wheaten terrier just diagnosed

[Sheridan]

Hello everyone

My 16 and a half year old wheaten terrier, Grumpy, has just been diagnosed with Cushing's. He has had tummy troubles for some years, which we had put down to mild pancreatitis. He began to have weak back legs some time ago, which I and the vet had thought to be as a result of him falling off my bed a while back. All indications was that he had done some mild damage to his spine. His kidney test results (as he is a wheaten he gets yearly checks for protein losing diseases) showed no issues with his kidneys until the most recent ones that diagnosed him with Cushing's.

However, recently, I noticed he was drinking more. Given the potential for kidney issues in wheatens I whisked him off to the vet and the blood test results indicated a liver issue, though the urine test didn't. His vet then asked for further tests on the blood sample and suggested to me that it may be Cushing's. The first test came back negative (the one hour test? can't recall what it's called) but the second test came back postive.

Grumpy has been prescribed Trilostane (one 60 mg per day) and has been on it for 10 days as of tomorrow so we are going back to check how he's doing. I have noticed he is getting some muscle twitches/spasms in his head. That started this morning. There was also a small amount of vomit when I arrived home this evening, though to be fair, it may have been my other dog. It was mostly bile and she has vomited up bile previously. I rang the vet immediately and told him but as Grumpy had galloped off down the back yard when I got home and was acting very normally, the vet wasn't too concerned. He said to call him on his mobile if there was any further symptoms.

Despite today's gallop, Grumpy really is very weak in his back legs. He sags badly and given his age, my concern is that his diagnosis has come too late for the medication to have an effect, though I understand with Trilostane it can be around a month before it can show a visible effect? I would say he has become even more wobbly in the two weeks since he began treatment, though again I understand this can be a side effect of the drug.

I haven't noticed any particular lethargy, at least not more than usual. He is 16 and a half, after all. He sleeps a lot and at particular times of the day, bounces around harassing me for food. He's always been greedy and although I have read this food greediness is part of Cushing's, I suspect it's also just Grumpy! :)

His other medication is a third of a tablet of Vivitonin twice a day, as he also has some dementia. Since last year he has been on 50 mg of Rimadyl once a day for his back. I did read in another thread Cushing's dogs should not have Rimadyl because of the liver issue. I discussed with his vet when Grumpy was diagnosed whether we should continue the Rimadyl and will bring it up again when I see him tomorrow.

Complicating matters is that Grumpy also has cysts on his kidneys, found via an x-ray and ultrasound. He also has a large cyst near his pancreas. A test on this has shown it to be benign. I have discussed the kidney cysts with the vet and he is gathering all the test results, ultrasound, etc, to send to the US wheaten terrier specialist who has offered to take a look at them for us.

Diet-wise, I notice that someone (I'm sorry, I forget whom) said that a high protein, low fat diet is best for Cushing's dogs. Grumpy has been on a canned sardine, fish based veterinary kibble diet for years. He has the occasional wheat based biscuit and liver treats. I allow him to have two slices a day of chicken loaf to take his tablets in (otherwise the little wheaten ratbag won't swallow his tablets at all). He doesn't get bones or pigs ears or anything like that now as he can't digest them. He had a bout of pancreatitis at Christmas (my fault, obviously) and spent two days on a drip at the vet. High protein may not be recommended due to the kidney cysts. The wheaten specialist may have a recommendation there but I am very interested in your opinions.

I think that's all the information I can tell you at the moment. Please let me know if you need further information. I am looking forward to getting to know you and your dogs and learning more about Cushing's and what's best for my Grumpy man. I am very interested in your opinions of what I've said.

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[jmac]

Hello and welcome to you and Grumpy!

I'm sorry for the circumstances that brought you here, but glad you found us! Thanks for all of the information you provided about Grumpy, but we usually ask more questions. Cushing's is a difficult disease to diagnose, so we like to get as much information as possible.

First, can you post any abnormal test results Grumpy had, along with their normal values? Also, if you can find out the names of the tests that were done to diagnose Cushing's, that would also help. Also, what does Grumpy weigh?

Did Grumpy exhibit other symptoms of Cushing's: ravenous appetite, increase in water consumption (yes), increased urination, pot belly, panting/heat intolerance, rear end weakness (yes), hair loss/coat issues?

We will probably ask a lot of questions, but it is so we can give you the best advice possible. You've found a wonderful group of knowledgeable, kind, helpful people, and we'll be here to support you and Grumpy however we can! :D

Julie & Hannah

[Sabre's Mum]

Welcome and glad you made your way over here.

I am the person who posted on Dogzonline with regards to diet but with the added issue of kidney cysts I am unsure what is recommended in this case.

Yes ... you are quite right about Rimadyl .... it is not recommended for a cushpup. Tramadol seems to be the alternative for a cushpup that some use here.

Probably the other query that we will have is what is Grumpy's weight ... as this corresponds to his Trilostane dosage.

Others may come along to give their experiences with regards to rear hind weakness and how long is takes to rectify with treatment with Trilostane. As I mentioned on the Ozzie site .... it really varies from dog to dog but may take "months" as opposed to "weeks".

Angela and Flynn (the needy Vizsla)

[Sheridan]

Thank you, both, for the kind welcome.

jmac, can you define abnormal in the Cushing's context?

I will check what tests were done. The vet explained there were two tests, one that takes an hour and another that took eight hours. I teleworked from the clinic that day! Grumpy weighs 18 kg, which is more than in the past few weeks. I was concerned about his weight loss, given the kidney issue, and started giving him a little more food each night. He usually weighs around 20 kg.

Ravenous appetite: yes, but as mentioned, he's always been the greedy man.

Increased urination: not really in comparison to his water intake.
Pot belly: yes, but it's not huge.

Panting/heat intolerance: panting, yes, but not in the past few months. It's winter and we usually have below zero temps overnight and it's not more than 14 C during the days, which are often sunny but icy. Heat intolerance: not that I've noticed.

Hair loss/coat issues: his hair has got thinner and duller. It doesn't fall out because wheatens don't shed.

Sabre's Mum, Grumpy can't have Tramadol. He goes into hallucinations.

Cheers

[Sabre's Mum]

Bumping this up.

[labblab]

Welcome to you and to Grumpy!

I'm very glad that Angela has "bumped up" your thread so that more of us will have a chance to greet you two. By this time, it sounds as though Grumpy will have had his first monitoring ACTH test performed. How did the testing turn out? If you can supply us with the actual testing numbers, that will be a great help, especially in light of his possible issues with vomiting, head twitches, and increased muscle weakness after beginning the trilostane. It is possible that Grumpy has been experiencing some side effects from rapid lowering of his cortisol level ("cortisol withdrawal"), or it may be the case that his cortisol level has truly dropped too low altogether. As you already know, the only way to determine with certainty whether or not there is a genuine safety issue is by performing a monitoring ACTH test with accompanying blood chemistries ("electrolytes"). So we'll be very anxious to hear the outcome.

Given Grumpy's weight, his initial trilostane dose may turn out to have been a bit too aggressive. Even though 60 mg. is indeed the appropriate dosage according to Dechra's published chart, their written commentary references an initial dosing range of 2.2 - 6.7 mg. per kg. And here in the U.S., Dechra's technical representatives have been advising vets through conferences and continuing education materials that it is typically best to start at the lower point in the range and work upward, rather than vice versa. This protocol lessens the likelihood of unwanted side effects. So in Grumpy's case, an initial dose of 40 mg. might have been easier for him to tolerate. However, the ACTH testing will be a very helpful indicator. If you don't already have it, here's a link to Dechra's Product Insert for Vetoryl (this is the U.S. edition):

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

So if you can stop back by again and tell us both how Grumpy is doing at this time, and also what the results of the ACTH testing turned out to be -- that will be very helpful information. In addition, the actual numerical results of his initial diagnostic test will also be much appreciated. Since Grumpy does have some ongoing kidney issues, it may take a bit of unraveling to separate out the possible relative effects of Cushing's vs. renal insufficiency.

Marianne

[lulusmom]

Hi and a belated welcome to you and Grumpy

I'm glad Angela bumped up your thread and that you've gotten some great information from Marianne. As usual, she is spot on and succinct in her comments and I will try not repeat anything that she's already covered. However, I am rarely without questions or comments of my own so you may be sorry that I found your thread this morning. :D The more information we have, the more appropriate and meaningful feedback we can provide.

I am not a well organized person and tend to ramble more than usual if I don't try to keep things on track so I am typing my text in blue within the body of your first post below:


He began to have weak back legs some time ago, which I and the vet had thought to be as a result of him falling off my bed a while back. All indications was that he had done some mild damage to his spine.

Did Grumpy start showing weakness in his rear legs immediately following the fall off the bed? Did your vet do an xray or imaging on the spine and hips to check for injury?

His kidney test results (as he is a wheaten he gets yearly checks for protein losing diseases) showed no issues with his kidneys until the most recent ones that diagnosed him with Cushing's.

BUN and creatinine are usually the two primary indicators of kidney function and these are usually normal in a dog with cushing's. Actually dog with cushing's can have low BUN and about 50% of cushdogs will have protein in their urine. My dog has been treating for 7 years and has consistently had 2+ protein even after treatment. This does not mean that the kidneys are impaired but persistent proteinuria should be monitored. I am including some good information on the subject from Dr. Mark Peterson's blog. Dr. Peterson is a well known and highly published endocrine specialist.

http://endocrinevet.blogspot.com/2012/06/hypertension-and-proteinuria-frequent.html

However, recently, I noticed he was drinking more. Given the potential for kidney issues in wheatens I whisked him off to the vet and the blood test results indicated a liver issue, though the urine test didn't. His vet then asked for further tests on the blood sample and suggested to me that it may be Cushing's. The first test came back negative (the one hour test? can't recall what it's called) but the second test came back postive.

The first test was undoubtedly the acth stimulation test. This test can yield false positive and negative results. Dogs with adrenal tumors are more likely to test negative. The second test was probably the LDDS which is an eight hour test. Is that correct?

It would help us greatly if you could round up all of the blood and urine test results and post the abnormal results here. Abnormal means values falling outside of normal reference range. The lab usually inserts an H or High and L or Low next to the result.

Despite today's gallop, Grumpy really is very weak in his back legs. He sags badly and given his age, my concern is that his diagnosis has come too late for the medication to have an effect, though I understand with Trilostane it can be around a month before it can show a visible effect?

The vast majority of dogs diagnosed with cushing's have had the disease for a very long time. It is a very slow progressing disease and pet owners usually don't pay much attention to subtle symptoms and chalk them up to old age. Sometimes the first clue is abnormal liver enzymes on bloodwork or most often, pet owners don't have a clue until overt symptoms like extreme hunger and constant drinking and peeing, becomes problematic for them. My dog was diagnosed at three years old but she had every symptom in the book for over a year. Unless a very senior dog has complicating problems that prohibit the prescription of Vetoryl (Trilostane) or Lysodren, it is never too late for treatment.

I haven't noticed any particular lethargy, at least not more than usual. He is 16 and a half, after all. He sleeps a lot and at particular times of the day, bounces around harassing me for food. He's always been greedy and although I have read this food greediness is part of Cushing's, I suspect it's also just Grumpy! :)

An already food driven dog with cushing's is like a Hoover vacuum. My little Tiny Pom was always a healthy eater but oh my goodness, with cushing's, if I let her, she would have eaten until she exploded. :D Dogs with cushing's are hungry all the time because of the catabolic effects of cortisol on every metabolic process in the body.

His other medication is a third of a tablet of Vivitonin twice a day, as he also has some dementia. Since last year he has been on 50 mg of Rimadyl once a day for his back. I did read in another thread Cushing's dogs should not have Rimadyl because of the liver issue.
I discussed with his vet when Grumpy was diagnosed whether we should continue the Rimadyl and will bring it up again when I see him tomorrow.

I think NSAID's in general give most of us the creeps because the side effects can be dire. Rimadyl is an amazing anti-inflammatory that does bring much needed relief to severely arthritic dogs. However, dogs with uncontrolled cushing's have an abundance of the body's own natural anti-inflamatory (cortisol) coursing through their veins and shouldn't need Rimadyl. A good number of pet owners are unaware their dogs have arthritis until it is unmasked when cortisol is reduced with treatment. Is your vet sure that what you were seeing was arthritis and not the muscle wasting associated with cushing's?

Complicating matters is that Grumpy also has cysts on his kidneys, found via an x-ray and ultrasound. He also has a large cyst near his pancreas. A test on this has shown it to be benign.

Was the test you mention a fine needle aspirate? If not what test was done?

I have discussed the kidney cysts with the vet and he is gathering all the test results, ultrasound, etc, to send to the US wheaten terrier specialist who has offered to take a look at them for us.

Is the US Wheaten Terrier Specialist an internal medicine specialist?

Diet-wise, I notice that someone (I'm sorry, I forget whom) said that a high protein, low fat diet is best for Cushing's dogs. Grumpy has been on a canned sardine, fish based veterinary kibble diet for years. He has the occasional wheat based biscuit and liver treats. I allow him to have two slices a day of chicken loaf to take his tablets in (otherwise the little wheaten ratbag won't swallow his tablets at all).
He doesn't get bones or pigs ears or anything like that now as he can't digest them. He had a bout of pancreatitis at Christmas (my fault, obviously) and spent two days on a drip at the vet. High protein may not be recommended due to the kidney cysts. The wheaten specialist may have a recommendation there but I am very interested in your opinions.

It seems pancreatitis is on the rise. Both of my noncushdogs have been in the hospital on iv drips for pancreatitis also. One was four or five months ago and the other 10 days ago. What do you think you did that caused Grumpy's pancreatitis?

Having a cushdog and two noncushdogs with pancreatitis history, if Grumpy doesn't have any kidney dysfunction, my recommendation would be the same one I follow. A good quality protein, lower in fat diet. What brand of dog food are you giving Grumpy?

I think that's all the information I can tell you at the moment. Please let me know if you need further information. I am looking forward to getting to know you and your dogs and learning more about Cushing's and what's best for my Grumpy man. I am very interested in your opinions of what I've said.

I'm sure sorry you found it necessary to come here but I'm glad you made it. I look forward to getting to know you and Grumpy too. You've given us a great start on your precious boy's history but I look forward to hearing lots more.

Glynda

[Sheridan]

Hi and a belated welcome to you and Grumpy

I'm glad Angela bumped up your thread and that you've gotten some great information from Marianne. As usual, she is spot on and succinct in her comments and I will try not repeat anything that she's already covered. However, I am rarely without questions or comments of my own so you may be sorry that I found your thread this morning. :D The more information we have, the more appropriate and meaningful feedback we can provide.

I am not a well organized person and tend to ramble more than usual if I don't try to keep things on track so I am typing my text in blue within the body of your first post below:

I'll do my best to answer:


Did Grumpy start showing weakness in his rear legs immediately following the fall off the bed? Did your vet do an xray or imaging on the spine and hips to check for injury?

Grumpy only started showing bad weakness in his hind legs in the past few months really. The fall was last year, before June, I think? I would have to check my records. No x-rays. The vet did a thorough exam and aside from some sensitivity in his back, Grumpy seemed to be fine. No leg issues.


BUN and creatinine are usually the two primary indicators of kidney function and these are usually normal in a dog with cushing's. Actually dog with cushing's can have low BUN and about 50% of cushdogs will have protein in their urine. My dog has been treating for 7 years and has consistently had 2+ protein even after treatment. This does not mean that the kidneys are impaired but persistent proteinuria should be monitored. I am including some good information on the subject from Dr. Mark Peterson's blog. Dr. Peterson is a well known and highly published endocrine specialist.

http://endocrinevet.blogspot.com/201...-frequent.html

I lost my previous wheaten to protein losing nephropathy and I run an information website on it for wheaten owners. Grumpy has had regular tests for PLN since I've had him. His blood panel has always been normal as has his urine creatinine protein ratio. I spoke to the vet today and the urine test results came back normal, no protein in the urine. He has recently tested normal for carrying the PLN allele mutations.



The first test was undoubtedly the acth stimulation test. This test can yield false positive and negative results. Dogs with adrenal tumors are more likely to test negative. The second test was probably the LDDS which is an eight hour test. Is that correct?

Yes, that's right. Grumpy came back negative on the first test and positive on the LDDS.


It would help us greatly if you could round up all of the blood and urine test results and post the abnormal results here. Abnormal means values falling outside of normal reference range. The lab usually inserts an H or High and L or Low next to the result.

I asked for the results and what they sent me doesn't have these. I have to go back to the vet to get some more Vivitonin and will get them to print out the original and the recent results.


The vast majority of dogs diagnosed with cushing's have had the disease for a very long time. It is a very slow progressing disease and pet owners usually don't pay much attention to subtle symptoms and chalk them up to old age. Sometimes the first clue is abnormal liver enzymes on bloodwork or most often, pet owners don't have a clue until overt symptoms like extreme hunger and constant drinking and peeing, becomes problematic for them. My dog was diagnosed at three years old but she had every symptom in the book for over a year. Unless a very senior dog has complicating problems that prohibit the prescription of Vetoryl (Trilostane) or Lysodren, it is never too late for treatment.

The most recent blood test results, which were at Christmas, didn't show impaired liver function from what I recall. They weren't even sure it was pancreatitis as not everything came back positive for it. It's good to know it isn't too late for treatment.


An already food driven dog with cushing's is like a Hoover vacuum. My little Tiny Pom was always a healthy eater but oh my goodness, with cushing's, if I let her, she would have eaten until she exploded. Dogs with cushing's are hungry all the time because of the catabolic effects of cortisol on every metabolic process in the body.

I think hoover is Grumpy's natural state.


I think NSAID's in general give most of us the creeps because the side effects can be dire. Rimadyl is an amazing anti-inflammatory that does bring much needed relief to severely arthritic dogs. However, dogs with uncontrolled cushing's have an abundance of the body's own natural anti-inflamatory (cortisol) coursing through their veins and shouldn't need Rimadyl. A good number of pet owners are unaware their dogs have arthritis until it is unmasked when cortisol is reduced with treatment. Is your vet sure that what you were seeing was arthritis and not the muscle wasting associated with cushing's?

Grumpy doesn't have arthritis. We thought it was because of his fall.


Was the test you mention a fine needle aspirate? If not what test was done?

Yes, and the sample was sent to a lab for testing.



I have discussed the kidney cysts with the vet and he is gathering all the test results, ultrasound, etc, to send to the US wheaten terrier specialist who has offered to take a look at them for us.

Is the US Wheaten Terrier Specialist an internal medicine specialist?

Yes, she is.


It seems pancreatitis is on the rise. Both of my noncushdogs have been in the hospital on iv drips for pancreatitis also. One was four or five months ago and the other 10 days ago. What do you think you did that caused Grumpy's pancreatitis?

Christmas plus chicken.


Having a cushdog and two noncushdogs with pancreatitis history, if Grumpy doesn't have any kidney dysfunction, my recommendation would be the same one I follow. A good quality protein, lower in fat diet. What brand of dog food are you giving Grumpy?

Grumpy gets a can and a half of sardines in springwater and a Royal Canin Veterinary Diet with blue whiting in it. Unfortunately, they've just rejigged this and put in duck instead of fish. Duck is too fatty for Grumpy so we're looking at another food. I will have to switch him over in a week or two. Ingredient wise, the Eukanuba veterinary diet with whitefish looks best in regards to fat content, particularly given it doesn't contain chicken. Grumpy does not do well on other protein sources.


I'm sure sorry you found it necessary to come here but I'm glad you made it. I look forward to getting to know you and Grumpy too. You've given us a great start on your precious boy's history but I look forward to hearing lots more.

Thank you all for the welcome. :)

[labblab]

Just checking in to see how Grumpy is doing. Hope he is well!

Marianne

[Sheridan]

Just checking in to see how Grumpy is doing. Hope he is well!

Marianne

Yes, he is doing very well. The tremors in the morning are now intermittent. He also seems rather brighter. Still greedy, still wobbly but it's very early days.

I am heading to the vet tomorrow to get some more Vivitonen and will see if I can get the blood test results.

[molly muffin]

That is such good news that he is doing well. It's so awesome to hear good news. :)

hugs,
Sharlene

[Sheridan]

Thanks, Sharlene.

The vet will send all the blood test results. We couldn't work out the dates that everything had been done so they're sending me everything.

[BreeandDaisy]

Welcome to the board. Although I do not have the medical expertise those who posted before me have, I will add a few coping mechanisms that might be of some use to you.

My Havanese, Bree, is developing weakness in his hind legs. He is 25 pounds so likely around the same size as Grumpy. Bree can walk to the far side of the park, but then sits and I have to carry him back. He is ok on the flat but stairs, jumping onto things, makes him nervous. a few years back I bought a second hand baby stroller (back then dog strollers were not too common) for when we did 5km walks since Bree cannot walk that far, and I can't carry him 1 or 2 km. I now take the stroller out with us, let him down to do his business, and then when he is ready, put him back in. I can take him on walks I wouldn't be able to take him on without it.

Secondly, Bree gets really hot - especially in the summer. Our temps have been in the mid 30s C (so well over 100F). With Bree being a black dog I suspect it is even worse. I have started soaking one of his t-shirts in cool water, giving it a slight ring, and putting it on him when we go out. He seems more comfortable when I do that. There are also chamois coats you can buy and wet for them.

I hope this helps.
Shari;)

[Sheridan]

Thanks, Shari, I was going to ask what exercise people give their Cushings dogs.

I have ducted air con so Grumpy has been inside on hot days. Not that we really had a summer this year.