Hi! We are new here. Daisy, 24 lbs, 8 yrs, Trilostane

[Daisy's Mom]

Hello,

I have been reading this site for awhile now, and I finally decided to join and introduce myself and my cushpup! My name is Becca, and my dog, Daisy, is a 24 lb cavalier/cocker mix, 8 years old, who has recently been diagnosed with cushings.

I adopted her from a shelter four years ago. Up until about three months ago, we always thought she was just a chubby food-monster. We'd laugh about it, makes jokes, but we never thought she might actually have a problem. About six months ago, she started drinking lots of water, having accidents in the house, and panting heavily. It was the start of summer in Los Angeles, so I took her to the vet to see whether this was due to hot weather or something more. One test led to another, which led to a trip to a cardiologist, which led me back to the vet for a low-dose dex test... and then finally we had an answer! Cushings!

Of course, I started spending hours and hours every day obsessing over any new piece of info I could possibly find about Cushings. This board has been the best resource I have found yet. Everyone here is so knowledgeable, kind, and willing to help. I am trying to learn from you all so that I can keep my Daisy healthy and happy for a long time to come.

Daisy has been on Vetoryl for just under 2 months now. We started her on 30 mg/day, but after a few weeks increased to 60 mg/day. We didn't ACTH stim test her because her clinical signs showed no improvement on 30 mg. Now, after close to one month on 60 mg, she is having her first ACTH stim test today. I've tried to read up on this, but I have no clue how to read the results!

One question I have... Ever since we increased to 60 mg, she has been so hyper! Usually, this has something to do with food. She is obsessed, and she runs in circles, pants, barks... goes nuts until she gets something to eat! Before any meds, she was like this sometimes. Now, on meds, she is hyper almost all of the time! I mean crazy around food, but also just happy and peppy on walks, in the house, etc. Anyone had a similar experience? What could this indicate... something good, something bad?

Oh, one more question... she coughs. We can't figure out if it's a collapsed trachea or chronic bronchitis. A trip to the cardiologist revealed an enlarged but otherwise totally healthy heart, and a chest x-ray didn't indicate collapsed trachea or chronic bronchitis. Anyone heard of coughing related to cushings?

I am really happy to be here, and eager to meet you all!

[Squirt's Mom]

Hi Becca and welcome to you and Daisy! :)

I'm so glad you decided to come out of hiding and join the gang! :p It's a fine gang, too, as you have already discovered in your reading.

We have several Trilo moms and dads here who, I'm sure, will be chiming in soon with their experiences and first-hand knowledge.

As for the hyperness over food...all I can say is that my Squirt has always been a food hound, a Miss Piggy, so judging anything by her appetite, unless she doesn't have one, is not really possible. Could it be that Daisy just really, really loves food as her normal self and now that she is feeling a bit better, she is showing it in a different manner? Just wool-gathering here....a common state of mind for me! :p

No real thoughts on the coughing other than the heart issue. Hopefully someone else will be able to help there, too.

Can you tell us if the low dose was the only test Daisy had? Do you have the actual results and, if so, do you mind posting them along with the units of measurement (ug/dl, mnol/L, etc) and normal ranges for that lab? That will help us in giving you pertinent feedback to your questions. Is Daisy on any other meds, supplments, herbs at the time and, if so, what? Ok! Enough questions from this corner for now! :p We do tend to ask lots of questions in the beginning but we don't get really nosy til we know you a bit better! :p;):D

Once again, I am glad you and Daisy are here and hope to learn much more in the future about you both. Keep reading and asking questions. We will do our best to help you and Daisy all we can on this Cushing's journey, one you no longer have to walk alone.

Hang in there!
Hugs,
Leslie and the girls

[Casey's Mom]

Hi and welcome to you and Daisy. There is a world of knowledge and advice on this site and all you have to do is ask. My Casey is on Lysodren and is doing very well and thanks to the people on this site they have given me courage and lots of great advice.

Good luck and I know the people with a lot more knowledge than me will be ready to chime in soon!

[Daisy's Mom]

Hello Casey's and Squirt's moms, and thanks for the welcome!

I am hoping that you are right about why she is hyper. I am hoping it is just behavioral, and that it's just who she is. I used to think she was mellow and a little lazy, and within the last month she has become energetic and almost high-strung. I am hoping it's because the meds are starting to help, and she just feels good now.

I asked today for the results of her bloodwork (pre-Trilostane) and her low dose test. They are going to fax them to me, so I can post those on Monday when I go in to work to get that fax.

As far diagnosing this goes, it was really round-about. When she starting having accidents and drinking water, I brought her in to make sure it wasn't diabetes, UTI, or something else. We did bloodwork and her alkaline phosphatase was high (670, if I remember correctly). So we put her on Denamarin (liver enzyme) for one month to see if the supplement helped. She was still coughing, though, so I brought her back for a chest x-ray. The chest x-ray did not necessarily point to collapsed trachea or chronic bronchitis, but her heart was enlarged. So I took her to the cardiologist. They ran a BUNCH of tests, and couldn't find anything to indicate heart failure. They said her heart was enlarged but actually very healthy. The cardiologist noticed her pot belly and the fact that the top of her tail was missing hair, and suggested I have our regular vet do a low-dose dex test to test for cushings. So we did, and when we got the results he said everything pointed to pituitary dependent cushings. Her symptoms backed up the cushings diagnosis: drinking excessive amounts of water, lots of accidents in the house, food obsessed, panting, big pot belly, high alkaline phosphatase, weak in the hind end, exercise intolerance.

So, on 60 mg/day (twice daily), I think she is improving some but I am not convinced we are totally there yet. Drinking less water, fewer accidents, we can go on longer walks once again, she is better about stairs and jumping up, and her energy has increased. However, she still has a pot belly (or maybe she is just big-boned!), hind end could be still stronger, tail hair still hasn't grown back, still panting, still hungry, some accidents still (though, I potty-pad trained her when I first adopted her, so maybe these aren't accidents since she just knows how to use the pads I leave down).

I know, so long-winded, but you are right... finally we don't have to walk this alone! I only talk about her cushings with the vet, so it feels amazing to have someplace else to tell her story and hear about your stories as well!

[Harley PoMMom]

Hi Becca,

Welcome to you and Daisy, I am so sorry for the circumstances that brought you here but I am so very happy that you came out of hiding and finally joined us. :)

I don't use Trilostane either, my boy Harley...well lets just say he's on a different treatment plan and leave it at that, instead of me going on and on about him. :eek::p:)

Once you get the test results could you post them here with their units, if you wouldn't mind, the more information we have about your sweet Daisy the better the advice and the more we will be able to help you help Daisy.

Re: coughing; My only suggestion would be to have a really good look at her teeth, if she has some kind of infection going on with one of her teeth that puss is going down her throat and making her cough. The only reason I know this is because it happened to one of my pups just a few months ago, I thought he had a collapsed trachea, rushed him to the vet and here it was a infected tooth :( Tooth pulled and no coughing, and now mommy brushes both of her boys teeth every other day. :D:D

You have definitely come to the right place for support and information, these wonderful people have years of cushings experience under their belts. They have helped me and my boy Harley tremendously and I know they will do the same for you.

Hugs.
Lori

[SasAndYunah]

Hi and welcome Becca,

After reading your story about Daisy I have a few questionmarks and red flags waving about... I am not saying that Daisy doesn't have Cushings, she very well could have the disease but the enlarged heart is what is bothering me most at this time. It's rather peculiar that a cardiologist would not say or mention that the (chronic) cough is more then likely caused by Daisy's enlarged heart. (or actually a cardiologist that could say that the heart was enlarged but otherwise totally healthy). The heart is enlarged because it is not healthy... The potbelly too, could easily be a consequence of the enlarged heart (fluids in the abdomen), the excercise intolerance, panting, etc...all very common signs in canines with an enlarged heart. And Cockers are especially prone to this condition, an enlarged heart.

If the heart enlarges, it presses against the trachea, causing the cough. An enlarged heart will eventually result in heart failure so it is essential to "treat" the condition. Unfortunately there is no treatment that will actually cure this but there are treatments one can start to slow down the process and to increase comfort levels. So I am seriously wondering why none of that was done/advised. Especially in Cockers, supplementing with Taurine may be helpfull but also heartmedication to help the heartcontractions, ACE inhibitors to reduce blood pressure and diuretics to get rid of excess fluids. These are all commonly used medications in dogs with an enlarged heart. And of course a change in diet...a low salt diet to reduce the retaining of fluids.

If it were me, I would want to get to the bottom of Daisy's enlarged heart first, since, IF the coughing and potbelly are a result of the enlarged heart, treating the enlarged heart condition is much more essential then treating any other condition she may have. Also, treating the heartcondition will lead to the use of ACE inhibitors, either now or down the road....and the choice of treatment for the Cushings (Trilostane or Lysodren...) would better be made with this in mind.

Don't want to alarm you, but also don't want you to think that Daisy's heart is perfectly fine (apart from being enlarged) An enlarged heart is per definition a "sick" heart and combined with the coughing, panting, potbelly and excercise intolerance, I would want to get to the bottom of it.

Best of luck to you and Daisy,

Saskia and Yunah,
The Netherlands.

[Daisy's Mom]

Hi Saskiah and Yunah,

Thank you, and totally agree with you about Daisy's heart! I am very concerned about the fact that it is enlarged, but I think I decided to put those concerns aside for a few months. Tell me if this makes any sense, or if I should pick those concerns back up and run with them starting Monday...

When Daisy got her chest x-rayed at the vets, another vet (not the normal one that knows our history) was in that day. She looked at the x-rays, found me in the waiting room, and she told me that Daisy's heart was enlarged and she probably did not have much longer to live. She said I could treat it through the vet's office, or go see a cardiologist and treat it through them. I had a complete meltdown with the news, went to the cardiologist, and waited while they tested her for about 3 hours. Afterwards, the cardiologist said it took a little longer than normal to test Daisy, and they even decided to run a few extra ones (free of charge). She said that after everything they could not find a cause for her enlarged heart. Even though her heart was enlarged, it still seemed to be functioning in a totally healthy way. I think that's why I said in that post that it was enlarged but healthy. Apparently her heart is pumping strong, the valves are working properly, and they couldn't find any loss of function. The cardiologist said that she couldn't remember the last time she saw a heart like this, large but no loss of function, and she said that rather than having answers for me, she just had more questions. She noticed her pot belly and balding tail, and suggested I test her for cushings. I THINK she said that sometimes cushings can cause a dog's liver and heart to become enlarged. She had already tested with high alkaline phosphatase levels. That day was the first time I had heard of cushings, so I honestly don't remember exactly what she said about it.

I then met with my normal vet, and once she was diagnosed with cushings, he said we should start her on meds and see which of her symptoms begin to disappear. Then, once we know what was caused by the cushings, we can then tackle anything leftover. I think he wanted to isolate this, and treat anything unrelated as a separate issue.

Do you think this is a good approach? Do you know of enlarged hearts/livers due to cushings? Should I call him on Monday and ask that we be more aggressive in tackling her heart issue? If so, I don't even know where to start. We have already been to the cardiologist, and aside from day telemetry, I don't think there are any other diagnostic tests left to do.

I should get the results of her ACTH stim test on Monday or Tuesday. When the vet calls me to give me the results, I want to be ready to discuss next steps with him. I am honestly lost, and I know I want to get her cushings symptoms resolved AND figure out the heart and the coughing, but I actually have no clue what the next step should be.

Ideas?

[Daisy's Mom]

Oh I forgot to add...

I took her into the vet's office for the ACTH stim test yesterday. Daisy ate/took meds at 6am, went to the vet's at 10am, and then at 11:16 they called to let me know she was ready. That means, I am assuming, they did a pre, and then a one-hour post. I thought this was a 2-hour test? Our normal vet was not in the office. Should I ask him to re-test her?

[gpgscott]

Hi Becca,

A pre and a 1 hour post are normal with an ACTH when either cortrosyn or synatcthen depot is used as the stim agent. These are the most common stim agents with cortrosyn being used commonly in the US. Some Drs. also do a two hour post but that is not common.

Like Saskia, I find the information concerning the heart conflicting, an enlarged heart can continue to function for a period of time but over time it usually breaks down and if Daisy is in need of heart meds in the future the Trilostane may create interaction issues. Based on what you have related from the cardiologist she is also conflicted concerning her finding of the enlarged heart in conjunction with normal function. Has this Dr. scheduled a follow up exam to confirm her findings?

I think this stim is going to be very telling concerning the Cushing's diagnosis, please let us know as soon as you have the results, too bad there was not a stim pre treatment.

Best wishes. Scott

[SasAndYunah]

Hi Becca,

if it were me, I would start to find out out what "disease" is causing what symptoms. A simple echo can tell you if Daisy's potbelly is Cushing's related (fat) or heart related (abdominal fluids) in which case she would need to start diuretics...which also may help with the panting and coughing. (perhaps the cardiologist already took an echo of the abdomen...?)

In the early stages, an enlarged heart will function more or less "normal" eventhough an abnormal process already caused the heart to become enlarged. But it will result in heartfailure...I'm sorry to say, and therefore will need medication in the future, near or far. And ACE inhibitors are very commonly used for this enlarged heart (and later on heartfailure) condition. So even when one would wish to treat the Cushing's at this time, Trilostane would not be the best choice given the fact that Trilostane and ACE inhibitors should not be used together.

I do not think it is wise to have the enlarged heart condition take a backseat at the moment and I think that any vet or specialist should treat/include both conditions in a treatmentplan. Like I said, with the heart condition one can expect the dog to have to start using ACE inhibitors sometime down the line...and that would influence the decission on what medication to use for the Cushing's. Please understand that I am not saying that Daisy doesn't have Cushing's, just that the enlarged heart should play a (huge) part in every decission made for any treatment option for any disease that might affect Daisy now or in the future.

I would have her abdomen examined to determine whether there's fluids in the abdomen or not, that's something I would want to know at this stage. If there are fluids in her abdomen, I would want my dog to start on diuretics to relief the pressure the extra fluids are putting on her heart and lungs, making it more easy to breath and making Daisy more comfortable.

Best of luck,

Saskia and Yunah.

[Daisy's Mom]

Thanks, that gives me an idea of where to start! So far we have an enlarged heart and cushings, and so now we have to figure out which symptoms go with which problem.

I will talk to my vet on Monday to ask him about our treatment plan. You are right, we should consider the heart AND the cushings in our treatment plan, and right now it looks like we are ignoring the heart issues.

I found the report from the cardiologist, and I thought I'd post some of her findings and conclusions.

Findings:
**No heart murmur, though rare irregular heart beats were noted
**Normal blood pressure (164/110 mmHg)
**Repeat thoracic radiographs showed no evidence of heart failure, confirmed mild enlargement of left atrium, mildly enlarged cardiac silhouette. Mild bronchial markings, liver appears mildly enlarged.
**Complete echocardiogram revealed mild enlargement of left atrium, mild dilation of left ventricle, trivial thickening of mitral valve, very mild mitral regurgitation
**12-lead ECG performed over 10 minutes, showed an exaggerated sinus arrhythmia, rare abnormal beat seen during echocardiogram but not during ECG

Conclusions:
**No known cause for Daisy's heart enlargement, possible causes include arrhythmogenic cardiomyopathy (though no arrythmia or irregular heart rhythm was seen on the ECG), myocarditis, or early dilated cardiomyopathy. Mitral valve disease is trivial to mild at most and does not explain the degree of left atrial or left ventricular enlargement.
**Bring Daisy in for day telemetry to rule out intermittent arrythmia
**Does not appear that Daisy's cough is due to underlying heart disease, no cause has been identified. Further steps to manage and diagnose include bronchoscopy or medical trials with bronchodilators and cough suppressants
**Recommended to test Daisy for cushings

I have numbers, too, from the echocardiograph report but I have no clue how to read them. I don't know what numbers are significant, but if you want I can share that too.


Think I should bring her in for day telemetry? Bronchoscopy? Re-evaluate the treatment plan to include her heart enlargement? The cardiologist did not recommend starting her on any heart meds at that time, so should I bring her back for the same tests to see if it has progressed? At what point would she need to go on heart meds?

I will talk to the the vet and make sure we figure out whether the abdomen is fat or fluid. Since starting meds, her abdomen seems to be less distended, but hard to say as her belly was never a HUGE pot belly, just a thick, round waist.

Thank you for pointing me in that direction!

[Franklin'sMum]

Hi Becca and Daisy

Welcome from me and the boys :)
You've been given some great ideas and guidance from more experienced members than me :).

I have 2 kids:
Bailey-11.5 year old long haired chihuahua (arrythmia and beginning to get cataracts)
Franklin-4.5 year old maltese (PDH).
Bailey lives with his Nanny and Poppy. He's not being treated medically for the arrythmia, as he has no symptoms at present.
However, his food is being supplemented with Taurine (as a previous post suggested. I can't remember who, sorry), and also Co-enzyme Q10 .
They're both great for heart health, and in Australia can be bought from most health food shops.
I look forward to learning more about you both,
All the best,
Jane and Franklin xx
________
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