New & Confused

[Karma's Mom]

Karma is a boxer / bull mastiff & weighs 88 lbs. She will be 6 in October. June 2010 her weight was 65 lbs. & she has always been very energetic. We winter in the Phoenix Az from Nov - Mar 2011. She started putting weight on around Christmas. I took her to the vet when we got back to Canada, she had thinning of hair on her tummy, alot of gas, lethargic & just not her normal self. T4 level was a little low, Vet prescribed Levothyroxine .6 mg twice a day. June 23 I took her back to vet because I had not seen any improvement. The vet took an xray, he didn't like her breathing (we have had a hot summer)- her heart & lungs looked good, her liver was enlarged - he wanted to do an ACTH test. Her base line was 5.18 / 25.7
He told me she had cushings & wanted to start her on meds. I starting searching the internet - she wasn't drinking much more water, not peeing in the house, hair loss was slight only on her tummy & she had a pot belly. She didn't seem to have enough of the symptoms - I was terrified of the treatment - I was in denial - I brought up to the vet the possibility of valley fever - 2011 in AZ was very high for infections. The vet said no to valley fever, based on the acth test it's cushings. So on July 10, I started the 5 day loading dose of Lysodren, Karma gets 750 mg once a day. On July 21 & 28 she got 750 mg once a day. On Aug 2 she went for another acth test - results are base line 9.39 / 27.18 - Vet called with the results which are higher than her 1st acth test, he wants to do the ldds on Monday, I am not to give Karma her meds this Thursday, but continue with the thyroid meds.
From the info I have read Karma's dosage of Lysodren seemed quite low based on her weight.
Why would her numbers go up after being on the Lysodren.:confused:
Any help or info would be very much appreciated - I just want My Karma back to herself

[Squirt's Mom]

Hi and welcome to you and Karma! :)

Typical loading dose is 50mg/kg/day. At 88 lbs, Karma weighs 40 kgs. So she would need 2000 mg/day. When she is loaded and goes to maintenance, she will take 2000 mg/week divided into 2-4 doses a week.

Has Karma had an abdominal ultrasound recently? If not, I highly recommend she have one. Not only will the adrenals been seen, if possible, the kidneys, liver, intestines, gall bladder, bladder, stomach, spleen will be seen, too. Cortisol is the body's natural response to stress, including internal stress, and the tests for Cushing's can be effected by non-adrenal illnesses/conditions. My Squirt is a case in point - five different tests showed positive for PDH, the pituitary form. But an ultrasound found a tumor on her spleen and once it was removed, her cortisol returned to normal. Without that U/S, that tumor would have ruptured, killing her so I cannot begin to tell you how much I value this particular test.

One simple test is the UC:CR. It can rule out Cushing's but cannot diagnose it. It is a non-invasive urine test and a good place to start if your vet is questioning the diagnosis. At the very low dose she is getting at the moment, it is possible that is why the cortisol is rising - there is nothing to hold it in check.

Is her thyroid controlled on the dose of med she is getting for that? The signs of the two condition mimic each other so it can be a bit difficult to determine which is off - if either is. :rolleyes:;)

You are in the right place for help. The knowledge and first-hand experience here is astounding, the support and care unmatched. Please ask any questions you have and we will do our best to help you understand. We are all here to learn and help each other out. ;) I know how distressing this disease can be, especially when we love our babies as you so obviously do but take a deep breath and relax those shoulders just a bit - you and Karma are no longer alone. We will be with you every step of the way. So give her a big hug and tell her ya'll have a new family by your side. :)

Hugs,
Leslie and the gang

[Maya]

Hi there!:) Welome to you and Karma. You have definitely come to the right place. We have a really great caring bunch here who are eager to help anyone who asks. We all know only too well how you feel in this moment. I cannot offer any advice as my Maya is on Trilo (vetoryl)
She was diagnosed in March. Not all dogs display all the common symtoms of Cushings. Maya drank normal amounts of water, no peeing in the house, no pot belly-she actually lost weight!! So, I had a real weird case on my hands...I wouldn't believe she had it! :confused: We only found out after blood tests followed by an ultrasound and then an ACTH test.
As Leslie said, an ultra sound is a good way to go. They can tell a lot by that...
In my lack of experience...what I do know is that if it is Cushings, once Karma is stabilised on the right dose of medication, over time you will see more of the 'old' karma come back to you! I have found that Cushings is not as bad as I thought it would be.
Hugs from Leah and Maya:)

[lulusmom]

Hi and welcome to the forum.

I'm sure sorry for the circumstances that prompted your need to find us but I'm glad you made it here. Cushing's is the most difficult canine disease to correctly diagnose which makes it the most misdiagnosed disease as well. Because of the many cases of misdiagnoses we've seen here and the number of gp vets who have limited experience with cushing's, we like to look over our vets' shoulders.

It would really help us if you could please post the abnormal values, including normal reference range for the most recently blood chemistry and complete blood count (CBC). A urinalysis is routine in diagnosing cushing's so please post the results of these as well, if your vet did one. Also as Leslie mentioned, an abdominal ultrasound is the imaging of choice with cushing's as an xray does not provide information on the adrenal glands. If your vet did an ultrasound as opposed to an xray, can you please get a copy of the findings and post them here. A dog with cushings, unless very early in the disease, does not have normal looking adrenal glands.

I am getting the impression that your vet is not well versed in treating a cushdog. As Leslie said the usual, but not exclusive, dose of Lysodren is 50mg per kg. Your vet prescribed a woefully inadequate dose of 18.75mg per kg, which is the most likely reason why it had no effect at all. The daily dose should also be halved and given twice a day for maximum effect, as well as mitigating any stomach upset caused by larger doses.

Dogs who do not have cushing's will usually not respond to Lysodren; however, I'm not sure that this is the case with Karma. Boxers are in the top five breeds that seem to be predisposed to cushing's and that combined with the two acth stim tests, low T4 and symptoms are definitely consistent with cushing's.

As for knowing when to start treatment, there is no cure for the disease and the object of treatment is to mitigate problematic symptoms, symptoms that are usually more bothersome to the owner than the dog. If Karma's symptoms are mild at the moment and she has no other concurrent conditions that are being complicated by excess cortisol, there is no reason to rush to treatment. Cushing's is a very graded disease which takes a very, very long time to severely compromise the immune system and affect internal organs. Since you are at square one, you have plenty of time to re-evaluate things. Take some time to read up on the disease and the drug (Lysodren). You may also want to consider consulting with an internal medicine specialist as they are the most knowledgable and experienced with cushing's and other endocrine disorders. You can access a wealth of information in our Helpful Resources section, including information for beginners and locating an internal medicine specialist in your area.

Would like to babble on and on but have to run to a meeting now and earn my keep. :D

Glynda

[Karma's Mom]

Thank you so much for your quick reply.
You suggest having the ultrasound test done before the ldds?
Karma has not had a urine test
Thyroid test - Apr 19........June 24
T4 8.4 12.0
T3 1.14 Not done
TSH 0.14 Not done
My vet is calling me tomorrow. They use another clinic for ultrasounds.
Thanks from Karma & Kelly

[lulusmom]

Thank you for posting the thyroid values. Can you please give us the normal reference ranges? Did your vet do routine bloodwork? There is a pattern of abnormalities that is common in Cushing's so I would be interested in knowing if Karma's blood tests reflect those abnormalities. i.e., high ALKP, ALT, triglycerides, cholesterol.

You already have two acth stim tests that show high levels of cortisol and since the acth stim test is less likely to yield a false positive results than the LDDS, I personally would pass on the LDDS and go straight to an ultrasound. Actually, I'm not sure I would do either unless my dog was showing more overt symptoms such as excessive drinking and peeing and a voracious appetite. It is these symptoms that pet owners need to observe in order to determine if the dog is loaded on Lysodren. Since Karma doesn't have these symptoms, it is very risky to load her. Now that I think about it, it's really good that your vet prescribed an inadequate loading dose.

If Karma has symptoms that are troubling you and you feel compelled to treat her, then I would suggest that you 1) consider consulting with an internal medicine specialist (if finances allow) and let the specialist complete the testing and confirm the diagnosis; 2) if the diagnosis is confirmed and treatment is agreed, then consider treating with Vetoryl as opposed to Lysodren.

If you do decide to go forward with further testing with your gp vet, the ultrasound is invaluable in checking surrounding organs but more importantly, it can differentiate between a pituitary and adrenal tumor. If a dog has an adrenal tumor, surgery can be a cure if the dog is a viable candidate and the pet owner can afford it. Your vet should have determined which form of cushing's Karma has before confirming a diagnosis. Most dogs (80% to 85%) have piutitary dependent cushing's (PDH) so the law averages says that Karma probably has PDH; however, if she has an adrenal tumor, I believe you and your vet need to know so if you choose not to do surgery, you can monitor it via periodic ultrasounds.