My dog treated for cushings still has urination issues

[stewiesmom]

Hi there. I was very happy to find this forum. My 10 year-old border collie mix was diagnosed with Cushings disease about two months ago and was put on trilostane given two times a day. When he has gone back to the vet for monitoring, all of his blood tests show that the medication is working, but he's still drinking and urinating a lot and apparently still can't concentrate his urine. Currently the vet has him on antibiotics in case he has a secondary UTI, but they don't seem to be doing the trick. Nobody seems to know what is going on or why the medication is not solving this problem. Is this something you've encountered before?

[labblab]

Hello and welcome! :)

I have only a moment to post right now, so I apologize very much for first asking you a couple of questions instead of giving you an answer to yours :o. But can you give us a little more information about your dog's overall health history and also the symptoms/testing that led up to the Cushing's diagnosis? Also, how much does your dog weigh, and do you have the actual numbers for the monitoring ACTH tests that have been performed since starting on the trilostane? All this info will help us to give you better feedback and support, so thanks so much in advance for anything more that you care to share with us.

Marianne

[stewiesmom]

Thank you so much for the help. By the way, my pup's name is Stewie. I initially took Stewie to the vet because of the excessive drinking and urination problems. The urine sample showed that, in fact, Stewie was not concentrating his urine. The vet did an initial blood test to rule out diabetes or kidney disease. An ACTH stimulation test confirmed the Cushings diagnosis. Stewie then had an ultrasound to confirm that he had Pituitary Dependant Hyperadrenocorticism. Stewie has been to the vet twice to make sure his dosage is correct. We've brought in numerous urine samples as well.

Stewie has been healthy overall, although he was horribly abused before I owned him. He currently weighs about 50 pounds. I haven't weighed him since I last had him at the vet, but in picking him up, he feels as if he is gaining weight.

I don't have Stewie's test results in front of me, but I'll get them from the vet and get them posted.

In the meantime, thank you for your help. It was scary at first hearing the Cushings diagnosis and now it's just frustrating to not know what the problem really is.

Thanks again,
Kristin

[Squirt's Mom]

Hi Kristin and welcome to you and Stewie! :)

I love the name! It brings to mind a spirit of joy, goofyness, and zeal for life! :D

Even tho weight gain is not typical with diabetes, that was my first thought. Diabetes can come on very rapidly, seemingly overnite, so even if this was ruled out in the initial testing phase, it might be worthwhile to check again.

Another thought is hypothyroidism. If that was not ruled out, I would have that checked as well.

Just to add to the fun of Cushing's, it is not uncommon for our pups to have more than one endocrine disorder so it is prudent to keep an eye on the whole system. ;) Issues within the endocrine system share many of the same signs to boot! Heaven forbid cush parents get comfortable or anything! :eek::p

These are easily checked and easily dealt with but wanted you to be aware of the possibilities.

It will help us to see the results of his monitoring tests plus the diagnostic ones. We have learned to our dismay that sometimes a vet will tell us the results are "normal" or "good" or "just where we want them" only to find that is not at all the case once the results were shared. We have many Trilo moms and dads who will be chiming in with their experiences and this info helps us all give better feedback.

One of the quirks with Trilo is that it sometimes takes quite a bit of tweaking to get the dose just right. Some pups do better with twice a day dosing VS once. Does he seem to exhibit more signs at night?

Yep, scary is the word alright. My whole world came crashing in the first time I heard "Cushing's". :eek::(:confused::mad::(:confused::eek: But, as I learned more I came to terms with it and, while I still hate the condition, I am do not feel as helpless or hopeless. You have found the very best place to be when faced with this disease. You will find the collective knowledge and first-hand experience amazing, and the support unbeatable!

In no time, you will find yourself feeling stronger and braver than you ever thought possible...all because you are going to be armed with your own knowledge. Read all you can and ask lots of questions; we will do our best to help you. We are all here to learn and share!

Most importantly of all, you and Stewie are no longer alone. We will walk every step of this journey with you. I am glad you found us and look forward to learning more in the future about you both!

Hugs,
Leslie and the girls - always

PS. Here is a link to our Helpful Resource section. Full of good info!

http://www.k9cushings.com/forum/forumdisplay.php?f=10

And a link on Trilo:

http://www.k9cushings.com/forum/showthread.php?t=185

[jrepac]

my first thought is also diabetes...

if cortisol is being controlled even somewhat, you'd be ok w/the drinking and urine concentration...unless a UTI was present..


Jeff & Angel Mandy

[lulusmom]

Hi Stewie's mom and welcome to the forum.

I see you've already gotten some good feedback from members but I wanted to make a few comments on Stewie's PU/PD (peeing and drinking).

Scenario 1. Some cushddogs have had PU/PD for so long that the kidneys have lost all the stuff they need to concentrate the urine again. This is called medullary washout and sometimes it takes a while to get things jump started.

Secenario 2. If Stewie's acth stimulation test results are within the acceptable therapeutic range, it could be that the PU/PD has not resolved because the dose is not effectively controlling the cortisol throughout the day. Trilostane has a short half life and starts to lose it's enzyme blocking abilities as quickly as 8 to 10 hours. Stewie could be one of the small number of dogs that may eventually require twice daily dosing to see resolution of all symptoms.

Scenario 3. Stewie could have diabetes insipidus (DI) but I think it's a little premature to try to diagnose that just yet. One of my cushdogs has DI and unfortunately, it's the kind that cannot be controlled with medication. This is not to be confused with Diabetes Mellitus, which Jeff and Leslie have mentioned.

Scenario 4. UC Davis has done extensive studies on Trilostane and they report some dogs on Trilostane never see resolution of PU/PD. I do hope this isn't the case with Stewie.

We'll be in much better position to try to figure things out with you after we have a chance to see the acth results. In the meantime, I'm providing handy links to information on Trilostane (Vetoryl) that can be found in our Helpful Resources section, as well as a link to good information on causes of polyuria/polydipsia.

http://www.k9cushings.com/forum/showthread.php?t=185

http://web.archive.org/web/20060904045120/http:/courses.vetmed.wsu.edu/vm552/urogenital/pupd.htm

I'm sorry for the circumstances that brought you here but I'm glad you found you way to us. We'll be looking forward to hear more about Stewie and his test results.

Glynda

[Rebelsmom]

Welcome to you and your Stewie. Most have already given you some great advice, but I wanted to give you some of my boy Rebels story. He is around 40lbs and started out with 60mg of trilo, this started helping a little but we ended up having to go to twice a day dosing. Same amount (60mg) but split into 2 doses. This has worked really well for him. I'm also wondering what Stewie's stim numbers are?? Normal ranges for "healthy" dogs are diffrent than those of cush dogs as I have come to find out. Normal ranges for cush dogs tend to be between 1.5 and 5. Rebel seems to do better when his runs on the low side, which is a little scary for me but has him doing wonderful. His last test he was at 0.9 pre and 2.3 post, just to give you an idea. Maybe Stewie's cortisol is still a little high to control his pu/pd. I know it took sme time for Rebel's to go back to normal. Looking forward to hearing more about Stewie.

Melissa