10 yrs. old Wheaten Terrier Mix: Possible Cushing's Disease

[Snoopy&Rummer_Mom]

Hello everyone. My name is Maria and my 10 yrs. old Wheaten Terrier mix, Rummer, appears to have Cushing's Disease. I am so glad to have come across this forum by coincidence because to tell you the truth, I am a bit freaked out since the vet told me this morning that Rummer may have this disease; you see, up until now she was my healthy dog. People say that nobody knows a dog like his owner and that is true in this case. I started noticing things that some people thought I was imagining.

About a month ago I started noticing that my normally lean girl started gaining weight. It was odd to me because I exercise her every day. Around the same time her appetite seemed to increase and she seemed to be hungry all the time; I am talking frantically hungry. She would eat her food furiously fast, then she would try to eat my Cocker Spaniel's food. To make things more odd, after she finished eating she would start begging for food. Immediately I knew something was off, but I didn't want to be a worrisome doggie mom. Well, two weeks ago she started getting really thirsty consuming almost double the amount of water she did before. Not even in the summer did she drink this much water. Of course because of all this water, she urinates more. But what really got me worried was the panting; she pants a little bit but now she does it more. I figured she was getting a little hot because instead of her bed, she prefers to lay down in the cold wood floor. In addition to all of these symptoms, she seemed to get a bit more exhausted when I took her on her walks. Anyhow, three days ago we went to the vet and they did a complete blood panel and based on the results they ruled out Diabetes and Thyroid issues like Hypo/Hyper Thyroidism. Liver and kidney seem to be ok. But based on some of the blood levels, the vet thinks it is Cushing's Disease. On Tuesday I am bringing her in for another test; I should remember the name but I freaked out when I heard Cushing's Disease. I know that I have to bring her in and during the day they will take blood samples to check her hormone levels. As the vet explained, Cushings can be hard to diagnosed and usually detected by exclusion.

Again, I have been reading some of the older posts, and I am breathing a bit easier. One question I do have, should I continue going in her normal walks? I don't want to tire her out unnecessarily. Look forward to getting more informed with all the information provided here. Thanks for reading my venting. 

[Harley PoMMom]

Hi Maria,

Welcome to you and Rummer and although I am sorry for the circumstances that brought you here I am so glad you found us.

Like your vet has mentioned Cushing's is one of most difficult diseases to get a confirmed diagnosis. Strong symptoms are a huge part of making a Cushing diagnosis and it does seem that Rummer does display strong symptoms.

If Rummer is staying all day at the vet for testing it sounds like your vet is going to perform a LDDS test which is the "gold standard" test for Cushing's. I was wondering if you could get copies of all test/s that were done and post the abnormal results with the reference ranges and units of measurement.

Cushing's is not a death sentence and is very treatable. The two most prescribed drugs used are Vetoryl/Trilostane and Lysodren/Mitotane which are strong medicines but are life-saving drugs for dogs with Cushing's.

As far as taking Rummer for walks I believe this is fine as long as you let her determine the length of these walks, meaning I would not push her, so if she enjoys her walks then I think she will benefit from them.

Please know we are here for you and Rummer and we will help in any way we can.

Love and hugs,
Lori

[Snoopy&Rummer_Mom]

Lori, thanks for the warm welcome. You have no idea what a comfort it has been to read previous threads and know I'm not alone on this. And sorry if I seem overtly emotional us just that my girl went through so much before I adopted her that I want the best for her, health included. I'm just glad I went with my instincts and took her to the vet as soon as I noticed the symptoms.

And I will definitely post the results from the lab tomorrow. Thanks again,
Maria

[Snoopy&Rummer_Mom]

As the day has gone by a few questions have come up in my head:

1. With all the water drinking, should I try to control how much water she drinks? The vet asked me to measure how much water she drinks over the weekend. Luckily I'll be here all weekend to make sure my other dog doesn't drink hers or vice versa.

2. How expensive are the mess usually? I have many vet expenses with my 14 yr. old Cocker who us the textbook case of a Cocker with all of their genetic diseases, so I would like to have a general idea.

3. Are there any dietary restrictions I should be aware of? Because both dogs are seniors I have them on Orijen senior formula and that seems to be working well.

4. If after the test on Tuesday it turns out that it point mire definite towards Cushings, should I request an ultrasound?

Thanks again!

[Harley PoMMom]

And sorry if I seem overtly emotional us just that my girl went through so much before I adopted her that I want the best for her, health included.
Maria

No apology needed as we all understand and can appreciate the loving bond one has with their furbaby.

[Harley PoMMom]

Hi Maria,

My replies to your questions are in blue.


As the day has gone by a few questions have come up in my head:

1. With all the water drinking, should I try to control how much water she drinks? The vet asked me to measure how much water she drinks over the weekend. Luckily I'll be here all weekend to make sure my other dog doesn't drink hers or vice versa.

Restricting water can be life threatening to a dog with Cushing's. Elevated cortisol makes the kidneys work more and since the dog is urinating excessively the dog has to drink a lot more water to keep up.

2. How expensive are the mess usually? I have many vet expenses with my 14 yr. old Cocker who us the textbook case of a Cocker with all of their genetic diseases, so I would like to have a general idea.

The majority of expense is with the diagnostic phase, after getting a confirmed diagnosis the expense does go down. We can also share with you some cost-saving advice about the ACTH stim test and about compounding the Cushing medicines.

3. Are there any dietary restrictions I should be aware of? Because both dogs are seniors I have them on Orijen senior formula and that seems to be working well.

Since muscle wasting usually happens with dogs with Cushing's it is important to feed a high quality feed with a really good protein source. Dogs with Cushing's are at a greater risk to develop Pancreatitis so a low-fat diet is also recommended.

4. If after the test on Tuesday it turns out that it point mire definite towards Cushings, should I request an ultrasound?

It is important to know whether Rummer has ADH or PDH. ADH is the adrenal type Cushing's and PDH is the pituitary kind. The LDDS test can, sometimes, differentiate between ADH and PDH, if not, an ultrasound is usually performed. If an adrenal tumor is present and it is causing the Cushing's, surgery is a cure.

Thanks again!

We are here to help so please do not hesitate to ask any and all questions.

Love and hugs,
Lori

[Snoopy&Rummer_Mom]

Lori, I think I may have deleted the post with the lab results and your reply. And based on your reply about Rummer not having a high ALP and whether the vet has asked to do a bile acid test, should I ask to do this before doing the LDDPS?

Also maybe you can put my mind at ease on something. Is it an emergency to do all these tests right away as in this week? The vet that saw Rummer this week is not her normal vet and I am not getting a warm and fuzzy. And her normal vet will not be back until next week.

Maria

[lulusmom]

Hi Maria,

You didn't delete anything by mistake. We experienced problems yesterday and it looks like we lost posts that were submitted for a good part of yesterday. Unfortunately, I'm not sure we can recover them so you may want to go ahead and repost the test results. Just the high and low values are needed. We're sorry for the inconvenience.

With respect to the ALKP, dogs are the only species that has a steroid induced ALKP enzyme but there is a very small percentage of dogs who lack the gene so it's possible Rummer may be one of those dogs. As I recall, the ALT was something like 151, which is usually the type of mild elevation we do see in cushing's.

Cushing's is a very graded disease so it shouldn't be a problem at all if you want to wait until your vet gets back to the office to schedule additional testing.

Glynda

[Snoopy&Rummer_Mom]

Glynda, thank you so much for the reply. So glad to know I can wait until next week. Wow, is it normal to feel like I've been holding my breath since I took her to the vet? :)

About the ALP , I didn't know that about the gene. And her ALT was 155.

Maria

[Harley PoMMom]

Was her bilirubin, creatinine, creatine kinase, and albumin within the normal ranges?

[lulusmom]

I'm seriously impressed that I was so close on my memory of Rummer's ALT. That usually doesn't happen. :D Actually the only reason I know about some dogs not having that gene is because I listen to audios of lectures given by the iconic veterinary endocrine specialists. I believe that little tidbit came from Dr. David Bruyette.

While us cushparents consider it perfectly normal, after hearing the word cushing's for the first time in relation to our precious pups, to hold your breath, scream obscenities, walk around like a deer in headlights and hug your dog so tight as to almost choke off their air supply, other people may think you are a little weird. :D:p:D

[Snoopy&Rummer_Mom]

Lori these are the results:
ALP: 56
Reference Range: 10-150U/L

ALT: 155
Reference range: 5-107 U/L
CK: 257
Reference range: 10-200 U/L
Creatinine: 1.1
Reference range: 0.4-1.8 mg/dL
Albumin: 3.6
Reference Range: 2.5-4.0 g/dL

Bilirubin: there are 3 different types listed but they are all normal

One question. I did notice that her cholesterol is really high at 487 (reference range: 112-328 mg/dL). Right now I am feeding her a really high quality food by Orijen. It us a senior formula with no grains. Should I be looking for something with less protein?

[Harley PoMMom]

Increased triglycerides and cholesterol are commonly seen in dogs with Cushing's. Both of these will often normalize when the elevated cortisol is treated. Abnormally high levels of triglycerides and/or cholesterol, known as Hyperlipidemia, can alter serum biochemical tests and is usually noted by the lab that performed the testing.

[lulusmom]

Was Rummer fasted for the bloodwork?

[Snoopy&Rummer_Mom]

Yes. She didn't have anything to eat since the night before around 7:00 PM, and I took her next AM at 8:30.

[lulusmom]

Okay. I was just wondering because if a dog isn't fasted, cholesterol can be elevated by a recent meal.

[Snoopy&Rummer_Mom]

Ok, so today I took the lab results to another vet who has handled various cases of Cushings, and she told me in her opinion it is not Cushings especially because her ALP is normal . She however was a bit concerned with the slightly above normal BUN. Ugh... so I am taking Rummer there because I have heard nothing bug great things about these vet. We'll see what they say.

[Harley PoMMom]

Clinical signs play a huge role in confirming a Cushing's diagnosis and although I am not a vet I do believe that the symptoms that Rummer is displaying a Cushing diagnosis is likely especially since diabetes and any thyroid issues have been ruled out.

Here are some links from our Resource Thread that have excellent and informative information about Cushing's: Cushing's disease and other adrenal gland disorders (Q&A with Dr. E.C. Feldman) (http://www.k9cushings.com/forum/showthread.php?t=2231) and Links to Cushings Websites (especially helpful for new members!) (http://www.k9cushings.com/forum/showthread.php?t=180)

[Skye]

Hello!
was catching up on your thread, i may have missed some things....BUT has an ultrasound been done? That helped me out tremendously and the angels can sure vouch for that one. also, proud of you for seeking opinion....have you considered asking for referral to see specialist? that will for certain get you on right track....
you wondered about protein, if there are not any renal issues..(?) i wouldnt think lowering the protein would be good....just my two cents worth. Grain free has its perks but there is some controversy on complete grain frees....some grains can benefit our animals but the form and ratio is very important. Many grains are not healthy for them. I would hold off on changing up the diet to much and first seek out what is happening and see if it is nutrition issue or indeed cushings. As the Cush Angels have said, clinical is HUGE in cushings...so even if testing says yes with low clinical hold off on treatment. Correct me if out of line on any of this angels, I learn a great deal from you! Follow their guidance, you can put faith and complete trust in in them, I know their wings fluttering around me and my girl have saved her, and carried me through some terribly stressful times, months more like it.
Big warm hugs from me and my girls to you and your baby

[Snoopy&Rummer_Mom]

Skye, thanks for the words of encouragement. This group has been a tremendous help especially in helping me with this stressful time. To answer your question, no an ultrasound has not been done. I have a lot of questions for my actual vet so I emailed her today and asked to meet with her next week when she comes back.

I do have a question that I hope do not sound stupid but can changes in food "trigger" Cushing's? I am asking because I started noticing all this changes when I switched my pups from their raw diet to normal kibble. Just asking.

And Lori by the way, thanks for all the links you suggested. I spent thus morning reading over them and learned so much more information.

Be blessed ladies :)

[Squirt's Mom]

Hi Maria,


I do have a question that I hope do not sound stupid but can changes in food "trigger" Cushing's? I am asking because I started noticing all this changes when I switched my pups from their raw diet to normal kibble. Just asking.

No such thing as a dumb question! ;) And up til a few months ago, I would have told you the answer to your question was, "no". But we have since learned there is such a thing as food dependent Cushing's. It is extremely rare and still much is not understood about it. I am giving you the link to a thread here about this subject where we learned about this form of Cushing's.

http://www.k9cushings.com/forum/showthread.php?t=3682

You will find several links in that thread that you can read and share with your vet just in case.

Hugs,
Leslie and the gang

[Snoopy&Rummer_Mom]

Wow! I guess my question was not stupid! Thank you for the thread. I think I have some reading to do! Thanks so much!

[Snoopy&Rummer_Mom]

Did some reading about this food dependent Cushings and will talk to my vet about it next week.

On another note, although related, I kept thinking about how I started noticing all these changes when I switched her food from raw to kibble. I did it mostly because of the expense. Two days ago I went back to the raw for her. I keep noticing this kibble just makes her seem uncomfortable after she eats and the panting gets worse. This raw food is more gentle since is good source protein and veggies that are dehydrated and you can reconstitute by adding water. Now, I'm still taking her to the vet next week but I have to tell you that in two days I have seen some improvement. She doesn't seem as hungry and although still drinking water is not as much (of course could be she is getting part of her water from what use to reconstitute the food). Most amazingly, the panting has decreased significantly. Again, not sure if this has anything to do with it; I'm just trying to make my girl comfortable and feel better.

[labblab]

Hello, Maria.

That is really interesting that you are seeing some improvement now that you have switched Rummer back to her original food. But if the new kibble was somehow prompting her symptoms, then I doubt there is anything "Cushing's-related" about her reaction. From reading the articles about the very rare form of food-dependent Cushing's, I don't think any specific type of diet has been implicated. Instead, in susceptible individuals, it's just that a full stomach prompts a specific Cushing's-related response. Therefore, Cushing's medication is administered to the dog prior to mealtime (regardless of the type of food that the dog is eating).

In the future, additional research may identify some dietary recommendations that can be helpful for this very small subset of afflicted dogs. But I just wanted to clarify the current research a little bit, so that members here with conventionally-diagnosed Cushpups don't get the impression that they may be able to cure Cushing's just by changing their dogs' food.

In Rummer's case, though, it will definitely be interesting to see whether her problems continue to resolve now that she's back on her original diet. Please keep us updated!

Marianne

[Snoopy&Rummer_Mom]

Marianne, definitely. I apologize if I came across as implying that she Can be cured like that. As mentioned, I still want to check her for Cushings because she has some if the other symptoms like a bit of pot belly, her hind legs seem a bit weak, etc. I know something is going on with this little girl so will definitely keep you guys updated.

[labblab]

Maria, no need whatsoever to apologize! You did not say anything at all that is a problem. I was just afraid that some folks might see the words, "food dependent Cushing's," but not bother to actually read the links -- and then jump to conclusions. I felt certain that you had taken the time to look through the articles, but I wasn't sure that everybody else would, too. :o

[Snoopy&Rummer_Mom]

Hello everyone! Just wanted to let you know that my vet called me today from where she is on vacation to discuss the blood work on Rummer. We spoke for about 30 minutes and came up with a "plan if attack" :-) she agrees that parts of the lab work are not very consistent with Cushings but since Rummer is strongly exhibiting quite a few of the symptoms she wants to go ahead with the LDDST. Based on the results we will decide on how to proceed. But I do appreciate the fact that she addressed all of my questions and she actually explained to me the entire lab results, and what are some things that can cause some if the readings we got.

Anyhow, I do feel better because she has been our actual vet for the past 8 years and I fully trust her. She us the reason my Cocker has lasted so long. And I always appreciate that if she does a procedure right before going on vacation, she always calls no matter where she us to follow up with me. And she actually thanked me for going to her when I needed some direction with Rummer so I'm feeling pretty optimistic. Just wanted to share since I'm pretty happy with our conversation.

[Snoopy&Rummer_Mom]

Well, yesterday we did Rummer's LDDST and it turns out that my girlie has Cushing's which my actual vet suspected based on the clinical symptoms Rummer is showing. I love my vet because she really listened to all of my concerns especially my confussion with the fact that her initial blood work did not look like Cushings. Anyhow, the plan is to do an ultrasound this week to try to determine which kind she has. Also we are going to start her with Trilosane (spelling?) and will recheck the dose in 10 days. Luckily I'm on vacation for 30 days so I can keep an eye on Rummer. And OMG, I have been holding my breath for two days I just realized :-)

Now with this med are there any natural supplements you recommend I give her? I have read about Milk Thistle. Anything else? Thanks

Maria

Moderator's Note: I have merged your update on Rummer into Rummer's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for members to refer back to the pup's history, if needed.

[Snoopy&Rummer_Mom]

Hello everyone! Maybe you can help me. I remember reading a thread about good supplements up give your dog while on Trilostane but cannot find it. I remember reading something about Milk Thistle, etc. Thanks fir your assistance!

Maria

MODERATOR NOTE: I have merged your update on Rummer into Rummer's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for members to refer back to the pup's history, if needed.

[Squirt's Mom]

Right now, I don't recall a thread on supplement in general, tho I personally like the idea, but we do have one on milk thistle here -

http://www.k9cushings.com/forum/showthread.php?t=2948&highlight=milk+thistle

If there are specific herbs or supplements you are considering, ask and we will share what we can about our experiences with them.

Hugs,
Leslie and the gang

[Snoopy&Rummer_Mom]

Thanks so much for the reply. Just want to make sure I'm prepared once she goes on the med tomorrow.

If I can trouble you with one more question. Is there anything I can do to help Rummer with the weakness of the hind legs? She seems fine most of the time but she is kind of wobbly today.

[labblab]

Good luck with starting off on the trilostane! Hindleg weakness from loss of muscle mass is a common symptom of Cushing's. It was a big problem for my own Cushpup prior to starting treatment. However, once the cortisol level is lowered into a therapeutic range, hopefully you will start to see improvement. It will not happen overnight, of course. But with time, things should get better.

May I ask what dose of trilostane you will be starting off on? The manufacturers of brandname Vetoryl are now verbally recommending that initial dosing be based on a formula of approx. 1 mg. of medicaton per each pound of a dog's weight. This falls at the lower end of the initial dosing range found in their published literature. Their revised recommendation corresponds with our personal experience here -- that unwanted side effects are less likely when dogs are started at low doses and worked upwards if necessary, rather than vice versa.

Here's a link to Dechra's U.S. Product Insert which contains a lot of useful info about treatment and monitoring:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[addy]

Hi,

My Zoe started Trilostane June 2011. I would say the last two months is when I started seeing less trembling in her back legs and not hearing the knuckle dragging when we take a walk. I limit her jumping off beds, etc (she still cannot jump on). I originally started out walking her one day on, one day off to rest the muscles. We started at a ten minute very slow walk and worked our way up.

It takes time.

Hugs,
Addy

[Snoopy&Rummer_Mom]

You know, the more I read, the more I think Rummer has been showing slight signs if Cushings even before I really noticed like A slight trembling of the hind legs as well as what you call knuckle dragging when I used to take her for a walk. I started her on a natural supplement of glucosamine, chondroiting and omega 4 fatty acid. I figured this would help her overall as well as my aging 14 yr. Cocker. Ok, this may sound crazy but I've been feeling really guilty I didn't notice if more before. :(

About the dosage. I won't know until tomorrow when I meet with the vet after the ultrasound. I did print the brochure from Decra that talks about dosage just in case.

I'm sorry if I sound all over the place but this is happening as I'm preparing to relocate from to Leavenworth, Kansas so this means trusting a new vet that I have no history with. So I'm a bit nervous. Thanks for all of your understanding.

[Jenny & Judi in MN]

Don't beat yourself up over not noticing. My first vet didn't even notice Jenny's big pot belly and crappy hair because he was so focused on her diabetes and prefers not to treat Cushings.

Her vet tech and I were talking and I had to ask him if it was possible. Her current vet knew immediately from her records before even bringing her in that she was probably a Cush pup.

I've been there done that on the beating yourself up but now that Jenny is regulated, she is like her old self!

xoxo, Judi

[lulusmom]

I was black and blue for a long time from the self inflicted beatings. The IMS and I are pretty sure my Lulu went undiagnosed for well over a year after she was showing every symptom in the book. My old gp vet and I shared the same amount of knowledge about cushing's...a big fat ZERO!

Thank goodness I ran into an internal medicine specialist when I took my noncushdog in for an emergency scoping for a rawhide stuck in his esophagus. It was that IMS who took one look at her and started asking questions. He mentioned cushing's and I looked at him like a deer in headlights. :D Say what? I explained her history, including symptoms, and we started testing two days later. That was almost seven years ago so I've had a lot of time to let go of the self loathing. Try to channel any energy feeling guilty into learning as much as you can about the disease. That's a much more effective use of your time and Rummer will greatly benefit.

[Snoopy&Rummer_Mom]

Well Rummer had the ultrasound today and it appears that she has the pituitary dependent Cushing's. We started her on Trilostane 20mg every twelve hours. Her kidneys seemed a bit inflamed due to an infection so she is also on Ciproflaxen. In two weeks we will do the ACTH test and check the dosage.

Now, with the Trilostane, what should I be on the look out for?

Maria

[Harley PoMMom]

How much does Rummer weigh? If one is starting their furbaby on low dose of Vetoryl/Trilostane, adverse reactions usually are not seen.

U-C Davis suggests a starting dose of 1mg per kg of a dog's weight and Dechra verbally recommends a starting dose of 1mg per pound.

All dogs can react differently so the adverse effects one should be aware of are but not limited to: lethargy, vomiting, diarrhea, and/or a dog not acting like him/her-self.

Do you have any prednisone on hand? And when is the next ACTH stimulation test scheduled?

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

Love and hugs,
Lori

[Snoopy&Rummer_Mom]

Lori,

Rummer is 38 pounds right now. So by what you are saying she will be taking about 2mg too many? Should i wait until her vet comes back next week to address this? And no, I do not have prednisone on hand although I have prednisolone which was given to my other pup. Are they the same? Right now her ACTH is scheduled for 6 Jan.

Maria

[Harley PoMMom]

Prednisolone and prednisone are basically the same.

Although I am not a vet, I do believe the starting dose of 20mg BID is just about right for a 38lb dog, keeping in mind that all dogs are different and can react differently, so just keep an eye out for any adverse reactions as we all know you will. ;):)

Have a very Merry Christmas!

Love and hugs,
Lori

[Snoopy&Rummer_Mom]

Hello everyone! Hope everyone had a Merry Christmas. Well as of today Rummer has been in Trilostane for four days and so far so good. Knock in wood but I haven't seen any bad reaction. The only thing I have noticed so far is that right after I give her the meds she just gets kind of "down in the dumps" just not her typical Rummer (I know, hard to explain) but that lasts between 20 to 30 minutes. After that she seems fine. Not sure if this is normal.

Today I started her in the milk thistle and let's just say, I don't think she likes. I put in the drops suggested (about 10 or 30% of the human dosage which is 50 drops) and she only ate half her food mostly leaving the area where I put the thistle. Any suggestions?

[Squirt's Mom]

What form of milk thistle are you using? It's been a while and I used a liquid tincture, but it seems like Squirt got 2 drops a day. She weighs 14-15 lbs. When she was taking a capsule form she got one a day.

We have seen other pups have a little down time after getting their meds so it's not that uncommon and I wouldn't worry unless she gets down and doesn't rebound. Trilo has a short life in the body so overnite the level drops off quite a bit and when they get the next dose, it goes back up and they can feel a bit off for a little bit.

Hugs,
Leslie and the gang

[Squirt's Mom]

Ok, in looking back, Squirt was supposed to get 1 dropper full of the tincture but because she had started getting sick from the capsules, I was starting her out one drop at a time. She still got sick. I don't remember any other pups here having her problem with it tho and it is supposed to be a very safe herb. Leave it to Squirt. :rolleyes::D

[Snoopy&Rummer_Mom]

Hello ladies! Well, I am happy to report that Rummer seems to be adjusting to the Trilostane very good. Even the "down in the dumps" attitude she was having right after the took the meds for the past couple of days is gone. But the biggest thing is the water consumption has decreased significantly. She is still drinking a bit more than usual but I am not having to fill her bowl 5 times as day like I was before. Her eating also seems to be getting better and she is not trying to steal my Cocker's food, which is good. Her energy level seems to have increased also and she is not sleeping almost the entire day like she was, as if she had no energy. Due to the ultrasound they had to shave her tummy and it was then when I was finally able to notice a slight pot belly, which was hard to notice before due to all of her hair.

Quick question, did any of your Cush pups started snoring after she developed this condition? Rummer did not use to snore; as a matter of fact you could narely hear her breathing and at times I had to watch her breathing to make sure she was breathing. But now this chica snores, and it started around the same time all the other symptoms became evident.

If I have not said it before, thank you for all of your advise and for providing the questions I needed to ask my vet.

[Snoopy&Rummer_Mom]

Hello everyone! Happy New Year! Well, Rummer is still doing good on Trilostane, although she seems to have lost some of her appetite. It is not that she has stopped eating but she is eating less than what she normally did, even before the Cushing's diagnosis. Not sure if that is normal.

She was supposed to have the ACTH on Friday but we moved it up to tomorrow because yesterday she started limping a bit, and then went away. Then again today when I came in she was limping again. I checked and she does not seem to be in pain, but she is limping. And because I was out, I know that she probably was jumping on and off the couch while I was gone. So, we just want to make sure nothing is out of place or strained.

[addy]

Good luck with the ACTH test. Hoping you get good results!!!:D

hugs,
addy

[Skye]

hope testing goes well and that she didnt hurt herself jumping!!! keep us posted!

[Snoopy&Rummer_Mom]

Hey everyone. Well I took Rummer to the vet yesterday and suddenly her limping stopped just as it started: suddenly. This morning she limped only fir a bit and them she stopped so we are at a lost. The vet gave me some pain meds to use only if needed but Rummer doesn't seem to be in pain.We also did the ACTH. And on the phone what the vet said that what we are looking for is between 2.2 and around 6.0. I don't have the results in front if me but she said these numbers:

Pre: 9.1
Post: 7.1

She wants to keep Rummer on her current dose of Trilostane since it has only been two weeks since she started on this med and her symptoms are improving. Of course, she is showing also some white cells on her bladder, which she said is consistent with Cushings, and she is on the Ciproflaxin for another week. We are going to re-check in two weeks before I depart to make sure we are on the right track. Any thoughts? Suggestions?

[Harley PoMMom]

I think what your vet is suggesting sounds very reasonable. Dechra recommends a therapeutic post range of between 1.5ug/dl - 5.5ug/dl but a post range up to 9.1 ug/dl is acceptable if clinical symptoms are controlled.

Love and hugs,
Lori

[frijole]

I just read that you are moving so that you can go to K State Univ. I just wanted you to know that I live in Nebraska and we had no IMS in the state (we now have a new one in Omaha but didn't last year) and after all kinds of testing (five or six false positives for cushings) I ended up taking my Annie to K State. If it wasn't for them I would have lost my gal for sure and never known what was going on.

The people there are so professional and I couldn't believe it but their services were substantially LESS expensive. An added bonus. Anyway - I wish you the very best and just wanted you to know they are top notch.

Kim

[addy]

Hi,

If Rummer has been on Trilostane for 2 weeks it is possible for her numbers to go lower. It is not unusual for a pup's cortisol to continue to drop on Trilostane, so keeping the dose the same and a recheck at the 30 day mark would be the norm.

Hopefully by then she will be off the antibitoic and the UTI will be gone.

Hugs,
addy

[Snoopy&Rummer_Mom]

Ok, I have a silly question. But do any of your Cush pups rubs their face on the carpet or furniture? Before being diagnosed she used to do this after eating because Wheatens have a long beard but now she does it more often. Just wondering. It is amazing the stuff one starts paying attention to...

[addy]

Hi,

I have found that sometimes it is to clean themselves, sometimes it is because they are itchy. Zoe does it sometimes just because she is happy, waiting to eat and she makes this "arrggggg" sound and smiles.

So as the dog rule seems to go: a
million possibilities:rolleyes::rolleyes:

Hugs,
addy

[Snoopy&Rummer_Mom]

I have been meaning to ask about this but always forget. What is the deal with the prednisone? Is this something to have on hand? What is it for? How much should I give if needed?

[Harley PoMMom]

If a dog's cortisol drops too low usually prednisone is given and if the electrolytes are unbalanced medicines such as Florinef or Percorten are administered.

Prednisone mimics cortisol in a dog's body and their system reacts to it as such.

The prednisone rescue dose for Rummer is calculated based on .25 mg/kg. How much does Rummer weigh?

One should have prednisone on hand in case of an emergency.

[addy]

Hi,

Since you are using Trilostane, prednisone is not as critical to have on hand as it has a shorter life in the dog's body. Prednisone is given if you think your dog may be experiencing an Addison's crisis and the cortisol is going to low. Prednisone is a must when treating with Lysodren. Some still feel safer having it on hand when using Trilostane.

The amount given is based on the weight of the dog. I am sure Glynda has the rescue dose and will be able to tell you what it is.

Hopefully, you will never need it. I have just a few pills put away for Zoe.

Hugs,
addy

[lulusmom]

Cortisol is a glucocorticoid produced by the adrenal glands and if the Trilostane is too much for Rummer, her cortisol could go too low, making her sick. When this happens, you need to replace the cortisol that is not being adequately produced with prednisone, a synthetic glucocorticoid.

If your vet gives you prednisone, the correct dose should be on the bottle but if not, the normal rescue dose is 0.25mg per kg. To calculate Rummer's weight in kg, you divide the lbs by 2.2 and then multiply the results times 0.25. For Rummer, the calculation would look like this:

(38/2.2=17.27kg) x .25 = 4.31mg, which would probably be rounded to 5mg.

[Snoopy&Rummer_Mom]

Thanks everyone! I will get some from the vet just in case.

[Snoopy&Rummer_Mom]

Hello everyone just wanted to stop by and say hello. Have been MIA most of January because my dad suffered a mild stroke and upon check up it was discovered he has lung cancer so it has been pretty hectic. Because of this my move to Kansas is on hold which in a way works since I can care for him.

As for Rummer, little girl seems to be doing goog although the past few days have noticed an increase on her water consumption and she is trying to steal my other dog's food again. She is in a low dose of Trilostane but she has an ATCH test this week anyway so we will be able to check her hormones.

[Cyn719]

Hi. So sorry th hear about you dad. I am glad it worked out and you will be here for him.

Glad the ACTH is this week so you know if the levels have gone up. Let us know when you get the results:)

Hugs and prayers xo

[Snoopy&Rummer_Mom]

Good evening everyone! We got the results from Rummer's second ACTH test and the results were markedly high from the first one. This is a comparison:

The vet put her on 20 mg twice a day after the LDDSP and kept her on the same dosage after the first ACTH test in January. The results of the first ACTH were:

Pre: 9.1
Post: 7.1

The results for the second ACTH were:

Pre: 11.9
Post: 22.7

Which in my opinion is consistent with Rummer's increased water consumption and trying to steal the food from my other dog; symptoms which decreased once we started her on Trilostane but started again about a week ago. So the vet increased her dosage to 30 mg twice a day. One thing that has really given me peace of mind is that my vet is very cautious about increasing dosage unless absolutely necessary. So, we will recheck Rummer's blood in about 30 days and see if we need to adjust. I was just really surprised by the big increase in the result numbers.

Mara

[Harley PoMMom]

With the increase in the post and Rummer's clinical symptoms a dosage increase is warranted.

Dechra recommends a stim test 10-14 days after any dosage change, since you are waiting 30 days just keep an eye out for any adverse effects, which we all know you will. ;):)

Please do keep us updated!

Love and hugs,
Lori

[Snoopy&Rummer_Mom]

Lori, my vet actually said that a stim test is recommended about 14 days after dosage change but she feels more comfortable giving it a few more weeks to give the meds a chance to kick in. Like you she did say to keep paying attention for her symptoms :)

[lulusmom]

Wow, Rummers cortisol shot way up on the second acth stim test. I don't believe I've ever seen such a big upward swing in such a short period of time. Is she getting her pill with a meal and were both stim tests done within 4 to 6 hours of her morning dose?

[Snoopy&Rummer_Mom]

I know! When I saw that range in the 20s I was pretty surprised. But to answer your question, she normally gets her pill about 1 hrs before her meals usually, but fir the stim test she was fasted as per the vet instructions and the pill was given at the vet because I had to drop her off earlier than when the dose was due. I do know the vet said it would be a bit later for pick up because they had to wait at least 4hrs after her meds to do the test.

[Harley PoMMom]

But to answer your question, she normally gets her pill about 1 hrs before her meals usually, but fir the stim test she was fasted as per the vet instructions and the pill was given at the vet because I had to drop her off earlier than when the dose was due.


With trilostane, it’s extremely important to give the morning medication with food, and then start the ACTH stimulation test 3 to 4 hours later.

Fasting these dogs on the morning in which the ACTH stimulation test is scheduled should be avoided since it invalidates the test results.

This excerpt comes from Dr. Peterson's blog. Dr. Peterson is renown Cushing's expert, here is a link to his article: What's the Best Protocol for ACTH Stimulation Testing in Dogs and Cats? (http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html)

Also the Vetoryl/Trilostane has to be given with food to be properly absorbed.

[lulusmom]

Okay, now I'm not so shocked by the huge increase in cortisol on this latest stim test. Vetoryl (trilostane) has a short half life, with effects starting to wane as early as 6 to 8 hours. Since Rummer hadn't had a dose for a day, that would certainly explain the surprising surge in cortisol. I am really sorry but if both of the acth stimulation tests were done under the same unacceptable conditions, neither test is credible. Regardless of return of symptoms, I would be a bit concerned about increasing the dose without an accurate acth stimulation test. If it were my vet, I would be asking for a free acth stim test so that an accurate assessment of Rummer's cortisol levels can be made......this time done under optimum conditions (dosing with food) and within the recommended time frame of 3 to 6 hours after the dose. The manufacturer of Vetoryl recommends 4 to 6 hours after dosing and as I recall, UC Davis recommends 2 to 4 hours after dosing.

For what it's worth, this isn't the first time a member has gone through this. You are among good company. I would highly recommend that you provide your vet with the URL to Dr. Peterson's blog provided by Lori or print it out for him/her. You may also wish to refer him to the manufacturer's recommendations for monitoring of treatment.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

Glynda

P.S. Mara, I came back to let you know that if your vet is using cortrosyn as the stimulating agent for the stim tests, you can save some money if your vet is cooperative. Instructions on the vial of cortrosyn says to administer the entire vial but studies have shown that only a fraction of the vile is needed for small or medium sized dogs. With Rummer weighing 38 pounds, your vet can get at least two acth stim tests out of one vial. Cortrosyn is called liquid gold for a reason. It's the reason why most of us pay so dang much for a stim test. You have nothing to lose and lots to gain by discussing this with your vet. I am providing a link to one Dr. Peterson's blogs which provides vets with information on how to reconsitute and store the cortrosyn for future use. My cushdogs treat primarily with a specialist but I have a gp vet do their bloodwork. I talked to him about splitting the cortrosyn vials and he was totally agreeable to helping save me money. My gp vet, as well as a number of members' vets, were unaware of this fact. Believe me, with two cushdogs, it has saved me a bundle.

http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

[Snoopy&Rummer_Mom]

Ladies, thanks so much for this information! I will talk to my vet about this and forward her the link also. So should I go ahead and keep Rummer then on the 20 mg twice a day until we get a retest?

Ps. I came back because I read over the good doctor's blog and wow, have I been doing things wrong. Thanks for the link! And you ladies are angels! :)

[labblab]

Just to clarify, from what you wrote earlier, it sounds as though Rummer did receive her trilostane dose 4-6 hours prior to the ACTH test (they gave it to her at the vet's prior to testing), but it was given without food? Is that correct? Was that the same procedure you followed for the first testing?

If so, it means that she didn't go for a full day without the trilo before the test, as Glynda is fearing. But that doesn't change the fact that the morning dose was given on an empty stomach, thereby compromising the effectiveness of the medication. If both tests were performed in identical fashion, however, I remain surprised by the increase in the cortisol from one test to the other.

Marianne

[Snoopy&Rummer_Mom]

Marianne, your understanding is correct.

Maria

[labblab]

OK then, so I guess my thought is -- even if both ACTH results are higher than they would have been had the trilostane been given with food, there is still a huge increase in cortisol since the first test. Plus, just as importantly, Rummer is more symptomatic again. So even though the previous testing conditions were not ideal, I might be inclined to go ahead with this increase, but making sure that the next ACTH (and all subsequent ones) is performed after the trilo is given with food.

By the way, though, I do now wonder if there's a chance that Rummer was not actually given her trilostane capsule at the vet's office prior to the testing. That would certainly account for such a big difference between the test results (and returns us to what Glynda was fearing).

Marianne

[Snoopy&Rummer_Mom]

Hey all, I checked with my vet this morning and Rummer was given the Vetoryl dose that morning at the vet clinic, then the test was done 5 hrs later. I did give the vet the link which she checked while I was on the phone and we are going to redo the ACTH w/o Rummer fasting. Will keep you posted.

[Skye]

good observation Marianne.............awesome. Way to be watching over us.

[Squirt's Mom]

Ain't it nice to have a vet that will talk with you and listen to you, Maria? That is a valuable commodity! :)

[Snoopy&Rummer_Mom]

It is indeed very nice! I love her to death because she's always listened to my concerns, and it's always there for us. I think there is a lot to be said when a vet performs test or surgery before going on vacation, and she calls (while on vacation or weekends) to follow up or check up on the pups progress. :) I'm so being spoiled with her... Haha!

[Skye]

how are you and rummer............how are things going?

[Snoopy&Rummer_Mom]

Hello everyone! Haven't been on the forum in a long time. Things have been just hectic. But I wanted to stop by because Rummer just had her 3rd ACTH done and boy what a difference. After I last visited the forum I talked to my vet about doing the ACTH on a full stomach instead of an empty stomach as she was doing it. And she was awesome about it and even read the links you guys gave me. So we did the test on Wednesday and for comparison I have included the results of the previous two tests including the crazy second one.

First ACTH
Pre: 9.1
Post: 7.1

Second ACTH
Pre: 11.9
Post: 22.7

Third ACTH
Pre: 5.0
Post: 4.9

From what she told me we want her to be within 2.0 and 5.5 so we will keep her on the 30mg twice a day. The vet was so excited about this too. I have a funny story that relates to you all. Because of all the information you all have been giving me, that I then ask the vet, she went to a vet conference that dealt with special conditions like Cushings, so when I saw her after that she came out to the lobby to tell me about how much she learned in the conference. It was too cute! Plus I think she has been talking to the Dechra people more. :)

[Squirt's Mom]

Great news, Maria! :D

[Snoopy&Rummer_Mom]

Hello everyone! Well it has been a long time since I posted. Since the last time, I think I posted when my dad was diagnosed with his canc and I became his caregiver, a lot has happened and life has been a surreal world. Unfortunately my father lost his battle with cancer three months ago, and last July I lost my cocker spaniel. I also relocated to a new state to it has been crazy. I will write more later on Rummer but she is doing good considering she still dealing with Cushings but I'm being very religious about her treatment. Aside from the weakness on her hind legs she is doing really good. Tomorrow I will post her latest test. But I wanted to say hello!

[Harley PoMMom]

Oh my, you have had a rough time, my condolences to you on the loss of you dear father.

So sorry to hear about your cocker spaniel passing. :(

Glad to read that Rummer is doing so well!! Please do keep us updated!! ;)

Love and hugs, Lori

[Trixie]

Hi Maria,
I'm new since your were last posting. Sorry to read about your father and your cocker spaniel.
Looks like from your thread that your very cute Rummer started all this back in 2011...and doing well today in 2013! That makes a newbie like me feel so good! I can only hope my dog does as well.
Hope to read more of your experiences with Rummer and his meds and tests.
Barbara:)

[goldengirl88]

Rummer's Mom:
I saw your post and wanted to say welcome. I saw your Rummer's avatar, and it brought back so many memories to me. My last dog was a Wheaton Terrier. I loved her to death, and she was wonderful. She developed cancer and passed away at the young age of 7. I was devastated. I am sorry to hear your father passed, and your cocker. You have had a lot of trauma going on. I hope you baby continues to do well. Blessings
Patti

[Snoopy&Rummer_Mom]

As I mentioned in the previous post, Rummer is doing good. She is still undergoing treatment for Cushings. She is still on Trilostane (30 mcg every 12 hours—she weights 26 lbs). The last test she had in March before we moved to Kansas was as follows:

Pre-ACTH: 3.9 ug/dL
Post-ACTH: 4.8 ug/dL

The majority of her symptoms are under control with the most prevalent being weakness and loss of muscle mass in her hind legs. Her hips have become more noticeable so she gets extra massages in the morning when she is most stiff. Because she has arthritis also, I have to keep an eye on it. Sometimes she is really stiff, sometimes she has problems standing up. She is on arthritis medicine and a muscle relaxer which I only give to her when necessary. I have come to learn the signs when she needs it by now but for the most part she manages. I do have to watch her because sometimes she forgets she is 11 yrs. young and wants to jump all over the place. Not sure if it is because of the Cushings but she has become really clingy; usually that is an indication that she is not feeling too hot. So she gets extra love.

For a while she was having some ear and skin infections, like demodex mites, and that is under control. I miss my old veterinarian because whenever she would treat Rummer she would check with the vets at the company that make Trilostane to make sure Rummer would not have an adverse reaction to whatever treatment she was recommending. Thanks to that she was able to adjust treatment and make Rummer comfortable. So thank you everyone for the links and points of contact when I first joined the forum.

Right now the only thing that we are getting checked is that she has been developing kind of like a gag reflex that reminds me of when she had kennel cough. It is not that because the vet checked and it only happens at night. But in two weeks we have an appointment at Kansas State Vet Center since they have vets that specialize in Cushings. Again, my girl is doing good but because of her muscle loss and she is getting older I would feel more comfortable taking her to see a specialist than a normal general vet.

Since she started on Trilostane, her appetite has decreased a bit but not too much. Sometimes she is just not feeling the dog food, so I always have chicken breasts or beef on hand to make for her. Some of my friends tell me I’m spoiling her but my thing is I need to get some food on her when she is not feeling good, and if chicken or beef will get her to eat, I will give it to her. 

Ok, I think this is it for my update. Its great to be back. One last note for the newbies in the forum: make sure your vet read the resources offered here and do their job. If a vet is not willing to listen to you—who knows your dog better than the vet does—then maybe its time to reconsider vets. The words “Cushing’s Disease” can send a doggie parent into freak out mode, but it is a condition that can be treatable and managed with the right treatment. Once you get into a routine and start learning the language of the treatment you will be able to take a deep breath and just focus on loving your dog and making sure he/she is comfortable. Hang in there!

Maria

[StarDeb55]

Maria, it's nice to hear from you, again, with such a great report for Rummer. Those last stim number are right within range, but I do want to point out that the ranges you posted are for a normal, healthy pup, not one who is being treated for Cushing's. Dechra's suggested range for trilo are 1.5-5.4 ug/dl. The upper limit can be up to 9.1 as long as the pup's clinical symptoms are under control. I hope the ranges you posted are not what your new vet told you is acceptable.

Debbie

[Snoopy&Rummer_Mom]

Not at all, i posted those then realized that was part of the lab literature at the bottom! :p Which is why I'm taking it out! Ha!

[goldengirl88]

Maria:
I am very anxious to hear what the people at Kansas State say about the gag reflex. My Tipper has something going on only at nite when she lays down, and I read Cushings can affect their trachea. Could this be Rummers problem?? Please let me know what they say. I am trying to solve this problem with Tipper currently. Blessings
Patti

[goldengirl88]

Maria: You are definitely doing the right thing by going to a specialist. Let me know about the gag issue.
Blessings
Patti

[Snoopy&Rummer_Mom]

Patti: that is exactly the best way to describe it! You are a genius! It only happens at night when she is laying down. All of the sudden she gets up and starts making these gagging noises like something is in her throat. It reminds me of a dry cough. Yes, I am glad I made that call yesterday to go to Kansas State Univ. (thanks Kim @Frijoles for recommending that on a post) because while she does not seem to be in pain, sometimes it keeps her up at night. Will definitely let you know!

Maria

[frijole]

You are welcome and I'm hoping you too have a great experience there. Take care. Kim

[goldengirl88]

Maria:
Just checking in to see how Rummer is doing today? Hope everything is going well for you both. I can't wait for your Kansas State appointment so you can get some definitive answers. Get your list ready so you don't forget anything. Blessings
Patti