Logan, 12 year old Shih tzu with bilateral adrenal tumors

[logans mom]

Hello,
I am a proud mom of a 10 l/2 year old Shih tzu named Logan. I'm not sure if I have a cushings dog. He hasn't displayed any outward symptoms I have been reading about. He did, although, start drinking more than ususal and wet his bed overnight twice. I took him to the vet and a blood test and urinalysis was performed. His ALK Phos has been increasing since 7/08 when it was 708. He has had 2 liver biopsies which showed he had a slightly enlarged liver. The vet said that was consistent with him getting older. The results from his current test were ALK PHOS at 2397. Alt 168 Trigylercerides 569, Specific Gravity 1.016, PH 7.5 , Protein 1+ and Microalbuminuria 15.7. The vet said he had an infection and prescribed Bayril as well as a low dose aspirin for 2 weeks. He goes back for another urinalysis on Wednesday. His drinking has subsided and he hasn't had any more accidents in the house. I have read that Cushings could be contributing to the protein in his urine as well as the urine microalbuminuria. Is this a start of kidney disease due to cushings? Should I proceed with additional tests to verify cushing or do I wait for outward signs to appear. My vet previously said you should treat the symptoms and not the disease. Also, is there a special diet he needs to be on? I tried to give him SamE but it resulted in an upset tummy. Is their anything else I could try? I also read that it is normal for a dog to drink about 1 oz of water per lb., is this accurate? I am so thankful to have found this forum. There is so much valuable information here and it is comforting to know there is help out there other than the vet. I would appreciate any input anyone may have.

[gpgscott]

Welcome,

I am not a Dr. but I am very suprised to hear of the liver biopsies. I would have expected a lot of bloodwork first. The results you have posted can inticate Cushing's but none of this is Cushing's specific. Are there any other tests and results

And a liver biopsy would not indicate the size of the liver.

The first, least invaisive diagnosis for Cushing's is UC:CR, it is recommended by a specialist who has posted on this site to do a three day pooled sample. This is a urine collection which is done at home and taken to the Dr.

Please let us know more. Thanks for asking.

Scott

eta, It has been pointed out to me by another admin that the liver biopsy was most likely U/S (ultrasound) guided and U/S would be diagnostic for liver size.

[littleone1]

Hi and welcome to you and Logan from Corky and me.

Would you please let us know your name? It's so nice to be able to post using your name.

I'm still learning about Cushings. Corky was drinking excessively, and having accidents in the house. He had two urinary tract infections, but he also had all of the clinical signs of Cushings. When they found out that his liver was enlarged and had a mass on it, this was done with x-rays and an ultra sound.

I'm sure that someone will be along shortly that has much more experience than I do. You have found a wonderful group of people.

Terri

[Squirt's Mom]

Hi Logan's Mom,

Welcome to you and Logan! :)

We will play 20 questions with you for a bit but that is just we can get to know more about Logan and how you came to be here. So here we go: ;) How much does Logan weigh? Does he have any health conditions that you are aware of? Is he on any meds, supplements, herbs, etc at the moment and if so what, how much and how often? Were thyroid issues and diabetes both ruled out in his blood work?

If you don't already it is a good thing to start getting copies of all his test results from the vet and keep a file at home for him just in case you ever need to see a different vet like on vacation. Also that will help you to answer our many questions? :p Keeping a daily journal on him is also a good idea - his diet, eating habits, pee and poop history, water intake, sleep patterns, moods, any odd behaviors you notice. That way you don't have to try to remember when he puked up that weird white stringy thing last month. :eek::D

When you get copies of the testing done recently, please post the results here...just the abnormal readings along with the units of measurement and normal ranges for that lab. We have members who are experienced in reading those things. ;)

The UC:CR that Scott spoke of is a great starting place for Cushing's. It cannot diagnose the condition, but it can rule it out. The signs, or symptoms, you mentioned are critical in both diagnosing and in monitoring once treatment has begun so if Logan is not exhibiting any signs at the moment, I would strongly caution against starting any sort of treatment for Cushing's. That should be done ONLY after a confirmed diagnosis has been reached via several tests, not just one.

I am glad you have found us and hope you don't really have any need to be here. But if it turns out that you do, you couldn't have found a better place to land. The collective knowledge here is amazing and we are a very caring bunch of folks. Please read all you can and ask lots of questions - no such thing as too many or "dumb" ones! :) You and Logan will have us beside you for as long as needed to determine what is going on with him and help you learn to cope. Hopefully, he simply had a urinary infection of some kind and will be back to his old self in no time. :)

Hugs,
Leslie and the girls - always

[Squirt's Mom]

Hi again...me again...:p

Just had another thought about the liver enzymes. Those readings may simply indicate that the liver is working extra hard for some reason - elevations in those levels do not always mean Cushing's, tho they are seen with cush babies. As the liver works harder, it enlarges. The cause could be any number of things so don't let those numbers get you alarmed about Cushing's. We have seen those numbers much higher here.

Keep your chin up!
Hugs,
Leslie and the girls - always

[Harley PoMMom]

Hi!

Welcome to you and Logan from me and my boy Harley. If you don't mind, what is your name, we are so friendly around here and starting my post out with just "Hi" seems so impersonal. :(:)

As far as Logan losing protein in his urine, was an UPC (urine protein:creatinine ratio) test done? It can detect very low levels of protein (›5 mg/dL) in canine and feline urine samples. Here is a link that discusses it further:

http://www.idexx.dk/animalhealth/analysers/vettest/chemistries/upc/faqs.jsp#1

My boy Harley was/is losing protein in his urine and this is due to his elevated blood pressure. Has Logan had his blood pressure checked lately and regularly?

Could you tell us more about Logan: is he on any herbs or supplements, I know you mentioned you tried SAM-e, have you asked your vet about Marin? Here is a link about Marin:

http://www.drugs.com/vet/marin-for-dogs.html

Has Logan been ruled out for diabetes and thyroid issues? This infection Logan had or has, what was it, an UTI, ear??

As Scott has mentioned the UC:CR (Urine cortisol:creatinine ratio) test is the least stressful on your pup but your pup has to be over this infection. Cortisol is a stress hormone, one of the "fight or flight" hormones in a pups body, so even tho the urine is collected at home, if your pup is suffering from any non-adrenal illness, his results could create a false positive on any cushings test.

Cushings is a slow progressing disease so one has time to get their pup a proper diagnosis. A proper diagnosis is vital to a proper treatment plan. Cushings is NOT a death sentence for a pup and it is treatable. One has to find a GP/IMS who is willing to work with them to treat their pup that has cushings.

Please remember you are not alone on this journey, we are here for you and Logan, ask all the questions you want and we will try to answer them as best we can.

Hugs,
Lori

[Squirt's Mom]

Hello,

me again....be nice if all my synapses would fire at once, huh? :p

About the drinking question you asked...on average, 1 cup per 10lbs of body weight is "normal". However several things can come into play. If Logan eats kibble he will drink more VS canned or a change in feed that has more or less moisture in it will effect how much he drinks; the temperature; his recent activities and stress levels; and just because they like to keep us on our toes. :rolleyes::D

A cush pup will drink copious amounts of water, staying at the water bowl for longer periods of time and/or returning more frequently, often waking their parents up in the middle of the nite a few times for a drink. Cushing's pups don't just drink a bit more, they drink A LOT more.

Ok...maybe I will be able to let you be for a bit now....but no promises! :D

Hugs,
Leslie and the girls - always

[logans mom]

My name is Debbie. (OOPS, I failed to mention that). Thank you Scott, Terri, Leslie and Lori for all your responses, questions and words of encouragement. It is so nice to have a support system during this time.
Here is some info on Logan. He weighs in at 17.3 oz. He did have an ultrasound guided biopsy which determined his liver was slightly enlarged. He has not had a urine protein/creatrine ratio test (That I know of)??? He has not had his blood pressure taken either. He does have arthritis in his left front leg and a bone spur in that leg which prevents him from going down the steps. I give him Glucosamine (400 mg) and Chrondroitin(100mg) per day. He is not taking any herbs. His last blood test on 12/23/09 showed his glucose at 98 (70-138) and his T4 was 1.7 (1.0-4.). He is currently eating adult Innova dry food. I want to switch him to a senior food unless you think he may need to be on a low protein diet. Thanks Leslie for the advice on starting a Journal. I will certainly do that. I do know he drinks anywhere from 16-19 oz of water a day. I guess that would be normal , right??? He does wake me up getting drinks in the night. Oh, I am starting to get paranoid now.

I will post the results from his urinalysis test later this week.
Thanks again to all of you.

[gpgscott]

Hi Debbie,

If at 17 lbs he is drinking 16-19 oz of water per day that is pretty normal. Rule of thumb is 1 oz/lb/day.

Cushing's is not a common issue. I really think you have something else going on. It is good to consider everything though and I would ask the Dr. why not do the UC:CR.

Scott

[logans mom]

Thanks for the link Lori. I guess I am still a little confused about the urine protein creatine test. Is that part of the urinalysis. The urinalysis stated PH 7.5 S. G 1.016 protein 1+ color yellow and appearance clear.

[Squirt's Mom]

Hi Debbie,

No need to get paranoid. There are many other signs that go along with Cushing's that most pups display. From Kate Connick's site, here is her list:

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

"The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures"

Not all dogs will display all these signs, but these are the things to look for that might indicate elevated cortisol or intermediate sex hormones, both of which cause Cushing's. It is preferable that the pup have several of these signs and that they be fairly strong in order to diagnose Cushing's and monitor treatment once it has begun. Until then, it is generally thought best to let things lie, testing every so often. Cushing's is a very slow progressing condition and the damages usually take years to occur. So don't panic just yet or let your mind get the best of you...tho I know how hard that is to do sometimes!

Hugs,
Leslie and the girls - always

[Harley PoMMom]

Thanks for the link Lori. I guess I am still a little confused about the urine protein creatine test. Is that part of the urinalysis. The urinalysis stated PH 7.5 S. G 1.016 protein 1+ color yellow and appearance clear.

Hi Debbie,

No, the UPC is a separate test done, it is done with urine caught at home and taken to the vets office but the UPC can test for protein loss that is very small unlike the regular urinalysis test. The reference range for the UPC is < /= 0.5, at least this is the reference range for the one I have done on my boy Harley. As you can see the reference range is very low ( less or equal to 0.5), so if your pup has this test done and the results come back within the reference range, then the protein loss is usually no problem.

Hope this helps.

Hugs,
Lori

[logans mom]

Thanks Leslie for the list of symptoms and calming words. The only symptoms I see on this list is the thinning of the hair in the middle of his back and the lumps on his skin he gets frequently ( My vets said they are sebaceous cysts) and also, his high alk levels. I so hope your right that I don't really need to be here. But, if I do have to go down that road with my boy, I know where my first stop will be. Thank you Scott and Lori for the info regarding the UC:CR. My vet was suppose to call me regarding Logans urinalysis today, but I never got the call. I guess I will have to call her tomorrow and I will ask about that test.

Debbie

[Casey's Mom]

The UC/CR was the first test my vet did to rule out cushings - its a fairly inexpensive test and if it rules out cushings then you look for other reasons. Caseys results on this test were high so then we did the ACTH stim which showed very high levels of cortisol.

Hope this helps,

Hugs,

[Roxee's Dad]

Hi Debbie,

I haven't posted to you before but I do have a special place in my heart for Shih-Tzu's so I have been following along. :)

After reading Leslie's post I just got to wondering if Logan is getting any treats between meals? I see that Logan weighs a bit over 17 pounds which to me may seem a bit high for a Shih-Tzu (but not always):o There have been so many problems with store bought treats that it concern's many of us. :( I have seen many a pup's numbers, skin conditions and symptoms subside when they have been taken off the popular store bought treats and put on a healthy diet. :) Do any of Logan's treats contain BHA , BHT, or ethoxyquin as a preservative?



Hi again...me again...:p

Just had another thought about the liver enzymes. Those readings may simply indicate that the liver is working extra hard for some reason - elevations in those levels do not always mean Cushing's, tho they are seen with cush babies. As the liver works harder, it enlarges. The cause could be any number of things so don't let those numbers get you alarmed about Cushing's. We have seen those numbers much higher here.

Keep your chin up!
Hugs,
Leslie and the girls - always


And a picture of Logan would be great, we love pics of our pups. :D:):D

[logans mom]

Your Shih Tzus are adorable. Logan is white and caramel. I will post a picture as soon as I can figure it out. (I'm not very computer savvy). I just figured out how to edit my profile. Still learning this site. Logan has gained a pound this year. I started feeding him adult innova dog food in July. (Bad Mom) I will now switch him to a senior food. The treats he gets don't have any ingredients you mentioned. I do get them at a local dog bakery. Their ingredients are whole wheat, oats, baking soda, chicken broth. Do you know of a good, healthy, treat?

I got a call from my vet and she said Logan's uti is gone, however, his urine microalbumin is high. Two weeks ago it was 15.7 <2.5 and is 10.5 which is still high. Does anyone have experience with a high urine microalbumin? She wants me to give him a low dose asprin for 2 months. She said if he had high blood pressure his eyes would be bloodshot and he would head press. I asked her about the the UC:CR test and she said it wasn't necessary at this point until logans exhibits more signs, but she would gladly run the test if I wanted.

[Squirt's Mom]

Hi Debbie,

Innova is a very good commercial feed. No need at all to feel bad about feeding it. The additives John mentioned are very difficult to avoid in commercial feed, no matter how good they are. Those additives should be listed in the ingredient list on the package, if the manufacturer added them. The problem is the manufacturers don't have to list anything that is in purchased premixes or ingredients purchased that already contain the additives. For example, fish is usually high in ethoxyquin as it is a better preservative for fish, but the dog food manufacturers aren't required to list that as part of their ingredients, they only have to list fish or fish meal.

A good company will tell you if those additives are in anything they use in their feed. If they won't tell you, if they give you the run-around or if they out-right lie about it, that is NOT a feed you can feel safe about using because the company obviously has something to hide or they would be forthcoming. Once the concerns about these additives were strongly voiced, especially ethoxyquin, quite a few manufacturers have reduced or stopped their use, but not all.

BHT, BHA, and ethoxyquin are also very prevalent in our own food. For example, the spices we use are preserved with ethoxyquin quite often as are the fish we eat. Some countries like Canada are stopping the use of these type additives in ALL food stuffs for humans.

Feed Logan the best you can, learn all you can about what you are feeding him from all available sources including the manufacturer, and he should do just fine for now. If, at some point in the future, he needs a more specialized diet then you might look into home-preparing his feed under the guidance of one who is educated and experienced in canine nutrition.

As for treats, if he will eat them, fresh or frozen (not canned) green beans, carrots, apples, pears, bananas, sweet potatoes, etc. in small amounts are very good. Tho the treats you are getting don't sound bad either! ;)

I wish I could help with the high urine micro-albumin, but I just don't know anything about it at all. I can do a bit of research later on, tho.

Good his infection is gone! :D Hopefully you will see him improving rapidly in the days ahead.

Hugs,
Leslie and the girls - always

[logans mom]

Thanks Leslie for all the great information. I had no idea about those additives. I have tried the bananas which he loves. I will give those other treats a try for some variation.


Debbie

[Harley PoMMom]

She said if he had high blood pressure his eyes would be bloodshot and he would head press. I asked her about the the UC:CR test and she said it wasn't necessary at this point until logans exhibits more signs, but she would gladly run the test if I wanted.

Hi Debbie,

My Harley HAS high blood pressure, his eyes are NOT bloodshot and he does NOT head press...all dogs ARE different. Even at his highest blood pressure reading of 200 never did he display any of the symptoms your vet told you about, the only symptom my boy had was the protein loss in his urine. When we were able to get his blood pressure under control his protein loss was minute, confirmed by the UPC test. Now that his blood pressure is up again and not being controlled, his protein loss is up, and again this is confirmed by the UPC test.

Love and hugs,
Lori

[Franklin'sMum]

however, his urine microalbumin is high. Two weeks ago it was 15.7 <2.5 and is 10.5 which is still high. Does anyone have experience with a high urine microalbumin? She wants me to give him a low dose asprin for 2 months.

Hi Debbie,
A very belated welcome to you and Logan from Frankin and myself :o
Urine microalbumin seems to (from what I can understand) be an early sign of possible kidney problems down the road. At least in people, they're unsure whether it is the same with pups. But they can test for it. This quote is from http://www.vetinfo.com/dogurinary.html and the doc is answering a question and gives some info. This was the answer for question #2. Hope it helps.


There is a new test for microalbuminuria in dogs ( E.R.D.-Screen by Heska) that may make veterinarians more aware of the potential benefits of monitoring albumin levels in the urine. At the present time there is some question about the meaning of various albumin levels in the urine. Hopefully this problem will be resolved in the near future, too. At the present time the "worry points" for protein and albumin levels in the urine are reported to be: Urine protein level of 2+ or more in dilute urine (SG 1.010 - 1.025 ish) should prompt monitoring of urine protein levels. Urine protein/creatinine ratio of > 1.0 (so less than 1.0 is considered normal, although most dogs have urine protein/creatinine ratios of less than 0.5). Microalbuminuria is considered to be present in dogs when the urine albumin level is between 10 and 300mg/dl ( I am pretty sure I converted this correctly, the value in Dr. Grauer's review "Diagnostic Testing Offers Early Detection of Renal Disease", in an April supplement to DVM Magazine was 1.0 to 30.0mg/dl ). However, this is a definition based on experiences in human medicine and it is unclear at this time how well they will relate to predicting canine renal failure. However, Dr. Grauer believes that it will work out to be an accurate early warning test for progressive renal failure based on his research. In a colony of soft-coated Wheaton terriers with familial kidney disease that he maintains, microalbuminuria shows up as long as two years prior to the onset of proteinuria. (from the Heska supplement to the March 2002 Compendium on Continuing Education). So, with this in mind, I think that it is best to consider the possibility that your dog is at risk for later development of kidney disease, based on your findings so far. However, this is new territory for veterinarians and I am not absolutely certain that I am interpreting the numbers correctly. This, along with the fact that isn't a definitive answer to the meaning of microalbuminuria in dogs at this present time, makes it reasonable to consider the possibility that the lab values really will turn out to be nothing to worry about over the long run. It would be reasonable to try to be certain that there is not an inflammatory or infectious process going on that is being missed. Microalbuminuria consistently occurs in dogs with heartworm disease, is present with pyelonephritis, inflammatory bowel disease, cancer and other conditions that continually disturb the immune system. Ultrasound examination of the kidneys to help rule out some forms of kidney disease might also be reasonable, especially since there were inflammatory cells and bacteria in his urine. A culture and sensitivity test run on urine extracted directly from his bladder (cystocentesis) would probably also be justified given the past history. The odds are probably good that these tests would not reveal a specific problem but that is the nature of testing. If your vet doesn't want to pursue this further given the otherwise normal lab work so far but it continues to worry you, it is reasonable to ask for referral to an internal medicine specialist for a second opinion. It does appear that intervention to control hypertension, elimination of any sources of chronic excessive immune stimulation and the use of enalapril (Enacard Rx) all can help slow the progression of kidney disease in some patients. If your vet subscribes to DVM Magazine and/or the Compendium, these supplements are recent enough that he or she may still have them. Calling Heska for information on their new test would probably be a good way to get some of this same information, as well. Personally, I hope your vet is right and this all turns out to be unnecessary worry -- but I really do think it is reasonable to go ahead with a search for potential sources of albuminuria and to keep track of the situation as you have been. I am not sure if the Heska test would be more accurate for microalbuminuria in a dog than the method of testing you have available to you but it might also be worth trying this test to see if it agrees with your findings so far. Good luck with this. Mike Richards, DVM 5/26/2002
If the UTI was being treated at the time of the test, it might account for the elevated microalbumin.

Jane and Franklin xx
________
LovelyWendie99 (http://www.lovelywendie99.com/)

[Harley PoMMom]

Hi Debbie,

Jane has given you a really good article to read and I have another which bascially confirms what hers says:


A urine protein creatinine ratio greater than 0.5-1 is considered abnormal.
However, both the dipstick method and the urine protein creatinine ratio can be inaccurate and can yield false positive results due to contamination of urine with red blood cells, white blood cells and bacterial protein and therefore must be measured on urine sample with an inactive sediment and a negative culture....

...In a large scale study of 3,041 dogs owned by employees of veterinary hospitals, the overall prevalence of microalbuminuria in dogs was 24.7 percent (S. Radecki et al. Proceedings of the 21st ACVIM Forum, abstract #110).

In the same study, the prevalence of microalbuminuria was significantly higher in the older population of dogs (4 percent at one year and 55 percent at 15 years).

This finding also correlates with the fact that proteinuria occurs in dogs with underlying diseases, which are more common in geriatric dogs. A follow-up study was conducted to survey for underlying diseases in the population of dogs with positive tests.

Follow-up information was provided for 572 dogs. Fifty-six percent of dogs were subsequently diagnosed with inflammatory, infectious, metabolic or other disease processes (www.heska.com/erdscreen/erd_data572.asp). These results are also consistent with those found by Whittemore et al., in which 56 percent of clinically ill dogs with microalbuminuria were found to have infectious, inflammatory or neoplastic disease (JC Whittemore et al. Proceedings of the 21st ACVIM Forum, abstract #234).

This is an important finding because proteinuria is often associated with underlying disease processes and thus the ERD test can be used as a screening test in older patients as a marker for these underlying processes.

Whittemore et al. also demonstrated that this ERD test was more sensitive in detecting proteinuria than the urine dipstick or the urine protein creatinine ratio. In a population of clinically ill dogs, 55 dogs with proteinuria were diagnosed positive using the ERD test but were not detected using a urine dipstick or urine protein creatinine ratio....

Please see this link for the full article:
http://www.vetcontact.com/en/art.php?a=685&t=

Love and hugs,
Lori

[logans mom]

Hello Jane and Franklin, Thank you and Lori for the articles you sent me. Logan has had 3 high urine microalbuminuria results. His number did decrease after the uti cleared up, but is still on the high side on his last test. My vet doesn't seem at all concerned about his number being high and recommended we continue giving him a low dose aspirin for 2 months. She told me his protein level was down (previously 1+) but didn't indicate how much. I am not sure why she is reluctant on running any further tests fo see if there is any underlying disease associated with this. I understand her reluctance about testing for Cushings at this point since he isn't exhibiting any clinical signs. I am considering possibly getting a 2nd opionion from another vet and also getting the uc:cr test that was mentioned. I just hope the HIgh Microalbuminuria and protein loss isn't a prelude to Cushings. Thank you again to all for your kindness and helpful advice. I just can't seem to say that enough.

Debbie

[Franklin'sMum]

My vet doesn't seem at all concerned about his number being high and recommended we continue giving him a low dose aspirin for 2 months. I am not sure why she is reluctant on running any further tests fo see if there is any underlying disease associated with this. I understand her reluctance about testing for Cushings at this point since he isn't exhibiting any clinical signs. I am considering possibly getting a 2nd opionion from another vet and also getting the uc:cr test that was mentioned. I just hope the HIgh Microalbuminuria and protein loss isn't a prelude to Cushings. Thank you again to all for your kindness and helpful advice. I just can't seem to say that enough.

Debbie

Hi Debbie,
IMO, it may be very worthwhile getting a 2nd opinion, especially from an IMS=Internal Medicine Specialist. A GP vet isn't always up to date with new theories or tests. There's nothing wrong with that, it's unreasonable to expect them to be a walking encyclopedia about everything that could possibly happen with our babies.

The protein loss does seem to occur in a number of our cush pups, and depending on the severity it doesn't appear to be of major concern though.
Cush pups usually have elevated liver enzymes, as the liver is working hard to filter the excess cortisol, I'm having a mental blank of if kidney issues are a precursor to cushings... But if the cushings is untreated (when there are clear symptoms, and the diagnosis has been made) and remains untreated, the excess cortisol wreaks havoc on the pups internals and can cause problems such as: diabetes, heart failure, kidney failure, hypothyroidism, infections, hypertension and pancreatitis. BUT this is if the pup is untreated for a serious length of time
Don't freak out Debbie. Cushings is a slow progressing illness, and you do have time to get a proper diagnosis, and you DO have time to find out what (if anything) is going on that isn't due to cushings.

You are doing a fantastic job taking care of Logan, he is very lucky to have you in his corner :)
I'd like to second what you have said, Debbie, A HUGE THANK YOU to everybody for their kindness and helpful advice. I would have remained a basketcase without their advice and support :)

Thank you,
Jane, Franklin and Bailey xxx
________
VAPORIZER WHOLESALER (http://vaporizerwholesaler.com)

[littleone1]

Hi Debbie,

I hope Logan gets better soon.

I agree with Jane about seeing a specialist.

Terri

[logans mom]

Thanks Jane and Terri,

Logan wet the floor last nite. He hasn't done that since a couple weeks ago when he had his Uriniary tract infection. But, the vet said it had cleared up.

My logan is giving me the stink eye and is waiting impatiently for his walk. It will be getting in the 20's today (Heatwave). Its been very very cold.

Have a great day!!!!

Debbie and Logan

[Harley PoMMom]

Urine accidents are frequent with our cush pups, to make a looong :eek: story short, the excessive cortisol makes the kidneys produce more urine and the pups have to drink more water to keep up with the urine output from the kidneys...one can never deprive a cush pup or a suspecting cush pup of water, this could be fatal to them.

For my boy Harley, I have bought those puppy training pads, they work fabulously and he uses them.

I know what you mean about the cold weather, the other day it was 10 degrees here....BRRR...by Thrusday it's supposed to get up to 43 degrees...WAHOO!! I hope you and Logan enjoyed your very cold walk! :eek:;):D

Love and hugs,
Lori

[logans mom]

Thanks Lori,

I haven't seen any increase in water intake from Logan. He has been drinking roughly 17-20 oz a day which isn't unusual from what I heard on earlier posts. But, that really concerns me that he peed. He did have a few accidents this summer during some Mean thunderstorms and I bought those training pads. I am taking him to a new vet tomorrow to have them look at his last blood and urinalysis tests and get another opinion.

Yeah for 40's!!! I think we are going to get there later this week.

Debbie and Logan

[Harley PoMMom]

Hi Debbie,

Was wondering how you and Logan are doing?

Love and hugs,
Lori

[logans mom]

Hello

Thanks for checking in on Logan and I. I have just been quietly reading all the valuable information here at the forum and learning what I can when I can. I decided to take Logan to the University of Illinois teaching hospital in Champaign IL to an internal medicine specialist after reading here how important it is to have an ultrasound on a high resolution machine. My vet had done 2 prior ultrasounds on Logan and it revealed an enlarged liver and she said the adrenal glands were consistent with pituitary cushings. Logan had increasing alk phos, some hair loss and and could not go up and down stairs. I took Logan in May for ultrasound and acth test. The ulstrasound interpretation is as follows: Hepatmegaly: most likely sterioid hepatopathy. Bilateral Adrenomegaly: Rule out adenoma/carcinoma vs secondary to PDH (very enlarged for PDH. Left adrenal gland measured at 2.48 X 3.12 cm and right adrenal gland measured 1.93 X 1.61 cm He said he did not need to do an acth test. The results took me by such surprise as the vet was telling me he most likely had pituitary cushings. I also took Logan 3 weeks ago for a follow up ultrasound which showed that the adrenal tumors are relatively unchanged. I am no longer going to the vet Logan had for 10 years for many reasons. She would dismiss anything I had to say regarding my little guy. Her answer was the only answer and she got very defensive if I questioned anything. (Which I tend to do). Enough was enough and I am in the process of trying to find a new vet.

My IMS said that surgery was an option, but it was a very high risk surgery and Logan would need both adrenal tumors removed. I have read some success stories on this forum with having that surgery done and that is so wonderful there dogs are doing well. MY husband and I have chosen not to have the surgery for Logan since it was so risky. The IMS said once Logan is showing more symptoms that we could treat with Lysodren but that most dogs with adrenal tumors don't respond well to being treated medically. I have read in this forum that most dogs with adrenal tumors have to be on a high dosage of lysodren and I think they just had one adrenal tumor. My little guy has 2 and I am so terrifed of using that drug at such a high dosage for him. Currently he isn't drinking excessively or eating alot. His symptoms are hind leg weakness and hair loss. He his taking Denamarin and Ursodiol.

Logan is the light of my life. He belonged to Christine, my stepdaughter who passed away from complications from diabetes. My husband and I have faced some difficult times with the little guy. He had a fear factor about him from the very beginning. I believe Christine bought him a a pet store. He bit me a couple of times and he got my husband right above the eye. But that was the past and with lots of loving and behavioral training he has become such a delight.

I truly want to do what is best for him. I have not done an acth test, my ims said it wasn't necessary and as soon as I can find a vet I will do an LDDS test.
Thaks again for checking on him and sorry this was soo long. A big smooch to harley. He is a cutie.

[Squirt's Mom]

Hi Debbie,

It's good to hear from you and Logan again! :)


Bilateral Adrenomegaly: Rule out adenoma/carcinoma vs secondary to PDH

To me, this is the part that would take precedence. It is possible the adrenals could be that enlarged from the extra work due to PDH - "secondary to PDH". If it is due to cancer - "andenoma/carcinoma" - then the treatment options will more than likely be different from Cushing's treatments. Here is some info on andenomas and carcinomas from Wikipedia:


An adenoma is a benign tumor (-oma) of glandular origin. Adenomas can grow from many organs including the colon, adrenal glands, pituitary gland, thyroid, etc. Although these growths are benign, over time they may progress to become malignant, at which point they are called adenocarcinomas. Even while benign, they have the potential to cause serious health complications by compressing other structures (mass effect) and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner (paraneoplastic syndrome).

Adrenal adenomas are common, and are often found on the abdomen, usually not as the focus of investigation; they are usually incidental findings. About one in 10,000 is malignant. Thus, a biopsy is rarely called for, especially if the lesion is homogeneous and smaller than 3 centimeters. Follow-up images in three to six months can confirm the stability of the growth.

While some adrenal adenomas do not secrete hormones at all, often some secrete cortisol, causing Cushing's syndrome, aldosterone causing Conn's syndrome, or androgens causing hyperandrogenism.


Carcinoma is a medical term that refers to an invasive malignant tumor consisting of transformed epithelial cells. Alternatively, it refers to a malignant tumor composed of transformed cells of unknown histogenesis, but which possess specific molecular or histological characteristics that are associated with epithelial cells, such as the production of cytokeratins or intercellular bridges.

Surgery is your choice, of course, and I don't know that I would be willing to risk it either. But there are other things you could do to help Logan such as supplementation, nutrition, acupuncture to name a few. Consulting with a nutritionist or nutritional consultant is one of the first steps I would take. I am a big supporter of nutriceuticals. Squirt's consultant is particularly involved in working with cancer pups because of one of her own dogs and has helped many of them. I will be glad to talk privately with you about this, and have several others to recommend as well.

Another thought is concerning the intermediate hormones. I'm not sure why the IMS said an ACTH was not necessary unless he is referring to the diagnosis itself. The ACTH is most commonly used to monitor once treatment with Lyso or Trilo has started. However, and again this is just me, I would have the UTK panel done which will check the cortisol levels as well as the intermediates - which could also cause the adrenals to enlarge.

I wish you the best of luck in your hunt for a new vet. It isn't fun and I have been amazed at some of the things I was told during my recent hunt. :eek::mad::confused::( I chose a vet who admitted he knew nothing about Cushing's and was not comfortable treating it. He is honest, humble, compassionate, and most important, he listens, is willing to learn, and includes me in everything. If I can learn about this condition, I KNOW he can! :p

The loss of your daughter touches me in a deeply, personal way. I lost my daughter, too, but suddenly, and it is a pain that never goes away. She's been gone nearly four years and I still reach for the phone to call her about some little thing or the other. I am so sorry for your loss and understand the connection with Logan. Squirt was supposed to be Gia's, but she was out of town when Squirt was delivered and by the time she got home, it was much too late! But Gia always referred to herself as Squirt's sissy and still today Squirt will perk up and look for her when she hears that name. She loved her Sissy very much.

Don't be such a stranger! As you can see...we will come looking for you! ;):p

Hugs,
Leslie and the girls - always

[logans mom]

Hi Leslie

First of all I want to say how sorry I am for the loss of your daughter, Gia. Christine was my stepdaugher and I loved her very deeply. She passed away 10 years ago when Logan was 1 and as you said the pain never goes away. Logan has given me great comfort through the years and he knows me as his OLD LADY!!!

The IMS said that with Logan having a high Alk Phos (4040) that he has alot of steroids in his body and recommended I do the LDDS test Im still on the hunt for a vet and one who doesn't require that Logan stay there the entire day for the LDDS test. I want to be able to bring him back at the 4 hour and 8 hour tests. But, am not finding a vet who will allow that.

I started feeding Logan Innova Senior dry and canned in January after much research on food choices. He seems to be doing quite well with this food so I really don't want to change his diet at this time.

I began reading your thread (Actually began at the end and then going forward) but have not read its entirety yet. But, I am very happy that squirt is doing well after surgery.
SEEING SQUIRT SWIM -- SO SWEET!!!

Thanks Leslie for your response and I won't be a stranger.

[Squirt's Mom]

Hi Debbie,

First, HAPPY BIRTHDAY!

Second, how are things with Logan going? I hope all is well at your house!

Hugs,
Leslie and the girls :D - always

[logans mom]

Hi- It has been quite a long time since I last posted. I was fortunate to find this wonderful forum in Jan 2010 and wanted to give you an update and also ask a few questions about Logan. Logan is 12 years old now and weighs 20.5 lbs. Almost 3 lbs more from last year. In May 2010, I took Logan to the Univ of ILL teaching hospital because he had high liver enzymes that had been increasing over the previous months and 2 small bladder stones. On Ultrasound, 2 adrenal tumors were found. The IMS said surgery was an option but was extremely high risk and my husband and I decided we were not going to pursue surgery for that reason. Logan wasn't showing any strong symptoms at that time, and the IMS (Dr. S) said I could wait to begin treatment. He told me at that time, that his recommendation for treatment is Lysodren, but that usually higher doses are needed for adrenal tumors and some don't respond to that treatment. He also told me that Logan's tumor on left adrenal gland was suspicious looking of cancer due to the shape and mineralization in the tumor. But, a biopsy would be needed to confirm. Again, we didn't want to put Logan through that surgery either. We have taken Logan to the Vet Hospital in July Dec, and most recently in April for additional ultrasounds and bloodwork. There is no evidence of any spreading if that tumor was malignant. Both tumors have increased in size. The right tumor is still not invading the vena cava. Logan has been doing quite well up until a few months aog. In November, he started slowing down on our walks and his hind legs were getting weak. I was considering treatment and then my brother passed away on Thanksgiving day. I just disconnected myself from any treatment plan for fear I was going to lose Logan too. Logan now has a huge appetite, accidents, weak legs and is getting a potbelly. His head at times, trembles a little also. A differnet IMS (DR. K.) who I have taken Logan to on the last 2 visits at the Univ said Lysodren would be treatment of choice, but if I as more comfortable with Trilo, she wouldn't be opposed to it. She has used Trilo on many dogs before but not a dog with an adrenal tumor and is a little skeptical of its use on adrenal tumors and not sure it will relieve him of his clinical symptoms, but agreed to use it. NOw, My IMS is off until end of June. I feel I have wasted valuable time not treating him and I need to move forward. Although this time has allowed me to do some reading and better educate myself (but still am nervous). Now, my vet, Dr T whom I just started going to a year ago, (which told me at that time neither drugs would work on adrenal tumors), has now said that he recently went to a seminar and trilostane does work on adrenal tumors but Lysodren does not. So many conflicting opinions on the use of these drugs and adrenal tumors. Dr T. has treated dogs with cushings but has only used Lysodren. So, Logan will be his first with treatment of Trilo and also with an adrenal tumor. We are going to start Logan on 15 mg of Trilostane. He will be having an ACTH test on Friday. I was wondering do most dogs receive the cortrosyn IM or IV for this test. Dr T. only uses the gel, My IMS said the gel wasn't as reliable as the cortrosyn so Dr T said he would order cortrosyn. They are going to dilute it and freeze in syringes so I can save some money for each stim test. Thanks to this forum, I read that on someone's thread. But, I thought it needed to be given in the vein? Another thing, Logan does have some soft poops at times. Usually never his first poop, but if he poops again later in the day, it comes out runny sometimes. I never thought much of it til now because it has been the norm for him for such a long time. Now I am wondering how would I determine if this was an adverse reaction to tilo or not? Logans most recent results in April that were out of the norm are: Alp 6020 (7-92), ALT 289 (8-65), GGT 83 (0-7), Chol 463 (129-297) Urine protein to creatinine ratio 2.04, and T4 8.94 (15-48) Sludge is present in the gallbladder beginning to form a mucocele. Progressive bilateral adrenomegaly: Andenoma/carcinoma, pheochromocytoma, hyperpasic. Vacuolar hepatopathy. Logan is taking Ursodiol and Denamarin. Sorry for long post

[littleone1]

Corky has a right adrenal tumor which is invading the inferior vena cava. He has been taking Trilostane for almost 20 months, and even though his dosage has had to be increased, the Trilo is keeping his cortisol in the reference range. His level does increase, and that's why his dosage has had to be increased.

Corky's clinical signs do go away when his cortisol level is lower, and when I notice any signs returning, he has a stim test done, and his level has increased, and this is why his dosage is increased.

When Corky had his first stim test done, he had a very bad reaction to the gel. His IMS only uses Cortrosyn on Corky. He hasn't had any problems with it.

Terri

[logans mom]

Terri,

It is so comforting to know that there is another dog here with an adrenal tumor who is doing well on Trilostane. I really do hope that it will help Logan, too. He does pretty well during the day. But when 4 p.m. comes around he his searching the kitchen floor, One eye usually gets red, he will pee and pant this will continue until about 7 p.m. Usually by then he is exhausted and falls asleep. He is going to start on Monday, JUne 6. I am going to take off 2 weeks to be home with him.

Debbie

[lulusmom]

Hi Debbie and welcome back.

I only have a minute but I wanted to tell you that Dr. Edward Feldman of UC Davis prefers lysodren over trilostane for dogs with PDH but in an interview with DVM Magazine, he stated that trilostane was his treatment of choice for adrenal tumors. Dr. Feldman is a world reknown endocrinologist and Professor at UC Davis and I am sure that Logan's specialist knows who is. If you share this information with the specialist, it may make her feel more comfortable with things.

I am so glad to hear that somebody has finally used the valuable tip about splitting cortrosyn into 5mcg/kg syringes. That will save you a lot of money. I believe there have been a few studies that show that results are pretty much the same whether cortrosyn is given IM or IV. My dogs' IMS prefers IV.

Glynda

[logans mom]

Glynda

I will take this post and show it to my IMS on my next visit to see her. I don't think they see alot of dogs there with adrenal tumors. She has only seen one, and he was treated with Lysodren.

That is definitely a money saving tip on diluting/freezing cortrosyn. I will be paying $152.00 (one-time fee) for the bottle of cortrosyn and will be getting five stims from it. So, I will only be paying the cost of lab work which is $142.00 each time Logan gets stimmed = Big Savings. Thank you for that good information and I think I will ask them to do it IV.

Also, I tried to change my title to Diagnosed with Bilateral adrenal tumors but would not allow me. Is that something that I have you change? I will give it another try. Thanks again

Debbie

[lulusmom]

Hi Debbie,

You are very lucky to have a vet that is willing to work with you and learn with you.

I've changed your thread title for you.

Glynda

[logans mom]

Hi Glynda,

I do feel lucky that Dr. T is open to my ideas, (which I have learned from here). He wanted to use the brand name vetoryl, and I explained to him many members here use the compunded trilostane and has been just as effective as vetoryl. So, with a little persistance, he agreed.
Thank you for changing Logan's title but he is now 12 years old. Could that be changed also. He goes in today for his first ACTH test.

Debbie

[logans mom]

Logan went for ACTH test today, and I get the results back already. They did a snap ACTH test through IDexx. The Pre is 10.0 ug and the post is >30. But, it didn't give me an accurate # because their machine only goes to 30. Does anyone else get a snap test done ?
How very disappointing, I really wanted to know at the 10 day mark how much lower his cortisol came down. Now, I won't know.


Debbie

[lulusmom]

Hi Debbie,

I see that somebody has already changed Logan's age on your title. I think I recall a few members mentioning a snap test and hopefully, somebody will chime in and share their experience with you. I do know that the machine needed to do these snap tests are extremely expensive which is why my dogs' specialist doesn't do them inhouse....and they treat hundreds of cushdogs. You'd think with something that expensive, they'd be able to give you an accurate reading without limitations. Go figure.

Glynda

[logans mom]

Hi Glynda

Yes, it would be nice to get an accurate reading especially with it being expensive. But, on a positive note, I got the results back in a half hour.
Logan is getting eye drops with dexamethesone due to inflammation in the eye. He has been taking them for 10 days and has to continue since it has not completely cleared up. Dr. T. said that this wouldn't interfere with results. Can I get your opinion?

Logan will be starting trilostane on Sunday, June 5th.

Thank you

Debbie

[Harley PoMMom]

Dexamethasone will not interfere with cortisol measurements during the ACTH stimulation test.

Wishing you and Logan the best.

Love and hugs,
Lori

[logans mom]

Thanks Lori,

It is nice to get confirmation. Have a good weekend.


Debbie

[logans mom]

Hi,

I have the results from Logans ACTH test: Pre - 3.7 Post 16.7. I am suppose to stay on same dosage and retest in 2 weeks. The girl in office said his results were in normal range other than the numbers that were previously high consistent with cushings. When I picked up the results and looked at them it said his Bun/Creat was 31 (6-31). and his B/C Ratio was 39 (4-27). My guess is that is Bun Creatinine Ratio. Does this mean the trilostane is now affecting his kidneys? Dr. T. is out of office today.

Logan has a decrease in his water intake, although it was never excessive to begin with. Huge appetite is still there. Logan also started to get very finicky with eating his dry food. Refused it all together and only would eat his canned food and chicken in the first few days. He will now eat his dry with warm water mixed in. He also seems to be a little more stable on his feet and is now confident enough to lift his leg while going potty. I haven't seen that in months.

Debbie/Logan

[lulusmom]

Hi Debbie,

Unfortunately, it appears that your vet's staff is not well versed in treating cushingoid dogs. Hopefully your vet will give you a more appropriate assessment of the stim results when he returns. For purposes of monitoring treatment, you cannot use the normal ranges listed by the lab. These ranges are for normal dogs, not cushdogs. The goal of treatment is to get both the pre and post cortisol numbers within the therapeutic range of 1 - 5 ug/dl. With Trilostane, the post stim number can be as high as 9.1 ug/dl as long as symptoms have resolved. Logans post stim of 16.7 is way too high so you have a ways to go. I think you are going to need to increase the dose but you may want to wait until the 30 day stim to figure that out. It is not uncommon for Trilostane to continue to lower cortisol well into 30 days.

Since cortisol is still very high, any lab abnormalities should be expected. I am impressed that with a post stim that all the blood values seem to be within normal range. I didn't go back and look to see if you had posted Logan's prior bloodwork. If you haven't, can you please do that for us now?

Please make sure you follow up with Dr. T. to discuss the possibility of dosing change.

Glynda

[logans mom]

Sorry, what I wrote was a bit confusing. Dr. T. had called me on Tuesday with the resutls of Logans Stim test and said they were high and we needed to retest in 2 weeks with the possibility of increasing dosage. Today, I received the results of the bloodwork that was sent out and the girl in office said those were in normal range other than the ones associated with cushings. I wanted to post all the results at the same time. Here are Logans previous high #'s

Bloodwork from univ on IL on 4/11
Alk 6020 7-92 u/l
ALT 289 8-65 u/l
GGT 83 0-7 u/l
Chol 463 129-297 mg/dl
Tri 179 32-154 mg/dl
Plat 498 200-900

6/14/11 - Bloodwork at Dr. T's
ALk 4132 5 - 137
Alt 246 12-118
GGT 68 1-12
Chol 374 92-324 mg/dl
B/C Ratio 39 4-27
platetles 443 - 170-400

Logans Bun was 13 6-30 on 4/11 and it is now at 31 6-31
with his B/C ratio high also at 39 4-27. Now, I am wondering if the Trilo is affecting his kidney function?


Debbie

[lulusmom]

Hi again,

With respect to the increased BUN, this can be caused from fasting a dog or a recent high protein meal. It can also be caused from any condition that speeds up the catabolic metabolism of protein, such as cushing's.

[logans mom]

Thank You Glynda

I will stop worrying (about that).


Debbie

[logans mom]

Hi,

I took Logan for his 30-day stim test. His pre was 4.7 and post 20.7. Sadly, it went up from his last stim test on 6/14 - 3.7 - post 16.7. Dr. T. wanted to increase it to 10 mg, I said how about 5 mg, so we settled on 7 mg. I am just wanting so badly to get him controlled. I hope I made the right decision by only go up 7 mg. So I am wondering could stress affect the post #? I called Diamondback Drugs to have them overnight his trilostane. It cost $30.00, but last 2 times it took 5 days to get his prescription and I want to start him asap. I asked them why so long as they advertise 2-3 days. They said that their clients in the Chicago area takes longer.



Debbie & Logan

[addy]

Go slow is a good approach.:):)

I just noticed you are in Chicago. I'm in Milwaukee:):):)

Hi neighbor:D:D

Wishing you luck with the 7mgs. I'm waiting for our stim results and I am thinking I am going to end up increasing Zoe's dose as well. I know it is a hard decision sometimes. We make the best decisons we can. You are doing a really good job.

Hugs,
Addy

[logans mom]

Hi Addy,

Your only 3 l/2 hrs away on I-39. I live 2 hours south of Chicago. My husband's niece lives in Milwaukee and just loves it there.

Your right, I need to continue with the slow approach. It's just so sad to see Logan trying to scratch his ear and is unable to do so because his hind legs are so weak. But, I also have to keep in mind were in the early stages of treatment and I have to practice patience.
I hope you get that 9 your looking for on Zoe's test results. Wishing you much luck.

Debbie

[logans mom]

Logan just threw up it was clear but it had a little blood in it. He has been tired today, (Not Lethargic) but he was up quite a bit yesterday. His poop was ok this morning. He stopped eating his dry food completely on Friday and I have been giving him canned food Innova senior since then with some chicken. I called the vet. He is out til tomorrow. Logan is scheduled for his stim tomorrow. Other vet is suppose to call me, not very knowledgable about trilostane. IMS is off clinics for today.

Debbie & Logan

[addy]

Thinking of you neighbor and hoping someone will come along soon with some advice.

Hang in there,
Hugs,
Addy

[frijole]

Logan just threw up it was clear but it had a little blood in it. He has been tired today, (Not Lethargic) but he was up quite a bit yesterday. His poop was ok this morning. He stopped eating his dry food completely on Friday and I have been giving him canned food Innova senior since then with some chicken. I called the vet. He is out til tomorrow. Logan is scheduled for his stim tomorrow. Other vet is suppose to call me, not very knowledgable about trilostane. IMS is off clinics for today.

Debbie & Logan

I went back to read a bit of history and if I am right you have not been able to get the cortisol levels down and so you recently increased from 5 mg to 7 mg and your dog quit eating on Friday? Did you continue to give the trilo? This could have been a sign of too much...course it could be something else is wrong but I would withhold trilo and get that test done tomorrow for sure.

Do you have prednisone on hand in case of emergency? You probably won't need it but with the vomit and lack of appetite those are both signs of too much trilo.

How much does Logan weigh? Hang in there! Thanks!!! Kim

[logans mom]

Kim - Logan stopped eating dry soon after he started trilostane. I then had to mix it with canned food and he would eat it some and then he just stopped completely on Friday. So, I began giving him canned food with chicken. I thought I had introduced it fairly slowly, but maybe not slow enough. His tummy had been gurgling the past 3 days. And, then this afternoon he vomited. I was able to get him today with the other vet. They checked electrolytes and did bloodwork. Electrolytes normal. But, on the bloodwork it showed his bun was 45.0 (9.0-29.0 ). She said he probably has an underlying kidney issue and that can cause vomiting She said his last Bun result was also high normal. 31 (6-31). She wanted me to put him on K/d, stop with the trilo and have is kidney levels checked again in a week. I asked if they would do a urinalysis on him. They did and he had SPG at 1.020 with 100++ for proteinuria. They will send that off to lab. But, then she said it probably isn't kidney issue because he was able to concentrate urine. I just looked back at what Glynda had told me earlier about the increased bun that it could be due to high protein (which I had just started giving Logan alot more chicken with his canned food). She then said most likely he was having gastro upset due to the food and gave him a shot of serenia.

He is acting fine other than panting alot this evening. He ate some I/d I gave him and is sleeping soundly. He goes in for stim tomorrow. Shouldn't I go ahead and give him his trilo tomorrow a.m

Addy - Thanks for checking on us.

[frijole]

Kim - Logan stopped eating dry soon after he started trilostane. I then had to mix it with canned food and he would eat it some and then he just stopped completely on Friday. So, I began giving him canned food with chicken. I thought I had introduced it fairly slowly, but maybe not slow enough. His tummy had been gurgling the past 3 days. And, then this afternoon he vomited. I was able to get him today with the other vet. They checked electrolytes and did bloodwork. Electrolytes normal. But, on the bloodwork it showed his bun was 45.0 (9.0-29.0 ). She said he probably has an underlying kidney issue and that can cause vomiting She said his last Bun result was also high normal. 31 (6-31). She wanted me to put him on K/d, stop with the trilo and have is kidney levels checked again in a week. I asked if they would do a urinalysis on him. They did and he had SPG at 1.020 with 100++ for proteinuria. They will send that off to lab. But, then she said it probably isn't kidney issue because he was able to concentrate urine. I just looked back at what Glynda had told me earlier about the increased bun that it could be due to high protein (which I had just started giving Logan alot more chicken with his canned food). She then said most likely he was having gastro upset due to the food and gave him a shot of serenia.

He is acting fine other than panting alot this evening. He ate some I/d I gave him and is sleeping soundly. He goes in for stim tomorrow. Shouldn't I go ahead and give him his trilo tomorrow a.m

Addy - Thanks for checking on us.

I am bumping this for someone who has used trilo to answer. I understand there might have been other issues but I'd be concerned... but I think you have to give it in order for the test to be valid... but I used lysodren not trilo so want someone else to answer!! :) Kim

[frijole]

BUMPING UP - Someone with trilo experience please answer the question bolded. Thanks! Kim

[Harley PoMMom]

Many members give Pepcid AC 20-30 minutes before giving the Cush meds. Both Lysodren and Trilostane can cause gastric upset so giving the Pepcid beforehand can help with the upset tummy.

For the acth stim test to really be meaningful the Trilostane has to be given 4-6 hours before the test is performed.

But there is a protocol about not giving any Cush meds to a sick dog. If Logan is acting like himself, eating and drinking normally with no more vomiting, then if he were my furbaby I would give him the Trilostane tomorrow morning for the stim test.

Hope this helps.

Love and hugs,
Lori

[logans mom]

Thanks so much Kim and Lori. I can't say it enough how comforting it is know that everyone here is just so caring and knowledgable and has my back when I am in need of advice.

Logan was pretty restless overnight. He woke up several times licking his feet and just couldn't get comfortable. But, this has been his pattern lately. I have turned into such a light sleeper since cushings came into our lives. I used to be able to sleep through my husbands loud range of snoring sounds. But, now just the slightest sound that Logan makes will open my eyes.

Logan seems fine this morning. He is in the kitchen now barking for breakfast. I tried to explain to him he has to wait an hour after I give him his denamarin before he can eat. He clearly doesn't understand.

Lori - Logan is on Ursodiol which I don't think you can give with an antacid. Is Pepcid AC an antacid?

They gave me Hills I/d for his tummy. (Dry & Can). Logan hardly ate their dry food, but would eat the can. I think I will probably have to switch his food to another can dog food. Do you have any suggestions? I had been giving him Innova sr. can food (just a little with the dry for past year). But, when he stopped eating dry, I gave him all can with chicken. So, I am really not sure if the canned food was the problem, or possibly going to fast with the canned??

Logan goes in for stim test today. I really see his symptoms rebounding at night especially between 4-7p.m. This was even before starting trilostane. He would drink, eat, pee and pant through that time period everynight. So, I wonder if twice daily dosing will be needed.

So, should I not worry about that high Bun??

Thanks again for being there

Love,
Debbie & Logan

[addy]

Debbie, the canned ID is highly digestible and is not a problem for most dogs. The dry ID I could see maybe being a problem if you went to fast but most dogs can go on the ID without transition. The only problem I found with it was having trouble getting my pups off of it and onto a new food because it is so digestible.

The dogaware website goes over different health issues and also goes over diets and foods. It is a good place to start researching different foods for Logan. All his health issues have to be considered.

If you are seeing rebound symptoms, twice day dosing may be in order and can be discussed with your vet after the stim results are in.

Hang in there and glad to see Logan is feeling better.

Hugs,
Addy

[logans mom]

Hi Addy,

It was the Innova Sr. can that I was giving Logan prior to him vomiting yesterday. He stopped eating his Innova dry. They gave me both dry and can of the Hills ID. I fed him some of the can I/D this morning and he would only eat a little. Then I added chicken to it and he finished his plate. So, I did give him his trilostane. It seems as if chicken has become his favorite meal. This could be a challenge trying to find him a can food to his liking. Thanks for the website, I'll start researching.

Love,
Debbie & Logan

[Harley PoMMom]

Lori - Logan is on Ursodiol which I don't think you can give with an antacid. Is Pepcid AC an antacid?

Love,
Debbie & Logan

From what I have read about Ursodiol is that it should not be given at the same time as aluminum containing antacids (such as Amphojel) as these compounds may bind together and impede the action of the ursodeoxycholic acid.

Famotidine, which is the active ingredient in Pepcid AC, is in a group of drugs called histamine-2 blockers. Maybe ask you vet if using the Pepcid AC would be ok.

[logans mom]

Ok Great!! Thanks Lori - Logan gets his ursodiol at night. I hope Logan continues to like his bananas cause that is where all his pills get hidden.

I really am embarassed about not have a picture of my boy. I am clueless with how to put up his picture. I have some pictures of him stored on my computer, but don't know how to transfer them over.
I would also be putting a embarrased icon right about here but I don't even know how to do that. I'll keep trying.

Love

Debbie & Logan

[logans mom]

Logans stim was pre 2.7 post 15.3. His symptoms are much more apparent at night between the hours of 4 - 7. Its like clockwork. He will wake up from a sound sleep around 4 and begin begging for food then the panting begins. This will continue on and off til he gets tired at 7. Dr. T suggested we go from 22 m.g to 15 mg twice a day. Can I hear your opinion on this. I called IMS and am also waiting on her reply.

Thanks

Debbie & Logan

[addy]

Hi Debbie,

That dose change seems reasonable to me. His two week stim was post 16.7ug/dl wasn't it? So it came down a bit. If we follow Dr. Peterson's papers it is a reasonable change.

Hopefully other Trilostane users will comment. I believe Zoe will end up on BID as well at some point.

Hugs,
Addy

[lulusmom]

I agree with Addy. The dosing change sounds reasonable based on the acth stimulation test and symptoms. Please keep us posted.

[labblab]

Ok Great!! Thanks Lori - Logan gets his ursodiol at night. I hope Logan continues to like his bananas cause that is where all his pills get hidden.

I really am embarassed about not have a picture of my boy. I am clueless with how to put up his picture. I have some pictures of him stored on my computer, but don't know how to transfer them over.
I would also be putting a embarrased icon right about here but I don't even know how to do that. I'll keep trying.

Love

Debbie & Logan



Hi Debbie,

Take a look at this portion of our "FAQs" for help with getting some photos of sweet Logan posted (and also for adding his photo as your avatar alongside your username):

http://www.k9cushings.com/forum/faq.php?faq=vb3_board_faq#faq_vb3_user_profile

Marianne

[logans mom]

Thanks so much Addy and Glynda - My Ims just called also and we are all in agreement. YES!!!. He will start tomorrow on his new dosage.

He seems to be better today. No gurgling in belly and sleeping well. But, he remains a finicky eater. I gave him the canned I/D with some enticing chicken. He seemed disinterested, but yet ate it. Still researching new food.

Thank you Marianne- That is on my list to do this weekend. He may have a girlfriend out there that may be interested. :)


Love,
Debbie & Logan

[logans mom]

I am concerned now because I just reread Addy's question on if 16.7 was his two week result. That result was 2 weeks being on 15 mg.
His 30 days stim was 4.7 post 20.2

He started on 7/5 on 22 mg and pre was 2.7 post 15.3

I started him on Friday 7/22 on 30mg BID.
Was I suppose to wait 30 days after him being on 22 mg
before beginning him on a new dosage?


Debbie & LOgan

[logans mom]

Correction 15 mg BID on 7/22.

Debbie

[littleone1]

Hi Debbie,

You don't need to wait to start a new dosage with Trilo.

[logans mom]

Terri,

Thank you so much!! I wasn't clear when I posted his results as to how long he had been on the dosage of 22 mg. So, I just wanted to make sure we were all on the same page. Ok, I feel much better now. HOw is Corky doing??

Love
Debbie & Logan

[logans mom]

Last night about 2 hours after giving Logan his trilostane he was breathing fast for several hours and very uncomfortable. This morning he will not eat his food so I didn't give him his trilostane.
Should I take him in for stim. I just panic in these situations

[addy]

Hi Debbie,

Other than not wanting to eat, how is Logan acting? Has it been about four days on the new dose?

Panic is a natural response, sometimes it is hard for us to stay calm.

Hugs,
Addy

[lulusmom]

If I were in your shoes, I would get Logan to the vet and make sure the vet checks the electrolytes.

[logans mom]

I just got back from the vet. Logans electrolytes were ok. But they found a mass on his lung. I am going to take him to the University of Illinois now to have them also review his xray. Please say a prayer for my baby boy. I can't stop crying.

Debbie & Logan

[Harley PoMMom]

Oh Debbie, I am so sorry to hear this and will definitely be keeping you both in my thoughts and prayers. Sending huge loving hugs.

[lulusmom]

Debbie, I am so sorry to hear this news too. My thoughts and prayers are with you both.

(((Huge Hugs)))
Glynda

[addy]

Dear Debbie,

Saying prayers for you and your little boy, Logan

Love,
Addy

[jmac]

Debbie,
So sorry to hear the news about Logan. I'll be thinking of you and hoping for the best.

Julie & Hannah

[Squirt's Mom]

Hi Debbie,

This is not what any of us wanted to hear about Logan. :( Please know your cush family stands beside you both and we are here anytime you need us.

Sending prayers, healing white light and positive thoughts!
Hugs,
Leslie and the gang

[logans mom]

Glynda, Lori, Addy, Julie and Leslie,

Thank you so much -- your prayers worked!!!!! I am so elated to be typing this and this time its with tears of joy but Logan has NO MASS!! My vet, Dr. T. got it wrong. He had taken 2 chest xrays of Logan. One xray showed nothing and the other showed a mass in the left lung. Dr. T said it didn't look good. He called U of I teaching hospital and set up appt for today so they can also review the xrays. Well, upon their review Dr. B who works in the emergency area of hospital said there was no mass. He compared the 2 xrays from Dr. T. with the chest Xrays which were taken at U of I in April and there was no change. I said how could he have misinterpreted the xray? Dr. B. said Logan was not standing straight in the one xray and given the angle in which it was taken revealed a shadowlike image. But, he absoluteley has no mass. So, I can't be any happier about that, but no so happy with Dr. T.

I asked Dr. B to check with Dr. K (Logans IMS) about what I should do with Logan since he is not eating. She suggested to take him back down to 15 mg until he starts eating and then gradually increase his dosage back to 15 BID. What?? Have you heard of that before?? I don't want to go backwards again. But, yet I don't know if I can continue to give Logan this drug if he isn't eating. Logan has not eaten anything all day. So, he has not gotten his trilo today or tonight. I have been trying to introduce Merrick canned senior food with chicken and rice the past few days. But now he won't even eat chicken and rice which he never refused before. My husband just gave him a little hamburger just now and he ate 2 bites of that. I need to get him on a bland food to settle his tummy. Can I give hamburger and rice for awhile. His belly was upset last week and he vomited and I had to take him to the vets for an electrolyte check and bloodwork. I just think everytime he doesn't eat it is trilo related and I run him to vets. But, what am I suppose to do? Now, switching foods around so much, I am afraid again that his belly will be upset and I send him back to vets unnecessarily.?

Any ideas or suggestions would be so appreciated. Also, If electrolytes are ok can cortisol still be low???

Thanks again for all your support

Love
Debbie & Logan

[jmac]

Debbie,

I am so happy to hear the good news! Yeah for Logan!!!!

I hope he is eating better soon and that you get that figured out. I always give my dogs hamburger (it is supposed to be boiled, rather than fried, but sometimes I just fry it and then rinse it really thoroughly with water) and rice when they need to calm their tummies after diarrhea, not eating, etc. I would think you would be okay doing that for a while, but see what others say.

Again, so glad to hear of the good results! I bet you were ecstatic! :)


-Julie & Hannah

[logans mom]

Hi Julie,

Yes I was Estatic!! Lots of hugs given out today!!! I too hope I can get him going on a food he will like for more than a couple of days. I will give the hamburger and rice a try.

I see we both have 12 year old Shih Tzus' . Hannah is a cutie Pie!!!

Love

Debbie & Logan

[Harley PoMMom]

So happy to hear that Logan does not have a mass!! This is great, great news!!!!

The electrolyte levels can be within the normal ranges even if the dog's cortisol is low.

If you believe Logan's cortisol level is low than I would suggest having an ACTH stim test done.

These additions are usually suggested to perk up the appetite of a dog that is being finicky: Grated parmesan cheese as a topper on the regular food, Drizzle sardine or tuna juice (water packed sardines/tuna) on the food, Add a bit of warm meat broth to the food, and add some tripe to their food. A dog will usually follow their nose when it comes to eating and it seems the stinkier the better!

Hope this helps.

Love and hugs,
Lori

[logans mom]

Hi Lori,

Thank you for responding to my question about cortisol and electrolytes. Is that information anywhere in the forums literature?

I will give your suggestions on the food front a try. Logan did eat some chicken today. But, that alone is not a very balanced diet.

Thanks Lori for being there

Love
Debbie & Logan

[Squirt's Mom]

Oh, Debbie! What wonderful news! :D No mass!!! :D:D:D:D:D YIPPEE!!!!! :D:D:D

I gotta know....did you kiss the vet that said it was just a shadow and not a mass? :p

Lori is on the mark with stinky feed! As our babies age, they can lose their sense of smell and taste as well as hearing and sight so sometimes they need a bit of stink to stimulate their appetite. Green tripe is good for them and you can find it canned. Fair warning, most folks think the smell is horrendous, but I sorta like it. Of course, I'm an odd old broad! :p

Keep up the good work, Mom!

Hugs,
Leslie and the gang

[lulusmom]

Hi Debbie,

I was thrilled to hear Logan doesn't have a mass. I can only imagine the joy you felt when you got that news. Yay!!!!!

My two cushdogs are currently on Lysodren; however, they were previously on Trilostane. If they appeared to be sick and were not eating normally, I would withhold the Trilostane until their appetite returned to normal. Trilostane has a short half life so you don't really lose ground by taking a Trilostane sabbatical. Did you inform your vet that Logan is not eating? If you did and she still told you to continue dosing without doing an acth stimulation test first, I would be very concerned about her level of experience and knowledge in treating a cushdog.

[addy]

Hi Debbie,

Stopping in to check on Logan and I am so glad Glynda posted to you. I was really worried about continuing dosing him if he is not eating.

The news of no mass brought joyful tears to my eyes.:D:D:D

Love,
Addy

[logans mom]

Leslie - No kisses to the good news vet, but a big old thank you thank you bear hug.:) Hmmm, horrendous smelly green tripe - I'll look into that. Thanks!!

Glynda - Logan has eaten better tonight, but has again been very picky on what he is eating . ( I still withheld his evening dose.) I thought I read on a post that trilo can stay in the system 12-18 hours. Is that right?? My vet, Dr. T. is the one who said we needed only to check electrolytes because if they were in normal range, Logan wouldn't be addisionian.

Addy - Thanks for checking in on us when you have so much going on in your family.

Love
Debbie & Logan

[Harley PoMMom]

Hi Lori,

Thank you for responding to my question about cortisol and electrolytes. Is that information anywhere in the forums literature?

Love
Debbie & Logan

This is an excerpt from Dr. Peterson's blog: Differentiating primary hypoadrenocorticism from secondary and atypical hypoadrenocorticism.


The finding of severe serum electrolyte disturbances (i.e, high potassium, low sodium, low sodium/potassium ratio), together with subnormal cortisol values that fails to rise after ACTH injection (see Figure above) is diagnostic for primary Addison's disease.

However, in dogs with secondary and atypical hypoadrenocorticism, the serum electrolytes are generally normal, making diagnosis more difficult.

http://animalendocrine.blogspot.com/2011/04/how-is-canine-addisons-disease-best.html

[addy]

Hi Debbie,

Stopping by to say hi and to wish you a good day. I hope you and Logan are okay. I love the photos, by the way. He is just so darn cute.

Hugs,
Addy

[Skye]

I think today is your birthday isnt it????? HAPPY BIRTHDAY!!!!!!!!! hope you have a beautiful wonderful day