Charley has been diagnosed with cushings/Charley has passed

[charley12345]

Hi, thankyou for this wonderful forum. My name is Steve and our Cavalier King Charles Spaniel, Charley, has been diagnosed with Cushings. He is just under 5 years old (Sept. 15 birthday). He weighs 23 lbs. We had a Low Dose Dexamethasone Suppression Test done this week and the results indicated he has the Pituitary Dependent variety of Cushings. I do not have the results. We plan to contact our vet tomorrow for guidance and I will try to get copies.

As far as symptoms, I have listed the symptoms that were listed on another the Kate Connick web site below and given a yes or no by each one.


• increased/excessive water consumption-yes, +- 1/2 gal/day

• increased/excessive urination- not that i can see

• urinary accidents in previously housetrained dogs- no

• increased/excessive appetite- yes, but we have kept him at 1 cup/day of rice/lamb Canidae dry food. He is at normal weight for a Cavalier, but he eats each meal like it is going to be his last:rolleyes:

• appearance of food stealing/guarding, begging- don't most dogs do this?

• sagging, bloated, pot-bellied appearance- yes

• weight gain or its appearance, due to fat redistribution- except for the belly, not really

• loss of muscle mass, giving the appearance of weight loss- yes, he does not want to climb stairs/jump

• bony, skull-like appearance of head- yes

• exercise intolerance, lethargy, general or hind-leg weakness- yes

• new reluctance to jump on furniture or people- yes

• excess panting, seeking cool surfaces to rest on- yes

• symmetrically thinning hair or baldness (alopecia) on torso- yes, mostly on belly area

• other coat changes like dullness, dryness- yes

• slow regrowth of hair after clipping- yes

• thin, wrinkled, fragile, and/or darkly pigmented skin- yes, skin looks thin and sort of reddish to me

• easily damaged/bruised skin that heals slowly- not sure as of now

• hard, calcified lumps in the skin- yes, large area on his back, about 2 to 3 inches wide from behind neck area and stopping just before his tail.

• susceptibility to infections (especially skin and urinary) - yes, has a urinary infection now and is being treated for it with Orbifloxacin- 22.7Mg

• diabetes, pancreatitis, seizures- No, as far as I know

So those are his symptoms. We first noticed the sagging belly last fall. Skin color last fall. This spring we noticed the problem with not wanting to go up steps. We asked out former (1st) vet about that and he checked his rear knees and said his knee joints needed to be operated on. We decided to get a second opinion on that and the 2nd vet said she did not think that was his problem since he was not limping and surgery was not needed at this time. We became concerned just last week with the lack of energy when walking and tried to get him in to the 2nd vet, but they were booked, so we took him to yet another, 3rd vet, who looked at ALL the problems we were talking about, since THIS vet actually listened to us. She said she likes to take a scientific approach to problems and she then drew some blood and Charley donated a urine sample and she said the results were alarming (no, I don't have any results, yet). She said all the symptoms, including the blood test indicated Cushings, so that is when we decided to have the LDDST done at her suggestion.


Questions:

I have been reading a lot about treatment using Trilostane. Are there fewer side affects using Trilostane -vs- Mitotane? One thing that concerns me about a comment from the vet we are using...she said Charley would need near constant watching while using either of these drugs. Is that true or is she just referring to the first days of the treatment? From what I have gathered from reading others comments, it is those first 7 to 10 days of treatment that are the most dangerous, is that true? Once we have to proper dose figured out, will we be able to leave him alone for 6 to 7 hours at a time while we are both at work?

Also, any suggestions on using Trilostane 30mg tabs -vs- 60mg tabs? Charley is right on the borderline as far as weight goes (23 lbs.). My first instinct is to go with 30mg tabs at first, since I DO NOT want him overdosed. Any ideas on this?

Any help towards these questions will be greatly appreciated. This forum is wonderful, so full of knowledge and that is half the battle for us. We love that little guy and want him around for many more years.

[jmac]

Hi there and welcome to you and Charley!

I'm sorry for the circumstances that brought you here, but you are right that this is a wonderful place with tons of information! There are many knowledgeable, kind, helpful people here and we will do our best to help Charley.

Thanks so much for all of the information you provided; it is very helpful. If you could post the test results from the LDDS and whatever other blood work, urine tests Charley had (with the abnormal values and the reference ranges) that would be wonderful. It will assist us in helping you.

Others will be along soon to give you their advice about Trilostane as far as what to watch for, and the dosage. Please don't hesitate to ask any questions you have. We will be here to support you however we can!

Julie & Hannah

[frijole]

Hi Steve! Welcome to you and Charley! This place is fantastic... I came over 7 yrs ago and was helped so much I never left :D Warning - we play 20 questions so we can get up to speed ok?

While Charley has alot of signs of cushings I found it strange that there haven't been problems with urination. Normal water intake is approx 1 oz per pound of weight so at 23 pounds - Charley is taking in 46 ounces a day so twice normal amounts. Cush dogs drink because they are urinating - they don't urinate because they drink...

Were there any other tests done to confirm cushings? I ask because it is so very very very frequently misdiagnosed. The ldds test is a good start but most will do an acth test or an ultrasound to confirm the diagnosis. This might sound crazy but do you know if Charley is able to concentrate his urine? (is his pee yellow?)

When we talk food - we are talking dogs that will headbutt trashcans that are way to tall to knock over and be successful, they would never think of leaving a kibble and they do not chew their food they literally inhale it. Does Charley do this?

Was a blood panel done? Usually this is done first - it would be nice to see if the liver enzymes are elevated. If you had one done it would be helpful to see anything abnormal. Other diseases that mimic cushings are diabetes and hypothyroidism.

I would not treat my dog until further testing is done (assuming no other tests were done).

Regarding the two drugs - they work differently but both are affective. Most go with the drug that their vet is most experienced with so I would ask that question. If you go with trilostane we have learned over and over here that starting low is safer. Dogs require different doses and there is no need to rush treatment... get it right vs do it fast. Vets give you prednisone to have on hand in case of emergency (overdose caused by cortisol dropping too low)

Most important - cushings is not a death sentence - your dog can live a very long and happy life. Also do not feel you have to rush into treatment. Get the diagnosis right first.

I'd like to know more about the calcified lump you described. How long has it been there, has it spread etc?

OK... I have rambled on long enough. I see you are from Iowa! I'm from Nebraska. Welcome aboard - don't be afraid to ask questions - it is overwhelming at first. Kim

[charley12345]

Thanks for the replies. Yes, she did a standard blood test which is what alerted her to trouble and coupled with all his other symptoms called for the LDDST to be done. I will try to get the results tomorrow. As far as his urination habits go, I do think he seemed to urinate more often than normal while we walk. But then, I am not sure if he is really urinating or just making his territory? We have a fenced back yard and I have to admit that I do not watch him really close when I put him out. He is such a good dog, he has not had an accident in the house for the past 3 years! He has a bell that he rings when he needs to go out and he does not seem to ring any more than usual, but when I do see him urinate, he does seem to go longer than he used to in one spot. And when he eats, he does the same, eats in a frenzy. Again, thanks for the responses, and I will try to get those results of all the tests done tomorrow. I forgot to mention, she did a Ultrasound also to check his liver and kidneys, but no results on those yet either.

Also, as far as supplements in his diet, he gets on glucosamine tablet/day, called Joint Plus...

http://www.amazon.com/Pets-Prefer-Joint-Plus-Dogs/dp/B0002YFBQC/ref=sr_1_3?ie=UTF8&qid=1342666245&sr=8-3&keywords=pets+prefer+joint+plus


and one greenie/day

[frijole]

Awesome... get the test results and post them and don't do anything til you get the ultrasound results. Think I forgot - 30 mgs would be the better starting point for trilostane. Thanks! Kim

[Squirt's Mom]

Hi Steve,

Welcome to you and Charley! :)

(My comments in blue) -


I have been reading a lot about treatment using Trilostane. Are there fewer side affects using Trilostane -vs- Mitotane?

The simple answer is, no. Both have the exact same risk factors with the exact same potential side effects. What makes Trilostane (Vetoryl) seem safer is the short life in the body. Trilo loses its effectiveness in 2-12 hours after ingestion while Lysodren (Mitotane) reaches peak performance at the 48 hour mark after ingestion. So if there is a crisis, the Trilo is out of the system sooner than the Lyso.

One thing that concerns me about a comment from the vet we are using...she said Charley would need near constant watching while using either of these drugs. Is that true or is she just referring to the first days of the treatment? From what I have gathered from reading others comments, it is those first 7 to 10 days of treatment that are the most dangerous, is that true?

The two drugs work differently and are used differently to obtain the max benefit from each. With Lyso, the pup undergoes what is called "loading" in which the Lyso is given 2X day until you see signs that indicate the load has been achieved then the pup goes onto what is called the maintenance dose in which the med is given 2-4 times a week, not daily. During the loading phase, it is critical that the pup be watched closely for those signs that the load is complete which can take anywhere from 3 days to 3 months, but typically happens in 3-7 days.

With Trilo, there is no loading phase. The pup simply starts on X mgs then is tested and observed to see if that dose is controlling the cortisol. Once the dose is dialed in, the pup continues that dose daily. But until the dose is tweaked to the right dose, the pup needs to watched just as closely as you would if it were loading with Lyso.

Once we have to proper dose figured out, will we be able to leave him alone for 6 to 7 hours at a time while we are both at work?

You will be able to work just fine more than likely. When using Lyso, most of us start the load when we can be home over the weekend so we can have the time to closely watch those first few days. It's a good idea to do the same if using Trilo. ;) But once they are settled on the treatment, you both carry on with life as usual. As you learn more about Cushing's, you will know the signs that can indicate a potential problem and take action to correct it. Most pups do just fine on treatment, tho.

I'm glad you found us!

Hugs,
Leslie and the gang

[charley12345]

I am sad to say, that Charley passed away during the night on Wednesday evening/Thursday morning. Just a few hours after I first posted here. My wife found him at about 2:30AM. The vet that had finally diagnosed Cushings, said it was most likely from heart failure. We are so distraught over this. We miss him so much. He gave us more joy than can be expressed. Thank you all for your replies and I thank you for your dedication to helping and educating people about this terrible disease.

Steve

[Squirt's Mom]

Dear Steve,

I am so sorry to hear about Charley. I can only imagine how your wife must have felt to find him and how your hearts are breaking.

It seems clear that Charley was well loved which means he left this old world carrying that love in his heart as he crossed The Bridge. He was met by all our babies who have gone before and is running in the Rainbow Fields, strong and whole once again. When your job here is done, Charley will be waiting at the end of that bridge for you and he will fly into your arms with eternal joy.

Please feel free to share your memories, post a tribute or memorial to Charley when you are ready in the In Loving Memory section. Charley's name has been added to our In Loving Memory list for 2012 where he will always be remembered and honored as a member of our family here.

http://www.k9cushings.com/forum/showthread.php?t=3918

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Tasha, and our Angels, Ruby and Crystal

[Jenny & Judi in MN]

Oh this is heartbreaking, he was so young. My sympathies to you and your wife. Judi

[jmac]

Steve,

I am so very sorry. How heartbreaking. I can't imagine how devastating this is for you and your wife.

Like Leslie mentioned, it is clear that Charley was loved very much, and he knew it. I am sure he went peacefully, and in his own home, where he felt safe and comfortable.

My thoughts are with you during this really difficult time. I hope your happy memories will bring you some peace.

Sincerely,
Julie & Hannah

[Roxee's Dad]

Dear Steve,
I am so very sorry. Rest in Peace Charley, you are our newest and brightest star in the sky.

[addy]

Dear Steve,

I am so sorry to read this news. How terrible for you and your family. Words cannot express my deep sympathy.

[mytil]

Oh Steve,

I am so very sorry. My heart goes out to you and your wife.

Please do stay with us.
(((hugs)))
Terry

[frijole]

RIP dearest Charley. Run free of pain and know you were loved and will be missed. May memories of all the good times sustain your family as they heal from your loss. RIP dear angel. Kim

[GabbySue]

I am so sorry to hear that Charley has passed. May the memories in time bring smiles instead of tears....RIP Charley

[k9diabetes]

Oh Steve... I'm so sorry. Charley was so young. It's just not fair.

Natalie

[lulusmom]

Steve, I am so sorry for your loss. My thoughts and prayers are with you and your wife.

Godspeed sweet Charley

[charley12345]

Thank you all so much for your kind, kind words. It's just so hard to believe Charley is gone. He was my little buddy on my days off from work, my wife's comfort while I was away at work...Again, thank you all for your dedication.

[molly muffin]

I am very, very sorry to hear about Charley passing. So young and yes, heart breaking. These little ones (and big ones too) just crawl into your heart and make themselves at home, never to leave. I've very, very sorry. :(

[Steph n' Ella]

Poor Charley! Reminds me of Cookie, my family's first Ingie Cocker, who died of heart failure at age 4. She was the first family dog that we got when I was old enough to train and love on as a puppy. Cockers are known to have weak hearts. If you know Charlie's breeder, you may want to notify.

We knew our Cookie came from a hick breeder who bred dogs for the money. But what are you going to do when you drive out their the farm to look at puppies? Come home empty handed? Heck no! She was sick the day we picked her up...then when we got her papers from the AKC we realized the damme and the stud were brother and sister...hope that litter was an oopsie!