Tess - 13 year 2 month Working Cocker Spaniel with Cushings

[bongolier]

Hello everyone,

I'm new here because my little girl Tess of 13years 2months has had an awful time recently finally resulting in her being treated for Cushings. A few weeks ago she collapsed and we eventually ended up in Glasgow University Small Animal hospital where she had an MRI. This showed that she had had hundreds of mini strokes (bleed outs) due to high blood pressure. We then found (by ultrasound scan) out this was due to a tumor on one of her adrenal glands. As a result her cortisol control is affected and now she has Cushings. She has been on Vetoryl for a few days now and we are taking her back up to hospital on Weds to get , we think, a low dose dex suppression test. Because of her age, we decided not to operate and just treat her to give her the best possible life she has left. I think her circumstances are unusual and any advice anyone can give would be appreciated. We would also like to give her some holistic treatment to support the rest of her system, any suggestions?

Whether it is relevant or not, we live in Scotland.

Many thanks in advance

[addy]

Hi and Welcome,

I am sorry to hear about Tess having a hard time. I want to take a moment to welcome you to our forum. As we wait for our moderators to stop by, it would help them if you could post any abnormal test results Tess has had.

Also, what does Tess weigh and what is her dose of Trilostane?

We have members who have pups with adrenal tumors and have done quite well on Trilostane. Some also with high blood pressure.

Many will be along soon to give you feed back.

In the meantime, please start reading through our reference section. It is a good place to start.

My Zoe has pituitary Cushings and started Trilostane last Saturday. We will go for an ACTH stim test on Monday to see where her cortisol is.

Hang in there,

Addy

[Harley PoMMom]

Hi and welcome to you and Tess,

High blood pressure can be common with a dog having Cushing's. But with Tess having both an adrenal tumor with high blood pressure I am wondering if a diagnosis of pheochromocytoma has been ruled out.

If you could tell us more about Tess's Cushing diagnosis that would really help us to provide you with more meaningful feedback.

What test/s were done to confirm her diagnosis of Cushing's? What symptoms was Tess displaying that led you or your vet to test for Cushing's in the first place? Is Tess on or did she have any other herbs/supplements/ medicines? Was a CBC/Chemistry blood panel done and if so, could you post any abnormalities with the reference ranges and units of measurements.

Please know we will help you and Tess in any way we can so please do not hesitate to ask any questions.

Love and hugs,
Lori

Some links that I hope you will find useful:

Canine Pheochromocytoma. (http://www.addl.purdue.edu/newsletters/2007/Spring/CP.htm)

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

[littleone1]

Corky and I also want to welcome you and Tess. I'm also sorry to hear that she has been having such a rough time.

Corky also has an adrenal tumor on his right adrenal gland. Due to his age and other medical issues, he is not a good candidate for surgery. He has been successfully treated with Trilostane for 20 months.

I hope Tess does well on the Vetoryl, and that you'll soon start seeing improvements in her.

Terri

[frijole]

Hi from me as well. I too wondered if this tumor is a pheochromocytoma. My dog was falsely diagnosed with cushings and it took close to a year to figure it all out. Pheos are very rare but my girl has one.

Please tell us about the symptoms you are seeing. Are the constant or sporadic?

Glad you found us.

Kim

[bongolier]

Thanks all for responding so quickly.

The vet specialist did talk about a pheochromocytoma and said that only 1 in 500,000 cases have this type of tumor. The person who has been seeing Tess is the Professor of the department. In discussion with a friend, she suggested that a rare case such as that, would be of interest to the academics and hence why we are being seen by the Prof (not an everyday occurrence).

He is a European expert in internal medicine and has never seen a pheochromocytoma in a living dog.

We have to go back in few days to get her checked out after being on Vetoryl for 10 days.

I have asked for blood tests to supply you guys with numbers.

Unfortunately we were in a similar position with her sister, Molly, last year. Difference is that Molly had canine renal failure.

Blood test numbers here in Europe use different units than US. Does anyone know how to convert?

[frijole]

Sending hugs. I understand that pheochromocytomas are rare but frankly the reason they are 'rare' is because most vets and human doctors fail to diagnose them. They are most often not found until after the dog or person has passed away.

The only reason I now know what is wrong with my dog is that I pushed and pushed for answers. Like I said she kept getting diagnosed with cushing's but things did not add up. The treatment did not work. She quit eating. She had spells when her BP would spike (I didn't know it at the time because the vet I went to didn't even have the machine to measure it!) During the spells she would shake all over, sweat, her skin turned pink, her back legs would fail and she would not eat.

I recently went to a 'human forum for pheos' so that I could read first hand what people were experiencing. It was a real eye opener. They had been misdiagnosed for years as having migraines headaches, high BP, depression. They described it as they could actually feel the blood rushing thru their veins up towards their head and the headaches were awful. Afterward they had no energy. They had dizziness and sometimes their legs felt like wooden poles. They also have very bad heartburn.

This is why I asked what the symptoms are and if they are constant or not. IF they are not I would strongly suspect a pheo. It took me so long to figure this all out that performing the operation to remove it is really not an option. I treat my dog by giving her weekly acupuncture, Vitamin B12 (don't overdo it as it causes peeing if too much is given), Pepcid AC before every meal, high bp meds.

My biggest challenge is keeping weight on her. Pheos emit adrenaline and as a result their bodies eat up calories. My dog always weighed between 17 and 18 pounds. When diagnosed she was at 14.5 lbs. She got down to 12.3 lbs recently and I am fighting to put calories into her.

Just sharing my story in case any of it is pertinent. Kim

PS Good point on converting the numbers. If you post the results, the ranges for normal and the units of measure we will figure it out.

[bongolier]

Hi Kim,

We are only new to this - we are watching Tess like a hawk for any signs of behaviour (note spelling is because I am Scots!) change.

She is on trilostane (vetoryl) and we were told that, if she is lethargic, then to stop. She is quite lively, almost normal, eats well and doesn't have too big a pot belly, not losing hair, does drink a bit more than normal (not excessively) or urinate more than normal.

Apart from the head tilt and imbalance from the strokes, she looks and acts fairly normally. There is no drastically sporadic change in what she does at all.

We saw with our own eyes the tumor from an ultrasound scan. I am learning more about strokes, tumors, adrenal function every day.

The small animal hospital we go to is one of the leading European establishments and they have all the latest equipment available to them.

You seem to have had an awful time with your dog, it is bad when you have to push for answers. I feel Tess has given us many years of pleasure and fun - now it is our turn to help her when she needs us most.

[frijole]

Yes it has been a challenge but I did successfully deal with a cushing's dog for over 4 years before this dog was diagnosed. :) That is why I am so diligent in sharing my story.

My concern is that Tess does not seem to exhibit the signs of cushing's. Pot belly, excessive thirst (like gallons a day - a normal amount is l cup of water per pound of weight), excessive hunger. The leading specialists in treating this disease all agree that it is best not to treat the disease if these signs are not present.

That said, I am sure your vets are using the trilostane because of the strokes. I think you will have your answer in the follow up testing to measure cortisol. If the cortisol levels are not reduced then you will know that either the dosage is too low or it is not cushing's.

Can you share with us the tests that were done and the numbers from them? Also, what dosage of trilostane is Tess on?

Wishing you and dear Tess the very best. BTW my clan is from the upper highlands of Scotland. :D Kim

[apollo6]

Welcome to our forum
Small world, my husband Douglas was born in Glasgow , Scotland.
My Apollo is also on TRilostane and I do holistic to help with other issues. Milk Thistle is good for the liver. Many on the forum use it. Also pumpkin is good. I would suggest you find a holistic vet in Scotland who could work with you. you may have a Scotland Holistic Veterinary Association. You are looking for quality of life for your sweet Tess. She is beautiful. We are here to support and help you any way we can.
Hugs Sonja and Apollo

[bongolier]

Hello all,

As I said before, I can only give the numbers I am given (European not sure how they compare with US numbers)

Before taking Vertoryl, Tess's post ACTH test was 1101. After 10 days the post ACTH reading was 200.

I think the normal is 120 so she is heading in the right direction - vet seems pleased.

Problem is controlling her high blood pressure - she is taking tabs for that and has to go back for further tests. Will report when I know more.

[bongolier]

Now we are a few weeks in with Tess who, in the circumstances, is doing quite well. My avatar shows Tess (only a few years ago) jumping along the beach - her favourite place.

The vet has said to me that Tess is "cushingoid" as a result of her adrenal tumor (don't know if it is benign or malignant).

She gets 30mg of Vetoryl per day. She weighs in about 20lbs. I think Americans might call her an "English Cocker Spaniel".

Her blood pressure has come down tremendously, from a high of 195 / (something) to 137/90 mmHg. She is a very anxious girl and hates vets. We asked if her blood pressure could be taken with us holding her. As 135 is considered normal - she is effectively normal and threat of further bleed-outs is minimized.

She has had her ACTH test done again.

Pre-Vetoryl, her cortisol levels were preACTH (142) postACTH (1101) nmol/l.

After being on 30mg Vetoryl daily for a week her cortisol levels were preACTH (?) postACTH (195) nmol/l. Needless to say we were pleased about these results but do realise that we are only taking the first few steps on a long journey.

Vet is recommending we keep her on 30mg Vetoryl per day. She is also taking 5mg Istin and 5mg Fortekor per day for her blood pressure.

As far as supplements are concerned she gets Omega 3 fish oil, Vitamin E. We also give her reishi, shiitake and maitake mushroom concentrate - in capsule form - as we have heard good reports about these slowing down tumour growth, boosting immune system and (I think) helping boost T-cell production.

Since we started all this she has become a much happier wee dog and jumps for joy (and food!) when she wakes up in the morning. As our main purpose is to prolong a good quality of life for her - we will continue like this. We realise that our situation has moving goalposts and so we will respond to each turn at the time.

One question though. We don't know whether the tumor is benign or malignant. If it does turn malignant, does anyone know about cytotoxic drugs?

[BestBuddy]

Hi to you and Tess,

You have had a great drop in cortisol in the first 10 days. It would be wise to keep a close eye on her to see that she doesn't go too low. A lot of us noticed that the cortisol kept dropping for the first month or more.

If you see any symptoms, or just generally unwell, then get Tess back to the vet.

Jenny

[lulusmom]

I just wanted to validate what Jenny has already told you. That is a huge drop in cortisol in just a week and I'm afraid it can continue to drop further. Keep a close eye on your girl.

Glynda

P.S. Your avatar picture is awesome. Tess is gorgeous!

[bongolier]

Don't worry, we'll be watching carefully. Please note that my numbers are European numbers not US units.

We had problems with our other girl, Molly, last year when she had renal failure (we had to PTS in November). I also joined a support group then for CRF.

It was difficult for me to start with as everybody seemed to have different numbers. Eventually worked out that US units in blood tests are different.

We use kg, mg and litres, etc.

Will report back once next ACTH test is done on 27th July. We are going to stay near the beach all next week - so Tess will be having a great time!

Alistair

[BestBuddy]

Hi Alistair,

I'm an Aussie so I can relate to your numbers. Mostly our blood results on an ACTH need to be divided by 27.59 to get US numbers. So your latest ACTH would be 7.06. Using trilo if all symptoms have abated and you are under 9 (248) then that would be ideal. Of course each dog seems to do better at their own level as long as they don't get too low.

Jenny

[Squirt's Mom]

Mornin',

Here is a handy dandy unit conversion site that John, Roxee's Dad, found.

http://www.vin.com/calculators/default.htm#

All you do is select the item you are trying to convert and the units desired - in this case, cortisol in ug/dl; then enter the number only; then select to convert from Standard International to Us Measurements; then click Calculate. It will give you the measurements in ug/dl, which are what we are used to seeing. We have seen just about every unit there is, I guess, since we have members from all over the world and this site is really easy to use.

The post number on the latest test (195 nmol/l), which is the number that counts, converts to 7.07 ug/dl. ;)

Hugs,
Leslie and the gang

[bongolier]

Hi Leslie,

Thanks for that. I'm sure it will be a big help. Hope you don't mind but I've shared the link with friends I made last year on a Facebook support group for dogs with canine renal failure.

Dogs with CRF have their bloods closely monitored as well (although different things like creatinine and urea levels are more interest to them)

It's a bit like having Google Translator for Blood Tests!

A.

[bongolier]

Just been to the vets to pick up more meds for Tess. She has been taking Fortekor but they have given me a generic drug called Nelio.

Has anyone heard of / used this drug. Is it as good as Fortekor?

I am very wary of generics as they must be cheaper for some reason....!

Tess still doing well and enjoyed her time at the seaside last week. I am going back up at the end of this week as well - so she can enjoy it some more (only wish the weather here in Scotland was better!)

A.

[lulusmom]

Hi Alistair,

Fortekor is known here in the U.S. as benazepril and according to the quick research I did, the active ingredient in Nelio is benazepril. It appears that Nelio is only available in the UK so I am hoping that one of our UK members may be familiar with the drug and can give you some feedback.

Glynda