Diagnosed with Cushings, resulting in BAD liver - (Rex) - 5 y/o Yorkie

[rex2005]

I used to live in the Bahrain (Middle East), a few months ago I moved to Paris.
I have a 5 year old Yorkie, Rex. He has always been a very happy and hyperactive little fellow.

Until a few months ago, prior to my moving to Paris, I noticed some change in behavior - excess water drinking and peeing. Stealing food. And a pot belly. I took him to the vet twice in Bahrain, and sadly she couldnt tell me what was wrong with Rex, she told me, he is just aging, accept it.

So a couple of weeks after coming to Paris, I located a Vet Clinic right where I live and took Rex to him for a check up (actually I wanted a second opinion). As soon as the doctor saw him, he asked me quite a bit about Rex, and told me he could be suffering from something called CUSHING'S (adrenal or pituitary) and he wanted to do quite a lotta tests - xrays, ultra sounds and a series of blood tests. So a week later he told me that just as he suspected poor Rex has a problem. and since it wasnt identified earlier, his liver was inflamed :(

And soon after the doctor got him started on Vetroyl (20mg per day) and Zentonil for his liver and Forthyrone (something to help him with the excess cortisols). He has been on these for a month now. I do see him getting more active and lively, BUT He seems HUNGRY ALWAYS. BEGGING FOR FOOD, I feel so sad when I have to tell him off.

I am looking for any advise on how I can help him cope with his hunger. He has two feedings a days, once in the morning just after his meds and once in the evening. In between I allow him to snack on carrots or some biscuits.

Can someone help me out? I dont seem to find someone locally to discuss these things coz I dont speak French and ppl here dont speak English! (Really annoying)

Any help is really really appreciated!

[sunimist]

Hi and welcome to you and Rex. :)

I have no experience using Vetoryl, (my baby was treated with Lysodren) but many here do use Vetoryl (Trilostane) with great success and will be able to help you.

As for the hunger, I think when the cortisol becomes properly controlled, the constant hunger will subside.

Glad you found us and someone will be on soon to give you some answers. :) Meanwhile, you might want to do some searching in our information section. Great source for information.
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Shelba and Suni

[zoesmom]

Ah, geez. Just lost my whole answer to you. Starting again.

Welcome to you and Rex. We have members all over the world, tho most are here in the states. We have a member, Saskia, in the Netherlands and her English is fantastic. Not sure if she does French. But we can help you . . . I guess the bigger problem will be how to convey the info to your vet. In some parts of Europe, the cushings tests can be a little different than what we know. At least I think they are where Saskia lives, so maybe she'll know more.

The standard tests for diagnosing cushing that we use here are the LDDS (an 8 hour test that suppresses their cortisol) and/or the ACTH (a 1 or 2 hour test that stimulates their cortisol). Does this sound like anything Rex may have had? I suspect your vet also did a blood panel/possibly urine, too, which is what usually gives the first clues to cushings. Certain liver enzymes will be elevated and the dog usually has very dilute urine. Many vets here proceed to then do an abdominal ultrasound as well. If it shows enlarged liver and adrenals, that is further confirmation of cushings. So maybe your vet was actually saying Rex has an enlarged liver, which is very common in cush dogs.

Anyway, I'm going to assume, for now, that the diagnostics were positive, because Rex has been on vetoryl(same as trilostane) for a month and has not had any problems. The problem is, it sounds like he may need a higher dose, since he's only had partial resolution of his symptoms. So first off, what does he weigh (in lbs or kgs). That determines the dosing.

Next, if you have or can get copies of any labwork, cushings tests, ultrasound reports, anything at all, and post them, that would help immensely. The results may vary from what we are used to seeing for the cushings tests, but hopefully someone can help interpret. Besides any cushings specific tests, we need to see what was out of normal range for Rex on any general labwork. (Here, that's usually indicated by an 'H' for high and or an 'L' for low.) So Rex's abnormal numbers AND next to it, they usually will put the normal range. Please include that too, AND the units of measurement for each.

The usual protocol for a dog on vetoryl is to test him 10-14 days into treatment with an ACTH. That's the 1-2 hr test. It has two numbers and those numbers will help determine if the dose is high, low, or hopefully, just right. Doesn't sound like he had that yet and it's overdue. So that would be the first basic step in determining how he's doing on the med. And from there, we can give you more input on what's next. Based on what you've said about his ongoing symptoms, it sounds like he may need a higher dose. But again, only those ACTH test numbers will tell. So......let us know what you have or can get your hands on, as far as previous tests. And then try to get him in for that ACTH test that's already a couple weeks overdue. How did your vet say that he wanted monitor Rex on the vetoryl?

The one medicine you mentioned sounds a bit like a thyroid medicine rather than one to help with cortisol (the forthyrone). It's not a name I recognize (we're familiar with thyroxine and soloxine instead), but many cush dogs will have low thyroid levels, so is it possible to ask him about that? I'm sorry you have the language barrier with your vet but we'll do the best we can to give you the info you need, and then, hopefully, you can communicate your questions to him. Gotta be difficult, I'm sure. :eek::rolleyes: Sue

[SasAndYunah]

Hi....what's your name? :)

Welcome from me as well. I'm the one Sue spoke about, Saskia from The Netherlands. I do speak (some) French so if you have any results in French which you don't understand, write them down anyway, I may be able to help you translate it into English :)

About the Zentonil, it contains SAM-e, used for supporting the liver. Do you have the Zentonil Plus (only SAM-e) or the Zentonil Advanced (SAM-e combined with Sylibine). SAM-e is often used as a supplement to support the liver in various diseases that include the liver.

Forthyron contains Levothyroxine, a medication used for low thyroid.

If you have any questions you like to ask the vet (in French) let me know and I will translate them for you :)

And like Sue said, if Rex wasn't tested after 10 - 14 days into treatment, that's what I should be persueing now first, see where Rex's levels are and adjust (if needed) the dose of Vetoryl.

Best of luck,

Saskia and Yunah,
The Nehterlands.

[zoesmom]

Yeaaaaa! I had a feeling Sas would be able to help with the French. And she is familiar with Rex's other meds. Double yeaaaa!!!! So hope we hear back from you soon. Sue

[rex2005]

Hi Guys,

Thanks a lot for the warm welcome. I feel so much better already. My name is Joy. I just realised that I hadnt mentioned my name.

And Yes Sue, am so glad that I found someone who can properly interpret the French Results.

Well, Saskia, Rex first ACTH test was 29th April 2010, the results were:
Cortisol T1 = 469 T2 = 1404
T4 libre T1 = 12 T2 = 14
TSH canine T1 = 0,1
It says "Resultat dans le domaine des valaeurs usuelles en faveur d'une hypothyroidie secondaire."

Now all that didnt make sense to me at all. The doctor told me the numbers are very high and will require special treatment. His English is very limited, so I guess all he could do was get me to understand that Rex is sick. Soon after this diagnosis, BEFORE we started on Vetoryl he gave me the ZENTONIL Advanced 200 pills and the forthyron to get started on. And couple of days later Rex got too sick to eat, he vomitted a few times and so the doctor said lets wait till he starts eating and then get him started on Vetoryl immediately.

So on 13th May we started him on all the pills above. Vetoryl (20mg) per day, Zentonil - 1 pill per day, Forthyrone - half a pill per day.
Rex weighs about 8-9kgs. I dont know why you asked how much weighs :)

And then on 1st June 2010, the vet did another test similar to the one before, and the results were:
Cortisol T1 = 126 T2 = 475
And below it says "Les valeurs de cortisol sont trop fortes pour un animal sous traitement, mais en raison des valeurs des parametres hepatiques, il semble difficile d'augmenter la dose"

Now he is scheduled for another test on 20th of July 2010.

The things that I would like to know are:
When will his hunger reduce? And why is he still losing hair? Because his activity levels have improved and he is playful again. His water drinking has reduced a little, but it isnt back to normal yet. How long do I have to wait before I see an actual improvement? I am really worried.....and like I said before I just have this language issue.....and so it worries me more.

Thanks guys for all your support. Joy

[SasAndYunah]

Hi Joy :)

Let me start with translating those lines...

"Resultat dans le domaine des valaeurs usuelles en faveur d'une hypothyroidie secondaire" means: The results are within the range of values that usually indicates secondary hypothyrodism.

"Les valeurs de cortisol sont trop fortes pour un animal sous traitement, mais en raison des valeurs des parametres hepatiques, il semble difficile d'augmenter la dose" means: Cortisol levels are too high for an animal undergoing treatment, but given the livervalues, it seems difficult to increase the dose.

Unfortunately my knowledge about treatment options, doses, etc isn't that good but fortunatly there are others here that are absolutely great at interpreting testresults and things like that :) I am sure they will react as soon as they can and help you further along.

Saskia and Yunah :)

p.s. T4 libre means Free T4

[apollo6]

Dear Joy/Rex.
Weight is important as to dosage to start on Trilostane. I am new to all this also. My little guy weighs 10lbs (approximately 4.5 kg. starting on 10mg.)
If I read right you are going to try your angel on. As any senior member input is better then mine . Check if any of the other drugs will interact with the Trilostane(Vetoryl)

This is the website of the company making it and there should be more information and literature on it.

http://www.dechra-us.com/Default.aspx?ID=38&pcatid=PRIMARY4&catid=PROPGRP14&fid=PROPFIELD107[/url]

[zoesmom]

Joy -

Can you check the test results and let us know what the units of measurement are. I'm gonna guess on the cortisol that it is nmol/L and, if so, then Rex's numbers convert to the following in ug/dl


29 April (diagnostic ACTH):

Pre # is 17 and post # is 50+

13 June (monitoring ACTH):

Pre # is 4.2 and post # is 13+ (This seems to be the ACTH test that we were recommending - the one done after a couple weeks on vetoryl.)

So based on his weight, Rex is on a decent dose of vetoryl(about 2m/kg) AND his numbers came down considerably in those first two weeks on the vetoryl. BUT, they are still not as low as they need to be to get good control of his cortisol. Two things. The first ACTH was really pretty high so it's no wonder his numbers are not yet within the right range. Second: The ideal range in ug/dL is about 1.5 to 5.5 (or up to 7.5 - 9 if his symptoms have resolved.) His have not. So. . . . we don't usually like to see the dose raised until after one more ACTH is done (at around 30 days after the last one.....so ideally, it would be around 10 July.) Maybe you can move that next ACTH test date up a couple weeks??? I suspect when you dget the next ACTH that his numbers will be even lower and you should start to see more improvement in his symptoms. But with that 4.2 and 13 on the last cortisol, test, those are not low enough yet. They may still drop further on his current dose, however. Gotta run right now but will try to post more later. Can you check the units of measurement for the thyroid tests (t4 libre, etc.) I'm not sure I know how to convert those but somebody probably will - or maybe we can look it up online. Also, can you copy any notations on his ultrasound report, if you have it. Thanks. Sue

[labblab]

Hi Joy :)

"Les valeurs de cortisol sont trop fortes pour un animal sous traitement, mais en raison des valeurs des parametres hepatiques, il semble difficile d'augmenter la dose" means: Cortisol levels are too high for an animal undergoing treatment, but given the livervalues, it seems difficult to increase the dose.


Hi Joy,

Sue has already done a great job of converting those lab values and giving you a summary of the ideal ACTH treatment range for a dog with Cushing's. I just wanted to add one thing, after seeing Saskia's translation of one of Rex's treatment notes (and thank you so much, Saskia, for helping with this!).

It sounds as if your vet is aware that Rex's cortisol level isn't yet as low as we'd like it to be in order to expect complete symptom relief. But because of issues with Rex's liver, there is concern about increasing the dose of Vetoryl. Without knowing more about Rex's liver problems, it's hard to give you a lot more feedback about that. It is true that Dechra, the manufacturers of Vetoryl, caution against giving Vetoryl to dogs with primary liver disease (in other words, serious liver disease that is caused by a liver-specific problem). But on the other hand, virtually all dogs exhibit some liver changes and elevated liver enzymes that are secondary to Cushing's until their cortisol level is well-controlled, and that in and of itself is usually not a contraindication to increasing Vetoryl doses as needed. So I'm not trying to second-guess your vet, but if we could find out more about Rex's liver problems, that would help us give better suggestions about Rex's Vetoryl dosing.

Marianne

[rex2005]

Thanks Marianne and Sue for your feedback. I have just discussed with the vet about doing the ACTH test earlier, he said we could do it on 14th July. I now have an appointment for the 14th. What a relief to have some actual knowledge on what is going on with Rex.

About his liver, I asked the vet, and I was told the liver condition is due to his cushing's. I didnt really understand what he was trying to explain, but he said, "Rex has inflamed liver as a result of this disease, that is why we are not going to increase his Vetoryl dosage. For now we will keep going on 20mg per day. After the tests in July, I shall decide what is next." So I guess for now, I'll just keep up his meds and WAIT.

In the meantime, is there anything you recommend I can feed him to keep the hunger at bay? I have been feeding him home-made food as per the vet's recommendations - it includes the following ingredients - green beans, carrots, broccoli, zucchini, beetroot and meat (no fat meat, like chicken breast and beef). I feed him twice a day and for snacking in between I let him snack on a couple of baby carrots or peeled apple slices. Am I doing the right thing so far? Is there anything else I can do for his food?

Thanks! Joy :)

[apollo6]

This is what I give my Apollo who has problems with pancreatitis



but please check with senior members before changing the little ones diet. You should not change the diet without letting your vet know.
low fat diet
A.M-low fat cottage cheese, Greek nonfat yogurt, egg white
, low sodium turkey slice, supplements

NOON- long WHEAT grain rice, cooked chicken( buy already done from market-no fat, no skin , white meat only), teaspoon canola oil,

,CARROT pieces

AFTER 4P.M-cooked potatoes with skin, chicken
Nutri Deni minichew or Greenie
Halo-Live N Little skin & Coat treat with Salmon
Have alternated with organic baby food-summer veg, turkey with veg, spinach.
Sliced apple, sometimes blue berries, honey melon
I alternate with organic baby food-spinach, turkey and vegetables, and spring vegetables.
Please note I was told Brocolli causes gas.

[frijole]

Hi Joy! I have had 2 cushings dogs and the hunger will be reduced once you treat and it is a result of the high levels of cortisol in the body. They are in a constant state of starvation - in their minds. So it is best to just feed them what is good for a normal dog and yes they will head butt trash cans and lick carpet etc but that does keep them occupied. :p;) Meanwhile the treats you have mentioned are all fine.

Main thing is that they cannot tolerate much fat in their diet. Again, once you treat life will be much more normal. Kim

[Bichonluver3]

Et bien, T4 libre means free T4!