Cushing disease and lack of appetite

[Tazman/Beagle]

My 14 year-old beagle was diagnosed with cushing's just over 3 months ago. He suddenly was having accidents in the house, quite a few weekly. His water intake increased and his appetite had increased. We started him on the Lysodren when first diagnosed, he had the iniital higher dose and is now taking 1/4 of a tablet five times per week.
In the past couple of weeks, his appetite has decreased. He would avoid his food altogether. I changed his food to give him incentive to eat, but that lasted about two weeks. He has refused his food to the point of vomiting. I now give him some can food in one bowl and dry food in another. Sometimes he'll eat the dry, sometimes the can food, sometimes neither. His water intake has also increased and with that, the accidents in the house have started again. His breathing has been heavy also (as if he's stressed out).
We took him for another ACTH test and his levels are high again (17).
I am frustrated at this point and need advice. The doctor does not understand the decreased appetite. He was also tested for a urinary tract infection which was negative. He initially was doing well while taking the Lysodren, but now where at this point. I just don't know what to do. Is his condition deteriorating? Need advice.

[apollo6]

Welcome
other's well be along to give you insight on the Lysodren. If your little guy starting losing his appetite and is throwing up it has got to be the medication. I would question your vet.
I can't give input on the Lysodren. Is your vet knowledgeable about cushing and it is so important you know which kind he has. This will determine which is the right form of treatment. If you give the wrong medication for the wrong cushing it can be a problem.

We are here for you. You are not alone.

[AlisonandMia]

Hi and welcome,

Given that his cortisol numbers where high on the last ACTH stim test (how long ago was that?) it sounds like it is something other than too much Lysodren/low cortisol causing his problems.

The thing that springs most readily to mind would be pancreatitis - has your vet tested him for this? There is a very accurate and specific test called the cTLI test. (Here is a link to some info on pancreatitis here: http://www.vet.uga.edu/vpp/clerk/west/index.php)

It could be a lot of other things too -but I think that checking out the possibility of pancreatitis would be the first step. Pancreatitis can be very serious and is potentially deadly so it is something you would want to test for pretty promptly.

Good luck and keep us posted.

Alison

[addy]

Hi and Welcome,

I know others have mentioned Lysodren can cause stomach upset and they suggest giving Pepcid 20 or 30 minutes I think it was, before serving the meal.

The lysodren users will all belong to chime in on that and you could ask your vet about it.

I know my IMS said if we have to put Zoe on lysodren we have to think about the gastro side effects. She has colitis.

Just a thought. I know Cushings is frustrating, it is such a puzzle. But hang in there, we have so many experienced members, we'll all get through it together:)

Addy

[Harley PoMMom]

Hi and welcome from me and my boy Harley! My boy Harley has pancreatitis but does not exhibit any signs of it. When I tried loading him with Lysodren, his appetite decreased substantionally. I initially thought he was loaded but he was not, it seems the Lysodren was having some unwanted reaction to his pancreas and it was making him feel ill and not want to eat.

A more accurate (and newer) way that many vets are now using to diagnose pancreatitis in dogs is the spec PL test.


Pancreatic lipase immunoreactivity (PLI):

Recently, assays for measurement of pancreatic lipase immunoreactivity in dogs and cats (cPLI and fPLI, respectively) have been developed and validated. As mentioned previously, many different cell types in the body synthesize and secrete lipases. In contrast to catalytic assays for the measurement of lipase activity, use of immunoassays does allow for the specific measurement of lipase originated from the exocrine pancreas.

The sensitivity of serum TLI concentration was below 35% and that of serum lipase activity was less than 55%. In contrast, the sensitivity for serum cPLI concentration for pancreatitis was above 80%.
In another study of cats with spontaneous pancreatitis serum fPLI concentration was more sensitive and more specific than serum fTLI concentration or abdominal ultrasonography.

These initial data would suggest that serum PLI concentration is highly sensitive and specific for the diagnosis of pancreatitis in dogs and cats.
http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml

Spec cPL is the current gold standard blood test for diagnosing canine pancreatitis. To run a Spec cPL test, the vet needs to send a fasted blood sample to IDEXX Labs or Texas A&M Lab. The results come back sooner from IDEXX Labs. Here is a link to read more about the spec PL test: http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf?SSOTOKEN=0
(http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf?SSOTOKEN=0)

Hope this helps.

Love and hugs,
Lori

[Squirt's Mom]

Hi and welcome to you and Tazman! :)

It looks to me as if something other than the Lyso is causing your babies current problems. Pancreatitis was my first thought, too. Cush pups are prone to this condition so it wouldn't be surprising for him to have developed it.

We will have many questions for you in the coming days, but for now I think you need to get Tazman in and have him tested for pancreatitis asap. When this organ is inflamed, the enzymes it releases are not properly used and they begin to eat on adjacent organs, like the liver. This is not a condition that "wait and see" can be applied to - it needs to be addressed asap.

While he is there, I would also suggest he be tested for diabetes. This condition can come on almost overnight so even if this was ruled out earlier it would be wise to recheck now.

Please keep in touch and let us know how things are going.

Hugs,
Leslie and the girls - always

[lulusmom]

Hi and welcome from me too.

I won't echo what the others have already mentioned but I would appreciate it if you could post the results of the acth stimulation test, both pre and post to include the reporting unit. I am assuming the reporting unit is ug/dl yes? Also, can you tell us how much Tazman weighs and what was the loading dose prescribed by your vet.

I do hope your vet has instructed you to withhold the Lysodren until Tazman is feeling better and eating normally. Lysodren should never be given to a sick dog and a cushingoid dog that is vomiting and not eating is a sick dog. What testing has your vet done to determine the cause of Tazman's apparent GI issues? I am assuming that he did a complete blood chemistry and if so, can you please post the high and low values, including the normal reference ranges and reporting units. Others have mentioned pancreatitis which is a possibility but dogs in severe kidney failure drink and pee buckets, vomit and stop eating all together. Did your vet rule this out?

If you see no improvement in Tazman and your vet cannot give you any answers, I highly recommend that you find an internal medicine specialist in your are and get Tazman in asap. You will probably need a referral from your vet and he should be happy to give you one, especially if he has no idea what is wrong with Tazman. If you don't know of an IMS in your area, you can do a search using the link below. If you are comfortable with telling what city you are in or near, we may have members that can provide you with a name.

http://acvim.org/websites/acvim/index.php?p=3

I'm so sorry that Tazman is having such a tough time of things right now and I do hope you get some answers quickly. The more information you can provide about Tazman's medical history, including any test results, the better equipt we will be to provide you with more meaningful feedback. As others have already mentioned, pancreatitis is serious and so is sudden and severe kidney failure so getting Tazman to somebody that you can tell without a shadow of a doubt that neither of these conditions are causing his problem is, in my opinion, is a very high priority.....like yesterday.

Glynda

[jrepac]

I would think your vet would have you hold off on the Lysodren for a few days...17 on the ACTH is not THAT high....the perceived need to get it down to single digits is just that, perceived...

lyso can suppress appetite, cause stomach upset, etc.

pancreatitis is definitely something to check for...

[Tazman/Beagle]

I took Tazman back to the doctor to have blood work done on his Pancreas and Kidneys. The test came back negative. Diabetes was ruled out also. He's maintained his weight, 32 pounds. I started giving him Pepcid before I feed him. His appetite is still not up to par, but he seems to be eating small amounts of can food and then will "snack" on dry food that I give him in a small bowl. He does show signs of being hungry, so maybe it is the Lysodren upsetting his stomach. Instead of giving him a quarter tablet five times a week, the doctor said to give a half a tablet twice a week. He seems more content today (after making these adjustments) and is drinking less water now=less accidents. So, we're taking it day by day. He's almost 15 years old, so I guess he's a tough cookie!

[StarDeb55]

A belated welcome to you & Tazman! As several other members have mentioned already, lysodren is well known for causing GI upset in some pups. The Pepcid is a good idea.


is drinking less water now=less accidents.
I must alert you to this statement that you made in your last post as it is a common misconception for parents of newly diagnosed pups. Our pups do not have excessive urination because of the gallons of water they drink, it's quite the opposite. Their kidneys are working overtime because of the disease, therefore our pups are peeing buckets. They must drink large quantities of water to keep up with the excess urination or they can dehydrate quite rapidly, & become quite ill.

Debbie

[addy]

Hi,

Glad to hear you have a bit of improvement!!!!! The lysodren can be really hard on some dog's tummies.

Keep us up to date and have a great weekend!

Addy

[Bagel's Mom]

Bagel has been on 1325 mg of Lysodren for 17 months.( increased a little at first)
At first, I was instructed to give it all at once .BAD CALL...She had all kinds of issues and diarrhea, listless etc..
People here on this board directed me to the Dr. Feldman of UCLA-Davis lectures- He said NEVER all at once and spread out at LEAST 2 times or more in a week. anyway, I figured out a schedule where it would always be in her system- Tues and Thurs she gets 1/2 pill AM 1/2 PM total 500 mg per day
Sat 3/4 pill... once
I ALWAYS give her one generic pepsid in the Am..10 mg NOT the 24 hour one...I give that to her daily.Even on non Lyso days..
and the internal med Dr. said to give the Lyso with a fatty snack like cream cheese- it helps the body process it better.
She does fine with that.( Beagle/Bassett 34 pounds)
Being diabetic now, her food has to be consistent. She eats Purina DCO but I add about 1/2 jar of beef babyfood to mix it and flavor it well. Hope this helps. Awfully partial to beagles!!
Sande and Bagel