TN in Knoxville. This test looks for elevations in five other hormones that often play a role in Cushing's for these breeds. Those hormones are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone and can cause the same signs and damages as the cortisol can. UTK is the only lab in the world we know of that does this testing and Dr. Oliver there is the premier researcher in this area.

Of the above tests I have mentioned, the most important for Lulu are the abdominal ultrasound and the UTK panel. The UTK panel will also include the ACTH.

Now for a few questions...we won't be too nosy til we get to know you better. :p You say:
We found out from her results that she definitely needed to go on medication... Can you explain what exact results you are referring to? How much does Lulu weigh? Does she have any other conditions you are aware of other than the heart murmur and hypothyroidism? What is she taking for the hypothyroidism, dose, and schedule of dosing? Is she on any other meds, supplements, herbs, etc. at the moment? Has she been checked recently for diabetes? What signs did she have that prompted the testing for Cushing's? Was her creatinine normal on the lab report? Has her kidney functioning been looked into? What diet is she on? Is the holistic vet you are seeing also trained in and practice traditional western medicine? Do you have a name we could use? Have you had enough questions for the time being? :p

I know so very well how scary it is when we first hear "Cushing's" in connection with our babies. :eek::eek::eek: How that fear, grief, confusion and frustration can simply overwhelm us. But, here's the good news - Cushing's does not have to mean "the end" for your sweet Lulu. There is much hope for Lulu and you. There is much that can be done for her to help her enjoy the remainder of her years - yes, YEARS. We have babies here who have survived for eight years after diagnosis and we know of those who have lived even longer...all on proper treatment.

You are not alone on this journey, Dad. We will be with you every step of the way. We are not vets and we do not try to take the place of your docs, but we have and do live with this condition on a daily basis and, as a result, the collective knowledge here is simply astounding. So use us. You are Lulu's first and last defense, her voice, her only advocate and the more you know the stronger you will be in these roles. Read, read, read, ask lots of questions, then read some more. Check out the Resource section here and read some of the threads posted. I think you will find some of that hope and a great deal of knowledge.

I am so glad you found us and hope to learn more about you and Lulu as time passes.
Hugs,
Leslie and the girls

K9C Resource section:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

[acushdogsmom]

Hi and welcome,

My dog was also a Bichon Frise and he was treated for Cushings very successfully with Lysodren for more than 6 years. You honestly wouldn't even have been able to tell there was anything wrong with him once we got his Cushing's under control.

Elevated liver enzymes is very common in untreated Cushing's dogs. Usually it's not primary liver disease, it's a liver condition that is caused by the excess cortisol that the adrenal glands of untreated Cushing's dogs are producing. The liver condition that results from high cortisol production is called "steroid hepatopathy" and it often resolves once the Cushing's is under good control. My own dog's liver enzymes were sky high at diagnosis of the Cushing's, but the liver function was totally back to normal after a few months on the Lysodren.

The key to successful Cushing's treatment, in my opinion, lies in having a really heads-up and Cushings-savvy Vet treating your dog. That and you being a concerned and involved owner who is the Vet's eyes and ears at home are the two most important things.

It sounds to me as if it may be that your regular GP Vet is not as savvy as you'd really want a Vet to be when it comes to treating Cushing's ... not that that makes your vet a bad vet ... it doesn't. It's hard for a GP Vet to be an expert in every single aspect of veterinary medecine.

But just like in "peoplemed" where your regular doctor would refer you to a Specialist if you developed certain diseases or conditions, there are veterinary Specialists too.

My dog was originally diagnosed with Cushings by our GP Vet, but we asked to be referred to a Veterinary Internal Medicine Specialist, who is an expert when it comes to diagnosing and treating Ciushing's. The Specialist re-confirmed the diagnosis and took charge (at our request) of the case for the rest of my dog's life. That was definitely the best thing we ever did, too. My dog got well again and he lived out a normal, healthy and happy lifespan for his breed. (He was diagnosed at age ten and lived to almost 17 years of age). I don't think he would have lived that long or done that well if we hadn't gotten an Internal Med Specialist on the case and insisted that she be his primary Vet for all things Cushing's or even remotely Cushings-related.

Okay, so now I hope you're wondering if there are any "Cushing's Specialists/experts" in Toronto. The answer: Yes! There are!

We've had several folks here in the past who took their dogs to see one of the Internal Medicine Specialists at the VEC SOUTH in Toronto ( 920 Yonge St. - (416) 920-2002 )

Here's a link to their webpage that talks a bit about the four Internal Medicine Specialists who work there:

http://www.vectoronto.com/staff_internal_medicine.php (http://www.vectoronto.com/staff_internal_medicine.php)

(Here's the link to their main page http://www.vectoronto.com/ )

I think that the folks we had here who took their dogs to the VEC used Dr. Mason and Dr. Norris at VEC South, although one may have used Dr. Finora, I'm not sure. I do remember that they were very happy with the expert care their dogs got there. The Internists at VEC South are probably all very good and very knowledgeable about diagnosing and successfully treating Canine Cushings. (I think I also remember that they may have tended to prefer treating Canine Cushing's with Vetoryl/trilostane rather than Lysodren)

Please don't waste your time going to an herbalist. Cushing's is a very serious condition and it needs to be treated with conventional medicine to get a successful outcome. That's not to say there aren't some herbs or supplements that can also be helpful as adjunctive therapy sometimes, but there are no herbs or "natural" "holistic" types of treatment that have ever been shown to work as a primary treatment for Canine Cushing's. Lysodren or Trilostane (Vetoryl) are the only two treatments that I know of that really do work.

P.S. You might need to have your Vet give you a referral to see one of the Internal Med Specialists at the VEC. But if your Vet is really concerned about the welfare of his/her patients, he/she should be glad to give you that referral. And if you request it, the Internist can take over for the long-term as the director of the Cushing's treatment on the case. Or, if you prefer, the Specialists can just re-confirm the diagnosis, make treatment recommendations and then send you back to your regular Vet to continue on with the treatment, consulting with your Vet again in future if need be.

I tend to be prejudiced towards having the Specialist direct the treatment long-term, because that's what I did and that's what kept my dog doing so well for so long.

And it's also nice when the Specialty Clinic has a 24 hour ER attached to it, (which VEC South does) so that if you ever need Vet help at a time of day when most regular Vet Clinics are closed or during the night, you can bring your dog right in and all the treatment records are right there in the same building. They can then contact your Specialist Vet directly, even at home if need be.

Hope this helps.

[Lulu's Dad]

Thank you for getting back to me .....
Lulu has had 2 LDDS TESTS. This is the test that is done over 8 hours, the first level base line the second level is after 4hrs and the 3rd level is after 8 hrs. I do not have a copy of these tests but they gave me the values over the phone
The first one was borderline,292 ml/l, 649 m, and 45.5 ( done in may09)
The second one ( Aug 25th, 09) 458, 147 and 155.
Creatinine is 74 ( range 44-141
Fasting Glucose 6.0 ( 3.9-7.7)
I do not believe they have done the urine test, but my vet says she is well trained in the endocrine system and she is sure that Lulu has cushings.
The Ultra sound results done in May showed enlarged heart, enlarged adrenals, a grossly enlarged liver, with no masses. I am not aware of any other conditions besides her hypo thriodrism and heart murmur Lulu does drink a lot of water and has to urinate frequently, she also pants a lot, and she has her good days and her bad days. I was all set to load her with the Lysodern , but the vet suggested that we retest and probably see an internal therapist for another ultrasound. I thought I would see a vet who is trained as a herbilist to see what he had to say, mind you his consulting fee is $4oo dollars. My vet said since we did the LDDS ,THE ACHT IS NOT REQUIRED.
I am confused and probably reacted to the liver news badly..... also Lulu has been loosing weight gradually, her weight a year ago was 11.8 and she is down to 11.4. I thought a dog with cushings gained weight. Lulu does have an excessive appetite , this began right around April of this year, before that she was a very fussy eater.

From her LDDS results the vet said that she is definately got cushings but now the catch 22 with the liver.....

Lulu is almost 13 years old but we do love her dearly, and we want to do the right thing for her, even if that involves going into debt. We have already spent over 3,500 dollars since this april and it has all gone on my line of credit, but thats besides the point

I hope this explains things a little further.

My name is Bomi by the way , and once again, thanks so much for taking the time to respond to me.

Should I cancel the appointment with the vet who is also a herbalist who has a really good reputation and go to the internal therapist instead? or shall i do both?? I know time is of the essence here and I want to do the most I can for my baby. Does any one have any ideas? Lulu is on the hIlls priscription diet, and at night during the day, at night, I give her a home prepared meal, consisiting of brown rice, ground lean chicken, grated carrots, celery, and raw potato.
She is takes cod liver oil every day and a vit e once every 10 days, and vit d and a multi every day.( I have cut my multi into 8 pieces and give her one piece every day.)

Lulu's Dad ( Bomi )

[Lulu's Dad]

Cushy, thanks so much for that info I will cancel the appointment with the herbalist and ask my vet to make an appointment with VeC South, at 920 Yng st. Thanks for that......bit of info. My vet seemed to think the the elevated liver enzymes could be caused by a condition independent of cushings.

thanks so much,

Bomi

[acushdogsmom]

Should I cancel the appointment with the vet who is also a herbalist

Hi again, Bomi,

If I were you, I'd cancel the appt with the herbalist, at least for now. Your money would be much better spent getting Lulu in to see an Internal Medicine Specialist. I just know that my dog would not have survived as long as he did and done as well as he did if we hadn't had the expertise of the Specialist for all that time.

I also gave my dog some herbs and supplements, but that came after getting the Cushing's under good control with conventional meds. And we had the Specialist's blessing to use the herbs and supplements that we were prescribed.

Your Vet can fax all of Lulu's pertinent test results to the Specialty Clinic before you go, so that they can look them over beforehand and have those test results on hand when you get there. They may or may not need to run additional tests.

[acushdogsmom]

Cushy, thanks so much for that info I will cancel the appointment with the herbalist and ask my vet to make an appointment with VeC South, at 920 Yng st. Thanks for that......bit of info. Good. :)


My vet seemed to think the the elevated liver enzymes could be caused by a condition independent of cushings. Sure, that is possible, but it's also very possible, if Lulu really does have Cushing's, that it's just steroid hepatopathy that's going on with the liver.

P.S. If you or your Vet is going to make Lulu an appt. at the VEC south, make sure the appt is with one of the Internal Medicine Specialists there. Not all the Vets there are Internists ... some are other kinds of Specialists, like surgeons or dermatologists or cardiologists or oncologists or other kinds of Specialists maybe. :)

[Lulu's Dad]

I spoke to VEC South and Dr Norris the internal specialist you mentioned is available, but I need my vet to call them to book the appointment and send the records over. The cost of the consult with dr Norris is 165 plus tax, Cushy would you happen to know if this is for the first consult or every time we see them?

thanks again......

[Squirt's Mom]

Hi Bomi,

I see that you are going for the specialist VS the herbalist - good move. The herbalist may be able to offer some suggestions on down the line but right now getting a definitive diagnosis and a treatment plan in place is the most important.

The LDDS tells how the adrenals react to added stress - stimulation. The ACTH tells how much cortisol is being held in reserve in the adrenals. Both the LDDS and HDDS are all day tests like you described. Is it possible the second test was the high dose stimulation test (HDDS)? The LDDS will give you a baseline for a starting point but it cannot diagnose Cushing's by itself. The HDDS will give an indication of whether it is adrenal or pituitary based. But, I prefer the ultrasound for this. Did Lulu's ultrasound mention anything like "bilaterally enlarged" - both enlarged, or "unilaterally enlarged" - one much larger than the other? Were both visible?

Cushing's is a complex condition that requires several tests that support a diagnosis before one can say with any certainty you are dealing with Cushing's. Hypothyroidism, diabetes, liver disease, kidney disease and other conditions can mimic Cushing's and even return positives on the Cushing's tests.

Let me tell you about my baby, Squirt. She had the LDDS, HDDS, ultrasound and ACTH which all said she had the pituitary form of Cushing's, PDH. Before I started her on any treatment I wanted to be sure all the bases were covered so she had the UTK panel I spoke of in my earlier post which determined she had Atypical Cushing's - natural elevations in some of those other hormones (in her case, 4 of the 5). On the result sheet, it was recommended that she have another ultrasound and we did. A splenic tumor was noted and it along with part of her spleen were removed. Since then her cortisol levels have returned to normal. Now her docs say the original diagnosis of PDH is "highly questionable" and she is being treated for the Atypical only.

Non-adrenal illnesses such as a tumor like Squirt's can cause these tests to give a skewed result, a false positive. The reason this can happen is that cortisol is one of the "flight or fight" hormones that the body releases in response to any type of stress, including physiological stresses. So when looking at cortisol as the cause of Cushing's, it is necessary to do several tests to rule out other possibilities and for confirmation - and even then there is the possibility conventional Cushing's is not the cause for the elevated cortisol level.

:o I need to apologize for something as well...I said that Lulu was one of the Nordic breeds. I believe that is incorrect. I was thinking she was a pom probably because I was just talking to a lady about her pom plus one of our members here has a Lulu who is a pom. :o I don't think Bichons are Nordic...I should know this as I work with a Bichon rescue group. :rolleyes::o

Unless a liver condition is behind this, her liver will improve with treatment. The excess cortisol causes the liver to enlarge as it tries to handle the extra load. As the liver enlarges, it presses on the lungs making breathing more difficult at times, hence the panting. The cortisol also causes them to feel hungry all the time and causes them to pee a lot. The don't pee a lot because they drink so much - it is just the opposite. They drink in an effort to keep themselves hydrated because they pee so much.

Her diet sounds ok, but as a canine nutrition student it makes me cringe to hear of someone using human multi-vitamins for their pup. The mineral and vitamin requirements for pups are quite different than human requirements and by using human vitamins we can cause an imbalance in their systems. I urge you to talk to you vet about a vitamin supplement designed for canines if Lulu requires supplementing.

Hang in there!
Hugs,
Leslie and the girls

[acushdogsmom]

I spoke to VEC South and Dr Norris the internal specialist you mentioned is available, but I need my vet to call them to book the appointment and send the records over. The cost of the consult with dr Norris is 165 plus tax, Cushy would you happen to know if this is for the first consult or every time we see them?

thanks again......I've heard that Dr. Norris is a very good Internal Medicine Specialist. I think he may even be one of the founders/owners of the VEC Specialty and Emergency Clinic.

I've never been to see him myself (I do live in Canada but I'm not in Toronto) so I don't know how their fee schedule works exactly, but the way it usually goes is that the first visit for consultation is more expensive than what you pay to see and consult with the Specialist on the follow-up visits. They will also be adding on the cost of any testing that they do, as you go along, though. But it's worth every penny, if you ask me.

The Internal Med Specialists diagnose and treat many many more cases of Cushing's than any GP Vet ever does and in addition to all the extra experience with Cushing's that they have, the Specialists also have extra training and expertise in conditions such as thyroid and heart conditions etc.

Just my opinion, but I think that the very best you can do for Lulu is to get a good Internal Med Specialist, such as Dr. Norris, on her case ... and then keep him on her case for the long term as the primary Vet who makes all the treatment decisions.

[gpgscott]

Welcome Bomi,

Sorry your Lulu is having issues but very glad you have found our site.

Please continue to let us know how things proceed after you have chosen a Dr.

I advocate the advice which Cushy has given.

Best to you and Lulu.

Scott

[Lulu's Dad]

Hi Leslie and the girls and every one else who responded,

thanks so much for your responses.

Yes I should have insisted on seeing an internal specialist right off the bat, but my vet was so sure it was Cushings, I took her word for it.

The reason why I took Lulu in for the extensive tests was because she had a near collapse, possibly due to a blood clot and on closer examination and radio graphs the liver, and heart were both enlarged.

My vet made an appointment for a visiting internal specialist to come down to the clinic and do an ultrasound of both her chest and abdomen. I was told they might have to biopsy her liver if they found a mass. They did not find a mass but noted that both her adrenal glands were fairly enlarged and he suspected cushings.

My vet then did a low dose suppression test- the 8 hour test. The results were borderline cushings she said. She decided not to treat for cushings right away but to tread for the heart, with benzapril 2.5 mg once a day and eltroxin twice a day. We rechecked her thryoid in 2 months and the levels very in a good range. Then she suggested we repeat the Ldsuppresion test again and this time the levels were very much elevated. Just to air on the side of caution before starting Lysodern therapy my vet kept lulu for the day, monitored her blood pressure and did a complete geriatric profile on her. I posted the results of that test that was done a few days ago.
I went in today for the consult, but the elevated liver enzymes made her question if there was now something wrong with Lulu's liver in addition to the cushings.

Thanks to all of you I am now on the right track and will take Lulu to see an internal medicine specialist early next week.
He will review all the tests that have been done and determine if he want to ultrasound L again .

I know time is of the essence and I really want to do all I can for my girl.

Thanks to all you for your support and advice it is really appreciated,

Lulu's Dad

[acushdogsmom]

I only have a minute, but just wanted to say that it does sound as if your Vet has been much more thorough than many would be (which is a good thing!) ... but it would still be a good idea to get a second opinion and have Lulu fully examined by an Internal Medicine Specialist, to get the diagnosis confirmed and treatment recommendations made. It might be Cushing's, or it might not be. And if it is Cushing's, it may not be only Cushing's that needs to be treated.

Some here have an Internist and their GP Vet working together, which is another good way to do it, if the GP is willing to work with the Specialist on the case.

Sorry, gotta run!

[jrepac]

yikes.....Liver Enzymes are typically high when cushings is present; not unusual for liver and adrenals to be enlarged


but it is always good to make sure nothing else is going on in there via ultrasound or biopsy

Jeff

[Lulu's Dad]

Cushy I have an appointment booked with Dr Mason( for Sept 2nd) who I thought would be the best fit, because his speciality is internall medecine for small dogs focusing on the endocrine system.
Thanks ,

Lulu and Bomi

[acushdogsmom]

Cushy I have an appointment booked with Dr Mason( for Sept 2nd) who I thought would be the best fit, because his speciality is internall medecine for small dogs focusing on the endocrine system. Thanks , Lulu and BomiYes, I saw the write-up on him in the staff profiles on the VEC Toronto website:

http://www.vectoronto.com/staff_internal_medicine.php



Dr. Mason graduated from the Ontario Veterinary College in 1994 and remained in private practice for the next 4 years, 3 of which were spent in emergency medicine. In 1998 Dr. Mason returned to the OVC to complete a residency in small animal internal medicine. In 2001 he completed his Doctor of Veterinary Science degree as well as becoming board certified by the American College of Veterinary Internal Medicine.

Following the completion of his residency Dr. Mason practiced as the staff internist at the Animal Emergency and Critical Care Center in Chicago, Illinois. Dr. Mason joined the VEC in January of 2003 where he maintains a small animal internal medicine practice. His primary interests include endocrinology, gastroenterology, cardiology and oncology. Dr. Mason also has a keen interest in ultrasound (abdominal/cardiac/soft tissue etc.) and its applications.
Seeing as how Lulu may have Cushing's and may also have possible cardiac (heart) issues, I think he'd be a very good choice for your Lulu. :) Sounds like he is also an expert at interpreting ultrasound images, which is also a good thing. Ultrasound is a fantastic diagnostic and monitoring tool for many different diseases and conditions, especially if you have an ultrasonographer performing the procedure who has expert eyes for interpretation of the ultrasound images..

I have a friend whose friend took her dog to see Dr. Mason (not about Cushing's) a few years ago, and she apparently loved him. She said he was very thorough and caring.

I think a few people on our message board (in the past) have also had Dr. Mason as their dogs' Internal Medicine Specialist and they were also very happy with his expertise and all of the services which he provided for their pets.

Let us know what he says. :)

P.S. I'm not always around here as much as I used to be, but there's always people here who are here to help and who will be glad to give you all the support that you need.

[StarDeb55]

Bomi, I haven't posted to you yet, but I wanted to give you & little Lulu a late welcome! Cushy & everyone else has got you pretty well covered, so I won't repeat much of that. When it comes to the value of an ultrasound, I wholeheartedly agree with what Cushy has said about it being a valuable diagnostic tool. On my Harley's ultrasound that was done at diagnosis, we, also, discovered that he has a pre-existing gallbladder condition including a dilated common bile duct. This knowledge has been vital for his GP vet as Harley became very ill with what was apparently a gallbladder attack just about a year ago.

I know you have expressed concern about Lulu's elevated liver enzymes. This is quite common with Cushing's, & the elevation in the alkaline phosphatase is usually the first hint that will point a vet towards Cushing's. My 1st Cushpup, Barkley, would have alk phos values that ran between 1200-1800. I have seen the values even higher in other dogs. With treatment, the liver function values should improve.

Let us know how the visit with the specialist goes.

Debbie

[BestBuddy]

Hi Bomi and welcome to you and Lulu.

This site is a great resource for knowledge and also support. I am glad you have an appointment with Dr Mason and hope you get your answers.

Jenny

[jrepac]

we've had liver enzymes as high as 3200
I would not panic over high #s
in and of themselves, they are not life threatening
just indicative of a larger problem (cushings, etc)

[acushdogsmom]

I have an appointment booked with Dr Mason( for Sept 2nd) who I thought would be the best fit, because his speciality is internall medecine for small dogs focusing on the endocrine system.Just wondering, how was the appointment with Dr. Mason?

[Lulu's Dad]

Hi all,

I took Lulu in to see Dr Mason an internal medicine specialist at VEC South in Toronto, and he recommended another ultrasound to determine the High liver and alkaline phoshpatase levels she portrayed and suggested he might do a liver bipopsy.

On meeting with him later he said that the liver appeared normal and the biopsy was not required, but that Lulu had " Bilary mucocele" which was causing her liver enzymes to be so elevated.

Lulu is 11.4 lbs and he prescribed Trilostane ( 10 mg) once daily and asked that we brought her back for an ACHT stim test in a week to 10 days if Lulu's cortisol levels were under control he would then strongly recomend her to have her gall badder removed.

Below is a brief discription of Bilary mococele.
Biliary mucoceles have become a common cause of extrahepatic biliary obstruction in dogs over the last two decades. The accumulation of mucinous bile in the gall bladder, cystic duct and common bile duct causes distension, and eventually rupture of the gallbladder. Many of these dogs present with jaundice and abdominal pain, though my impression is that we are detecting biliary mucoceles in asymptomatic dogs as well.

I have started Lulu on Thilostane today and am confused if she is 11.4 lbs why would he put her on such a low dose? The recommended dose is 6mg/kg ...which would be approximately 30 mg/day. Do you think he started her on a low dose to air on the side of caution? I am confused and did raise this with him but he said this was the way he wanted to proceed.

Any suggestions or comments would be appreciated.

thanks,

Bomi ( Lulu's Dad)

[StarDeb55]

Bomi, I have merged your new thread with the update about the visit to the IMS with Lulu's existing thread. We like to keep all posts & information on one pup in a single thread, it's easier for members to keep up with what's going on with Lulu when we do it that way. I will also change the title to reflect the update with the IMS.

A couple of comments concerning the visit with the IMS. Let me say right off that I'm not a Trilo parent, but I feel confident that some of the Trilo parents will confirm this. It is usual protocol to start Trilo at a lower dose than recommended, then work up to a higher dose, if needed. Your ACTH at the 10 day mark will let you know about that. It's also very important that Lulu's electrolytes be checked any time she has an ACTH done.

With regards to the comments on the ultrasound about gallbladder disease, this can be a very serious issue. My Harley was found to have a pre-existing gallbladder problem with a dilated common bile duct on his diagnostic ultrasound a little over a year ago. This has been very important information to have as Harley became seriously ill several months later with turned out to be a gallbladder attack. Harley is 14 yrs. old & he would not be a candidate for surgery. If Lulu is a candidate for surgery, IMHO I would seriously consider it for her, as the research I've done on canine gallbladder disease indicates that when a gallbladder attack is serious enough, it may be life-threatening.

Debbie

PS- I forgot to mention that if you would like the thread title changed to something else, please let any of the mods or administrators know, & we will be happy to do that for you.

[BestBuddy]

Hi Bomi,
One of the last Vetoryl brochures I have states that dogs should be started on less than 5mg/kg and that most dogs stabilize on average with 2-10mg/kg. There are also thoughts that dogs should be started on as low as 1mg/kg so I would not be too concerned that you are starting on 10mg. We all want to fix the problem now but slowly is better for your Lulu and it's much easier to bring the dose up than have to deal with giving too much.
Jenny

[Lulu's Dad]

Hi all,

I though I would post a Lulu Update.....
Lulu has been on 10 mg Trilostane ( Vetrol) for just over a week now.
I see a remarkable improvement in her disposition. She is not panting, the tremors are much reduced and she water consumption had decreased. I am keeping my fingers crossed!!
Lulu goes in for her ACHT stim test on Wednesday the 16th and will post after the results. Her IMD discovered lulu had Bilary Mococele and has recommended we remove her gall bladder once she is stable on TRILO. I will post once I have some more news.

Take good care and enjoy each day to its fullest!

Lulu's Dad

[Harley PoMMom]

Hi Bomi,

That's great...it sounds like Lulu is really improving.

There is one thing I wanted to ask...you do have prednisone on hand...right?

Please let us know the results of Lulu's stim.

Hugs.
Lori

[Lulu's Dad]

Lulu's ACHT results came in this Wen and her numbers were still very high......Dr Mason had started her on 10 mg /day and she seemed to be doing so well on it.....till the results got back.
Her dose has been now bumbed up to 30 mg /day of Trilo/Vetrol and she is not as bouncy and alive as before, she still has a good appetite though. Hopefully she will adjust to the new dose and the ACHT will be repeted in 10 days to check her levels.
Her last leves 2 hrs post injection were in the 600 range and the dr said he wants them to be below 100. Fingers crossed.
Have a wonderful weekend every one and take good care of yourselves and your kids!

BOMI

[Harley PoMMom]

Hi Bomi,

Keeping all fingers, toes, paws, tails and eyes :eek: crossed that this bumped up dosage will get Lulu's ACTH stim into range.

You have a wonderful weekend yourself, give Lulu a gentle hug from my Pomboy Harley and me.

Love and hugs.
Lori

[lulusmom]

Hi Bomi,

Your vet increased Lulu's dose by 200% so that is a pretty hefty increase. Dogs do go through cortisol withdrawal which makes them feel pretty darn yucky and I suspect that this may be what Lulu is going through at the moment. This normally passes in a few days; however, be ever vigilant in watching your girl for signs of cortisol going too low. Common signs would be not eating, vomiting, diarrhea, weakness, extreme lethargy and trembling.

Vetoryl/Trilostane has a short halflife so unlike Lysodren, once the dosing is withheld a dog normally bounces back rather rapidly. This is why most vets do not prescribe Prednisone to keep on hand in case cortisol goes too low. Both of my cushdogs treated with Trilostane and with my Lulu weighing less than 5 pounds, I always had Prednisone on hand. I call it "sleep insurance". :D

Please do get copies of the acth stimulation tests and post the results here. It is highly recommended that you keep a folder with all of Lulu's medical tests, vaccine records, etc. That folder comes in really handy if you ever have to make a trip to an emergency hospital and the vet on call will really appreciate it. The folder comes in even handier for when us members keep hounding you to post test results. :D:D:D

Glynda aka Lulu's Mom

[Harley PoMMom]

Hi Bomi,

I was just checking in on you and Lulu to see how she is doing on her increased dosage of Trilostane.

I hope everything is going great.

Love and hugs.
Lori

[caz]

Lulu's Dad ( Bomi )
My name is Christine and my havanese is Teddy (havanese are relatives of the bishon). In any case I live in Toronto and my dog was just diagnosed with cushings. Someone told me that you took your dog to the VEC animal clinic in Toronto and saw Dr Mason, I was just wondering what your thoughts are as I was going to take Teddy there.

Thank you
Christine

[Lulu's Dad]

Hi all,

Lulu was diagnosed with cushings last April and has been on thrilostane 30 mg/ day. she was doing really well and was the picture of health...last evening she started to limp a bit, and late this evening( Friday) she could not stand on her hind legs. Her specialist is not in till Monday and if I take her to emerg all they will do will be to put her on IV fluids. what should I do? Any suggestions

Lulu's Dad :eek:

[frijole]

Hi! Gonna ask some questions so we can help. First off - I haven't used trilo... but we have seen cases where dogs who are regulated at a give dosage all of a sudden have their cortisol drop. I would CEASE the trilo for now. Do you have any prednisone on hand? You should have got it when you first started giving trilo in case of emergencies. I would give the recommended dosage RIGHT NOW.

If you don't have any prednisone you need to get some. And it is important you call the emergency no. to get it now. It mimics cortisol and after a couple of hours your dog should feel normal --- assuming I am right.

I am curious why you said the vets office would just run IVs. Has this happened before? This usually is done when the cortisol levels have gone too low. Has your vet been doing regular acth tests to test the cortisol levels of Lulu?

Sorry for the questions but just making sure we have all the info we need. What is Lulus weight?

Tell us as much as you can. Thanks! Kim

P.S. I found your original thread and read it. Lulu is only 11 lbs. 30 mgs is a high dosage! She went from 10 to 30 mgs I read. Seems like that was fine since the end of last year. Again I am suspecting the cortisol has gone too low. I didn't see any acth test results since you started on the 30 mgs. Have you been having them done regularly? How were they?

We will merge this thread with your original one but I am going to leave it alone right now in hopes that you will find the responses more quickly.

[Lulu's Dad]

lulu weighs about 10 lbs do you have any idea what the level of prednizone would be for her

[Lulu's Dad]

Sorry I did not answer the questions earlier, but Lulus internal specialist last tested her cortisol levels about 4 months ago she was due to have a recheck in June. Her back legs are trembling and she cant seem to stand up

[frijole]

yes - my dog is 15 lbs and was prescribed ONE HALF of a 5 mg prednisone in emergency. I would guess you would be safe with just under 1/2 a tablet.

The emergency dosing amount is .25 mg of prednisone /kg of weight. It comes out to like 1.5 mg of prednisone so like I said - less than 1/2 of a 5 mg tablet

[frijole]

Sorry I did not answer the questions earlier, but Lulus internal specialist last tested her cortisol levels about 4 months ago she was due to have a recheck in June. Her back legs are trembling and she cant seem to stand up

That definitely sounds like low cortisol. Do you have prednisone on hand?

[Lulu's Dad]

I have decided to take Lulu in to the emerg and have her checked out.
Will keep u posted. I hope they are able to give her the prednizone.

[Lulu's Dad]

no i do not
But hopefully the emerg will be able to give her some..

[frijole]

Tell them it is an emergency and you need it now. Bring Lulu with you so you can give it to her at the clinic and it'll save time. Usually the drug works wonders within a few hours. It will give her alot of comfort and make her feel more normal. She might need to take it for a while. But let the vet tell you how often and you'll have to wean her slowly off it.

[frijole]

I have decided to take Lulu in to the emerg and have her checked out.
Will keep u posted. I hope they are able to give her the prednizone.

Great. Do keep us posted. They will probably check out her electrolytes to make sure they don't have to give her fluids.

[Harley PoMMom]

I agree with everything Kim has said, she has given you very good advice...please get Lulu to the emergency clinic now and please keep us posted.

Love and hugs,
Lori

[Lulu's Dad]

Took Lulu to the emerg and they gave her prednisone, hopefully that will help.

B

[StarDeb55]

I'm sorry that Lulu is having a rough patch, right now. Just to let you know, I have merged your update thread with Lulu's original thread. We normally like to keep all posts on a pup in a single thread as it makes it easier for members to refer back to the pup's history.

Debbie

[Lulu's Dad]

Hi All,

Lulu is doing so much better and tomorrow I will talk to her vet in detail.
I had asked him about having some Prednisone on hand, but he was very empathic that it was not required with Thrilo treatment. I will make make sure she is tested prior to putting her back on meds .

Fingers and toes crossed,

Bomi

[Lulu's Dad]

Great. Do keep us posted. They will probably check out her electrolytes to make sure they don't have to give her fluids.

Yes they did check her electrolytes and put her on iv fluids and then rechecked them before I could bring her back home.

Even if your pet is on Thrilo please keep an emergency supply of prednisone on hand. I will re post when I have some more news.

[Lulu's Dad]

To those of you who are wondering about how Lulu is doing.....
I have an appointment to see Dr Mason at VEC south on Wednesday of next week. I had a conversation with him on the phone and gave him a piece of my mind.... he still refuses to give me Prednisone, for some weird reason, and has the ego the size of a melon. He claims it could have been anything ......and none of his dogs on Thrilo have ever had a cortisol low. However he is going to test her on Wed, and she her levels and we can go from there. If he is still offensive and full of himself I might be looking for another internal specialist. I cannot understand why people like him become Vet's in the first place. he appears to resent the fact that I have educated myself on canine cushings. Will keep you posted when I have news.

If any of you have comments or thoughts I really would like to hear them. Also thanks once again to the angles on this site who pointed me in the right direction. If I had not taken Lulu in to the emerg that night I might have lost her. Thanks for reading and god bless you all.

[Squirt's Mom]

Hi Bomi,

Glad that our little Lulu is doing better and home.

As for advice, I would run like HELL :mad: from Dr. Mason...but that's just me! :rolleyes: Close-minded, arrogant vets have no chance of treating my babies...I would go to jail for punching 'em one! LOL ;) Just kidding about the punching part but I would definitely be looking for another vet who cared more about Lulu than about his own ego.

Let us know what you learn! and keep up the good work!
Hugs,
Leslie and the girls - always

[clydetheboosmom]

Oh my. I have a dog on Trilo and she has gone Addisonian four times. Four times!

I keep prednisone on hand, just in case. I do not understand your vet's reluctance to give it to you "just in case"? Is he afraid you won't use it correctly?

Please let us know how Lulu (and YOU) are doing!

Lynne, Clyde & Bailey

[Harley PoMMom]

Hi Bomi,

I am very glad to hear that Lulu is feeling much better. Not all vets/IMS's feel the need to give the owner prednisone, I believe they think that since Trilostane/VETORYL has such a short half-life and is out of the pups system fast that simply with-holding the Trilostane/VETORYL will be ok. BUT according to Dechra's U.S. Product Insert:


PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules.

WARNINGS:
In case of overdosage, symptomatic treatment of hypoadrenocorticism with corticosteroids, mineralocorticoids and intravenous fluids may be required.

http://www.dechra-us.com/File/prod_vetyrol.pdf

If I were treating my pup with Trilostane/VETORYL, and since Hypoadrenocorticism can develop at any dose of VETORYL Capsules, I would demand to my vet/IMS to give me prednisone incase of an emergency situation.

Love and hugs,
Lori

[frijole]

Hi Bomi,

We are glad to help. I'm glad it all worked out. And also glad Lori posted that product insert. I would print that out and hand it to the IMS vet with the ego and highlight the part about prednisone. Like she said, some vets don't realise how important this is. If he still cops an attitude.. well.. maybe there is another IMS out there that is more caring and open.

Regardless, Lulu made it thru last weekend and is better now. Really good to hear the updates. Hugs, Kim

[MiniSchnauzerMom]

Bomi,

I have been following Lulu's story and I agree with Lori - I would demand the pred to have on hand. Munchie's "former" IMS had the same attitude as Lulu's doctor and lucky for me I absolutely insisted she give me some pred to have on hand. As it turns out, I did have to use it for my dog.

My thinking....the IMS works for you, you hired and pay him for his knowledge and service. Lulu is your dog, not his. He may recommend and suggest options and treatments - the decision is yours to make. If this IMS is disrespectful and noncommunicative with you and continues on that way if it were me, I'd be looking for somebody else. Just my 2 cents worth.

I'm glad your Lulu is doing better and please do keep us posted.

Louise

[Lulu's Dad]

Hi All,

Just a quick update on Lulu.....
Last week we tested her and her levels indicated that it was time to go back on the Thrilo....we have started her up on 10 mg last week. We will be taking her for her tests at the 2 week mark. It is amazing how subdued she is on the the thrilo, though, and it was amazing to have our old Lulu back when she was off it for almost two weeks.

Will keep you posted when I know more and we are keeping our fingers and paws crossed.

Bomi

[frijole]

Glad to hear our dear Lulu is doing OK and getting checked out. Is that dosage reduced from the previous one? Sorry, can't remember. Good luck and hugs, Kim

[Harley PoMMom]

Hi Bomi,

Some pups that have been on Trilostane for a period of time do sometimes need to have their dosage decreased. And with Lulu having an emergency situation, this is the best route to take. I do believe the 10mg will be adequate for Lulu, and the 30mg she was taking before was just a little too much for her handle.

Thanks so much for keeping us updated, we do appreciate it as we worry so about our family members!

Love and hugs,
Lori

[Lulu's Dad]

An update for Lulu. After discontinuing Trilo 30 mg and giving her pred, Lulu seemed to bounce back to her old self if about 10 days. We repeated her ACCHT test and restarted her on Trilo at 10 mg. We retested her at the 2 week mark and her levels were good , but Lulu's appetite decreased noticeably after the 5th day of Trilo and I had to hand feed her . She is also loosing weight and is now down to just under 10 lbs from her original 12 pounds. Her other symptoms are confusion, and a lack of strength in her back legs. I taken her off the thrilo again and go to see the vet again tomorrow as he suspects that Lulu might have somthing else wrong with her, Lulu is also on eltroxin for her thyroid and benzapril for her heart as she has a heart murmur.( She is still taking the Ben, Elteroxin and Milk Thistle) She has now been off the Thrilo the second time, for a week and her appetite has still not come back, though she seems less confused, but still far from her old self. I am at my wilts end and am very worried. If any of you have any suggestions I would greatly appreciate them and in the meanwhile I will keep my fingers and toes crossed.

[Franklin'sMum]

Hi Bomi,

Good luck tomorrow at the vet. Please keep us posted. Sending you both good thoughts, and keeping Lulu in my prayers

Jane, Franklin and Bailey xxx

[Roxee's Dad]

Hi Bomi,

Sorry to hear of Lulu's problems. Just wondering...how is Lulu's eyesight? If she has lost some or most of her vision, this may contribute to the confusion. Is her hearing okay?

When at the vet, you may want to ask the vet to check her neurological functions. I really hate :( to bring this up but it is possible the tumor on her Pituitary is growing. I went through this with my Roxee and maybe I was in denial but in the end, she lost most of her control of motor functions in her hind end and had trouble standing and even eating when her food was right in front of her. I think the vet said she lost nerve function on the left side of her mouth.

A CT or MRI can be quite expensive but it would be able to check the size of a pituitary tumor. At least you would know.

Keeping everything crossed for you and Lulu. Please do come back and let us know what Lulu's vet says.

[Harley PoMMom]

Hi Bomi,

I am sorry to hear that Lulu is having these issues. :( John has given you some really excellent advice and I have nothing else to add except to let you know that I'll be keeping you and Lulu in my thoughts and prayers. Wishing you both the best of luck with your vet appt. and please do keep us updated.

Love and hugs,
Lori

[Casey's Mom]

Hi Bomi,

Just letting you know I am wishing all the best for you and Lulu. Keep us posted okay?

Love and hugs,

[Lulu's Dad]

Hi All,
So an update for Lulu.....
We took her back to the specialist and he did a compleate blood pannel on her and found her cushing was well under control with the 10 mg , but that the liver enzymes had gone trrough the roof. We had just done a compleate test on Lulu and her Liver enzymes were normal then. Any way to make a long story short....the vet strongly felt somthig was going on with her liver, and strongly suggested an abdominal ultrasound and a liver biopsy. This was done on Friday and we should have the results back next week.
According to the specialist, Lulu's lethargy, confusion and disorientation were because there was a build of of the trio in her system because of her liver...
So for the time being she is off all meds for Cushings till we get the results back and can make an informed decision as to how we should proceed.

Bomi and Lulu.

[Roxee's Dad]

Hi Bomi and Lulu :)

Thanks for coming back to update us. I believe the liver is the only organ that can regenerate itself. So hopefully it's not too serious and can be corrected. Just wondering if Lulu has been on any liver supplements like SAMe or Milk Thistle?

Wise move to stop the meds until they get this figured out. Looking forward to your next update.

Thoughts and prayers are always with you and Lulu.

[Lulu's Dad]

Hi all,

I have been giving Lulu Milk thistle 3 times / day since September of last year.

Bomi and Lulu

[Lulu's Dad]

Hi All,

We just got back the liver biopsy results from VEC South and Lulu's IMS, ruled out cancer or hepatitis. He he baffled with her liver function and has now put her on Clavaseptin 50 mg every 12 hrs.
Lulu continues to be off her Trilo, but she has been on Milk Thistle since Sept of last year.( small dose 3times /day)

Lulu has lost a lot of weight and is now down to under 10 lbs from 12 lbs last Jan. Her appetite has improved since she has been off the Thrilo, but she she does seem to be thirsty and drinks a lot of water. Otherwise she seems fine and follows me around every where.

A friend of mine suggested I take her to the East York Animal Clinic where they specialize in holistic remedies as a secondary line of treatment. Even though her IMS at VEC south does not think this will help, I intend to take her there to either see Dr Cindy Kneebone or Dr McCutheon.

Any thoughts or suggestions from any of you are always welcome and appreciated.

Bomi and Lulu.

[apollo6]

Would like some input on you. My vet wants to start at 30mg, Apollo weighs 10.6 lbs (normally 9.8 to 10lbs)
How much does Lulu weigh.

[apollo6]

My vet won't give me the Predisone either. Why?

[Harley PoMMom]

Hi Bomi,

On Lulu's complete blood panel were the liver enzymes the only values that were elevated? If not, would you mind posting anything on there that is marked abnormal along with the reference ranges and the units of measurements (also post her liver enzymes values, please).

Please let us know what the doctors at East York Animal Clinic have to say, as I am always interested in holistic remedies.

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[apollo6]

I plan on doing a combination of treatment and holistic. My holistic vet was the one who suggested testing for cushings and finally said I should go to a specialist. LIKe everyone says there is no holistic cure for Cushing. I have done holistic with herbs and I feel the two combined may help to boost his organs, etc.. I even showed the specialist all the supplements and diet Apollo is on and for now he doesn't want me to change anything. I have attached the web site for the American Holistc Veterinary Medicine. But don't do anything without letting your treating vet know and the holistic vet should look at your tests also. Hope this helps.

http://www.holisticvetlist.com/

[Lulu's Dad]

I have asked for copies of Lulu's blood work and will post them once I know. I will also update my thread after the visit to Dr Kneebone at East York.

Take good care of yourselves ( including your 4 legged children)

Bomi and Lulu