Proteinuria in cushings dog (Mickey has passed)

[Helgs]

I'm confused and need help. My 11 year old Australian Terrier x has just been diagnosed with Cushings. We are at the testing stage but a urine sample showed protein loss at 6.5 which apparently is substantial kidney damage. We have been told to go away and think about whether we want to proceed with treatment for the Cushings. The vet said it would be an uphill battle and was not confident, but willing to try treatment. He said he had not treated a dog with such high protein loss and said the treatment itself may kill him. I want to hear from people in a similar situation to help me make an informed decision.

[missygirl]

First of all welcome to this site you will find the people here are so kind and helpful. I'm sure some other people will chime in on this but I wanted to give you my thoughts. Cushing dogs urine is is very diluted, almost like water. There is no smell or color and usually lots and lots of it. I'm not sure of this but it would seem to me the urine would also be laking protein. When I first took Missy to the vet because she was drinking excessively and peeing all over the house I was told she was in kidney failure also.
I know the testing stage can be very frustrating, hang in there you are at the right place.

Sandi ;)

[Roxee's Dad]

Hi and welcome to the k9cushings forum.

I don't have much advice to give but the other's as I affectionately call them will be by to help you sort thru this.

My only experience with kidney failure was with my Roxee, one vet diagnosed her with kidney failure and said she only had weeks to live. :( I took her to another vet and it turned out she was dehydrated which gave a false result which resulted in a false diagnosis. She went on to live quite a while longer. :)

Hang in there, I am sure other's will be by to help you sort thru this.

BTW: What is your pup's name and what symptoms led you or your vet to test for Cushing's? What test have been performed aside from the UC/CR? Was there an ACTH Stim test or an LDDS?

We are looking forward to hearing more.

[StarDeb55]

Welcome! I'm sorry for what brought you to us, but very happy that you found us. I must tell you that we usually play "20 questions" with new members, but that just helps us to give you the best feedback we can from the group's collective experienced. We are very interested to hear about your pup's medical history. First thing I need to ask is do you & your pup have names? It's much more personal than saying, "Heh, you". Could you tell us about the symptoms your pup has that led you to go to the vet? If you don't have them, could you get copies of all testing that has been done? We are very interested in seeing the results of all testing that was done to make the Cushing's diagnosis. If any general lab work was done, could you post just the abnormal results, along with normal ranges & reporting units? Most of us do keep files for our pups at home as you never know when they might come in handy, especially if you end up at a strange vet. Was diabetes & thyroid ruled out? I ask about these 2 issues as their symptoms can overlap with Cushing's? Does your pup have any other medical problems? What is your pup's breed, age, & current weight?

When it comes to the testing that was done that showed elevated urine protein, could post exactly what that test was, along with the actual results? Just to let you know, I'm a medical lab tecnololgist with 29+ years experience, so I'm kind of used to looking at these numbers. I really don't want to offer any input about possible kidney disease until I can see those results.

Hope to hear more.

Debbie

[jrepac]

I'm sure others will weigh in, but I think all the urination (particularly when undiluted) contributes to the protein loss...I would think if you treated the cushings it would help alleviate some of this...

some vets have a very negative attitude/outlook re: cushings, which is not good...there are several treatment options

I am beginning to think Aussies are pre-disposed to this condition...my current one has a mild case of cushings and my last one had a severe case. Plus, there is another person on this board who just lost her Aussie...

At 11yrs, I would try to treat; my last one was diagnosed at 10.5. and she made it to nearly 12; she had other complications arise w/the Cushings. My current Aussie, Mandy, is going on 13, god bless...she is a spunky one.

[Helgs]

Thanks for the replies. My name is Helen, currently live in South Australia, moving to Queensland after Christmas. My beautiful dogs name is Mickey. My 17 year old son has grown up with him and this has hit us hard.

Mickey was taken to an emergency vet last week as he wouldn't open his eyes and was in obvious distress. Turns out he had ulcers on both eyes but the vet said straight away he looked like a cuchings dog. We took him to a vet in our local area as our usual vet told us he was fat and to put him on a diet. He has the pot belly, is obsessed with food - growls our other dog away from her food if we don't watch them, gets in the bin, hangs at my feet when cooking waiting for me to drop bits of food. His hair is thinning, he drinks a lot of water, has had a few accidents in the house, won't jump up on the furniture anymore - has to be picked up now.

I have test results. He had a FBC with abnormal results as follows.

Urea is 10.8 mmol/L should be between 2.5-9.6
ALB is 20 g/L should be 22-39
ALT 184 U/L should be 10-100
ALKP 1644 U/L should be 23-212
CHOL 13.08 mmol/L should be 2.84-8.27
EOS 0.1x10^9/L should be 2.00-12.00

ACTH Stimulation Test
Resting serum cortisol 497 nmol/L
Post ACTH serum cortisol 1380 nmol/L

VPC - Vet UR. Protein/Creatinine Test
Urinary Protein 1.51 g/L
Urinary Creatinine 2.00 mmol/L
Protein Creatinine Ratio 6.7 (<0.5)

I really hope you can make sense of these results. I'm really keen to hear what you have to say about it all Debbie as its double Dutch to me.

[StarDeb55]

Helen, let's start with the general labs first. The 3 liver function tests, alk phos, ALT, & cholesterol, show elevations that are quite typical for a cushpup. In fact, an elevated alk phos is usually the thing that will tip off a vet to start looking at Cushing's. The urea or BUN is a kidney function test which can be affected by things as simple as dehydration or a high protein diet. There is a 2nd more important kidney function test, creatinine. If the creatinine was normal, then the urea is nothing to raise an alarm about.

When it comes to the urine protein tests, I will tell you up front this is not exactly my area of super expertise, but I can offer you some input. The UPC, protein/creatinine ratio, does appear to be consistent with renal disease. With that elevation, I would suggest you ask your vet about the possibility of glomerulonephritis. There are some things that can be done to help Mickey & support his kidney function including the use of blood pressure medication, if your vet feels it would be appropriate. Also, Mickey probably needs to be put on some type of renal diet dog food which would have lower protein & sodium.

The results of the ACTH are consistent with Cushing's, but in light of the possible kidney issues, I would suggest a second test to confirm the diagnosis such as an abdominal ultrasound to take a look at the adrenal glands, along with all of Mickey's internal organs. In light of the strong possibility of kidney issues, the ultrasound might be a pretty good idea. In the US, we are used to looking at ACTH results in units of ug/dl, to convert, one divides by 27.59. After the conversion, Mickey's results are:

Pre: 18.0 ug/dl
Post: 50 ug/dl

The pre value is extremely high & usually indicates a dog who is already stresses out for some reason, either illness, or the pup just doesn't like being at the vets. I think there is a strong possibility that treating the Cushing's, getting the cortisol under control, may go a long ways to help with Mickey's kidney function. I would urge you to discuss this possibility with your vet.

Lastly, it's extremely difficult to make a Cushing's diagnosis on the basis of a single test. There is no single test that is 100% sensitive or specific, so you always want to confirm that positive result, whether it's an ACTH or low dose dex test, with a second test. It's extremely important to make sure you have a concrete diagnosis of Cushing's as administering either of the 2 medications used to treat cushing's to a healthy pup, can have serious, even life-threatening consequences.

I almost forgot, are you seeing your general practice vet or an internal medicine specialist? If you are seeing a GP vet, I would strongly urge you to get a consult with a specialist in light of the renal problems as they are the one's who the training to get these multiple issues sorted out.

There are a couple of other members who are also dealing with renal issues presently or have past experience. Hopefully, they will stop by & give you some more input.

Debbie

PS- Were diabetes & thyroid ruled out?

[AlisonandMia]

Hi and welcome from me too.:)

I haven't got a lot to add to what Debbie has already said with regards Mickey's condition.

If you are going to be moving in the next month or so you probably won't want to start treating Cushing's now anyway. You usually want things settled and have some sort of stability before embarking on that as observing the dog's behavior is such an important part of assessing the treatment. You also want to have your own stress levels at a manageable level. Cushing's seldom warrants really urgent treatment.

However the kidney issues could well be a different matter. In your position I would be wanting to get some sort of handle on that as soon as possible, particularly getting Mickey's blood pressure checked out (Cushing's dogs often have high blood pressure and kidney disease can cause high BP and high PB can cause kidney problems too), and medication to help kidney function started and maybe dietary changes made. You might want to ask the vet to repeat the kidney-related tests or at least some of them. We've seen a quite a few cases where things are not necessarily as they first appear kidney-function wise so redoing the tests could be useful.

How has Mickey been handling the heat? Untreated Cushing's dogs don't often handle the heat at all well, particularly if they are at all overweight, but even if they aren't. How are you planning to handle the move with regards Mickey - are you bringing him up by car or flying him? I think he'll need careful observation and care on the trip with the heat - it won't be impossible but you'll need to keep an eye on him for sure and keep him well hydrated and as cool as possible.

Finally, what part of Queensland are you moving too (if you don't mind saying:)). I'm in Brisbane. It isn't usually anything like as hot here as SA (touch wood!!!) but a lot more humid, unfortunately.

Alison

[Helgs]

Hi Debbie & Alison

Thanks for your thoughts. Debbie are you saying that Mickey's levels seem low for Cushings? Allison - We are moving to the GC - Mudgeeraba. The heat hasn't affected him at all. Mind you, he has been inside in air conditioning the whole time. We are driving up - plan to take a few days to get there.

I was told by the vet that ulcers on the eyes were one of the later symptoms of cushings. This vet takes a special interest in Cushings and I'm told he is quite knowledgeable. I have to say, its all very confusing. I have no idea whats wrong with him now. He seems perfectly fine within himself. I'm worried he will be treated for the wrong thing.

Thanks again guys. Helen

[Harley PoMMom]

Hi Helen,

Welcome to you and Mickey from me and my boy Harley. My goodness you and your beautiful boy have been going thru alot, and it is so heart-breaking to see our furbabies not feeling well or acting like themselves.

My boy Harley has high blood pressure, he was/is losing protein in his urine. This was confirmed with the UPC tests. His first UPC test done 8/14 was 2.3 and his BP was 160-190. He was started on BP meds and with his BP at 140 another UPC was done on 9/2, this time 0.6. I just had another UPC done on 11/18 following a BP reading of 185, results...2.6. :eek: Elevated blood pressure does have a bearing on protein loss in our pups.

One other thing I took notice to is the low Albumin which is usually found in Glomerular disease. Here is an exerpt I took from an article about it.


Most of the time when kidney disease is discussed, renal insufficiency or chronic kidney failure is the subject. In renal failure, the kidney loses its ability to conserve the body’s water as it removes the body’s daily toxin build up. Excessive water consumption is seen as an early sign of trouble as large amounts of water are required to make enough urine. Eventually toxins build up despite increased water consumption. Weight loss ensues. The classical metabolic changes that result are collectively called uremia or uremic poisoning.
Glomerular disease is different. Glomerular disease represents more of a filtration problem rather than a failure to excrete harmful toxins; in fact, glomerular disease is all about losing protein inappropriately through the kidneys.

Low Blood Albumin Level Found on a Blood Panel

• Albumin can be lost through the holes in the kidney membranes caused by glomerular disease.

http://www.veterinarypartner.com/Content.plx?A=1352

I realize this is alot of information for you right now and I also know how scared and confused you might feel too. When my boy Harley was first dx'd with Cushing's I was utterly terrified, I didn't even know what Cushing's was. By some miracle I found this forum with these amazing and knowledgeable people and they took my hand and have guided me by sharing their experiences and wisdom...they have taught me so very much.

So please remember you are not alone on this journey, we are here to help you in anyway we can.

Hugs.
Lori

[StarDeb55]

No, Mickey's cortisol levels on the ACTH are very high which is consistent with Cushing's. Your vet is correct about the corneal ulcers being a possible symptom. Cushing's depresses the immune system which can lead to repeated infections. To show you about corneal ulcers, my Harley fought a non-healing corneal ulcer for almost a year. The problem first started immediately prior to his Cushing's diagnosis.

When it comes to the corneal ulcers, did your vet do a Schirmer's tear test to check for dry eye? This is where 2 small tapes that are marked in millimeters are placed in the corner of each eye to check how well the eye is making tears. After being referred to a vet eye dr., Harley's problem was actually undiagnosed dry eye. Once the dry eye was treated, the ulceration stopped. If your vet did not do this test, I would suggest you ask him about it.

Debbie

[Helgs]

The dry eye test was not done. Mickey was put on eye drops (Tricin) and I was told the ulcers would be very slow to heal. He said Cushings slowed the healing process down significantly. He even said we may have to draw blood and spin it down to take the healing properties out of the blood and inject it directly into his eyes if they didn't heal. Some drops were put in his eyes to turn the ulcers green -the ulcers covered almost the entire eye surface on both eyes.
8 days later, the test was repeated. It showed NO eye ulcers at all. The vet was very surprised, almost shocked by this.
I worry about being lulled into a false sense of security with all of this. He seems so well at the moment. What I am getting is the need to deal with his kidney problems ASAP. He is booked into the vet for Friday morning.

[StarDeb55]

I would insist on the tear test being done. If Mickey does have dry eye, without treatment for the dry eye, I can just about assure you that the eye will re-ulcerate. There are several products available to treat dry eye. I would assume they are available in Australia, but what you are looking for is either drops or salve that contain cyclosporin as the active ingredient. Non-healing corneal ulcers can cost a pup their sight.

Yes, the kidney problems need to take absolute priority.

Debbie

[BestBuddy]

Hi and welcome to you and Mickey from another Aussie.

I know this is such a scary thing to be dealing with but as you can see you are not alone and we all help each other through it.

I have to say I agree with Debbie about having the test for dry eye because it is such a quick and easy test but so impor6tant to prevent eye problems that can even cause the loss of an eye. It really is just a strip of special blotting paper that is placed over the eyeball and reacts to the moisture with a color change.

We had this test done at the vets and also the eye specialist,along with pressure readings as well because the ulcers Buddy had would not heal. In the end after surgery and lots of meds the ulcers healed and it was the medications used after for dry eye that stopped any more problems.

I am guessing that the green stuff they put in Mickey's eye was stain so the ulcer could be seen.

If you can't get the vet to do the schirmer (sp?)tear test then I would asking for a referral to an eye specialist.

Jenny

PS Cyclosporin eye ointment wasn't available in Australia except at the vets and eye specialist. It was really expensive but cheaper at the specialist and we only had to use it for a few months after the ulcers healed and then we used an over the counter human eye ointment after that.

I ordered some cyclosporin ointment from the US but it was confiscated at Aussie quarantine. It apparently is made from a fungus or spore or something and they just would not let it through. I could have fought it but it would have cost me hundreds and lots of paperwork so I told them to go ahead an "destroy it". I still imagine several men in asbestos suits with flame throwers aimed at a couple of tiny tubes of eye ointment.:D

[StarDeb55]

There is a 2nd eye med for dry eye that has an active ingredient called Tacrolimus. My other boy, Chewy, has dry eye, too, which did not respond to the cyclosporin. The tacrolimus eye drops have worked wonders.

Debbie

[MiniSchnauzerMom]

Hi Helen,

A belated welcome and "hi" to you and Mickey. You've got a lot on your plate right now with Mickey's multiple health conditions and I'm glad you found us. I agree with both Jenny and Debbie about having your vet perform the Schirmer Tear Test. Actually my personal preference would be to have a consult with a Veterinary Ophthalmologist but again, that's just my preference and what I have done with my Munchie. The green stuff put in Mickey's eye is called Fluorescein.

If you're up to more reading I have included a couple of links to articles about both dry eye and corneal ulcers from the 32nd Annual WSAVA Congress (World Small Animal Veterinary Association) held Aug. 19-23, 2007 written by Veterinary Ophthalmologists who are actually from Australia.

"Dry Eye in Veterinary Ophthalmology"
Cameron Whittaker, BVSc, DVCS, DACVO; Robin G. Stanley, BVSc, FACVSc
Crows Nest and South Strathfield, NSW; East Malvern, VIC

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2007&Category=&PID=18230&O=Generic

"Management of Corneal Ulcers in Small Animals"
Robin G. Stanley, BVSc(Hons), FACVSc (Ophthalmology)
Animal Eye Care
East Malvern, Australia

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2007&Category=&PID=18054&O=Generic

Eye problems, cushings, kidney problems....I'm sure your head must be spinning. I've been in a similar place and know how frightened I was for my Munchie. I'm very glad to read you've scheduled an appointment for Mickey on Friday regarding his kidneys. If it has not already been done, checking Mickey's blood pressure would be a good thing to do too. One step at a time. We're here to walk them with you!

Will be watching for your updates.

Louise

[k9diabetes]

Hi Helen,

My diabetic dog had numerous experiences with very large corneal ulcers. If you can manage it, I really heartily recommend a veterinary ophthalmologist. We found that the GP vet generally isn't well equipped to handle difficult ulceration cases. The ophthalmologist not only has more in-depth knowledge but also better testing equipment for things like eye pressures, which are an important indicator of inflammation in the eyes.

I too suggest the Schirmer tear test - very quick and easy, and to have the eye pressures checked. While high pressure would suggest glaucoma, low pressure suggests inflammation in the eye.

The other thing we had done when Chris' large corneal ulcers wouldn't heal is a punctate keratotomy where the ophthalmologist punched out teeny tiny little spots across the cornea to help the cornea heal better. You wouldn't think taking bits of cornea out would help but in fact it was the one thing that finally healed up Chris' ulceration, which covered pretty much his entire eye.

The ophthalmologist will check for corneal dystrophy, something our dog had. His corneas didn't cement properly onto the surface of the eye. At one point, we thought the large ulcer was healed but it wasn't actually properly cemented and it reulcerated. In an exam the ophthalmologist can check to see if there is a lip along the edge of the ulceration or if it's cemented as it should be.

Although the ophthalmologist visits can be pricey, there were worth every penny to us. We had worked for several months to heal the first ulcer before being referred and it would have saved us a lot of time and Chris a lot of time in the cone if we had just gone straight to the ophthalmologist as soon as the ulcer showed signs of not healing properly.

Natalie

[Franklin'sMum]

Hi Helen,

Welcome to you and Mickey, from me and my little muppet, Franklin. Cushing's, Kidneys and eyes...:( I hope you get a resolution for sweet Mickey's issues.

Jane and Franklin xx
________
ECIG FORUM (http://www.ecigarettes123.com/)

[Helgs]

I just want to say a big thanks to you all for your kind words and loving support. Mickey was back at the vet today for an abdominal ultrasound and blood pressure check. I have to say i'm almost sorry we are leaving Adelaide as we have found such a wonderful, caring and knowledgeable vet. He's brilliant! He took the time to read this forum and thought it fantastic. He also took the time to sit us down and explain everything to us - the symptoms, the treatment, the testing and test outcomes and the timelines for all of this, side affects of the meds etc.
Mickey does not have diabetes. His blood pressure is through the roof - his systolic BP is 230.
It looks like he does have glomerulonephritis but hopefully with the meds for the BP, his protein levels in his urine will come down too. He's going on a low protein diet and starting the meds for Cushings.
To begin with, Mickey has been put on Fortekor for his BP with a possibility of going on Amlodipine also. He has been put on Trilostane 30mg for Cushings as an entry dose. We will monitor Mick over the next week or so and then back to Alex the vet for more testing to see how he's going.
I have to say, that after today's visit I feel much happier and more informed with all of this. I will keep you all posted on his progress.

[Harley PoMMom]

How much does Mickey weigh? The reason I am asking is 30 mg could be alittle high for a "starting" dose. According to Dechra's Product Inset:


The starting dose for the treatment of hyperadrenocorticism in dogs is 1.0-3.0 mg/lb (2.2-6.7 mg/kg) once a day based on body weight and capsule size.

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

Also the UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=3

Here's hoping that Mickey will respond to his BP meds and that protein loss will be history.

Please keep us updated because we tend to worry about our family when we don't hear from them. ;):)

Hugs.
Lori

[Dollydog]

Hi Helen and welcome,
I'm the member who just lost my Aussie in September. She had Cushings for 4 years and diabetes for 32 months and was 13+ years when I let her go.
I've been wanting to post for a few days now and just have a minute. I'm glad that you've got such a lovely vet for this part of Mickey's journey and feel sure you'll find another one when you move. Maybe this vet knows of another one like him where you're moving to or even a clinic with more than one super vet.

I'm also very relieved to hear that there is a plan in place for Mickey. Lady was started on 60mg of trilo when she was 17.5lb and that proved to be too much for her. It took a few months but 30 mgs was the best for her and we eventually were at 15mg, twice daily.

I could stare at Mickey's picture all day...it's all in those eyes!!! ;)
As far as Aussies being prone to Cushings, I'm beginning to believe that it's more about where we live and what our environment does to our dogs than their breed. But that's for another discussion and another time!
Looking forward to your updates,
Jo-Ann & my Dollydog angel :)

[Franklin'sMum]

Hi Helen,

HAPPY BIRTHDAY to you! Hope it's a wonderful day for you both.

Love and Hugs,

Jane and Franklin xx
________
How to roll a blunt (http://howtorollablunt.net/)

[jrepac]

Mickey is REAL cute....I can't resist an Aussie...

I have my Mandy on a low fat, low protein diet as well, per vet advice. She had high protein levels in her urine way back. Along w/UTI at the time....uggg...

Tho' it is a little hard to stick to 100% of the time...I'm a bit too generous w/the treats and table tidbits.

The breed does seem to have a tendency for endocrine related issues (diabetes, cushings, etc).....you can go to the Aussie Terrier club sight and read the health survey results...they do them regularly amongst owners that they have email addresses for. I did one a few years back. It was pretty comprehensive.

Jeff

[Helgs]

My beautiful boy Mickey - nearly 13 yo Australian Terrier was diagnosed with Cushings nearly 2 years ago. After a few months of getting his dose right, he ended up on Trilostane 60mg daily. All of his symptoms disappeared with the exception of drinking excess water. His levels were perfect every time he was tested. In recent months, he has started loosing weight and his appetite decreased to almost nothing. Treatment was stopped for 2 weeks then commenced on 30mg daily, but after only 2 weeks back on Trilostane, he again has become very lethargic, loosing more weight and lost his appetite again. I'm quite concerned. Can anyone give any advice? Or have a similar story? Much thanks

Moderator's Note: Helen, I have merged your update post on Mickey into Mickey's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[addy]

Hi,

I am wondering what any recent ACTH tests showed Mickey's cortisol level to be. When was his last test and what were the results? Has he had any blood work done recently? Any chance of kidney problems?

I have read in papers Trilostane can cause anorexia in some dogs.

Hopefully the moderators will be along soon with some insights.

Hugs,
Addy

[frijole]

I agree with Addy... check out the cortisol by doing an acth test. We have seen dogs that were regulated all of a sudden go low and in a few cases the dog went off of the trilo completely. So go have an acth test done to make sure. Kim

[Squirt's Mom]

Hi Helen,

If Mickey has not had an ACTH in the last day or two that shows his cortisol level within the normal range for a Trilo pup, please do not give any more Trilo to him right now. What you are describing could be an indication that his cortisol has gone too low and without a current ACTH, there is no way to know. So if there is ANY chance it is too low, stop the Trilo now until he can be tested - and get that done ASAP.

If he has had a recent ACTH, please post the results...that will help us have a better idea of what could be going on. How much does he weigh now?

Has he been tested for diabetes recently - within the last 30 days?

Please let us know how he is doing!

Hugs,
Leslie and the gang

[Harley PoMMom]

I agree with the others that a recent ACTH stim test should be done. Also in your previous post you mentioned that Mickey was started on BP meds, is the elevated BP under control? Dogs with uncontrolled high BP are at a risk of doing damage to internal organs, especially the kidneys.

So in addition to the ACTH stim test, if it were me, I would have a Chemistry blood panel done too.

Love and hugs,
Lori

[Helgs]

Hi Guys. I have to say I'm quite worried. Ok, I just spoke to Mickey's specialist who said to stop the Trilostane (I didn't give it this morning anyway). He was last tested on the 19th May 2011. His ACTH was 20 and when stimulated went to 42. The vet said that was a really good response as it should be under 100 - that seems way under 100 to me. His BP was 170 which is high normal. Mickey is on meds for his BP. His electrolites were normal. He was tested for diabetes in light of the fact that he's loosing weight but that was normal. His protein loss is very high. His creatanin ratio is 6.6 and should be under 1 - so yes, kidney problems. I knew that. They had regulated a while ago so he was taken of his Forketor but was put back on it early June. I think that's all the results asked for. Would appreciate some good advice. I'm told Mickey is currently lying by our front door in the sun! Forgot to mention, Mickey is down to 5kg!

[labblab]

Dear Helen,

I am really glad that you have discontinued Mickey's trilostane until you can get things figured out. I share your concern about his May ACTH result. Per the U.S. Product Insert for brandname Vetoryl, a post-ACTH result any lower than 40 nmol/L (1.45 ug/dl) signals that the trilostane dosage is too high, that the drug should be discontinued for a period of time to allow the cortisol to rebound, and then restarted at a lower dosage. So if Mickey's May response was 42 nmol/L, it could easily be even lower (too low!!) now.

Secondly, the resumption of the Forketor (benazepril) could be a an additional serious problem. Forketor is a member of the drug class of "ACE inhibitors," and here's a specific warning about the combination of ACE inhibitors and trilostane that is also contained in that Product Insert:


(ACE) inhibitors should be used with caution with Vetoryl Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient's ability to maintain normal electrolytes, blood volume and renal perfusion.

Here is a link to the Vetoryl Product Insert:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

What with Mickey's known renal issues, his borderline-low ACTH test in May, and now the resumption of the Forketor -- I really worry that both his cortisol and aldosterone may have dropped too low, resulting in electrolyte imbalance and additional renal stress. So I definitely agree with Lori that I would be wanting to see a basic chemistry panel for Mickey right now, in addition to a repeat ACTH test and assessment of his kidney function.

Marianne

[Helgs]

Mickey's specialist is away until next week. Should I be looking at getting him in ASAP? I know this is serious but not sure how serious. Will he be ok now he's off the Trilostane or should I discontinue the Forketor aswell? Until I can get him booked in? His renal function has been quesionable since day one, so why put him on trilostane when it states not to be used on dogs with kidney problems. I'm worried, but not sure which way to go here. Obviously, I don't want to make the situation worse by waiting to see how he goes.

[labblab]

Helen, since I am not a vet, I cannot advise you to stop the Forketor. I do not know what effect that would have on Mickey, but it might be dangerous if the med were to be stopped suddenly, and I don't think it should be done without consulting a vet. I do think that stopping the trilostane is the right route to go, so I am relieved that you have been advised to take this step.

As to whether or not Mickey can wait to be seen until your specialist returns, I think that all depends upon his behavior. If he seems to rebound now that the trilostane has been stopped, then I would think it is safe to wait. However, if the lethargy continues or he otherwise worsens in any way, then I would take him in to be seen by a stand-in vet if your specialist is not available. I am curious, what did the specialist advise you to do -- anything other than just stopping the trilostane? For how long? And did he give you any instructions if Mickey doesn't rebound now that the trilo has been discontinued?

Marianne

[Harley PoMMom]

His protein loss is very high. His creatanin ratio is 6.6 and should be under 1 - so yes, kidney problems. I knew that. They had regulated a while ago so he was taken of his Forketor but was put back on it early June. I think that's all the results asked for. Would appreciate some good advice. I'm told Mickey is currently lying by our front door in the sun! Forgot to mention, Mickey is down to 5kg!

Are you referring to the Urine Protein:Creatinine Ratio (UPC) test with Mickey's results being 6.6?

You could ask your vet if Amlodipine would be a better option than the Forketor. Amlodipine is in a class of medications called calcium channel blockers not "ACE inhibitors" so it is not considered to be a contraindication with the Vetoryl.

I would also suggest using slippery elm bark. Slippery Elm Bark (SEB) is a good treatment for ulcers, gastritis, colitis, and other inflammatory bowel problems. It may also help alleviate nausea and vomiting in pups suffering from non-GI illnesses, such as Kidney Disease. Here is a link about SEB: http://www.littlebigcat.com/health/slippery-elm/

Love and hugs,
Lori

[Helgs]

Hi Lori

Mickey is already on Amlodopine. Its a 5mg tablet, he has a quarter twice per day. And yes, his urine creatinine ratio is 6.6.

hi Marianne

The stand in vet gave no instruction other than to stop the Trilostane. He said to book Mickey in next to have his levels checked then.

[Harley PoMMom]

Has Mickey been diagnosed with Protein-Losing Nephropathy (PLN)? Getting the elevated blood pressure under control is very important.

[Helgs]

If he has been diagnosed with that, they haven't told me. Iv'e not heard of it before. They told me 170 for his BP was high normal.

[Harley PoMMom]

My boy Harley had kidney disease and was dx'd with Glomerulonephritis. His vet wanted to see his blood pressure around 140.

[Helgs]

Yes, Mickey was diagnosed with Glomerulonephritis. I do remember that name. I believe that's why he was put on the Forketor - to increase the blood circulation to his kidney's.

[HarrysMom]

My Harry is a diabetic / Cushingoid dog with proteinuria - He has been on Trilostane, Benazepril (Fortekor) and NPH insulin.
Both Trilostane and Benazepril can cause elevation in potassium - so when you start your dog on any one of these meds, it is advised to do an electrolyte panel to make sure that there is no imbalance. In my dog's case, the combination has not impacted his electrolytes (yet - knock on wood).
Amlodipine is not going to help with proteinuria - it will be more effective at lowering blood pressure.
I am not a vet, but I would definitely run an electrolyte panel - if it is out of whack, they can give some fluids to immediately restore the balance.
Are you also feeding low protein diet to help with GN?

[Helgs]

Today Mickey lost his battle with cushings.

He was peacefully put to sleep on Saturday August 6th, 2011.

Rest in Peace.

[frijole]

I am so sorry to hear this...please know you were a fantastic advocate for Mickey and no doubt he had a wonderful life. May all the wonderful memories of the good times sustain you as you heal. RIP dearest angel Mickey. Run free of pain and know you will be missed. Hugs, Kim

[addy]

I am so very sorry to hear about Mickey. The pain is so bad because the joy was so great. Please come back and talk to us whenever you need to or if you need a shoulder; we are always here for you.

God speed Mickey, fly free little one.

Love,
Addy

[Jenny & Judi in MN]

I'm so very sorry for your loss. xoxo

[Squirt's Mom]

Dear Helen,

I am so sorry to hear about Mickey's passing. I know your heart is broken and the pain you feel is immense but as Addy said, it is your love for him that makes the pain so great.

He was so very lucky to have you by his side through all his battles, giving him your all as he gave his to you. I know Mickey is grateful for all you did for him, for the wonderful life he had with you and your family.

Mickey's name has been added to our Remembering list for 2011. He will always be honored here as a member of our family.

http://www.k9cushings.com/forum/showthread.php?t=2865

When you feel up to posting a memorial to Mickey, we would love to share in celebrating his life with you. We are here any time you need to talk.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[ThreeJacksMom]

I am very sorry to hear of your loss. Mickey will forever live in your heart. Sending you hugs......
Lauri

[Nika'sMom]

I am so very sorry to hear about the loss of your Mickey.My heart aches for you...sending you hugs...Lynda

[apollo6]

I am so sorry to hear about the loose of your angel Mickey, may he be watching over you.
Hugs Sonja and Apollo

[bgdavis]

I'm very sorry for your loss of little Mickey. He was in good hands for 13 years with your care and love.

Bonnie and Angel Criss

[jrepac]

So sorry to hear of Mickey's passing.
Rest easy little fella.

Jeff & Angel Mandy, Pebbles and Pepper

[littleone1]

I'm sorry for your loss. RIP Mickey.

[k9diabetes]

I am truly sorry to learn of Mickey's passing. He was a beautiful dog.

Natalie

[rbeasl]

Helen,

I am so very sorry for your lost. I will send a special prayer that God gives you strength to make it through this very difficult time. I can tell Mickey was loved so very much

RIP
Rhondalyn and Honey

[liz]

I am sending hugs and kind thoughts to you in the loss of your dear boy Mickey. I know how you feel. I lost my beloved Cassidy the same day.--Liz