Harry, 11 y/o Irish Setter - Hyperestrinism to Cushing's/Diabetic - Harry has passed

[HarrysMom]

Hi,
I have 11 year old Irish Setter boy named Harry.
For a few years, Harry has had proteinuria (urine protein creatinine ratio of 1.6-2.8) - we have been controlling this with low protein diet (Natural Balance Reduced Calorie Formula). His blood pressure is normal. His kidney values so far have been normal. No protein deficiency in the blood numbers.
Harry's routine blood panel in December showed slightly elevated Alk Phosphatase (208). His T4 was a low, but additional test (free T4?) ruled out hypothyroidism. We started Harry on Denamarin. Harry has had unusual hunger, so our vet and I debated Cushing's. Despite his age, Harry is still a very active and fit dog, being able to go on hours of trail runs. We decided to just monitor him closely.

Early February, Harry had a non-recurring episode of vomiting. A blood test for pancreatis was negative. Blood chemistry showed even more elevated Alk Phosphatase (280) and ALT (128). Ultrasound done by a radiologist showed everything normal, including liver, stomach, gall blader, kidneys, testicles (Harry is intact). Some gas in his stomach. He has not had any vomiting since, so we attributed to one-time gasteritis.
A follow-up blood test in early April showed even more elevation in Alk Phos (480!) and ALT (140).

We did a tick panel, lepto and U Tennessee Adrenal Panel test. Tick was a very slight positive on Rocky Mountain Spotted Fever. Lepto was negative, and U Tennessee Adrenal Panel came back hyperestrinism.

Cortisol - Normal, Baseline (9.5 vs range of 2.5-56.7), Post (107 range of 70.8-108.5).
Androstenedione- Normal, Baseline (2.97 vs range of 0.21-4.26), Post (3.67 range of 0.68-7.92).
Estradiol - Abnormal, Baseline (105.3 vs range of 30.5-66.6), Post (98.9 range of 30.0-65.6).
Progesterons- Normal, Baseline (0.10 vs range of 0.03-0.40), Post (1.0 range of 0.55-1.70).
17 OH Progesterone - Abnormal, Baseline (0.52 vs range of 0.08-0.84), Post (3.31 range of 0.37-2.87).
Aldosterone - Normal, Baseline (50.4 vs range of 11-139.9), Post (196.5 range of 72.9-398.5).

Other than hunger and begging Harry has not had any other symptoms. Some hair loss around his anal area (hair fell off when he has some skin rashes there a few months ago, has not grown back much). He has had some plant material embedded around his toes and got infected (due to thinnern skin? But then he is a trail running dog).

Our vet does not think that we need to pursue additional diagnostics to dig deeper into liver (biopsy or bile acid test). She thinks that Harry's estrogen elevation is significant, and this could cause vacuolar hepatopathy that could elevate enzymes. She also thinks hypothyroidism is still a possibility given many Irish Setters are prone to this.

For now, she is recommending melatonin and flaxseed hulls.

Now, I also belong to a Yahoo Cushing's board, and the prevailing thought on that board seems to be that there is no such thing as Atypical Cushing's and that melatonin / flaxseed do not really work.

I wanted to get your opinion on this issue and understand how to deal with this issue.

I was also told that U Tennessee Adrenal Panel often results in elevated estrogen due to collection / testing method problems. Is Harry's estrogen even elevated?

Are there any other procedures I should follow?

As you can tell, I am very very confused and would appreciate any help.

Harry's Mom
California

[Harley PoMMom]

Hi Harry's mom and welcome to our cush family. When my boy Harley had his first adrenal panel done from the University of Tennessee he also showed very elevated estradiol levels.

There is a cushings known as Atypical Cushings and this is when one or more of the intermediate/sex hormones...Androstenedione, Estradiol, Progesterone, 17 OH Progesterone, and Aldosterone are elevated but the cortisol is not.

Now if the estradiol is the only one elevated this is known as Hyperestrinism.

Melatonin and lignans high in SDG is what is recommened for pups that have elevated hormone levels. My boy Harley's estradiol levels have dropped considerably...from 132.2 to 96.6 in 7 months...yes it does take time.

I don't know if you would consider getting Harry neutered, considering his age, but this could take care of that high level of estradiol.

Was diabetes ruled out?

I am sure the others will be along to give their advice also, so hang in there, just remember you are not alone on this journey, we are here to help you in any way we can so ask all the questions you want and we will answer them the best we can.

Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's"
http://www.k9cushings.com/forum/showthread.php?t=198

Love and hugs,
Lori

[jrepac]

Atypical Cushings exists....and cases of "regular" cushings may involve most/all of the hormones being elevated (which is what I have been dealing with)....I am not sure why folks on the other board would say that Atypical does not exist. The UTK seems pretty reputable to me and you can find other citations of Atypical Cushings on the web. Many vets are not aware of atypical cushings nor the UTK testing procedures.

I have been following a combo therapy of anipryl, melatonin and lignans for several (many?) months now with fairly good results. We are due for a checkup this month. I only added the melatonin and lignans after I had the UTK panel done (was already on anipryl alone for several months based on what was a "borderline" case of cushings at that time). I do feel they have helped, based on observation of symptoms and our last checkup in the fall (we had a "low" reading of cortisol on the UCCR screen using a multi-day sample...which was markedly better than 6 months prior before I started the melatonin & lignans).

If you are curious and search the net, you can read a lot about melatonin's anti-cortisol properties; it is widely used by competitive body builders in fairly high doses. They too, want to reduce cortisol at all costs, because it adversely affects their ability to build muscle.

Jeff

[HarrysMom]

Lori,
Harry's blood chemistry panel did not indicate diabetes. Just elevated Alk Phos, ALT and cholesterol (note that it was not a fasting blood panel). Everything else was normal.

Sertoli Cell tumor was cited by U Tenn as a possible cause of hyperestrinism, but the ultrasound showed normal testis, and palpitation did not indicate any tumor.

Fixing him is an option, but with his proteinuria and liver values, the vet is reluctant to put him under general anethesia. We also debated how neutering him at this point would impact his quality of life (energy levels, exercise tolerance, etc.). Something to keep in mind.

Thank you for your kind words.

Yunhee - Harry's Mom

[HarrysMom]

Jeff,
Thanks for your response. Our vet did say that U Tenn Adrenal Panel is the current gold standard for this kind of test, and even if the tests do have bias towards elevated estradiol, Harry's values were too high to attribute to false test results.

I think some of the members on the other board feel that there is no Atypical Cushing's, and these turn out to be full blown Cushing's cases eventually - so it seems that some researchers believe that abnormal Adrenal Panel results are early indicators to Cushing's. Hard to say as I am just starting to research this.

For whatever it's worth, after taking melatonin for the first time last night, Harry's had a very peaceful sleep (he usually wakes up a few times to jump up on bed, but not last night).

Harry's Mom - Yunhee

[Harley PoMMom]

Hi Yunhee,

My boy Harley is a 13 y/o Pomeranian with PDH cushings and elevations in all his intermediate/sex hormones. He also has high blood pressure, which he takes meds for; still has protein loss in his urine. He also has pancreatitis. In Nov. 2009 his ALP levels were 761 (5-131) and his ALT were 272 (12-118). His vet and I noticed that his teeth needed a good cleaning and maybe some extractions, and even with these liver enzymes numbers she put my boy under a general anesthesia and extracted 3 of his teeth and cleaned the ones that were left! :D They do have general anesthesia's that are not as hard on our cush pups systems.

Estradiol is produced from the adrenals but also is formed in other places, like fat cells, hair follicles and the liver.

I really would suggest that your vet contact Dr. Oliver who heads the lab at the University of Tennessee. He is a saint! Harley's vet has talked with him, via email, many times about my boy and he always responds very quickly.

Here is his email address: joliver@utk.edu
Love and hugs,
Lori

[HarrysMom]

Thanks, Lori. I will mention it to my vet. Actually, I have been very happy with my vet - she has been very thorough through this entire ordeal (starting with proteinurira about a year ago and then elevated liver enzymes). I am sure she will be happy to reach out to Dr. Oliver.

Yunhee, HarrysMom

[Harley PoMMom]

His T4 was a low, but additional test (free T4?) ruled out hypothyroidism.


Was this additional test done, was it the FreeT4 by Equilibrium Dialysis to rule out the Hypothyroidism?

Love and hugs,
Lori

[HarrysMom]

Free T4 was done, and it ruled out hypothyroidism.

Yunhee

[lulusmom]

Hi Harry's Mom and a belated welcome to you and Harry.

I have a few questions and comments and in order to keep things organized, I've posed them in blue text within your post below:


Hi,
I have 11 year old Irish Setter boy named Harry.
For a few years, Harry has had proteinuria (urine protein creatinine ratio of 1.6-2.8) - we have been controlling this with low protein diet (Natural Balance Reduced Calorie Formula). His blood pressure is normal. His kidney values so far have been normal. No protein deficiency in the blood numbers.

I just wanted to point out that the mild proteinuria can be caused from strenuous exercise so with Harry being a trail running dog, this may be normal for him. I would be more concerned if his urine specific gravity was low. Do you have copies of urine tests and if so, what was the USG and PH?

Harry's routine blood panel in December showed slightly elevated Alk Phosphatase (208). His T4 was a low, but additional test (free T4?) ruled out hypothyroidism. We started Harry on Denamarin. Harry has had unusual hunger, so our vet and I debated Cushing's. Despite his age, Harry is still a very active and fit dog, being able to go on hours of trail runs. We decided to just monitor him closely.

Early February, Harry had a non-recurring episode of vomiting. A blood test for pancreatis was negative. Blood chemistry showed even more elevated Alk Phosphatase (280) and ALT (128). Ultrasound done by a radiologist showed everything normal, including liver, stomach, gall blader, kidneys, testicles (Harry is intact). Some gas in his stomach. He has not had any vomiting since, so we attributed to one-time gasteritis.
A follow-up blood test in early April showed even more elevation in Alk Phos (480!) and ALT (140).

Believe me, 480 Alk Phos is not that high for a cushdog. We've actually seen numbers in the thousands. To touch on Harry's intact status, the gonads are at the top of the list of body tissue where you can find estradiol so this can be contributing to the elevations you see on the UTK panel.

We did a tick panel, lepto and U Tennessee Adrenal Panel test. Tick was a very slight positive on Rocky Mountain Spotted Fever. Lepto was negative, and U Tennessee Adrenal Panel came back hyperestrinism.

I'm not sure of the significance of a very slight positive on Rocky Mountain Spotted Fever would be. I know that you can see elevated cholesterol, Alk Phos and Alt with this condition so am wondering what your vet had to say about this.

Cortisol - Normal, Baseline (9.5 vs range of 2.5-56.7), Post (107 range of 70.8-108.5).
Androstenedione- Normal, Baseline (2.97 vs range of 0.21-4.26), Post (3.67 range of 0.68-7.92).
Estradiol - Abnormal, Baseline (105.3 vs range of 30.5-66.6), Post (98.9 range of 30.0-65.6).
Progesterons- Normal, Baseline (0.10 vs range of 0.03-0.40), Post (1.0 range of 0.55-1.70).
17 OH Progesterone - Abnormal, Baseline (0.52 vs range of 0.08-0.84), Post (3.31 range of 0.37-2.87).
Aldosterone - Normal, Baseline (50.4 vs range of 11-139.9), Post (196.5 range of 72.9-398.5).

Other than hunger and begging Harry has not had any other symptoms. Some hair loss around his anal area (hair fell off when he has some skin rashes there a few months ago, has not grown back much). He has had some plant material embedded around his toes and got infected (due to thinnern skin? But then he is a trail running dog).

Our vet does not think that we need to pursue additional diagnostics to dig deeper into liver (biopsy or bile acid test). She thinks that Harry's estrogen elevation is significant, and this could cause vacuolar hepatopathy that could elevate enzymes. She also thinks hypothyroidism is still a possibility given many Irish Setters are prone to this.

Hyperestrinism can cause vacuolar hepatopathy but this is usually apparent on abdominal ultrasound and Harry's liver appeared to be normal. I assume that the adrenal glands were also normal? PU/PD (excessive drinking and peeing) is also the norm in most dogs with this condition so with Harry lacking this symptom, I think your vet's thinking that hypothyroidism shouldn't be ruled out just yet is understandable. In my opinion, Harry seems to have more lab abnormalities and physical symptoms consistent with hypothyroidism and until you absolutely rule it out, there's no way to tell which condition is causing the symptoms. Can you post the results of the Free T4 test that was done?

For now, she is recommending melatonin and flaxseed hulls.

Now, I also belong to a Yahoo Cushing's board, and the prevailing thought on that board seems to be that there is no such thing as Atypical Cushing's and that melatonin / flaxseed do not really work.

Atypical cushing's, also known as pseudo or occult cushing's, does exist. More than a few reknown endocrinologists use these tags when defining a dog that has clinical signs and blood chemistry indicative of cushing's yet circulating serum cortisol levels are normal on the LDDS and acth stimulation tests. I'm therefore not sure why the folks at ccac feel that atypical cushing's does not exist. It may be because it's a highly controversial subject and the veterinary medical community seems to be split as to whether or not it's truly the elevated sex hormones that are at the root of the problem.

It is known that efficacy for melatonin and flaxseed treatment is slow and low in comparison to the conventional treatment used for typical cushing's; however, we have seen some good results here.

I wanted to get your opinion on this issue and understand how to deal with this issue.

I was also told that U Tennessee Adrenal Panel often results in elevated estrogen due to collection / testing method problems. Is Harry's estrogen even elevated?

I've personally never heard about problems in collection methods skewing test results but this can easily be clarified by Dr. Oliver at UTK. FYI, estradiol is an estrogen.

Are there any other procedures I should follow?

I think you should follow your vet's plan of action and I also agree with Lori that your vet should contact Dr. Oliver to discuss Harry's case. It doesn't cost a cent and Dr. Oliver may have some sound recommendations based on Harry's full medical history presented by your vet.

As you can tell, I am very very confused and would appreciate any help.

I understand how confusing all of this is and everybody has their own opinion based on their own experience and research. It took me a very long time after my first cushdog was diagnosed to get my arms around the disease and I didn't form my own opinions about anything for months. Try to catch your breath and go easy on yourself. We're here to help you in any way we can and I promise that the more you learn, the more unconfused you will become. :)

Harry's Mom
California

[HarrysMom]

Lulusmom,

Thanks for the info. My answers to your questions are below:

"I just wanted to point out that the mild proteinuria can be caused from strenuous exercise so with Harry being a trail running dog, this may be normal for him. I would be more concerned if his urine specific gravity was low. Do you have copies of urine tests and if so, what was the USG and PH?"

= Harry's specific gravity in April was 1.028 (range of 1.015-1.05). This urine was taken around 1PM, so the first catch number would probably be higher. His lP was 8.0 with some crystals seen. The previous urinalysis pH was 6.5, with no crystals. Since ultrasound did not see any stones, the vet thinks that these could be caused by food. No bacteria found in urine (culture was done).


"I'm not sure of the significance of a very slight positive on Rocky Mountain Spotted Fever would be. I know that you can see elevated cholesterol, Alk Phos and Alt with this condition so am wondering what your vet had to say about this."

=According to Idexx, this number is very very low and is not at all clinical. Our vet highly doubts that this is causing his elevation. Just in case, Harry was put on Doxycycline - in the past, this has brought down his UPC (anti-inflammatory effect?).


"Hyperestrinism can cause vacuolar hepatopathy but this is usually apparent on abdominal ultrasound and Harry's liver appeared to be normal. I assume that the adrenal glands were also normal? PU/PD (excessive drinking and peeing) is also the norm in most dogs with this condition so with Harry lacking this symptom, I think your vet's thinking that hypothyroidism shouldn't be ruled out just yet is understandable. In my opinion, Harry seems to have more lab abnormalities and physical symptoms consistent with hypothyroidism and until you absolutely rule it out, there's no way to tell which condition is causing the symptoms. Can you post the results of the Free T4 test that was done?"

=Interestingly, Harry's ultrasound in July 2009 showed slightly enlarged adrenal glands - both same size, so tumor unlikely. His ultrasound in February 2010 did not indicate any adrenal enlargement. The radiologist (who did both ultrasounds) did say that Harry's liver did not show any changes consistent with Cushing's dogs.

=Harry's Free T4 was 0.84, low range of normal (0.65-3.00), so hypothyroidism is not an impossibility. Would Harry have such a raging hunger with hypothyroidism though?


Yunhee, Harry's Mom

[lulusmom]

Hi Yunhee,

Thank you for responding to my questions. As I mentioned previously, PU/PD is extremely common with hyperestrinism and Harry's urine seems to be normal in every way so yay, Harry!!

My littlest cushdog was diagnosed with hypothyroidism at one year old and her appetite was out of control. Increased appetite is at the top of the list of symptoms associated with hypothyroidism as is skin and coat problems. A good number of dogs that are hypothyroid have mild elevations in liver enzymes as well as cholesterol so in my opinion, Harry fits the hypothyroid profile a lot closer than the atypical cushing's/hyperestrinism profile. It is not uncommon for vets that suspect hypothyroidism to prescribe thyroid supplementation to see if symptoms resolve. Has your vet discussed this possibility with you? If it were me, I'd want to rule out hypothyroidism within a shadow of a doubt before starting treatment for the elevated sex hormones.


Glynda

[HarrysMom]

Glynda,
I just googled hypothyroidism and do agree that there may be something there.

Harry did have two bouts of eye infection of this year. Also he is getting benign (per biopsy) cysts on his paws - never had that before, but then we used to live in LA where there were not as much vegetation as here on the trails. It seems that hypothyroid dogs do get this. Our vet did mention that she has been seeing a ton of eye infections lately - particularly due to the heavy rain season in Northern California.

He is very very active, even at almost 12 y.o. He does have some morning stiffness, but then again he does have some arthritis.

We did also notice that he has become more anxious - barking a bit more and certainly very fearful at the vet office. Not sure if this is because so much has happened to him at the vet's.

Our next course of action is to retest UPC and liver values in a few weeks. I will also ask the vet to recheck Harry's thyroid (free T4, I think). The vet did mention that it may be worth it to start Harry on some thyroid hormones if things don't improve.

I am hoping that doxycycline combined with melatonin and flax seed hulls would help with these numbers, but who knows. Our vet recommends starting these supplements as there is very little downside. Harry is also taking Denamarin.

Yunhee

[lulusmom]

It's true that there is very little downside to the melatonin and pressed flaxseed hulls but you will notice that the melatonin may make Harry sleep more.

Behavioral changes are more likely to occur with hypothyroidism than atypical cushing's. As a matter of fact, I've never read anything that mentions behavioral issues relating to excess sex hormones.

Dr. Jean Dodd is probably the world's premier expert on hypothyroidism and I would recommend that you request your vet to send Harry's next serum samples to her lab for a confirmed diagnosis. I've included a link where you will find her contact information.

http://www.itsfortheanimals.com/HEMOPET.HTM

I've also included a direct link below to frequently asked questions about sending samples:

http://www.itsfortheanimals.com/Adobe/FAQ%20Hemolife%20REV%20_2[1].pdf

[Nathalie]

Hello Yunhee,



A good number of dogs that are hypothyroid have mild elevations in liver enzymes as well as cholesterol so in my opinion, Harry fits the hypothyroid profile a lot closer than the atypical cushing's/hyperestrinism profile. It is not uncommon for vets that suspect hypothyroidism to prescribe thyroid supplementation to see if symptoms resolve. Has your vet discussed this possibility with you? If it were me, I'd want to rule out hypothyroidism within a shadow of a doubt before starting treatment for the elevated sex hormones.
Glynda

I do agree completely with what Glynda is saying – if Harry would be my dog I would have a full Thyroid Panel done by Dr. Jean Dodds.
Even so his Free T4 is within range, considering his symptoms and the rather low Free T4 indicate that Harry may benefit from Thyroid replacement. Perhaps being at the lower end of the range is too low for Harry.
If this was my dog I would do the Full Thyroid Panel through Hemopet – that is what I have done with my Phillip – worth every penny.


The below information is from

"Diagnostic and Treatment Misunderstandings about Thyroid Disease" (http://www.k9cushings.com/forum/showthread.php?p=23229#post23229)
can be found on page 3 of the following article:

Behavioral Issues with Thyroiditis: Theory and Case Review
W. Jean Dodds, D.V.M.

Veterinarians commonly are confused about which tests are necessary to accurately diagnose thyroid dysfunction in the dog and cat, as well as another animal species. During case review, many veterinarians contact us about the reference normal ranges provided by their commercial clinical laboratory. Many colleagues assume that these reference ranges are finite and apply to all breeds and breed types [toy and small breeds have higher basal levels, while large or giant breeds and sighthounds have lower basal levels], as well as all ages and physiological circumstances. For example, veterinarians are generally unaware that the printed reference ranges on laboratory reports typically pertain to adults, and not to very young, adolescent, [higher basal levels] or geriatric animals [lower basal levels].
Furthermore, these reference ranges are intended as general guidelines and may not apply to individuals that are athletic, performance animals; under general anesthesia; undergoing sex hormonal change; a pregnant or nursing mother; obese; a patient that is ill or recovering from illness, or taking specific drugs that might influence thyroid function (e.g. corticosteroids, phenobarbital, potentiated sulfonamides, dietary soy and soy phytoestrogens, insulin, narcotic analgesics, salicylates, tricyclic antidepressants, furosemide, phenylbutazone, and o, p1-DDD )……..


Cheers,
Nathalie

[Franklin'sMum]

Hi Yunhee,

Welcome to you and Harry!! I'm so glad to see you made it over here to us :). I have nothing to add to the great information you've already received from the other members, but just wanted to pop in and say hi :)

Good luck to you and Harry, and we're looking forward to hearing more.

Jane, Franklin and Bailey xxx
________
WASHINGTON MEDICAL MARIJUANA DISPENSARY (http://washington.dispensaries.org/)

[lulusmom]

After reading Nathalie's post, I wanted to highlight part of the excerpt she included about reference ranges used for the thyroid panel. I was unaware that the laboratory reference ranges are intended as general guidelines and may not apply to certain individuals, in particular those dogs that are athletic. With Harry being a trail runner, he is a high performance athletic dog which can apparently make a difference in interpreting test results. It would therefore be important to include Harry's physical type as part of testing information.

Thanks, Natalie, for the great information which is very germane to Harry's case.

Glynda

[HarrysMom]

Thank you.
I will definitely ask the vet to run a full thyroid panel and send it to Dr. Jean Dodd.

Yunhee - Harry's Mom

[HarrysMom]

Jane,
Thank you for the introduction to this site.


Hi Yunhee,

Welcome to you and Harry!! I'm so glad to see you made it over here to us :). I have nothing to add to the great information you've already received from the other members, but just wanted to pop in and say hi :)

Good luck to you and Harry, and we're looking forward to hearing more.

Jane, Franklin and Bailey xxx

[HarrysMom]

More questions to the group.

I would like to try lignans since it seems to have limited downside (Harry does have high estrogen after all). I also spoke to the vet about fixing Harry, but she was not sure whether that will reduce his estrogen since it may also reduce testosterone, and she says that it is a very complicated feedback loop, and neutering could actually increase estrogen. Does anyone have any info on this?

Today, I received NSI Flexseed Lignans - it says 40mg lignans standardized 20% - so each contains 8mg of extract. UTenn recommends 1mg per 1lbs - Harry is 80 lbs, so does this mean tha tI have to give 10 pills????? It seems like a lot. How do I give so many pills to him - break it apart and mix with food?

Also, are there better brands (e.g. enough concentration so that I do not have to give 10 pills a day)?

BTW, it's been three days since Harry started melatonin - so far, no extra drowsiness, but he has been sleeping much better at night. He had been somewhat restless - jumping up and down the bed several times a night. He likes cold hard surface when he sleeps, but he also likes the "status" of sleeping on the bed - never able to make up his mind.

Once again, thank you again for your great help.

Yunhee and Harry

[Harley PoMMom]

I buy Harley's lignans from flaxhulls.com...no they are not standardized but they have a very high SDG and their product contains everything that is in the flax seed hull, including all of the lignans (25 or 27 of them) without the oil.

http://www.flaxhulls.com/order.html

Like I mentioned before, Harley's estradiol came down from 132.2 to 96.6 in 7 months on the melatonin and the lignans.

To help Harley stay a bit cooler I keep a spray bottle with water beside my bed, I spritz his belly and paws with it...he doesn't overly love it when I'm doing this but it does help keep him cooler. :)

Hope this helps.

Love and hugs,
Lori

[HarrysMom]

Thanks.
I also went over Harry's medical records and him and noted a couple of additional symptoms previously not deemed to significant.

1 - Hyperpigmentation of testicles. Harry had his first ultrasound in July 2009 where they had to shave his testicles. In November, I noticed numerous dark spots on his testicles. He's never had them before.
2 - Enlarged nipples. Another thing I noticed late last year. He used to have tiny sesame seed sized nipples. Now, they are about the size of flat peas.
3 - Male dogs seem to like him.
4 - Enlarged prostate - noted by the radiologist during the last ultrasound. Hyperestrinism can cause this apparently.
5 - Skin problems. He's had numerous cysts and infecitons. Hair loss underneath his tail- around the anal area. Some crusting of the skin around the anal area. I attributed this to some allergies, but I read that estrogen could cause this.
6 - Panting. Seems to be overheated.

[Harley PoMMom]

Some of these symptoms can be attributed to the elevation of the estradiol but some of them can be attributed to hypothyroidism too, except, maybe the enlarged prostate. This is probably because he is not neutered.


The most common prostate problem is benign prostatic hypertrophy, or BPH. In this condition, the prostate gland has increased in size over time because of exposure to the male hormone testosterone.
http://www.webvet.com/main/article?id=80&med=1

Hypothyroidism can cause hyperpigmentation but it usually isn't confined to just the testicles.

Here is a really good article on Hypothyroidism:
http://www.lbah.com/canine/hypot4.htm

Harley panted ALOT when we first got him dx'd, his panting has since to almost come back to normal, but I do keep my house very cool...68 degrees.

Hope this helps.

Love and hugs,
Lori

[HarrysMom]

Thank you, Lori.
I will definitely ask for a full thryoidi panel sent out to Dr. Jean Dodds the next time Harry has his regular check up on urine protein and liver values (in two weeks). My vet bills!!!
I agree that some of the symptoms can be attributed to both. However, I did read that hypothyroid dogs get cold while Harry is often panting and seeks very cold surfaces. He also functions the best on a cool day. Lethargic on a warm day.
I also realized that his hair is not growing back quickly at all. Usually with my other Irish Setter, shaved hair would grow back substantially within a few weeks. Unfortunately, Harry's tummy hair stil has not regrown much at all following his ultrasound in early February.
In addition to hair loss under his tail, I am also seeing some dry, white-tinted dry crusty raised bumps on his skin around his anal area. His pores seem to be blackish there. Could this be calcinosis cutis? I will also get this checked out. He's had it for a few months, but I did not really check it out as closely as now (my bad). It does not seem to bother him, and since Harry gets his anal glands regularly checked, I did not think too much about it.
On a positive note, Harry, his sister, Amy and I had a great trail run this morning - 1.5 hours on the coastal mountains of northern California. The weather was perfect for Harry - 45 degrees. Harry was always running ahead of us. Enjoying every moment we have with Harry...

Yunhee

[HarrysMom]

Hi,
I had Harry at the vet office again today due to a really inflamed cyst. We also found a few more cysts underneath his tail (sent for another needle biopsy).
I am getting really upset about these cysts. Is this a common problem for dogs with hyperestrinism or hypothyroid? He's never had them until a year ago.
Could low-protein diet also cause some of the skin problem? It seems that he started having all these problems after switching to low-protein diet (for his proteinuria).
We also ran a full thyroid panel test, and our vet decided to sent it to Michigan State rather than Dr. Jean Dodd. Are these two panels basically the same things? For some reason, our vet likes Michigan State.

Yunhee

[Harley PoMMom]

If I would ever have a thyroid panel done again on one of my pups it would definitely go to Dr Dodds, She takes in consideration the pups breed, sex, age and medical history...NO other place does this.

[Nathalie]

Hello Yunhee,

"Could low-protein diet also cause some of the skin problem?"

What exactly was Harry eating before the switch and when did you switch him?
What exactly is he eating now?

"I am also seeing some dry, white-tinted dry crusty raised bumps on his skin around his anal area. His pores seem to be blackish there. Could this be calcinosis cutis?"

Did you point this out to your vet and what did he/she have to say about it?

There are some nice added bonuses when you send blood to Jean - lets just see what you get back.

Nathalie

[HarrysMom]

Nathalie,

What exactly was Harry eating before the switch and when did you switch him?
What exactly is he eating now?

For most of his life, Harry was on Canidae (26% protein) mixed with some canned food (various premium brands like Merrick, Innova, etc.). However, about two years ago, I noticed that Harry's poop was very loose. It turned out that Canidae changed the formula drastically, and Harry did not respond to well. I put Harry on Wellness Core (high protein 30%+ and no grain), and his pool looked great. However, when I mentioned this to our vet, she was concerned about Harry's proteinuria in urinalysis done three years ago by a different vet. She ran another urinalysis and UPC, both of which showed urine protein. After several repeat tests showed rising urine protein, she had me Harry on a low protein (16%) Natural Balance Reduced Calorie Formula - this was in July 2009.

Did you point this out to your vet and what did he/she have to say about it?

She thinks this is likely another cyst - she did another needle biopsy to make sure. She did not think that it looked like calcinosis cutis.

There are some nice added bonuses when you send blood to Jean - lets just see what you get back.

I am upset that she did not sent it to Dr. Dodd - it was actually my husband who took Harry in today, and he was not insistent and thought that Michigan State sounded fine. When I called the vet again, they already processed Harry's blood sample, so it is too late.


Yunhee

[Nathalie]

Hard to tell whether or not the new kibble is causing/contributing to Harry's skin issues.

I am strong believer in a fresh, grain free diet.
At this point I would just wait for the thyroid test results and take it from there.

Having a diet formulated by a nutritionist might something to look into for you. I know several members use Monica Segal (http://www.monicasegal.com/)

A couple of other things to think about are vaccination, flea/hearworm pesticides.

Nutritional deficiencies or imbalances as
well as exposures to various chemicals, drugs and toxins present an
ongoing immunological challenge which can suppress immune function,
especially in those animals genetically susceptible to immune
dysfunction (immune deficiency, autoimmunity, allergies).

Nathalie

[HarrysMom]

We received Harry's Thyroid panel results back, and every value is within the range.

TT4 49 vs. range of 15-67
TT3 2.2 vs. range of 1.0-2.5
Free T4 by dialysis 21 vs. range of 6-42
Free FT3 10.4 vs. range of 4.5-12.0
T4 Autoantibody 6 vs. range of 0-20
T3 Autoantibody 1 vs. range of 0-20
Thyroid Stimulating Hormone 8 vs. range of 0-37
Thyroglobulin Autoantibody 5 vs. range of 0-35

It appears that Harry definitely does not have hypothyroid.
The needle biopsy on his anal-area growth came as cyst.

So now, the only explanation I have for his elevated liver value, hyperpigmentation, enlarged nipples, panting and appetite seem to be hyperestrinism.

Our vet really thinks that estrogen is what is causing Harry's liver values. She is currently treating another dog with symptoms and Adrenal Panel similar to Harry's, except that dog's Alk Phos is over a thousand vs. Harry's 480.

Are there anything else we should pursue to get to the root of this liver enzyme value?

We are going to redo UPC and liver enzyme in a few weeks. Meanwhile, we will continue to melatonin and lignans.


Yunhee

[Harley PoMMom]

Hi Yunhee,

When my boy Harley when first dx'd and the full adrenal panel showed that he had very elevated estradiol levels only, his ALP was 416 but his ALT was also high 208 (12-118). Is Harry's ALT elevated too?

Love and hugs,
Lori

[HarrysMom]

Harry's ALT is also high at 183 vs. ref of 12-118.

Yunhee

[HarrysMom]

Lori,
What other symptoms did your Harley have? How did you get comfortable that it was estrogen that was causing all of his symptoms?

Yunhee

[HarrysMom]

I shoud also point out that liver enzyme done at the end of March showed Alk Phos of 480 and ALT of 140. The ones from the full chemistry panel performed A WEEK LATER showed additional elevation of Alk Phos of 580 and ALT of 180. I am concerned that these two values escalated so quickly.

Yunhee

[Harley PoMMom]

Harley's symptoms were excessive drinking and urinating, ravenous appetite, pot-belly, panting, minor weakness in his rear legs and he started to lose the hair on his tail.

In the beginning his cortisol remained in the normal ranges so we only treated the high estradiol. Looking back now...Harley had ALL the cushings symptoms and I should have loaded him on Lysodren then. We did not start him on the Lysodren until his cortisol rose to 18.5 ug/dl and it's only been a maintenance dose.

I have done alot of testing on my boy...full adrenal panels, endogenous tests, LDDS test, 2 ultrasounds, etc... :eek: His last full adrenal panel done in Nov. 09 showed that his estradiol has decreased from 132 to 96 and some of his symtoms have also waned. He is no longer the piggy who wants to eats everything in sight, he does not drink or urinate excessively anymore and he does not pant alot. He does have a rat tail...poor Harley. :p:)

His drop-off in appetite, I believe, could be caused by the excessive cortisol in his body. The maintenance dose he is on is not working as of yet to control the cortisol. But the decrease in panting I think is definitely because his estradiol level is lowered.

Here is a link to another members thread, Tammy and her Atypical pup Crash. Crash has had great success on this treatment of melatonin and lignans for his Atypical Cushings.

We're back...
http://www.k9cushings.com/forum/showthread.php?t=407&page=6

Hope this helps.

Love and hugs,
Lori

[HarrysMom]

Harry had is regular liver enzyme and urine protein creatinine ratio - no good news. His Alk Phos number continues to go up to 650 now from 550. He has been on Flaxseed lignans and melatonin for about a month now - should his liver values continue to go up? Is this too soon to tell?

Another bad news - as some members of this group has suggested, Harry is definitely a lot less energetic and been sleeping all the time. In fact, it has been difficult to motivate him to run, and he has gained 8 lbs in a month! Is this normal to lose this much energy due to melatonin?

Our vet has suggested lowering his daily dosage from 12 mg to 6 mg - would this dosage still help bring down his estrogen?

Harry's UPC value is now above 3, so we will also get him started on blood pressure medication. Has any one in this group experience with Benazepril? Any side effects?

Any input would be aprpeciated.


Yunhee

[Harley PoMMom]

Hi Yunhee,

It pretty much does take at least 3-4 months for the melatonin and lignans to work. Is Harry on any kind of liver support supplements? Milk thistle or denamarin?

Melatonin can cause lethargy in some pups, they want to sleep more and don't want to play anymore. Dropping the dosage is most definitely an option. If I were you, before I would do anything, I would email Dr Oliver and let him know that Harry is having issues with the melatonin.

Hope this helps.

Love and hugs,
Lori

[HarrysMom]

Thanks Lori.

Harry is on Denamarin, but it has not really helped with his liver values.

I will e-mail Dr. Oliver. I have reduced his melatonin dosage by half for now.

The little (now big) piglet has gained 8 lbs in one month! I am going to reduce his food by 25% and force him to walk longer. He is an expert begger, and I will ignore him.

Yunhee

[HarrysMom]

One more thing to add, Harry's Alk Phos went up by 100 from 580 to 650, but his ALT decreased from 183 to 170.

[Harley PoMMom]

Aha! ALT decreasing is great!!! the ALT is more specific to the liver than the ALP (Alk Phos), ok.

[Bichonluver3]

Hi Harry's Mom!
We live near Palm Springs in Rancho Mirage. Chloe's diagnosis from Tennessee was Atypical Cushing's + mild to moderate Cushing's. I have had her on Bartlean's Flax Oil (not flax SEED oil) with highest lignan and Melatonin. Our vet has been working very closely with Chloe. He spends an enormous amount of time with me on the phone (after hours!!), explaining everything in great detail.
I called him 2 days ago to tell him that, after 2 weeks of treatment, she sleeps well all night, no excessive panting, thirst or hunger. God willing, this will continue. We are all praying the other symptoms will disappear over time.
Carrol
PS Miss Chloe is the little girl in front. The "brothers" are behind her!

[HarrysMom]

What three adorable dogs!
Harry has been panting a bit less and sleeping more peacefully on melatonin and flaxseed lignans - perhaps a bit too much though because he gained 8 lbs in one month. Same amount of food. A lot less exercise - he used to run an hour to two hours almost everyday - now he goes on a strike whenever we head out (but sprints back home for food). This behavior started with melatonin.

Yunhee

[Bichonluver3]

Hi Harry's Mom!

Our dogs are rescues but they clean up not bad!! Harry has a place in my heart - he has red hair and so do I (could be that we are related!).

I have found that with the weather getting warmer (particularly here in the desert), that having our ceiling fan and a stand up fan on at night works wonders with Chloe. She sleeps like a baby all night very comfortably. That is good since I thought I was in for many sleepless nights but, now, we are both happier.

I cannot believe that we saw such a change in a week and a half on the melatonan and lignans. I hope her pot belly will disappear next as it pains me to see her have to lug all that weight around. When we adopted her 10 years ago, she had been very badly abused and I promised her a good life. That is why it is doubly painful for me as she has been through so much already.

Let's pray for Tennessee to make progress by leaps and bounds!
Carrol

[SavingSimon]

Harley's symptoms were excessive drinking and urinating, ravenous appetite, pot-belly, panting, minor weakness in his rear legs and he started to lose the hair on his tail.

In the beginning his cortisol remained in the normal ranges so we only treated the high estradiol. Looking back now...Harley had ALL the cushings symptoms and I should have loaded him on Lysodren then. We did not start him on the Lysodren until his cortisol rose to 18.5 ug/dl and it's only been a maintenance dose.

I have done alot of testing on my boy...full adrenal panels, endogenous tests, LDDS test, 2 ultrasounds, etc... :eek: His last full adrenal panel done in Nov. 09 showed that his estradiol has decreased from 132 to 96 and some of his symtoms have also waned. He is no longer the piggy who wants to eats everything in sight, he does not drink or urinate excessively anymore and he does not pant alot. He does have a rat tail...poor Harley. :p:)

His drop-off in appetite, I believe, could be caused by the excessive cortisol in his body. The maintenance dose he is on is not working as of yet to control the cortisol. But the decrease in panting I think is definitely because his estradiol level is lowered.

Here is a link to another members thread, Tammy and her Atypical pup Crash. Crash has had great success on this treatment of melatonin and lignans for his Atypical Cushings.

We're back...
http://www.k9cushings.com/forum/showthread.php?t=407&page=6

Hope this helps.

Love and hugs,
Lori

I'm new here but WOW - my Simon has the exact same diagnosis as Harley and even the same symptoms. We just started the melatonin and Flax lignans ... seeing a little difference and hoping for great success. Simon even needs a "tail toupee" - that is the only place he is losing hair. Is there anything else helping your boy (or that didn't help) that we should know about? Please keep in touch as I haven't read everything about Harley yet, but he seems to be in the same boat as Simon, down to their tails from what I can see. Did Dr. Oliver at the U of TN diagnose him? Just curious ... that is who told my vet not to put Simon on Trilostane but to be sure and treat with melatonin and flax hull lignans. So far, it seems to be working in just around a month of treatment - except for his weight, pendulous abdomen, and for his weak hind legs. Did Harley happen to lick the furniture until it was so wet you thought maybe he or another dog peed there? Just wondering if that is another sign (I have only read that it is in one place, written by one vet). Hope to get to know you and Harley better! Take care, and hug Harley! ~T.S.D. & Simon

[HarrysMom]

It's been a long while since I've visited this forum. After Harry's diagnosis of hyperestrinism in April, I had him on lignans and melatonin. No change in coat and behavior. Meanwhile, Harry's UPC was creeping up, so we were busy dealing with his kidney issues. He is now on benazepril, and we managed so far to get his UPC around 3. A few weeks ago, we started to see his symptoms worsen (more dilute urine, frequent urination, even more excessive hunger), so our internist suggested LDDS test.

Finally, his LDDS test showed that Harry has Cushing's.

Cortisol Sample 1 - 3.3 (range of 1.0-6.0)
Cortisol Sample 2 - 3.5 (range of 0.0-1.4)
Cortisol Sample 3 - 4.9 (range of 0.0-1.4)

We had ultrasounds done in July of 2009 and February 2010. Both ultrasounds showed nothing remarkable except slight bilateral enlargement of his adrenal glands. Liver was fine, so were the kidneys.

Before the test, the internist was thinking that Harry has PDH. However, his LDDS test shows that Harry may have adrenal tumor.

He is due for another ultrasound early next week.

Meanwhile, I am really mad at myself for not pursuing this test sooner. If it is cancer, I've wasted valuable 7 months waiting around when I could have done something sooner. How detrimental is this wait? We did do a chest x-ray in August, and it was "normal." Our regular vet and our internist told us that we could wait and watch Harry' symptoms to worsen before doing the LDDS test because they did not want to start the treatment unless it was absolutely warranted (given all the danger, etc.).

Any input into Harry's test would be appreciated.

Yunhee and Harry (12 y.o. Irish Setter with Proteinuria, Hyperestrinism and now Cushing's)
Royal Canin MP, Benazepril, Melatonin, Flaxseed Lignans, Fish Oil, Cosequin, Denamarin
California

Mod note- Harry's threads have been merged to keep all Harry's information and history in one thread for easy reference.

[HarrysMom]

I have been doing some research on Harry's LDDS results. Does the fact that Harry failed to suppress after 4 hours indicate a particularly bad prognosis (pituitary macroadenoma or adrenal tumors)? I would really appreciate hearing about members who went through this type of results. Thank you.

Yunhee

[Harley PoMMom]

Hi Yunhee,

Do you think Harry got stressed while at the vets? According to Dr. Feldman, who is a renown Cushing's expert:
Misleading Results: As with the ACTH stimulation test results, dexamethasone screening test results can be misleading.... The stress of bathing, hospitalization, illness, and numerous other factors may interfere with the suppressive effects of dexamethasone.

http://www.io.com/~lolawson/cushings/articles/feldman4.pdf

Just a thought...

Love and hugs,
Lori

[Spiceysmum]

Hi Yunhee,

Just wanted to let you know that the ldds results don't necessarily mean that Harry has an adrenal tumour. My Spicey's results were almost identical when she was first tested 3 years ago but the ultrasound showed it was pituitary cushings. The liver is usually enlarged too but this might show up in next weeks ultrasound.
Sadly, Spicey passed away in July but she had 3 happy years after diagnosis, with 18 months remission in between but thats another story! As you probably know other illnesses can affect the ldds results but I'm sure you will have a better idea after the ultrasound next week.

Sending best wishes.

Linda

[labblab]

I want to "second" what Linda has said above. I believe that the pattern of Harry's LDDS results could be consistent with either pituitary or adrenal Cushing's. According to another article by Dr. Feldman, 65% of dogs suffering from pituitary Cushing's do exhibit suppression on their LDDS results. But that means that 35% do not. So there is still a definite possibility that Harry's Cushing's may be pituitary-based. Here's a quote from Dr. Feldman:


Approximately 90% of dogs with Cushing's syndrome have an 8 hour postdexamethasone plasma cortisol concentration >1.4 μg/dl and another 6 to 8% have values of 0.9 - 1.3 μg/dl. The results of a low dose test can also aid in discriminating PDH from ACT, using three criteria: 1) an 8 hour plasma cortisol >1.4 μg/dl but <50% of the basal value; 2) a 4 hour plasmacortisol concentration <1.0 μg/dl; and 3) a 4 hour plasmacortisol concentration <50% of the basal value. If a dog has Cushing's and it meets any of these three criteria, it most likely has PDH. Approximately 65% of dogs with naturally occurring PDH demonstrate suppression, as defined by these three criteria. A dog with Cushing's that fails to meet any of these three criteria could have either PDH or ACT.

So the results of Harry's ultrasound should shed more light on his diagnosis. If the results are similar to the ultrasound last February -- both adrenal glands showing some enlargement -- then I think you can still assume that his Cushing's is pituitary-based. And it sounds to me as though your vet's testing recommendations thus far have been sensible, based on Harry's earlier ultrasound results. With an LDDS result such as Harry's, it is really the ultrasound to which you turn for a definitive answer as to the type of Cushing's. So even if you had given him an LDDS last February, his ultrasound report at that time did not give any indication of the presence of an adrenal tumor.

As far as which type of Cushing's would be a "better" diagnosis, there are lots of variables involved. If the Cushing's is adrenal-based, then the location and nature of the tumor factor in. Surgical removal of the tumor can offer a complete cure, but due to age and other physical considerations, not every dog is a good surgical candidate. In that event, the vets turn to the same medications as are used to manage the symptoms of pituitary Cushing's.

We'll all be anxious to hear how Harry's ultrasound turns out, so please do update us as soon as you get the results!

Marianne

[HarrysMom]

[QUOTE=Harley PoMMom;43311]Hi Yunhee,

Do you think Harry got stressed while at the vets? According to Dr. Feldman, who is a renown Cushing's expert:


Lori,
Harry does get extremely stressed at the vet's - we have to pull all sorts of tricks to get his blood pressure because it can range from 120 to 200 depending on his stress level (his normal BP taken in our car is around 120-140 - in the vet office 150-220!). He hyperventilates and starts to shake sometimes.
However, the internist did tell us that while Harry was stressed during the first hour or two, he did eventually calmed down after a while. Of course, he could have gotten re-stressed when they stuck needle in him.

Yunhee

[HarrysMom]

As far as which type of Cushing's would be a "better" diagnosis, there are lots of variables involved. If the Cushing's is adrenal-based, then the location and nature of the tumor factor in.
Marianne

I became panicked when I read a medical quizz stating that no suppression typically indicate (1) adrenal tumor; (2) pituitary macroadenoma, and; (3) tumor in pituitary pars intermedia (?).

Harry, after over a year of showing Cushing's symptoms, have not so far indicated any neurological signs, but who knows.

I would also note that when he was a puppy, Harry had a developmental disease called Hypertrophic Osteodystrophy - and the treatment of choice for this disease was prednisone. So, during the first 18 months of his life, he was put on prednisone regimen at least once every two months or so due to recurrence. I think such early exposure probably had a profound impact on his pituitary / adrenal axis. No regrets because he would not have made it without the pred.

Yunhee

[HarrysMom]

Harry's ultrasound was done today. I don't have a full detail because my husband took the call (and he has absolutely no clue about the specifics), but generally, nothing "serious." My husband mumbled soemthing about bilateral "something" so I think it is likey pituitary. I have left a message to the internist, but it takes her forever to return phone calls (sometimes as long as a week, but usually late Wednesday - VERY FRUSTRATING). You'd think if you are spending $800 for ultrasound, you would at least get someone to call you back the same day.

Yunhee

[Spiceysmum]

Hi Yunhee,

Hope you get good results from the ultrasound, whatever 'good' is.

I would never let my husband take any calls from the vet, he would only get half the story!

Linda

[Squirt's Mom]

Hi Yunhee,

Hope the results are all good news! "Bilateral something" does sound like PDH. :p

This comment made me think of a joke I got the other day about the differences in how men and women think according to engineers. It showed a male thinking and had only one point of focus :rolleyes:; the one showing women thinking was very complex and interconnected with all these pulleys, wheels, wires running all over the place! :p:p

Hugs,
Leslie and the girls :D - always

[HarrysMom]

I know - husbands... My husband also noted that only women would spend so much time on these forums minutely discussing pets' health issues. He thinks I am crazy (although he loves our dogs as much as I do). It just does not occur to him to ask a lot of questions.

I did finally speak with the internist. It is PDH, and Harry will start his Trilostane starting tomorrow. She recommends initially ONCE a day 2mg/kg dosage for Harry and then do ACTH and blood panel 7-14 days after starting the drug. Hope this works for Harry...

Yunhee

[labblab]

Yunhee, I'm glad you've finally gotten your answer and I will hold positive thoughts for Harry as he starts out on his trilostane. I'm really glad to hear your internist's dosing plan of 2 mg/kg once daily (which equals approx. 1 mg/lb for those of us who calculate more frequently in those terms :)).

And be sure and tell your husband that we've got some boys on the forum as well as all of us girls, so we're not totally estrogen-laden...;) :D

Marianne

[HarrysMom]

We had to take Harry to the vet early this morning and yesterday afternoon.

Yesterday, he vomited all afternoon. We took him to the internist and she thought gastritis given the fact Harry ate some human poop on the trail two days ago. She gave him an injection of anti-nausea meds and fluids. At home, Harry had diarrhea. When he woke up this morning , he was back to hungry Harry and ate his breakfast of rice and cottage cheese.

After his breakfast today, I gave him a tiny bit of Booda bone when Amy (his sister) got hers after her breakfast. Harry could not chew it (this is a dog that could dismantle a gigatic frozen carrot in one minutes).
I also saw that the third eyelids were also extremely swollen and covering half of his eyes.
Harry also seemed a bit wobbly.
He also had diarrhea (expected).

Anyways, the internist said that Harry's gastritis is improving because he is hungry again. It is not unsual for a Cushing's dog to have gastritis because they will eat anything apparently.

She checked Harry's mouth and saw some cavities. She says these things can flare up any time, and unfortunately it is happening now. She would like us to get these taken care of but only after we stabilize his Cushing's.

I thought Harry had a bit of eye infection about 10 days ago and started him on neo-poly-dex ointment, but stopped it when he was getting the LDDS test. Switched to neo-poly-gram drops. I thought that his eyes seemed redder after the drops. His whole red eye thing happened after I applied the eye drops this morning. The internist thought that Harry's red eyes were due to allergies (that is why they responded to neo-poly-dex), and Harry may be allergic to some ingredients in the neo-poly-gram drop as well.

Harry also has a festering cyst under his tail that got aggravated when the vet did a needle biopsy. This, too, may require surgery eventually.

Given the ultrasound two days ago, and by the fact that we have recent blood and urinalysis, the internist says that we did not miss anything systemic that could cause this. She says that Cushing's dog can have all these problems due to weak immune system and indiscriminating eating habits. It could be he has been under stress through 2 separate days of hospitalization (LDDS test and ultrasound). Am I missing something?

Now Harry is having problems head to toe, literally (eyes, pituitary gland, teeth, tummies, adrenal glands and even the cyst under his tail). When it rains...

[Harley PoMMom]

Hi Yunhee,

Poor Harry! :( So many issues going on.



She checked Harry's mouth and saw some cavities. She says these things can flare up any time, and unfortunately it is happening now. She would like us to get these taken care of but only after we stabilize his Cushing's.


Concerning his teeth, if this were me, I would want this taken care of right away.


Infected gums and teeth aren't just a problem in the mouth -- the heart, kidneys, intestinal tract, and joints may also be infected. The tartar and any infected areas of the mouth contain a multitude of bacteria than can 'seed' to other parts of the body.
http://vetmedicine.about.com/cs/diseasesall/a/dentalcare.htm

Although they are cavities now, the Cushing's could take a while to get under control and by then those cavities could turn into something worse...JMO.

Additionally, if those cavities cause Harry any pain down the road during your Cushing's treatment and he would stop or hesitate upon eating, how would you know if it is the Cushing's meds causing the problem or the cavities?

Just throwing my thoughts out there...hopefully the others will be along to share theirs too.

Love and hugs,
Lori

[HarrysMom]

It turned out that Harry's inability to chew was his allergic reaction to Flagyl (along with eye swelling). All stopped with stopping this antibiotics.
Given Harry's allergy and gastritis, we waited until today to start Trilostane. The vet prescribed 2mg/kg of Trilostane once a day to start.
I wonder if it is too soon to see a response to the drug? We could be imagining, but he seems to beg and pant less than usual this evening. Still eating well. I am worried that the dosage may be too high for him (hence this early response?). Any input would be appreciated.

Yunhee

[Harley PoMMom]

According to this article:
After oral dosing trilostane is rapidly absorbed and peak concentrations are seen in healthy dogs after 1.5-2 hours. Concentrations return to baseline levels after 10-18 hours.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2010&PID=56127&Print=1&O=Generic

So, this may be why you are seeing improvement in symptoms. Do you have prednisone on hand?

[HarrysMom]

We do actually have prednisone on hand. We are keeping a very close eye on Harry. He is still very hungry and alert. Just panting and begging less. Keeping our fingers cross. Thank you!

Yunhee

[Harley PoMMom]

Lethargy, diarrhea, vomiting, and inappetence are the main symptoms of low cortisol. BUT...YOU know Harry best so if he seems "off" at all, then this would be a sign too.

[Harley PoMMom]

Yuhnee,

Exactly what is the dose of Trilostane Harry is taking?

[HarrysMom]

Harry is on 75mg -he weighs over 85 lbs.
He seems fine - alert, active, and carrying around his blanket this morning - also barking to be let out and throwing bossy tantrums. He was not "off" yesterday - just not panting and begging (which started to happen with his hyperestrinism a year ago). I guess these are the results we were seeking with the treatment, but I am really hoping there will be no side effects. and that the dosage is OK.

Yunhee

[HarrysMom]

We had a very scary incident with Harry this morning.
We were finishing our morning hike, and Harry's rear end basically collapsed, with him dragging his legs behind. He was still eating well and alert.
We took him to the emergency vet, and he thought it was more likely arthritis. Harry does have spondylosis, and I did notice that his hindquarters seemed weak last few days. It is also cold and damp here.
Is this something that happens once you get cortisol under control? Harry has not had an episode like this for over a year, and when it did happen, it was not as severe.

Yunhee

[HarrysMom]

I am traveling today, but my husband is describing Harry as being weak in the hindquarters although he is not as paralyzed as earlier.

Yunhee

[frijole]

Hi! My 14 yr old schnauzer has spondylosis and same issues with hind legs. We've done tests for 9 mos and there is still debate as to whether or not she has a form of cushings or a pheo but they are hesitant to give her pain meds for the spondylosis. The head of the animal science department at Kansas State Univ recommended Annie try duralactin which is a natural alternative for anti inflammatory conditions.

Annie has been on it for over a month now and I am very happy. She was completely losing her ability to use her hind legs and it was very frightening. You have to give these chewable tablets twice daily for life but they are all natural and vanilla tasting.

Here is a link to my thread on it:
http://www.k9cushings.com/forum/showthread.php?t=2635

If you google it you will find some wonderful testimonials. I bought mine online. No side effects either. Hope this helps. Kim

[frijole]

We had a very scary incident with Harry this morning.
We were finishing our morning hike, and Harry's rear end basically collapsed, with him dragging his legs behind. He was still eating well and alert.
We took him to the emergency vet, and he thought it was more likely arthritis. Harry does have spondylosis, and I did notice that his hindquarters seemed weak last few days. It is also cold and damp here.
Is this something that happens once you get cortisol under control? Harry has not had an episode like this for over a year, and when it did happen, it was not as severe.

Yunhee

Spondylosis, can really be a painfull condition and is not only about bonespurs pressing against a nerve. It also changes ligaments in the area that can cause pain, it can cause a swelling that can press against whatever and cause pain. My guess is that the cortisol Harry was producing before was acting as a natural pain remedy. Now that you have lowered the cortisol the pain is probably coming back. Kim

[labblab]

Is this something that happens once you get cortisol under control? Harry has not had an episode like this for over a year, and when it did happen, it was not as severe.

One of the downsides to Cushing's treatment (especially as it relates to older dogs) is that it can "unmask" other physical conditions that were being silently treated by the high cortisol level. Arthritis would be one such condition. Basically, any condition which improves with steroid treatment is a condition that can worsen when cortisol levels are suppressed.

Other members have also been challenged with arthritis in their Cushpup. So I'm hoping that they will be stopping by to make suggestions regarding nonsteroidal treatment strategies that have been helpful to their dogs.

Marianne

[HarrysMom]

Marianne and Kim,
Harry's family does have a history of bad spondylosis and dogs put down because of this. This is one of the reasons why we waited so long to treat cushings.
I just did not expect this to happen so soon and wonder if the treatment is worth it.
A friend once recommended yucca intensive. Is this safe for a cushings dog?
I have used tramadol before, but read somewhere that this could trigger seizures when combined with denamarin.

Yunhee

[Harley PoMMom]

According to Dechra's U.S. Product Insert:


Additional adverse events included: renal failure, diabetes
mellitus, pancreatitis, autoimmune hemolytic anemia, vomiting, diarrhea, anorexia, skin reactions
(rash, erythematous skin eruptions), hind limb paresis, seizures, neurological signs from growth
of macroadenomas, oral ulceration, and muscle tremors.
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

[HarrysMom]

Do you think hind limb paresis is due to worsening of arthritis? Should we stop trilostane? He is walking, but seems weak.

[labblab]

I do think it would be reasonable to talk with your vet about at least temporarily discontinuing the trilostane in order to see whether Harry improves. Another of our members, Sonja ("apollo6"), contacted Dechra directly with concerns over the "hind limb paresis" warning. Sonja's dog has been taking trilostane for some time now, and has also developed hind end problems. Here's the reply that Sonja received from one of Dechra's technical reps, Dr. Tim Allen:


Ms. Honeyman, Sorry for the delay in responding to your inquiry. I was traveling Tuesday and Wednesday. I think your veterinarian or the neurologist who examined Apollo should be involved in the decision. But from my perspective, yes I think it is reasonable to stop trilostane for several weeks to see if Apollo’s hind leg weakness improves. The rationale for that is that trilostane has a short duration of effect so that if it is causing his weakness you should see improvement quickly. An additional point is that if the weakness does not improve you can re-start trilostane and you have not lost anything in terms of long-term control of his hyperadrenocorticism. As you and your vets decide what is the best thing to do for Apollo be aware that just because hind leg weakness is listed as an adverse event that doesn’t necessarily mean that trilostane causes weakness. The FDA requires that we report everything that happens during clinical trials. Thus if a dog developed weakness related to the underlying Cushing’s syndrome during the clinical trial, it is listed as a side effect. Another point about trilostane, is that unlike the FDA approved product (Vetoryl) the stability and purity of compounded liquid trilostane is not been reviewed and approved by outside experts like the FDA. Contact me if you have further questions. Tim

Marianne

[HarrysMom]

Marianne,
I will talk to the vet tomorrow.
I am actually on a plane traveling for work today. Thank goodness for inflight wifi or I would have gone crazy worrying about my red headed baby.
A good update from my husband. Harry ate all his food and tried to steal his sister's lunch as well. He even managed to climb up on the sofa and went for a walk.
This is like a year ago. A sudden rear limb weakness and then recovering throughout the day. Ironically, I also have spondylosis and si joint degeneration. My back has also been really miserable with this cold and rain, and I have to do 2 months of physical therapy. I think this weather is triggering arthritis in many of us -including harry's sister Amy, who has been acting stiff as well.

[HarrysMom]

I had to take Harry to another emergency vet visit today because he started to pee and drinkg excessively. Well, after 4 hours, we found out that Harry is diabetic with blood glocose level of over 600. Interestingly, his blood panel a week ago had only slightly elevated glucose (under 200).
I am puzzled and depressed.

From what I've read, it is harder to control diabetes with Cushing's. Does Harry even have Cushing's? I am confused and depressed. Sorry if I am too negative when others have so many more problems.

Yunhee

[labblab]

Oh Yunhee, I am so sorry for this turn of events! There is no need at all to apologize. You have every right to feel depressed, confused and more!! But please do not despair, because we do have other members who have successfully treated the diabetes/Cushing's combination. As an added help to you, I encourage you to visit our "sister" site that focuses on dogs with diabetes: http://www.k9diabetes.com/. I've given you the link to the site's homepage, and listed on the homepage you will find another link to an interactive forum just like this one. We have several folks who are members of both forums, and who will be able to give you additional feedback and support re: a dual diagnosis.

Does your vet have an immediate gameplan in mind?

Marianne

[HarrysMom]

Marianne,
The ER vet said that we should do insulin shots twice a day (9 units?) after meal until Harry's internist appointment next Monday (9 days after starting Trilostane).
The internist and ER vet practice out of the same clinic. The internist vet actually got to see Harry in the back before she left, so she is aware of the issues.
I wonder if Harry's Cushing's diagnosis is real (even though he did have bilaterally elarged adrenal glands and no suppression at all in the LDDS test). I also wonder how much Harry's low protein (mostly rice) and high fat diet impact Harry's pancrease and ability to control glucose.

Yunhee

[labblab]

Yunhee, I hope it's OK with you -- I've revised Harry's thread title so that people will be aware of this new diabetes diagnosis. This way, it should be easier for folks with diabetes experience to see and respond.

Marianne

[HarrysMom]

Thank you, Marianne.

[HarrysMom]

I am convinced that Harry's rear end weakness is not just due to a disc problem or spondylosis, but perhaps due to a reation to Trilostane.
His rear end collapse happend on day two of Trilostane.
When we gave Harry Tramadol, his rear end weakness became worse. When Harry was given Benadryl for eye allergies, he could not even walk on a flat surface.
When we discontinued Tramadol and Benadryl, his rear end collapse improved, but his rear end still seems really really weak.
He does not seem to be in pain.
He had his ACTH test on Monday - I am still waiting for the internist call (she will call me tonight - still in a procedure).
When I asked her about Harry's symptoms, she really thought it was a disc problem, but she told me to discontinue Tramadol because it can cause musle weakness.
I asked about blood chem, but she says that hyperkalemia will make a dog sick, and Harry is not a sick acting / looking dog.
What do you think?
I know reduced cortisol could reveal arthritis, but Harry is not acting like an arthritic dog. He still wants to and tries to jump on the furniture. He makes it about 50% of the time, and even when he doesn't, he is not in pain - his rear end just splatters and goes limp.

Yunhee

[HarrysMom]

I also have to add, as Harry's rear end started collapsing, diabetes revealed its ugly head. Could diabetes also cause this?

Yunhee

[HarrysMom]

For once, a good news on Harry - ACTH stimulation test 9 days after Trilostane treatment came 1 pre and 4 post. The internist says that Harry definitely has Cushing's and that he is on the right dosage.
She would like us to repeat the test in a month with a blood chem, etc.
On Harry's diabetes, we are to do a glucose curve next week after Harry's body gets used to the current dose of insulin. We bought our own glucometer to check Harry's blood glucose and do our own curve - apparently with Harry's Cushing's, we need to constantly adjust the insulin amount.
On rear end weakenss, Harry has three conditions that could cause all this - spondylosis / disc issue, Cushing's and diabetes. Once we get the endocrine diseases controlled, we will have a better handle on this.
I would appreciate your input.

Yunhee

[BestBuddy]

Hi,

Congratulation on those great ACTH numbers but I want you to be aware that some dogs keep dropping for a month or so on the same dose. It may not happen to Harry but if you see some of those signs you may need to test sooner. It may not happen but it is good to be aware.

When you have been on trilo for a month or two and the cortisol is at a good number and staying there then you will be able to find the right insulin dosage and not be changing all the time. It is great that you are going to home test because not only does it save you money it is so helpful to be able to test and not guess how those BG numbers are throughout the day.

Jenny

[HarrysMom]

Harry's rear end continue to worsen, so I took him to the regular vet's to get his electrolytes checked - it was OK.
However, the vet was a bit alarmed about Harry's rear end weakness. She called the the internist's clinic - our regular internist was out, but she spoke with the other internist there.
They both agreed that Harry could have a reaction to Trilostane, and we should stop the treatment for two days to see if the symptoms improve.
I don't know what we will need to do if this was caused by Trilostane - reduce the dosage?
I also want to know if pre 1 and post 4 numbers are a bit too low for a dog that 's been on Trilostane for only 9 days.
The weakness seems to be worse after a stressful event (eg going to the vet's office) and after a short walk.
Another bad news - Blood glucose was high at 470. All the vets agree that we should not increase insulin until this weekend or until we get the first glucose curve done.
We are again discouraged.

Yunhee

[BestBuddy]

Hi Yunee,

I have checked back (quickly) and couldn't see if you had an ACTH test done before starting the trilo. I ask because you could see how much of a drop from beginning to the test just done. It may be that Harry has dropped much to quickly causing these other problems.

Jenny

[HarrysMom]

Jenny,
We should have, but did not to the ACTH test - just LDDS. I know I should have, but we had all these other weird medical events. I don't know if LDDS numbers measure anything, but it was like 3.3, 3.5, 4 (I think).

[BestBuddy]

It is really hard to know but I would imagine that if Harry has dropped into the "perfect" range in just 9 days then either he wasn't very high or he has dropped too quickly, it is just too hard to know. There is a bit of info that suggests that dropping the cortisol too quickly is very hard on the dog.

I think it would be wise to stop the trilo for a few days and if you see some improvements then it may be that you have to start the trilo at a lower dose.

Jenny

[HarrysMom]

Jenny,
I totally agree, and our regular vet also recommends stopping Trilostane for 2-3 days.

Yunhee

[k9diabetes]

Hi Yunhee,

It is possible for diabetic dogs to suffer from diabetic neuropathy resulting in weakness in the back legs. It usually occurs only after the blood sugar has been very high for a while. But in dogs who may already have compromised communication across the spinal cord it does tend to occur at lower levels of blood sugar. So it could be that the disc disease was already impinging on the spinal cord and then (1) the reduction in cortisol could cause the spinal cord inflammation to increase, and (2) the high blood sugar could be further reducing communication through the cord. All three together could make small contributions that would add up to a significant impairment.

I'm thinking that in a dog with pretty severe disc problems it might be advisable to allow the cortisol levels to stay on the higher side than they normally might to help prevent inflammation from the disc problems.

Diabetes-induced neuropathy generally is temporary and resolves after the blood sugar has been down for a while.

Natalie

[HarrysMom]

Natalie,
This is probably the most rational explanation for Harry's hindquarter issues.
We stopped Trilostane this morning - we will stop for two days and see if there is any improvement.
It seems that Harry is a tiny bit better - although he still has spectacular collapses on the stairs. However, he is able to walk a block without collapsing and is able to step up on the curb (unlike yesterday). I am not sure if I am imagining though.


Yunhee

[k9diabetes]

They have thoroughly checked other sources I assume... like heart problems and soft tissure injuries?

It may still be the trilostane and could be "piling on" in the same way that the diabetic neuropathy would be.

Natalie

[HarrysMom]

Natalie,
On Friday, Harry was off Trilostane. He was still falling off going up the stairs, but he managed to walk OK on the flat surface. I weighed on all the pros and cons of Trilostane and decided to put him back on it Saturday (with diabetes and all the infections he was getting, I was getting paranoid about not treating him for Cushing's). He did OK yesterday - the same as on Friday.
Today - on day 2 of resuming Trilostane, Harry is doing much worse - like Thursday, he is unable to even walk around the house.
The only rational explanation is now that Trilostane dosage may be too high. He is not Addisoninan, but maybe Harry's body requires a bit more cortisol than the current level.
Let me know what you think.
Harry will be at the internist all day tomorrow for the glucose curve. I will discuss with her.
He is now on 75 mg of Trilostane - I wonder if it makes sense to reduce to 50 mg or less.

Yunhee

[HarrysMom]

I plan on having a lengthy discusison with the internist tomorrow about Harry's Trilostane dosage.
Before that discussion, however, I would really appreciate it if I could get a sense of what dosage the members have gotten initially for their LARGE dogs and where the Trilostane dosage ended up being eventually (and how effective it was).
I do suspect that Harry's Trilostane dosage may be too much at 2mg / kg (75mg for 85 lbs dog). After 9 days, his pre ACTH was 1, post 4 - indicating perhaps too much control too soon.
Our internist's idea was that larger dogs do not respond too well to 1mg/kg dosage, and 2mg/kg is better.
Any input would really help me in my discussion tomorrow.

Yunhee

[k9diabetes]

I wouldn't hesitate to reduce his Trilostane dose or discontinue it altogether for a while and see how much of a difference that makes. Cushing's is debilitating only over long periods of time without treatment. I find these collapses of his much more worrisome than leaving the Cushing's untreated for a while.

I have never had a Cushing's dog but had a diabetic one and he was infamous for being extremely sensitive to most medications. He weighed 60 pounds and he needed multiple meds for severe heart disease. He wound up taking cat sized doses of some of them because he was very sensitive to everything. To the point that some vets were just kind of incredulous that he used such tiny amounts.

Perhaps Harry is one of those dogs or perhaps he just doesn't tolerate the Trilostane... I think you haven't tried Lysodren, have you?

If not, that's another option. There is a tendency to think Trilostane is safer but both Lysodren and Trilostane are very powerful drugs. It's a matter of using them skillfully and carefully.

Natalie

[HarrysMom]

Thanks, Natalie.
I definitely think it is Trilostane dosage problem. His rear end is the worst 4-6 hours after taking the drug. In the evening, he was very active and able to even walk up the stairs with minimal help. He is OK this morning - jump up on the sofa. It is around mid-day and when is he is stressed.

Yunhee

[labblab]

Hi Yunhee,

I'm really sorry that Harry is having this problem, and from your description it certainly does sound as though the trilostane is involved. Even though it may not be causing the problem directly, this level of cortisol reduction may be too much for Harry to handle -- perhaps in the manner that Natalie has described.

In answer to your question about comparisons with other dogs, I'm afraid that it is pretty much impossible to guage any individual dog's experience from those of others. On one hand, we have had some large dogs that did seem to be particularly sensitive to trilostane and ended up being maintained adequately on seemingly small doses. But we've also seen the reverse. My own Labrador retriever is a perfect example. At the time we started treatment, trilostane was just first being introduced in the U.S. and the initial dosing recommendations were much higher than those prescribed today. My dog weighed 65 pounds, and we started out with 60 mg. twice a day. We soon shifted to 120 mg. twice a day, which seems like an incredibly high dose now. But at no time did he ever have a "post" ACTH result any lower than approx. 6 ug/dl. So there you have it...

It really does appear that individual dogs metabolize the dog with different degrees of speed and efficienty. So in making dosing decisions, you have to rely on the ACTH monitoring tests as well as the clinical appearance of your own dog. You really can't rely on the dosing experiences of others.

Marianne

[labblab]

I just wanted to add a "P.S." that I agree with what Natalie has said -- if it turns out that the trilostane itself is an issue for Harry, you can and should consider Lysodren. But before making such a change, I would first try a reduced dosage of trilostane. Because if it's the cortisol reduction that is the real issue (rather that the medication itself), for most dogs it is faster and easier to reverse the cortisol "low" by simply discontinuing or reducing the trilostane. It generally takes a longer time to reverse the effect when Lysodren is used.

Marianne

[HarrysMom]

Natalie and Marianne,
Harry spent all day at the internist getting his glucose curve done and back x-rayed.
The internist and the orthopedic surgeon there spent a lot of time looking at Harry's back. Harry is not in pain, but they think that he has some disc problem exacerbated by muscle weakness (which could have bene caused by Cushing's and diabetes). The x-rays did not reveal anything remarkable surprisingly - however, they said that slipped disc does not always show up on the x-rays. My husband, who has a lot of back problem, concurs and says that you'd often never know about back problems from the x-rays.
He is doing a bit better today - backwise - so who knows what is causing it - it comes and goes.
The internist - who by the way is well respected by all the vets around here (including Dr. Kay) - strongly disagrees that we should lower Harry's Trilostane dosage. She says that Cushing's could just as easily cause muscle weakness and so can diabetes. Harry's rear-end splatters after a bit of exertion, and this could be weak spine issue exacerbated by muscle degeneration. She also keeps reminding me that it is hard to get diabetes under control without treating Cushing's. Diabetes came on so suddenly after getting the Cushing's diagnosis and treatment - so it is possible that Harry has diabetic neuropathy - so if we don't treat diabetes and Cushing's, it is not a good thing.
All the vets agree that pre ACTH of 1 and post 4 numbers are "great."
Meanwhile, Harry did not seem bothered by Trilostane - any more than the day when he was off.
We now restrict his activity, and he is wearing rubber booties to keep from slipping.
I am so torn - between listening to the vets who have helped all my other creatures vs. worrying about Trilostane.

Yunhee

[HarrysMom]

BTW,
Harry's glucose curve showed some control from insulin, but numbers are still very high (in the 400s). We are to raise his insulin d=from 13 units to 14 units tonight. We have to do another glucose curve this weekend (we will do it ourseves) and then re-adjust the dose next week.

Yunhee

[Squirt's Mom]

Hi Yunhee,

This is a group I found when working with Crys, who had multiple skeletal problems as a result of early neglect and starvation. They have some great ideas for helping pups with all kinds of mobility issues that might help Harry, and help you help him. ;)

Conservative Management:
http://pets.groups.yahoo.com/group/ConservativeManagement/

Hugs,
Leslie and the girls - always

[HarrysMom]

Thank you, Leslie.
I was doing some research on the spine issue and came upon some articles on spinal tumor. The internist's report mentioned this as an unlikely possibility, but you'd never know.
I am rather getting freaked out now - He's had so many things going wrong recently, I don't even know what to think.
He has not slipped on the floor last night and this morning. We don't know how he is doing up the stairs because we were supporting him with a towel the entire time. He seems a bit better, but it could be a wishful thinking.
Positive side - his coat looks better already and panting & hunger are gone. Still has a good appetite and finishes all his meals.

Yunhee

[HarrysMom]

I have not slept much because of Harry getting up 3-4x a night due to uncontrolled diabetes.
This morning, I was pilling the dogs, and I think there is a slight (I repeat slight) possibility that I gave Harry's Trilostane to Amy. Amy gets probiotic pill that is about 2x larger than Harry's Trilostane pill. Each of my dogs get two, and each of my cats get one probiotic pills. I thought I counted six pills, but there was one left over (of course, I could have wrongly counted the number of probiotic pills). I thought I visually remember giving Harry his Trilostane pill, but who knows.
What do I do in case there is a slight chance that Amy got Harry's Trilostane?
I am an idiot, I know.

Yunhee

Yunhee

[labblab]

Yunhee, I really don't think you need to worry. One single dose of trilostane should not have any long-lasting effect on Amy. Of course, watch her to see whether she starts acting oddly. But the drug should be entirely out of her system by tomorrow. How much does Amy weigh?

Marianne

[HarrysMom]

Yunhee, I really don't think you need to worry. One single dose of trilostane should not have any long-lasting effect on Amy. Of course, watch her to see whether she starts acting oddly. But the drug should be entirely out of her system by tomorrow. How much does Amy weigh?

Marianne

She weighs 75 lbs - about 10 lbs less than Harry. So far, she is acting OK - alert and begs for treats.

Yunhee

[HarrysMom]

I think I am completely losing my mind.
I had to take my other dog, Amy, to the vet to get her anal glands expressed as they were full. The vet told me that Amy's bordatella and 6 month geriatric panel (blood and urinalysis) are due, and in my sleep induced stupor, I told her OK.
I completely forgot that there is some chance that Amy might have gotten Harry's trilostane.
So far, she is acting her normal self - got really mad at me and threw a fit when I did not give her dessert (I am trying to cut down on junk food and treats for all my pets after Harry's diagnosis).
How would this show up in her blood (electrolyte imbalance)? Is bordatella shot safe with Trilostane? What is wrong with me?!?
Both my husband and I really need a full night's sleep (Since diabetes diagnosis three weeks ago, Harry has been getting up 3-4x a night).

Yunhee

[Harley PoMMom]

After oral dosing trilostane is rapidly absorbed and peak concentrations are seen in healthy dogs after 1.5-2 hours. Concentrations return to baseline levels after 10-18 hours.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2010&PID=56127&Print=1&O=Generic

Hi Yunhee,

I think Amy will be fine. We all goof up now and then so please don't be so hard on yourself, you have a lot going on right now.

Sending big hugs your way,
Lori

[labblab]

Yunhee, I don't think there should be any issue at all with the bordatella vaccination. And I think it highly unlikely that the trilostane (if Amy even took it) will be reflected in the lab results. Since she is acting normally this evening, either she didn't get the trilostane after all or it hasn't had any negative impact on her behavior. And I don't see you'll see any evidence in the labwork either.

I feel so badly for you, though, that Harry's diabetes is causing such problems. I'm afraid I can't offer any help at all in that regard, but for all your sakes, I surely hope that he can be stabilized SOON...:o

Marianne

[HarrysMom]

Lori and Marianne,
Thank you so much.
I am a mess today - I usually don't function very well without at least 7 hours of sleep, and my husband and I have been functioning with minimal sleep for three weeks now.
Harry's blood glucose numbers shot up to 715 last night, and we have been increasing the insulin dosage.
We don't now if it is cortisol or something else. I have reasons to believe that my last night's injection was faulty as well.
We may have to go to twice a day dosage for Trilostane or go to Lysodren.
I now believe that Harry's weakness is also due to high blood glucose levels. With the glucometer. I have been correlating Harry's collapses with BG levels, and Harry's rear end is absolutely at the worst whenever his BG readings go above 600.
He also lost some weight, so when our internist comes back from her holiday vacation, I will have to discuss reducing the dosage for Trilostane and benazepril.
Taking a deep deep breath.

Yunhee

[HarrysMom]

Hi,
Amy's electrolyte numbers were normal (Whew). Blood and urine tests all normal except the dreaded Alk Phos - which was at 160 vs. high normal of 131.
I noticed that Amy is eating well and sleeping on hard stone floors. This is how Harry started.
I am putting her on Denamarin, retesting Alk Phos in a month and see where we are.
This time, even with any slight suspicion, I am going to do U Tenn and LDDS ASAP. I really don't want to wait until the diabetes development.
Interestingly, Amy suffered from a joint infection that later became immune mediated arthritis - consequently, she had to be on immunosuppressing dosage of Prednisone for a long time (along with Azathioprine). Either this, or Cushing's runs in our Irish Setter family (Amy has same parents as Harry - different litter).

Yunhee

[HarrysMom]

Another quesiton. Is shaking one of the side effects of Trilostane?
Harry has been occasionally shaking - teeth chattering etc. esp when he is excited. Also, I think he not only has rear end weakness, but the whole body weakness.
I was determine to tackle Cushing's with the diabetes diagnosis, but not so sure if Trilostane is helping him. Of course, most of Harry's Cushing's symptoms are gone - such as panting, begging, etc., but this weakness is really bothering me - and now chattering.
We are on vacation in the mountains - so our regular vet is 200 miles away.
Before we left home, we did check his electrolytes again - all normal. Do dogs have to go Addisonian to experience side effects?
We are still struggling with diabetes control - now insulin up to 18 units from 9 units initially - but his blood glucose ranges around 300-500.
Harry has also lost some weight - used to be 85 lbs, but now 80 lbs. He was prescribed 75mg of Trilostane once a day.

Yunhee

[HarrysMom]

Update on Harry,
We did another stim test on Harry - a month after starting Trilostane - pre 2, post 4.5. One week after stim was pre 1, post 4.9. His dosage is 75 mg once a day. So at least, the "numbers" would indicate that this is probably the "right" dosage.
Unfortunately, Harry's weakness seems to be deteriorating. Granted, there are many things that could cause this - diabetic neuropathy, existing disd problem and Trilostane.
So, I think we will stop Trilostane for a week to see how this impacts his life quality.
We may re-start in a week if we do not notice any difference.

Yunhee

[addy]

It is always so hard because the problems could be caused by so many things. You have had such a time of it. I have been following along and wish you did not have so much to go through.

I wonder, too, if the trilostane is elevating his intermediates and could that be causing some of the weakness. I always worry about that.

Hang in there, you have been doing such a great job, you truly have.

Hugs,

Addy

[Harley PoMMom]

Hi Yunhee,

How are you and Harry doing? When you have time, please let us know. :)

Love and hugs,
Lori

[mytil]

I am so very sorry to read about Harry's passing - he had a wonderful life and family. My deepest condolences to you.

Always in Loving Memory of your sweet Harry
Terry

[addy]

Oh Yunhee,

I logged on for a minute and I saw your thread change. I can't begin to tell you how sorry I am to hear this news. I followed you here and on the other group.

Be at peace Harry, fly free.

My deepest sympathies, Yunhee.

Love,
addy

[Squirt's Mom]

Dear Yunhee,

I was so sorry to read of Harry's struggle and recent passing. You did all you could to help him have the best possible life. I know Harry is grateful to you for all you did on his behalf.

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

[Cyn719]

So sorry about Harry - your memories will always be with you - love prayers and strength -

Rest now Angel Harry xo

[Bichonluver3]

Dear Yunhee,
I am so sorry to read about Harry's passing. I would always smile when I saw the picture of his red hair flying! You were an incredible Mom and Harry was so lucky to have you as you were to have him. My thoughts and prayers are with you and I hope that before too long happy memories will replace the tears.
To Harry: Run free and fast through the fields of heaven, healthy and whole once again. Your Mom and all of us will miss your sweet face but we know we all we meet one day across the rainbow bridge. Until that time, stay close to your mom and watch over all of us. Rest easy, precious Harry. God speed and God bless.
Carrol & Chloe

[mypuppy]

so sorry for your great loss of Harry, brings me many tears.

May you find strength.

God Bless you and sweet Harry.

Xo Jeanette and Princess

[HarrysMom]

Thank you everyone.
Harry has given me the happiest and the saddest moments of my life - he was totally worth every pain I am experiencing now, and I was blessed to have this amazing creature in my life. I will never be the same without my wonderful boy.
I will detail Harry's problem later when my mind is clear (because I do believe that Harry's ordeal could help someone), but the summary is that Harry did better without Trilostane (including diabetes control), and at the end, we had to put him to sleep because of rear end weakness, continuing infections (progressing to MRSA in his middle / inner ear) and neuropathy / neurologic symptoms. This was a dog that loved to run 10+ miles on a given day. We could not bear to see him unable to get up, soil himself and then get depressed and anxious. We tried acupuncture, holistic vet, neurologist and a pain specialist. None of them seemed able to help him - and we did not want to prolong his suffering. During the last week of his life, he could not sleep well and was extremely anxious. Ironically, his diabetes was well controlled.
Given all his symptoms (neuropathy / weakness started after Trilostane), I am starting to think that he had macroadenoma. I could shoot myself for not pursuing this further, but then again, hind sight is 20/20.
A large part of me feels that I pulled the plug too soon, and I wonder if somehow I failed him. One thing for sure, and I am proud of this - we did love him with everything we had. We miss him terribly. If one could measure one's life with the love left behind, then Harry had an incredible life.

[Harley PoMMom]

Dear Yunhee,

In no way did you fail Harry. You did everything that was humanely possible for him.

The decision to let them go is a most difficult one but it is made from one's heart that is filled with love. Your deep love and devotion for Harry was very evident.

Please know we are here for you and love you.

Love and hugs,
Lori

[Squirt's Mom]

Dear Yunhee,

Harry knows how much you love him, how very hard you worked to make his every minute as enjoyable as possible, and that you let him go because you do love him so. Setting him free was the greatest gift you ever gave him; you took his pain and made it your own.

Hugs,
Leslie

[Rebelsmom]

Dear Yunhee, my heart hurts for you and I'm so sorry for your loss. harry was a beautiful dog and I know he knew how much you loved him. You never failed him and gave him the greatest life full of love. Letting him go was the greatest love you could have shown him.

Sending you lots of love.

[ChristyA]

Dear Yunhee,
I am so sorry to read of Harry's passing. I too had a wonderful companion that passed from complications of Cushing's. I, like you, believe he had a macroadenoma which caused his escalated problems in treating the Cushing's. Just know that you did everything within your power to treat Harry's disease and he had a great life full of love. Memories are the greatest gift given to us during our time of sorrow.
Take Care,
Christy

[HarrysMom]

Dear Yunhee,
I am so sorry to read of Harry's passing. I too had a wonderful companion that passed from complications of Cushing's. I, like you, believe he had a macroadenoma which caused his escalated problems in treating the Cushing's. Just know that you did everything within your power to treat Harry's disease and he had a great life full of love. Memories are the greatest gift given to us during our time of sorrow.
Take Care,
Christy

Christy,
What happened to your dog after Cushing's treatment? Harry immediately started experiencing rearend weakness after starting Trilostane. Trilostane just suppressed his adrenals too much - after three months, we could not get his pre cortisol to be above 0.8, and we got no stimulation with Cortrosyn. He did so much better without Trilostane. At the end, it was the neurologic symptoms that caused us to put him to sleep - the symptoms were weaknes in all his limbs, incoordination, severe trembling and falling (it was as if he did not know where his paws were). We stoppe Trilostane in August - his last stim in November was pre 2, post 5 - all without Trilostane. I was reading that macroadenoma actually requires min dose of Trilsotane.

[jrepac]

So sorry to hear of Harry's passing; he was a beautiful boy.

Jeff, Angel Mandy & the Girls

[Casey's Mom]

I am so sorry to learn of your loss of Harry. Such a beautiful boy.

Love and hugs,