Recently Diagnosed, my 9 yr old Bichon Mr Harry

[fluffmum]

Hi everyone so so glad I have found you,my 9 yr old Bichon Mr Harry was diagnosed with Cushings on Fri, after 2 weeks of blood tests,he has commenced on Vetroyl 60 mgm.

I'm looking for lots of information....to tell the truth I'm scared as I have never heard of Canine Cushings and what to expect.

Marilyn

[StarDeb55]

Marilyn, I would like to welcome both you & Harry! Let me warn you that we ask a lot of questions of new members, but that just helps us to give you the most appropriate feedback from the group's collective experience. Can you give us a little more history on Harry? What symptoms was he suffering from that led you to go to the vet? Did the vet do basic bloodwork such as a senior wellness panel, or super chemistry panel? If possible, could you post the results of only the abnormals tests including reporting units, & normal range. What diagnostic testing was done to make the Cushing's diagnosis? Some of these tests might include an ACTH, low dose dex test, or high dose dex test, possibly an abdominal ultrasound. Again, we would love to see the results of these tests, also. We are not trying to second guess your vet, but we have seen just a few too many pups mis-diagnosed with Cushing's. Cushing's is probably the most difficult endocrine disorder to diagnose as its symptom mimic diabetes & thyroid. Were diabetes & thyroid ruled out? If you don't have copies of the results, your vet should be happy to provide them. Most of us keep files on our pups at home as you never know when they might come in handy, especially if you end up at a strange vet. What is your boy's current weight? Did your vet explain that when starting trilo, your boy will need an ACTH at the 10-14 day mark to monitor how he is doing on the med?

Looking forward to hearing more.

Debbie

[addy]

Hi Marilyn,

Welcome and I am so glad you found us! I was terrified when the first vet told me Zoe had Cushings, so you are not alone feeling frightened. Knowledge is power for me so I have been reading all I can and you may find it helps you as well. The reference section has alot of good information. Reading other's threads helps as well.

We are all here to support you in any way we can and the moderators and adminstrators sure do know their stuff!:)

So read and ask questions and be glad you found this wonderful, caring group of people!!!!!!

I had to fix my Zoe's chronic diahrrea before I could start her on Lysodren. We are almost there now.

What you can expect depends on your dog, the symptoms and how Cushing savy your vet is.

It is best to start at the beginning with test results, symptoms, etc as Star Debbie has already mentioned.

Again, welcome!

Addy

[BestBuddy]

Hi and welcome to you and Harry.

I just want to add my welcome to this great group.

Jenny

[fluffmum]

Mr Harry was diagnosed with Oxylate Stones in Oct last year.He had further surgery in June for ''stones''.He was well untill 24th June he had been given a steroid injection for overgranulation of his wound.It was after that he started with the raging thirst,5-9 pints per day,he was also
ravenous,this is what took me to the vet after a week end from hell.

My vet did all the tests and Harry's liver enzymes were sky high so high his machine couldn't calibrate they had to be sent out for further analysis his cholesterol was alsoraised.

Last Wed he was admitted for further bloods and ACTH the findings were conclusive.

Harry has the pot belly and is loosing his hair by the handful he also has the rat tail.

I don't have the copies of the findings but sure the vet will provide

[Harley PoMMom]

Hi Marilyn,

Welcome to you and Mr Harry from me and my boy Harley! I am sorry for the circumstances that brought you here but glad you found this forum.

You are definitely not alone on this journey anymore, we are here for you and Mr Harry. Since Debbie did such a fine job at the "20 questions" I don't feel the need to ask any more. But if you have any questions that you want answered please feel free to ask, ok?

Here are some links to our Resource Thread that may help you understand Cushing's Disease better and hopefully you will become less frightened by it.

Links to Cushings Websites (especially helpful for new members!)
http://www.k9cushings.com/forum/showthread.php?t=180

Trilostane/Vetoryl Information and Resources
http://www.k9cushings.com/forum/showthread.php?t=185

Dechra's U.S. Product Insert
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Love and hugs,
Lori

[Harley PoMMom]

Mr Harry was diagnosed with Oxylate Stones in Oct last year.He had further surgery in June for ''stones''.He was well untill 24th June he had been given a steroid injection for overgranulation of his wound.It was after that he started with the raging thirst,5-9 pints per day,he was also
ravenous,this is what took me to the vet after a week end from hell.



How many steriod injections did Mr Harry have?

[fluffmum]

He had Domperidone 1 mgm

I must say I have noticed a great improvement since Sat the raging thirst has gone so has the p-ing.

[fluffmum]

Here's a link from Dechra very informative

http://www.canine-cushings.co.uk/index.htm

[StarDeb55]

How long after the steroid injection was the ACTH done? I am asking because injectable steroids will mimic cortisol on ACTH testing which may cause a false positive result. Was the ACTH the only diagnostic test that was done for Cushing's?

Debbie

[fluffmum]

He had the steroid on 24th June.

Harry has had numerous bloods taken the ACTH was done on 22nd July to get a conclusive diagnosis

[StarDeb55]

It is very difficult to get a "conclusive" diagnosis based on a single ACTH test. Was any other testing such as a low dose dex test or an abdominal ultrasound done to confirm the elevated ACTH? An ultrasound will allow the adrenals to be looked at which will help determine what type of Cushing's you are dealing with. An ACTH stim will not distinguish what type. If Harry might be in the 15% of dogs that have adrenal Cushing's, surgery offers the hope of a permanent cure, assuming that Harry would be a good candidate.

Debbie

[Squirt's Mom]

Hi Marilyn,

Welcome to you and Harry! :)

Scared, huh? Boy, do I remember when Squirt was first diagnosed...I was a complete basket case when I got here! :eek: A friend here told me she could just see me - hair standing on end like someone who had stuck their finger in a light socket. She was kind enough to leave out the parts about bugged-out eyes and flying slobber! :p I was a real mess, no joke.

I couldn't understand anything anyone said, or that I read, or that my vets said. Asking all these questions that I didn't understand much less know how to answer, telling me all this stuff in Greek,...geez! All I knew was that my baby was sick and I wanted to know how to help her. I found that help here, those answers here among these wonderful folks.

They gently took my hand and led me along until I could begin to understand just a little bit. And they have never been further away than a key-stoke since. The more I learned, the less fearful I became. As Addy, said - knowledge is power and that is certainly true when dealing with Cushing's. You are Harry's first and last defense, his only voice, his advocate. The more you know the stronger you will be in these roles. The same gentle education I received here is available to you. Please ask all the questions you can think of, any time - someone is on 24/7 most of the time. If we don't know the answer we will learn together. But, I think you will find the collective knowledge and experience of our members as astounding as I do. ;)

Something else you will soon learn...you couldn't ask for a better group of folks for good old-fashioned hand-holding when the need arises. Mine have been absolutely dripping with sweat at times, but there is no way Squirt and I could have made it the last few years without knowing we had such support behind us.

You and Harry aren't alone on this journey. We will be with you every step of the way.

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

[fluffmum]

Yes he has had low dose dex test and abdominal ultrasound done.

I may be sounding very vague here but to be honest I'm still in a state of shock and this has been one rollercoaster the we want to get off. My vet has been fabulous leaving no stone unturned as Harry was badly managed from another member of the practise.

Like Squirt's mum said I knew my baby was sick,really sick and was being ''fobbed off'' by being told all the signs and symptoms were age related!!!!

We are dealing with two situations here post op bladder surgery, Harry had to have a urethrostomy http://www.vetsurgerycentral.com/urethrostomy.htm performed to prevent stones forming in his urethra and those new symptoms,it was also noted that his new wound was not healing as it should.The vet says it should heal up now he is on treatment for cushings.

[marie adams]

Hi Marilyn,

Welcome to you and Mr. Harry.

As everyone has said we were all in your shoes at one time--some of us just recently this year--February for us. The saying been there done it fits. We all learn from each other and it makes us have more knowledgeable to work with our vets. Many of us have changed vets because it was the "they are just getting older":mad:, but it didn't make sense so we pushed and researched.

Hang in there it does get easier to handle and understand--it is not a death sentence. Your Mr. Harry may get a little tired of you staring at him all the time looking for any signs of change, but sometimes I think they thought we were a little crazy before all of this cushings stuff started--haha!!:D:D

Relax a little and just ask all the questions you want because there is a wealth of knowledge here to gather.:):)

[apollo6]

Hi Marylyn
Welcome. You are not alone. My husband was born in Glasgow , Scotland. If you read my thread-Apollo, Tristalone, you will see you are not alone. Steroids found in many medications can cause cushing's. Some questions we will ask , do you have a diagnosis as to which cushing it is? PHD(pituitary) adrenal( in ultrasound would show on is a lot larger then the other-tumor) or ATYPICAL(signs but not elevated readings) this will determine what treatment is the right one. I read you little Harry is on Trisloane. I thought I would go over the deep end when I learned my boy, Apollo had cushing, he has the pituitary kind. It sounds like you have had many of the test done. The ultrasound will show if both or one adrenal gland is enlarged, enlarged liver, other abnormal organs. In my case the pancreas showed previous traces of pancreatitis. Also because of back problems, Apollo was on many medications that have steroids in it. I changed vets, because I did not like the option the vet was suggesting. I did a lot of research, asked lots of questions before I started any treatment. You are in charge. Trust your instincts, use us for support and guidance.
Sonja and Apollo

[fluffmum]

The ultrasound did show enlarged liver, things have moved so fast since the new vet took over for which I'm eternally gratefull:)

Were back at the vets a week on Tues to have further blood screening done,I will be sure to ask many questions.

Marilyn

[Squirt's Mom]

Hi Marilyn,

If Mr. Harry has had the LDDS, ultrasound and ACTH then the diagnosis can be fairly well trusted. There are occasions where a non-adrenal condition can cause the cortisol testing to support a diagnosis of Cushing's even with all these tests and more...my Squirt is one of those cases...naturally! :rolleyes:;) For this reason and others, we ask all these questions and like to see the actual test results.

I know it often seems like we are questioning the vet or the process your baby has been through, but that isn't it at all. We are here for the pup first and foremost and everything we ask, share, or recommend is based on our personal experiences as well as years of study on the condition by members well versed in such things. We just want to make sure from the very first that you and Mr. Harry are off on the right foot. ;)

Be as vague as you need to be...we will keep prodding... ;):D Just remember we do it out of concern and care for Mr. Harry and you.

The state of mind you describe is familiar...HA! There were a few websites about Cushing's that helped me understand more about what was going on and what people were saying to me. ;):o I am on a different computer these days and don't have my files yet but I will look the sites up and post them for you in a bit.

Stay in close touch over the next little while, answer questions as best you can, read until things start to make a bit more sense, and ask your own questions. That will help clear the fog more than anything...did for me, any way. :)

Hugs,
Leslie and the girls - always

[fluffmum]

Thank you Leslie I have read this link http://www.kateconnick.com/library/cushingsdisease.html over and over and all the symptoms could be Mr Harry they are talking about.

Although I have noticed a BIG difference in the polydipsia, polyurea & polyphagia since commencing on vetoryl 60 mgm.

Marilyn

[Squirt's Mom]

Ok....here are the links I was talking about -

The first two are found in our Resource section:
http://www.k9cushings.com/forum/showthread.php?t=180

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

Long Beach Animal Hospital:
http://www.lbah.com/canine/cushings.htm


This one is a site by Dr. Chuck Newman:
http://www.newmanveterinary.com/CushingDiag.html

Hang in there!
Hugs,
Leslie and the girls - always

PS. I see I missed your last post about Kate's site. duh.... LBAH is a bit more in depth and Newman's a bit more that LBAH but both are plain and easy to understand.

[fluffmum]

Thank you I will digest those :)

[Squirt's Mom]

Enjoy! :D

[Marilyn Brandt]

Hi--I'm Marilyn too, and I have a Bichon!!! My Sidney - 13 yr old male was just diagnosed too. We are planning to use Lysodern. Guess we will go down this road together. I must get a picture posted. Blessing, Marilyn Brandt and the Fluffers!!!

[fluffmum]

I have some results

22nd July ACTH stimulation test

cortisol pre 773(25-125)
cortisol post1120(125-520)

There are more can anyone advise me of any others needed

Marilyn

Marilyn sorry to hear about your wee ONE Mr Sydney looks like we may have a journey together

[Squirt's Mom]

Hi Marilyn,

Can you tell us what the units of measurement are for those values? Usually something like ug/dl, mnol/L, ect. Those are unusual numbers for cortisol so the units will help us put them into something we recognize.

Thanks!

[StarDeb55]

I'm going to assume that units of measurement for Mr. Harry's ACTH are nmol/L which, I believe, is the unit of measurement used in the UK, but please confirm that for us. In the US, we are used to seeing these results reported as ug/dl, so to make the conversion you divide by 27.59 which gives you:

Pre: 28.0 ug/dl
Post: 40.6 ug/dl

The post result does appear to be consistent with Cushing's. What I have a concern about is the pre, it appears to be unusually high. Does Harry get pretty upset & stressed during vet visits? If he does, that might be the explanation for the pre result.

Debbie

[fluffmum]

Full Blood results 15th July(prior to ACTH)

UREA 2.2 mmol/1 2.50 9.64 ***LOW***
Ca 2.23 mmol/1 1.98 3,00
CHOL 10.30 mmol/1 2.84 8.27***HIGH***
CREA 47 mmol/1 44 159
GLU 5.80 mmol/1 4.28 6.94
PHOS 1.23 mmol/1 0.81 2.10
TBIL 2 umol 0 15
TP 60 g/1 52 82
GLOB 31 g/l 25 45
HCT 42.8 % 37 55
MCHC 31.5 g/dl 30 36.9
WBC 31.7 X 10^9/L 6.0 16.9 ***HIGH**
GRANS 29.8 X 10^9/L 33 120***HIGH***
%Grans 94%

L/M 1.9 X 10^9/L 1.1 6.3
%1/m 6 %

PLT 505X10^9/L 175 500 ***HIGH***
Retics 0.4

Hope this helps,maybe someone can explain those results to me.

To answer your question he's usually fine when visiting the vet,he had been given a slight sedation prior to the procedure.

Tomorrow 3rd he returns for follow up bloods since commencing Vetroyl.
I see a difference in him,he is more alert,the drinking is back to normal.....but the hunger Mr Harry lives to eat:eek:.
He has almost stopped the panting thank gawd,that was really distressing and no amount of reassurance could help him.
He is walking further without wanting ''carried''
All in all I'm so relieved,he appears to be progressing:) as the vet told me he would.

We...his sister Poppy and I just want our boy back to normal again.
Were missing the fun round here:D

Marilyn xox

[StarDeb55]

Marilyn, I'm a medical lab tech with 30+ years experience. After looking at this lab work you posted, Harry's WBC count is very high, along with this absolute granulocyte count. This is very indicative of a probable bacterial infection. Has the vet said anything about this? I would be asking, if he hasn't.

Debbie

[fluffmum]

Thank you,when those results were taken,he did have a wound infection and was prescribed Amoxyl 40 mgm

What do you think of the other results?

Marilyn

[zoesmom]

Hi and welcome, Marilyn and Mr. Harry -

Just browsed quickly thru your thread and have one concern. And that is that 60 mg. seems like a rather high dose for a bichon. I noticed someone did ask you about Harry's weight but didn't see if you posted it - unless I missed it. Dosing is determined by the dog's weight. How many days has he been on the vetoryl now? Five or six?? And did your vet give you any prednisone, before starting the med? (They don't always do that with vetoryl.) If you've been reading here, tho', you probably know what to watch for as far as signs of too much medicine. What did Harry's abdominal ultrasound show - specifically the adrenals and liver? (There are usually notes with the u/s describing all the findings/appearance of the organs. Maybe you could get those and post too.) Looks like both the LDDS and ACTH were done and that Harry was getting some steroids for awhile? Just wondering about Harry's weight, mostly. Sue

[fluffmum]

Harry weighs in at 23lbs this is the starting dose for his weight,to your question about prednisone ...no I never got them.....should I????
All I was told was his liver was enlarged it was scanned and nothing sinister showed up as for the adrenals that was never mentioned.I will ask tomorrow tho.
Today is his 10th day on Vetoryl

[zoesmom]

Hi Marilyn-

It's true that Dechra does give the range of 1 - 3 mg of vetoryl per lb. of dog's weight. But Harry's dose is at the top of that range (3 mg.) and his weight is at the bottom of the recommended weight for that dose. Univ. of California at Davis starts dogs at 1 mg./kg (to get Harry's weight in kg, you'd divide 23 lbs. by 2.2 - so basically he's 10 kg which would suggest a starting dose of 10 mg using that formula). I can only say from my own experience and the experiences many others here, that starting at the low end of the range is the safest approach. You can always increase the dose, after you see how it's going (via the ACTH monitoring tests).

I don't know how many dogs we've had here who were started at the mid to upper end of the 'range' for their size who ended up having some trouble. My own girl, Zoe, was 80 lbs. when she started on vetoryl and after several bad starts at multiple 'high' - and then even mid-range - doses, she was finally able to tolerate a dose of only 45 mg. (We did have to increase over the coming months, but did so gradually with no further problems.) So just sayin' . . . .you might want to be real careful in monitoring Harry for signs of too much medicine (loss of appetite, weakness/lethargy, diarrhea, vomiting). The prednisone can counter the effect of too much med. The fact that he's gone 10 days with no problems is a good sign. But just be aware that their cortisol can continue to drop steadily for the first several weeks, and that dose amount could catch up to him soon. Alternatively,, that's why I asked about the adrenals. If both were enlarged (or of equal size) on u/s, then he most likely has pituitary-dependent cushings. But if just one was enlarged, that could indicate adrenal-based cushings and dogs who have that often tolerate/need a much higher dose. So maybe some more things to discuss with your vet. Sue

PS - If he had the LDDS, those results can sometimes indicate which type of cushings it is. Not always, but sometimes. If you can get those, too, and post, great.

[littleone1]

Hi Marilyn,

Welcome, also, from Corky and me.

I agree with what Sue said about the dosage. When Corky started taking Trilostane, he weighed over twenty pounds. His IMS started him on 20mg once a day. His dosage has had to be increased over a 9 month period, but he is still on less than 3mg per pound a day. He is taking 31mg a day. I'm really glad that his IMS started him on a lower dosage.

I hope you get good test results tomorrow.

Terri

[fluffmum]

Thank you....Interesting:confused: I will ask the vet tomorrow.

So far so good he has none of those contra-indications

He's in tomorrow,then again in 4 weeks for another blood screen.

There's nothing wrong with his appetite..Mr Harry lives to eat always has!!!

[fluffmum]

Those are his new results of his Latest test taken 3rd Aug

cortisol pre 773 normal range (25-125)
cortisol post 45 normal range (25-125)

the vet is happy with those results,he's to be re tested in 4 weeks

I must say Mr Harry is like a new dog I cann't believe the difference in him :D

Marilyn

[Spiceysmum]

Hi Marilyn,

The post ACTH results have dropped dramatically since the last test on 22nd July and yet the pre has stayed the same. This seems strange to me but someone more experienced will give you more advice. You wouldn't want the post number to go any lower. It's good to hear that Mr Harry is well but I'm sure you know what signs to look for if his levels did go too low. It's not usual for vets here to give prednisone as a precaution but my vet did give me some when I was concerned.

Linda

[zoesmom]

Hi again Marilyn -

I agree with Linda - in that the pre # seems odd since it's exactly the same as on his previous ACTH. Could you check it again - to see if it's maybe wrong (or check with the vet that it's correct.) If it is, that would indicate a non-stimulatory response which usually calls for stopping the trilo for at least a week. Plus that post number is on the very low end. The therapeutic range in ug/dl for trilo dogs is about 1.5 to 5.5 (to convert to ug/dl, divide by 27.56 which gives you something like 1.6 for his post number). That may be ok as long as Harry is acting fine. But you wouldn't want him to drop any lower. But right now, it's really difficult to offer an opinion based on that still very high pre-#, other than we usually expect to see it below or about the same as the post number. If the 773 is an error, and his pre # is actually much lower than the 1.6, that would be important to know as Harry hasn't been on treatment very long. Sue