Pharaoh with a recent diagnosis (Vetoryl)

[Mitvisz]

Hi everyone! After spending most of the last 2 weeks reading here I thought it would be appropriate (and more helpful for my dog) to join the club. I wish I could say it's a pleasure to participate, but... Well, I'm sure you know how this feels.

First of all, let me apologize beforehand if I use weird words or totally non-readable sentences. We live in Northern Europe and English is not my own language.

My sweetheart, Jusa, is 8 years old Pharaoh hound. His health has been somewhat problematic during his whole life, but these last 5 months have been just awful. He started drinking and urinating a lot, then he got extremely tired and lethargic and turned to be even slightly aggressive toward visitors - totally unlike him. We checked his blood samples (borderline for hypothyroidism, elevated liver enzymes - but liver values were found already 1½ years ago, and kept in control with diet), tested for tick-mediated diseases, scanned his body with both ultra sound and X-ray (found a mucosele in his gall bladder), checked his lumbar spine with MRI... Nothing was found. After the mucosele was found he started to eat Adursal (ursodiol) to keep bile moving better. He started to drink normally (which is, almost nothing) after that. We started thyroxin to see if that would liven him up. Nothing happened.

Finally, I asked for ACTH stimulation test. Even if the symptoms didn't fit. The results were suggesting Cushing, so another test (Low-Dose Dexamethastone Suppression) was performed and indicated again that Jusa has PDH, even if his symptoms are totally untypical.

He does not eat, on the contrary, his appetite has been very poor. Also at the moment he doesn't drink at all, but if given water (with a syringe) he does pee a lot. He is uninterested in any activities and sleeps a lot, but when awake he tends to pace relentlessly around our apartment until asked to get to sofa. He has not lost his fur, but the fur shaved in December due to his castration is not grown back. Not even a bit. He has a nice body of a sighthound and is not at all pot-bellied but has lost all the muscles in his head, leaving nothing but a scull with big ears and very dry nose. Also his eyes are dry (checked with Schirmer's test) and we need to use moisturizing eye drops to make him feel better with them.

I don't know what to do. He has been eating Vetoryl for almost 2 weeks now, and it has made his appetite a little bit better. Yes, I know that is not how it should happen either. The vet just checked the medication with another ACTH test, and it seems that his cortisol levels are better, but we need to rise the dose from 60 mg per day to 90 mg.

He was so energetic and happy only 6 months ago, training agility and everything. Now he is only shadow of himself, uninterested even in clicker training, which has always been so important for him. It breaks my heart to see him like this. What should I expect from here? Can the medication ever return him back to what he was? :(

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[labblab]

Welcome to you and to Pharaoh!

First off, your membership has now been formally approved, so you do not need to worry about looking for the email confirmaton. Secondly, your English is fantastic!! I would never know that you are not a native speaker, so you need never apologize for your writing.

I do feel worried, however, about the accuracy of Pharaoh's Cushing's diagnosis. Even though the ACTH and LDDS tests were "positive," both tests can give false results if there is another illness going on in the body. That's why symptoms are such an important part of the diagnosis. And since Pharaoh's symptoms are not characteristic of Cushing's, it makes me feel worried that it is instead another problem that is elevating his cortisol. It sounds as though you have done exhaustive diagnostics to try to identify what else could be responsible. But in this case, without appropriate symptoms, I'm afraid the Cushing's diagnosis remains suspect.

For that reason, I am also concerned about the Vetoryl treatment -- especially increasing the dose for a dog who is not drinking water. Was that also the case before you started giving the Vetoryl, or has that problem developed during these past two weeks? Also, can you please get the actual numbers for his diagnostic tests and this first monitoring ACTH test? That information will be very helpful as we try to sort things out.

Marianne

[Mitvisz]

Thanks for the approving the membership. I guess I messed up something with the e-mail anyway...

We are all somewhat sceptical about the validity of Jusa's diagnosis - including the vets taking care of him. Personally, due to his behaviour I expected Addison, definitely not Cushing's (although due to Jusa's head one of the vets did say - the day after the first ACTH test was made, before we got the results - that he looks like he would have been eating lots of cortisone). But since the abnormal blood results have been all what we have been able to find, we decided to give treatment a try. I mean, euthanizing him right away started to look like the only other option we had left. :(

He has always been a poor drinker, excluding the moment when his elevated liver enzymes were found, and a short period in November-January. So he was totally noninterested in water already before starting Vetoryl. He has been eating it for 15 days now, only change I have noticed is that he eats a little bit better now than before starting medication.

First ACTH results (reference range 10-100 - can't remember the units though, sorry about that):
0-cor: 58
1-cor: 1051

Second ACTH results (after 9 days on Vetoryl)
0-cor: 30
1-cor: 345

LDDS:
0-cor 76
1-cor 51 (4 hours later)
2-cor 34 (8 hours later)

Blood results (I took away the units, since I couldn't make them look clear with all the superscripts and stuff...):

Leucosytes 3,3 (6,0-12)
Erythrosytes 6,96 (5,5-8,5)
Hemoglobin 163 (120-180)
Hematocrit 50,2 (37-55)
MCV 72 (60-70)
MCH 23,4 (19,5-24,5)
MCHC 325 (320-360)
Thrombocytes 151 (150-500)
Lymphocytes 0,7 (1,0-3,6)
Monocytes 0,2 (0,1-1,1)
Granulocytes 2,4 (2,9-9,3)

Urea 3,3 (2,4-8,8)
Creatinine 68 (57-116)
ALAT 128 (18-77)
APHOS 425 (33-215)
Glucose 5,7 (4,0-6,4)
Total protein 59 (58-77)
Albumin 35 (30-41)

Ca 3,02 (2,3-3,0)
Pi 0,92 (0,93-2,25)
Na 150 (147-157)
K 4,5 (4,2-5,4)

The low number of leucocytes is considered normal for sighthounds, and is totally in line with the blood samples taken before Jusa got ill. I'm worried of his hemoglobin and hematocrit though, they have always been over the reference values (he is a sighthound after all, but since November they have been in the reference range, even on the higher side still.