13 Year Old Miniature Dachshund

[linda126]

My 13 year old Dachshund (weight 23 lbs.) was diagnosed with Cushings. Had inconclusive tests at first but ultrasound showed swelling in glands. He has been on Trilostane 30 mg. once a day for a little over 2 months. In the long process of diagnosis he also went blind and doesn't appear to hear much either. Vet says he can see a little light. How do you know when they are getting the right dosage besides the blood tests. My vets seem to be a little baffled and are sending me 200 miles away for a consult with a Veterinary Hospital. He doesn't seem to move much. About 2 hours after his medication he is active and moves around quite a bit, but it's mostly walk a few feet and plop down. He eats ok, doesn't seem to have overthirst anymore, panting has pretty much stopped, but how do I know if he's really getting better. Has anyone else had the blindness come on with the cushings. I heard it might take 4-6 months to see real results other than the thirst & panting which seemed to cease a little after starting medication. The vet said the last test seemed to indicate he might need a higher dose but wanted me to go for the consult first. Are there any natural remedies which may work with the Trilostane?

[lulusmom]

Hi and welcome to the forum.

I have real concerns about the cushing's diagnosis so I am very happy that your vet has referred you to a specialist. I am assuming an internal medicine specialist, right? It appears that your vet confirmed a diagnosis and started treatment based solely on imaging which showed plump adrenal glands. Nonadrenal illness, atypical cushing's and any other condition that causes adrenal hyperactivity can cause plump adrenal glands. FYI, cortisol is the hallmark in typical cushing's and atypical is diagnosed when cortisol is normal and one or more of the other adrenal hormones are elevated and the dog is symptomatic. If an acth stimulation test and/or a low dose dexamethasone suppression test were negative for cushings, that means that cortisol is most likely normal and you never, ever give Trilostane to a dog with normal cortisol. I am assuming that your vet did an acth stimulation test after starting treatment which is why s/he said a dosing change may be needed. Can you post the results of that test here? Can you also please get copies of all of the tests that were done to diagnose your dog and post those results here too. We only need to see the abnormal values on the blood chemistry and cbc, including the normal reference ranges.

With respect to the blindness, there is a condition called Sudden Acquired Retinal Degeneration (SARDS) which is thought to be connected to cushing's but nobody seems to know what that connection is. Some dogs with this condition will start to exhibit cushing like symptoms before the onset of blindness and others will develop symptoms after going blind. I believe the few studies done on SARDS dogs show that most of these dogs don't necessarily have elevated cortisol levesl but rather elevated intermediate hormones. I am therefore concerned that your dog has SARDS and most likely atypical cushing's. If there is any good news for a dog with SARDS, a lot of cushing's savvy vets choose not to treat the symptoms because quite often the symptoms resolve on their own within months of going blind.

If your are going to be seeing an internal medicine specialist, s/he will most likely be knowledgable of SARDS and will probably refer you to an opthamologist. If not, you should consider doing that yourself.

I'm sorry for the circumstances that brought you here but I'm glad you found us. We're here to help you in any way possible. Sorry for all of the questions and requests but the more information we can get, the better able we will be to provide you with meaningful feedback.

Glynda

[littleone1]

Corky and I also want to welcome the both of you.

You have found a wonderful group of very caring, supportive, and knowledgeable people that are here to help you in anyway they can.

Terri

[linda126]

I will get the test information and post it. I live in a rural area so don't have a lot of good vet facilities here.

[linda126]

I have all the test information and scanned it. There are 8 reports. Can I email those to someone as jpg files. I don't see where I can upload scanned items here.

[linda126]

My profile says I cannot post attachments. It will take me a while to type all of the 8 tests results. If I could I would like to email the scanned reports to someone if you'll give me an email address. They are all .jpg files.

[Squirt's Mom]

Hi,

Some of our members have used Google Docs for scanned test results. Here is a link where you will register then start:

https://www.google.com/accounts/ServiceLogin?service=writely&passive=1209600&continue=http://docs.google.com/&followup=http://docs.google.com/&ltmpl=homepage

If you decide to type it out, all we really need to see are the abnormal values from the blood work, the three numbers from the LDDS and/or HDDS, the two numbers from an ACTH, and any notations from an ultrasound. If your baby has had the UTK panel, there will be six numbers. Please include the units of measurement (ug/dl, nmol/l, ect.) and the normal ranges for each. This helps a great deal in interpreting these tests.

Hope this helps!
Hugs,
Leslie and the gang

[linda126]

I uploaded to googledocs but not sure if this will work. Will someone let me know if they can see the results. I made it open to anyone who knows the link.

https://docs.google.com/leaf?id=0B4R-IYwlODg3ZmExMWQzM2EtNGNiMy00ZGNjLTk2ZWYtNjI4YjczNm I1ZGU1&hl=en_US

[linda126]

That only gives the last test. I hope this shows all 8

https://docs.google.com/?pli=1#query/vr?view=2&parent=folder.0.0B4R-IYwlODg3MDFkYWFmZDktYTE3Yi00YWM2LTk5NzMtODY1YjBkYT FlZWI3&filter=images

[linda126]

Guess I really don't know what I'm doing but if those don't work, try this one

https://docs.google.com/leaf?id=0B4R-IYwlODg3MDFkYWFmZDktYTE3Yi00YWM2LTk5NzMtODY1YjBkYT FlZWI3&hl=en_US

[lulusmom]

Linda sent me Copper's tests and I have recapped the pertinent information below:

Blood Chemistry – 4/4/11
Potassium 6.0 (3.5 – 5.0 mmol/L)
Calcium 13.1 (9.7 – 12.2 mg/dL)
ALKP 1238 (20-155 U/L
ALT (SGPT) 93 (3 -50 U/L)
Triglycerides 147 (25 – 73 mg/dL)

Urine Protein/Creatinine Ratio – 4/6/11
Normal at 0.12 with reference range of 0.00 – 0.19

Low Dose Dex Suppression Test – 4/9/11
Baseline above normal but normal suppression.

Blood Chemistry – 4/28/11
Potassium 5.8 (3.5 – 5.0 mmol/L)
Calcium 13.3 (9.7 – 12.2 mg/dL)
Albumin 4.4 (2.3 – 3.9 g/dL)
ALKP 3337 (20 – 155 U/L)
ALT (SGPT) 165 (3 – 50 U/L)
Protein Total Serum 7.4 (4.8 – 6.6 g/dL)
Cholesterol 630 (126 – 359 mg/dL)
Triglycerides 99 (25 – 73 mg/dL)

Bile Acid Test – 5/13/11
Both Pre and Post meal within normal ranges

First ACTH Stimulation Test after 30mg SID (taken 4.5 hours post dosing) – 5/21/11
Results in nmol/L
Pre – 59 (15 -110)
Post – 155 (220-550)

Results converted to ug/dL
Pre – 2.1
Post 5.6

ACTH Stimulation Test – 6/16/11
Results in nmol/L
Pre – 153 (15 – 110)
Post – 217 (220-550)
Results in ug/dL
Pre – 5.5
Post – 7.9

My layman's comments: Cooper fits the profile of a SARDS dog to a tee. With the exception of the ACTH stimulation tests, every blood abnormality, negative bile acid test and negative LDDS test is classic SARDS. I don't believe Copper has typical cushing's and if your vet had done a full adrenal panel as part of the diagnostics, he most probably would have seen that cortisol was normal but big elevations in one or more of the adrenal sex hormones. These sex hormones can cause the same blood abnormalities seen in typical cushing's and it can cause adrenal hyperplasia (enlarged adrenal glands). If Cooper were my dog, I would stop the Trilostane immediately. Dogs with normal cortisol should never be given Trilostane. If your vet needs confirmation of this, he should contact Dechra, the manufacturer of Vetoryl. Many of us have communicated with Dr. Tim Allen, who is an internal medicine specialist on staff at Dechra. Dr. Allen told me that under no conditions should a dog with normal cortisol be given Vetoryl (Trilostane). Also, if your vet would like additional information on SARDS and how it affects the adrenal sex hormones, please give him the link below. This is a link to an abstract but as a veterinary professional, he should be able to access the entire study via one of the many veterinary journals out there.

http://www.jaaha.org/cgi/content/abstract/45/5/207

Dr. Jack Oliver, recently deceased, was the world's expert on adrenal steroids. As you can see, he co-authored this paper. I communicated via email with Dr. Oliver about three years ago about SARDS and he told me the same thing I've already told you. Most, if not all, dogs with SARDS will have elevated sex hormones at some point and it's not always necessary to treat the symptoms because they often resolve on their own. He specifically told me that if a SARDS dog was his, he would wait 4 months before doing anything.

In closing, I just want to say again that there is every reason to believe, based on the facts and all of the test results, that Copper has been misdiagnosed and he should not have been prescribed Trilostane.

Glynda

P.S. Here is a link to Dechra's contact information: http://www.dechra-us.com/Default.aspx?ID=365

P.P.S. I forgot to provide you with an additional link to a case study for a SARDS dog in Canada. I think you will find it interesting and confirm a lot of the things I've mentioned. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC339566/

[lulusmom]

Linda has asked that I update her thread with information she sent me via email. She would like to know if anybody can provide a holistic way to help with kidney function or any herbal things that may help.


First we got good news then bad. He didn't have Cushings--did have SARDS. That was good news, but she said there is other things going on so they ran some tests and when they did the ultrasound found a mass near his kidneys, actually quite large. We had to make the decision to operate, which would cost about $4400 (we already had spent $1,200 today plus all the money we had put in before). And she wasn't sure that removing the tumor would actually solve everything else. We made the decision to treat the symptoms and hope the mass is slow growing and not operate. I cried for hours. There is no way we could afford the $4400 so we are filled with guilt about that. We are giving him an IV under his skin to get more fluids in him. Decided to do that ourselves since they wanted $2,000 to admit him to do it. The IV is because he is dehydrated from the kidney problems. Also blood pressure is high so giving him blood pressure meds. They will reevaluate next week to see if the IV is helping the kidney function better. Urine is not concentrating and he is somewhat dehydrated. She said it was the right thing to do taking him off the Trilostane. He's not in pain now, so I'm looking at finding maybe a holistic way to help with his kidneys while we pray the tumor is slow growing.

[Harley PoMMom]

Hi Linda,

CoQ10, wild salmon oil, and a kidney-friendly diet are some of the things that I tried with my boy, Harley. Here is a link to an article called: "Supplements Recommended for Dogs with Kidney Disease" http://www.dogaware.com/health/kidneysupps.html

Hope this helps.

Love and hugs,
Lori

[linda126]

My dog was treated for cushings with Trilostane for 70 days before I was referred to an internist. If your dog goes blind shortly after the Cushings Symptoms and they aren't familiar with SARDS you need to get to an Opthamoligist for a correct diagnosis and an internist. SARDS symptoms sometimes resolve on their own. My dog still has problems because they found a mass with an ultrasound, but he did not, I repeat, did not have Cushings. Most vets like mine weren't familiar with SARDS and just pushed the blindness off as old age and cataracts. The opthamologist told me my dog didn't have cataracts at all. Very important to get a correct diagnosis at the beginning.

[Squirt's Mom]

Hi Linda,

Very good to hear from you again at last! :) And a very good post about SARDS and Cushing's. I am glad you went to an IMS and eye doc and got the correct diagnosis for Copper. SARDS can really confuse an already confusing condition for sure and Copper's story will serve to help others who may find they are facing the same thing.

Please keep in touch and let us know how Copper is doing. I have two blind babies - one from glaucoma and one from Hydrocephalus. They both function great and are happy, loving itty bitty ones. So don't get too down over Copper's loss of sight - they usually handle it much better than we do. ;)

Hugs,
Leslie and the gang

PS. I merged your latest post with Copper's original thread. We like to keep all the info about each pup in one place. That makes it much easier to look back at the history if needed. ;)

[linda126]

I just got more bad news that kidneys are worse than last week. The sub q fluids didn't help. The specialist said that although uncommon the trillostane I was giving him may have done permanent damage to adrenal glands. Just what I needed to hear. They did another baseline cortisol test but won't get the results for a few days. Now my only hope is to improve the function of his kidneys and pray that the mass he has will not grow any larger. Other than the blindness he doesn't seem in too much distress yet. They gave me some prescription kidney (Hills K/D) dog food and aluminum hydroxide powder (phosphate binder) to bring down phosphorous levels to mix with it. Her recomendations to my vet will be to recheck kidney values and blood pressure, sub q fluids if he goes downhill and if the calcium remains elevated than very caution steroid therapy should be started. I don't know what is in store for him but just the fact that she mentioned that the extended decreased cortisal production could be from taking the trillostane for the 70 days he didn't really need it. I have spent close to $3,000 now ($2,000 this week alone for diagnostics mostly). If the SARDS had been correctly diagnosed Copper might be in better shape. Has anyone ever used a product called Tripsy from pet well being for improving kidney function. I bought some. Figured it couldn't hurt so will be giving him that. It is mostly herbs in it.

[linda126]

Thank you I will check into this. The KD dog food they gave me was $2.00 a can and he eats a can a day so not too bad--just hate the idea of a prescription for it and would like to develop a diet myself.
How much CO Q10 and Salmon Oil would you give a dog?

[linda126]

Giving Copper a herbal medication from Pet Well Being called Tripsy for improving kidney function. He's been on it 4 days and I'm not sure that has anything to do with him perking up but he seems to be much perkier. Don't know how his kidneys are doing since checked last but he seems to be better than last week. Hoping it's doing something for him. He's even chewing on a busy bone and he hasn't done that in weeks. He barked a few times today too and he very seldom does that anymore. He sure doesn't seem to be going downhill as fast as the vet made it sound. He's still eating well, drinking lots of water and sleeping comfortably. Keeping my fingers crossed.

[Squirt's Mom]

Hi Linda,

I am glad to hear that Copper is a bit perkier than he was. I have never heard of the herb(s) you are giving. What are the ingredients in it? I hope it helps and gives you and Copper some great quality time!

I don't use CoQ10 but we do use salmon oil. The kind we use, Only Natural Pet, is a liquid with a pump and it tells you the dose by weight. I have also used Kronch and it also tell you. The capsules are just a PIA to use since they are too big for my babies to swallow - I was having to poke a hole in the caps and squeeze the oil out. Which got incredibly messy! :rolleyes:

http://www.onlynaturalpet.com/products/Only-Natural-Pet-Pure-Salmon-Oil/999060.aspx

http://www.animalworldnetwork.com/lakse-kronch-100percent-cold-pressed-wild-salmon-oil-for-cats-and-dogs-35-2-oz-lo1000.html

Be sure to clear it with your vet and make sure the oil is ok.

Hugs,
Leslie and the gang

Hugs,
Leslie and the gang

[Harley PoMMom]

The dosage of CoQ10 for a dog with kidney disease is 1-2mg per pound of body weight daily, preferably split into two doses. Give with food that contains fat for best absorption.

So glad to hear that Copper is feeling better.

Love and hugs,
Lori

[linda126]

Copper is still with us. The vet pretty much told me not to bother bringing him in anymore for tests but we are giving him iv fluids, using a product called tripsy which I found online, and he just plugs along. He has gotten used to his blindness and walks better. He has a tumor on his adrenal gland which is quite large but they wanted $4,400 to operate and he's already 13 years old. We figured he probably wouldn't survive the surgery so we are just trying to make him comfortable. The vet told us in mid August he'd probably only have a few weeks or a month. It's over a month now and he's still eating and drinking well and doesn't appear to be in pain. Trying to appreciate everyday we have with him. Am going to take him in for a blood test in a few weeks just to see if it's worse or staying the same.

[addy]

Hi Linda,

Thank you for the update on Copper. Every day we get to spend with our dogs is truly a blessing. I am so sorry your journey was so difficult.
Keep on loving him and cherish every moment, no matter how small.

Hugs,
Addy