Boji, 8 yr old Havanese, dx February this year (Trilostane)

[Erin&Boji]

Hello. :)I have an 8 year old Havanese (Boji) who was diagnosed with Cushings earlier this year. He started trilostane (15 mg once per day) and it worked beautifully. He seemed more like himself again. Just recently, however, his symptoms have returned (constantly hungry and thirsty) He's going back to the vet for another ACTH stim test- but is this common?

[Rebelsmom]

I seem to be having the same problem. My pup Rebel started the Trilo on March 26th. Within a week or 2 his symptoms improved a lot. Just in the last week and a half they have started to come back. We just did a urine test to rule out infections and his vet is gonna do another u/s and some lab work on Wed to rule out other things. He is having another stim test first week in June to see where we are at with that. I'm not sure if it's common or just luck of the draw at this point.

Hope you can get it figured out also.

Melissa & Rebel

[lulusmom]

Hi Erin and welcome to you and Boji.

Unfortunately, it is very common for a cushingoid dog to require some type of adjustment in dosing, whether you are treating with Trilostane or Lysodren. Having the acth stimulation test done is certainly the correct step to take at the moment.

I'm sure sorry that you had the need to find us to begin with but I'm happy that you found us. Now that you're here, let's get as much of Boji's history on your thread so member's will be better equipt to give you more meaningful feedback. Can you tell us what tipped your vet off to a possibly cushing's diagnosis. Can you also round up the diagnostic tests that were done and post the results here? If you don't have copies, your vet should be more than happy to give your copies. It's always a good idea to maintain a medical folder for our babies. I can tell you first hand that it comes in really handy if you ever need to take Boji to an after hours clinic/hospital. Vets on call appreciate having the dogs medical history at his/her fingertips. They also come in hand for times when we hound you to post test results. :D We would be most interested in any abnormalities in bloodwork. Please post the high or low values only and make sure you let us know what unit of measurements are being used, i.e. nmol, ug/dl. Also be sure to include the normal reference range. Did your vet do a urinalysis? This is a standard screening test because the vast majority of dogs with cushing's will drink and pee to excess. The urine specific gravity is almost always low. A dog with normal specific gravity would be odd. The three most telling diagnostic tests are the low dose dex suppression test (ldds), the acth stimulation test and an abdominal ultrasound. Hopefully, your vet was concientious in reaching a confirmed diagnosis and ran at least two out of the three of these tests. We would be very interested in seeing the results of these tests as well.

Can you tell us how much Boji weighs? How many acth stimulations tests has your vet done since Boji started treatment and what were the results of these tests.

I apologize for all the questions but your answers really will help us greatly. There is no such thing as too much information so feel free to share any and all info on Boji.

Again, I'm glad that you're here and rest assured that you and Boji are now part of our family. We're here to help you in any way possible so take hold of the many hands that will be held out to you.

Glynda

[Erin&Boji]

Hello everyone :) Thank you so much for the support. I've been doing through all of his records - I don't think I have everything here, but I'll share what I do have.

I first took him to the vet in late November 2009 for frequent urination and excessive thirst. He was also wanting to eat more and more often (up until then he was a VERY picky eater. This dog wouldn't touch a normal "milkbone" and would usually turn his nose up at them. My other dog loves them and suddenly Boji wanted to devour them) He also had a slight limp going up the stairs. So this is everything that prompted my first vet visit. My vet took an xray, did a blood test (the paperwork I have says Chem 25, CBC, U.A., T4 FT4ed), blood pressure, and a urine test. At this time he weighed 16 pounds (avg weight prior was 13 pounds) He was treated for a UTI and she found that his liver was enlarged. She suggested Cushings and said that his bloodwork was negative, but that that was common. He also started glycoflex and S-Adenosyl-225 after this visit.

My vet is awesome. She kept in touch with me to check on him over the next month or so In January this year he went back to the vet again. It seemed like suddenly his hair was different and his belly had grown. My vet and my groomer both noticed a difference in his hair. (Havanese have long hair - his seemed to suddenly be incredibly thin) At this visit, my vet suggested the urine test for Cushings and explained that if it was positive, she'd do ACTH stim test. I opted for just the ACTH stim test. When the results came back, my vet told me that in order to dx cushings, the cortisol level must be 22 or higher. Boji's was 41. This was when he started the Trilostane. His weight was 18.6 pounds. Yikes.

A week later, he had the ultrasound. This is what's on the report:
- Liver is mildly enlarged; Gall Bladder has mild gravity dependent sludge; Spleen has 1.3cmX1.4cm mixed echogenic nodule and several small hyperrechoic nodules up to 4mm; Kidneys - hyperechoic cortices; small regions of mineralization at cortices, normal in size; Urinary bladder has irregular and thickened cranioventral wall; two 7mm calculi; Adrenals - bilaterally enlarged. The ultrasound also confirmed a previous diagnosis of pancreatitis (january 2009)

After the ultrasound, he also started taking Urisodiol 50mg twice a day. Two weeks after starting the Trilostane, he had another ACTH stim test and his cortisol level was really low. I don't have the exact number but I'll get it this week.

So that's what I have. I hope this isn't information overload! This is just heartbreaking. I'm sure you all understand that. It sucks. When he's feeling good, I can forget about it for a while, you know? I'm not constantly reminded that he's sick. How do you really know when they started to have symptoms? I feel like it was gradual for so long and then it was a sudden, drastic change. Maybe I was in denial. I don't know. Last spring/summer was when I first started to feel like something wasn't right. Like I said before, I thought it was just him getting older. His attitude was different, but it was subtle. (This is a dog with PLENTY of attitude! - and he sometimes seemed depressed.)

Anyway, this post is long enough! Thank you so much

[lulusmom]

Hi again and thanks for providing more information. With a post stimulated cortisol of 41 ug/dl and an abdominal ultrasound showing enlarged liver and blaterally enlarged adrenals, it does sound like your boy was diagnosed with pituitary dependent cushing's. 80% to to 85% of dogs with cushing's do have pituitary based disease so Boji is in the majority.

Cushing's is a very graded condtion, meaning it takes a very long time for symptoms to become apparent as well as for the excess cortisol to do the real damage that can be life threatening. I've read a few articles and texts that mention that most dogs with cushing's have the disease between one and six years before being diagnosed so yes, it's no wonder that you are thinking that Boji's symptoms came on very gradually.

It is odd that even though a dog with cushing's can gain weight, they still seem to look and feel thin, especially along the spine and the hindquarters. This is not a loss of fat but rather a loss of muscle mass caused by the catabolic effects of excess cortisol. Dogs will regain their muscle tone with treatment but it's not instantaneous so keep in mind that it can take upwards of six months to see a noticable difference. Also keep in mind that cushing's dogs may have a disease but unless they have underlying conditions that are causing problems, they really aren't suffering or in pain. They're just incredibly hungry most of the time and they are drinking a lot of water because they're peeing so much. Prednisone is a synthetic form of cortisol and if you've ever known anybody with severe asthma that has been prescribed long term prednisone treatment, they'll tell you how much they want to eat all the time. They'll also tell you that they feel much better despite the increased appetite and maybe drinking and peeing more.

It does suck to get the bad news diagnosis but the good news is that most dogs stabilize on treatment and go on to live a really good quality of life. It looks like you and Boji may just need a bit more time to try to figure out an appropriate dose of Trilostane so as hard as it might be, try to be patient and together we'll all try to get Boji where he needs to be. In the meantime, why not take advantage of all the reference material we have in our Resources Section. The more you learn, the calmer you'll be and the end product is that you'll be the best advocate Boji could ever hope for.

We'll be looking forward to your posting the results of Boji's last acth stim test results as well as the results of the one you have currently scheduled. Don't ever worry about posting too much because you can't give us too much information. In case you haven't noticed, I don't worry much about being too wordy. :D

Glynda