Bailey 13.5 yr dachsie - Cushings for sure

[Standsmom]

Hi. I'm new here. We live in CO. We have two dachsies (and three children; 11, 9, and 5). Bailey is our older girl (only by a year though). She is 13 1/2. She is our sweet black and tan. Sammy is our feisty little red. Bailey has been sick with this for a while I think. Last year was when she started drinking too much water, dumping trash cans and being constantly hungry. A couple of months ago, we did a full blood panel on her which pointed to cushings, but we've been debating - because of her age and because of the cost. We just weren't sure if the cost of the treatment would be a smart decision or not. But honestly, the sicker she has become, the more it's become an issue of her comfort. She is extremely weak now. I have to carry her in and out. I've started putting rugs around more of the kitchen because her hind legs slip out from underneath her and I'm so worried she's going to break a leg or something. She has finally reached the point where she will leak a little urine while she is sleeping or she'll pee in our closet in the early morning hours because she can't hold it any longer. Anyway, we finally did the acth this week and she was confirmed with cushings. Now we're trying to get started on something. Trilostane I think. I'm really nervous about the meds. I'm worried about the side effects, the cost, the hassle of getting them regulated, the cost of the repeat acth tests ($260 each time). I'm worried that we waited to long to get started. My vet says we did not. And I still wonder if we shouldn't just let her go. I was happy to find this forum this morning. I hope that I will learn a lot. A lot of the medication talk sounds kind of a like a foreign language to me, so I have a long way to go. Anyway - nice to meet you all.

[Harley PoMMom]

Hi and welcome!

I want you to know that Cushing’s is a treatable disease and not a death sentence. Delivery of competent and humane medical care by a skilled GP and/or specialist experienced in the diagnosis and management of Cushing’s has a significant impact on patient survival and well-being. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Cushing's is one of the most difficult diseases to get a confirmed diagnosis. Strong symptoms are a huge part of making the diagnosis, and a Cushing's savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis. Since Cushing's is a slow progressing disease one does have the time to have their furbaby properly diagnosed.

I was wondering if you could get copies of all test/s that were done to confirm the Cushing diagnosis and post the results here. Also could you post any abnormalities that were found on the CBC/Chemistry blood panel. All information we can get our hands on is very helpful in giving you more meaningful feedback.

The two most rx'd medicines, which are Trilostane/Vetoryl and Lysodren/Mitotane, can be compounded and this is a huge cost savings.

This article written by renown Cushing expert, Dr Mark Peterson, has information that can help cut the cost of an ACTH stim test: How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing (http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html)

Please know we are here to help in any way we can.

Love and hugs,
Lori

[Gusmonster]

So sorry to hear about Bailey. I'm just starting this process with my boy too so I have nothing to offer yet but sympathy and good wishes but you definately have those. Good luck, Deb and Gus

[frijole]

Just wanted to make sure you know cushings is not a death sentence! It really isn't. Ignoring could result in death but most people don't figure out their dog has cushing's til years after the fact... myself included.

The key is to have a vet that has experience and to get up to speed enough to ask questions and understand what is going on. It is not cheap to treat but the biggest expense is the testing that you do in the beginning until you get regulated. Once you find the right dosage the cost is just the drug.

Cush dogs cannot tolerate fat so no more table scraps/people food unless lean meat. Dog food should also be low fat but high in protein.

Bailey will be just fine and we can help answer questions along the way. You will find before long that you are not alone and that this isn't so bad. Hang in there. Kim

[Standsmom]

Oh my goodness! You guys are so positive and so nice. !! Not that I didn't expect you to be friendly, I guess I just didn't know how much I would appreciate hearing a few more optimistic opinions about Cushings. I do have a copy of Bailey's full blood panel, but I didn't get a copy of her acth yet. I will dig it out in a little bit and give you some of those details. P.S. We started 20 mg of trilostane per day yesterday. I feel very impatient to see some results. But we haven't seen any adverse reactions yet either. ::crossing fingers::

[Standsmom]

Ok, I'm not sure what you want to see from her blood results. So I'll list the things that were highlighted either because they were high or low. Again, this was the regular blood panel that led us to suspect Cushings enough to go ahead with the acth that we did last week.

ALK. Phosphatase 4210
ALT (SGPT) 937
AST (SGOT) 92
CK 206
GGT 143

BUN 45
CHOLESTEROL 365
GLUCOSE 133
TCO2 (Bicarbonate) 13
B/C Ratio 64.3
TRIGLICERIDE 127
ANION GAP 25
T4 0.6
NEUTROPHIL SEG 84
LYMPHOCYTES 6
EOSINOPHIL 0
ABSOLUTE LYMPHOCYTE 708
ABSOLUTE EOSINOPHIL 0

SPEC cPL 845

[Harley PoMMom]

The Vetoryl dosage is based upon a dog's weight, how much does Bailey weigh?

Please remember that we are here for you and we will help in any way that we can.

Love and hugs,
Lori

[Harley PoMMom]

Could you post the reference ranges for the lab numbers you posted, you don't need to retype everything just edit your post and type them in.

I see that Bailey Spec cPL is very elevated, does she show symptoms of pancreatitis?

[Cyn719]

Hi and welcome to the forum - we found out our Penny had Cushings at 8 and didnt treat until 11 and she will be 12 in November - she had her ups and downs but she is doing ok now -- you are in good hands here - these people are wonderful - we call the people on this forum Cush Angles -- they really are!!! My Penny had a bad situation and they were all here to help me and if it was not for them I dont know where Penny would be today -- we use the Vetroyl and she is doing good now that she is on the right dose - make sure your vet knows what they are doing and anytime you are unsure check with Dr Tim Allen who is the vet at Dechra the company that makes the Vetroyl - he is wonderful and you can call him toll free - keep posting and keep us updated and keep your questions coming!! Also there is another wonderful Cush Angel named Sonja who is a member who has an adorable dachie named Apollo - she will most likely join in soon -

[Standsmom]

Bailey weighs 17.3 lbs.

Results -- Reference Range
ALK. Phosphatase 4210 -- 10-150 U/L
ALT (SGPT) 937 -- 5-107 U/L
AST (SGOT) 92 -- 5-55 U/L
CK 206 -- 10-200 U/L
GGT 143 -- 0-14 U/L

BUN 45 -- 7-27 mg/dL
CHOLESTEROL 365 -- 112-328 mg/dL
GLUCOSE 133 -- 60-125 mg/dL
TCO2 (Bicarbonate) 13 -- 17-24 mEq/L
B/C Ratio 64.3
TRIGLICERIDE 127 -- 10-100 mg/dL
ANION GAP 25 -- 12-24 mEq/L
T4 0.6 -- 1.0-4.0 ug/dL
NEUTROPHIL SEG 84 -- 60-77%
LYMPHOCYTES 6 -- 12-30%
EOSINOPHIL 0 -- 2-10%
ABSOLUTE LYMPHOCYTE 708 -- 1000-4800 /uL
ABSOLUTE EOSINOPHIL 0 -- 100-1250 /uL

SPEC cPL 845 -- > or =400 ug/L Serum Spc cPL concentration is consistent with pancreatitis.


Regarding the pancreatitis, a couple of years ago, Bailey began vomiting and sleeping in odd places, not acting like herself, not eating, etc. We took her in and my vet suggested a pancreas thing. Honestly, I don't even remember what we did for her. But she recovered well. The only thing I've noticed lately that could be consistent with pancreatitis is depression and weight loss. She isn't eating very well right now either. Almost like she just doesn't want to go to the trouble to chew up her food. The vet I spoke to about the blood results said that any one/all of the numbers that were flagged could be that way simply because of the cushings. So I didn't think anything of it. I have noticed on a day that she gets a snack from the table or steals food from my kids, she feels a lot worse. So, we have greatly cut back on the amount of people food she gets. We will probably just stop it altogether.

One more question: When beginning Vetoryl or Trilostane, how soon do you think we'll see any difference? Our first concerns are her thirst/urine output, her strength, and her overall energy and mood. I'd love to see her fur fill in again and her pot belly go away. But she is so weak I'm afraid every time I watch her walk anywhere. If we're not seeing any difference or any evidence that she's even taking anything, should we be concerned?

So far I feel okay with my vet. She owned a dog herself that had cushings, which she treated for 3 years before her dog died from something entirely unrelated to the cushings. She also talked about several patients that she is treating currently and says she tries to charge as little as possible for the tests, etc. I guess I don't really know any better, but she's been our vet for approx 10 years and has always been very good with our dogs.

[Harley PoMMom]

Dog's with pancreatitis need to fed a very low fat diet so your suggestion of stopping the table scraps is a really good idea.

The dosage that your vet rx'd, 20mg of Vetoryl, seems reasonable to me with Bailey weighing in at 17.3lbs. Did your vet suggest giving Pepcid ac 20-30 minutes before Bailey gets her dose of Vetoryl? Since Bailey does have pancreatitis the Vetoryl may be upsetting her tummy. Also the Vetoryl has to be given with food to be properly absorbed.

Symptoms such as excessive thirst/urination and ravenous appetite should decrease in about two weeks but all dogs are different and react differently. I would not be concerned if Bailey's symptoms do not subside quickly, the concern would be if she displays signs of her cortisol going too low. Signs of too low cortisol are any of the following; lethargy, vomiting, diarrhea, and Bailey not acting like herself.

When is Bailey's next ACTH scheduled? And is your vet aware that the ACTH stim test has to be taken 4-6 hours after the Vetoryl dose is given?

Since Bailey acts like she doesn't want to go to the trouble of chewing her food have you tried putting her food in a blender or food processor with some boiled chicken breast and rice and pureeing it?

Please keep up posted and remember we are here for you and Bailey.

Love and hugs,
Lori

[Cyn719]

Hi I used the pedcid ac also with Penny and it seems to help alot - like Lori said 2 weeks you should see some changes - but when on Vetroyl keep an eye on Bailey - just make sure the drinking does not stop completely and Bailey doesnt get lethargic - the adjusting period can be sensitive - also did your bet give you predisone to use in case this did happen? Lori is giving your great adivce and may have already asked you this - you are doing a great job wtih Bailey - hang in there:)

[Standsmom]

Bailey has been on the Vetoryl for several days. Everything seems to be progressing the way it was before we started the meds. She is getting weaker still. She is progressively less able to hold her urine. This morning, we found she had gone on her bed while she was sleeping. She wakes up consistently earlier every night panting. Last night it was 1:30 am. She couldn't get out of her bed by herself and when I helped her get up, she cried a little. Sometimes she even paces back and forth in the yard, pausing like she's going to go to the bathroom, but doing nothing and then pacing some more. We are feeling quite discouraged and very sorry for her. And now her 'sister' Sammy had a tooth pulled today which cost over $500, and they say she has elevated liver enzymes and her platelets are extremely high. Having old dogs is hard. Expensive, and hard. I don't know how people pay for all of these tests. Bailey's pills alone, if they work, will be $100 a month. At this point, however, we are really questioning her quality of life. This isn't a place I've ever been with a dog before. Bailey is the first dog I've ever owned. (I grew up with cats). And to add to the pity party, I'm sorry, but I just found out I have a blood disorder; and I'm going to need a full shoulder replacement in a few months. I feel like I'm an old dog too. I guess my main purpose for this update, however, is our concern about Bailey's continued progression of getting worse, instead of better. Any thoughts? P.S. Have you all noticed that the panting seems to be in direct correlation with the need to drink water? When Bailey wakes up panting in the night, her body is really hot and I find that she's extremely thirsty. A big drink cools her off and then she can go back to sleep.

[Cyn719]

How much trilo are you giving - it can take two weeks to see any improvement and sometimes longer for the panting to stop - Penny was the same way - the experts on this forum will be poping in to give you some advice soon - hang in there - I get it - I am not doing good with my health neither and it really takes a toll and the bills for the dog are so much!!!

[Standsmom]

Bailey is taking 20mgs per day. She weighs 17.3 lbs.

[lulusmom]

Did your vet tell you that you need to do an acth stimulation test 10 days to two weeks after starting treatment? This test will tell you if the current dosing is adequate. I will validate what Cindy has told you about resolution of symptoms. Not all resolve right away once cortisol is within the desired range and panting is usually one that takes a bit to improve. With Bailey being symptomatic after several days, there is a good chance that the problem is simply the dosing.