8 yr old Boston just diagnosed with Pituitary based Cushings... [Archive] - Canine Cushing's Information and Support Forums

winston's mama

08-11-2012, 04:50 PM

I just learned 4 days ago my 8yr old Boston Terrier has Pituitary based Cushings...I was ignorant of the diseases symptoms, so I just figured he was aging rapidly due to the fact he's been on Phenobarbitol & Potassium Bromide for almost 6 yrs now due to SEVERE Grand Mal seizures that required emergency hospitalization each time in order to get the seizure to stop...(He's been seizure free now for 3 yrs so Im assuming that combo of meds is why.) So, upon Winston getting an eye ulcer last week that wouldn't respond to my family vets antibiotic drops, (the ulcer appeared to be literally melting his eye away) I took him to the emergency clinic for fear he might lose his eye. The emerg vet took one look at him & suggested we test for Cushings, so we did, & he was diagnosed with pituitary based Cushings. (Now that I'm educated on the disease, i feel he's had symptoms for over a year & Im hating myself for not being more diligent in recognizing them & trying to get a diagnosis.) Anyway...the emerg vet started him on 10mg of Vetoryl twice daily. Winston's been on the meds for only 4 days now but he is SO LETHARGIC & ALMOST APPEARS TO BE "SPACED OUT" almost all the time now. His panting has actually increased to the point that I was afraid he wouldn't get enough air intake to survive last night. He seems MISERABLE, the only thing that gets him even remotely excited is when I offer him food or treats! I'm scared to death of the Vetoryl now after researching it, will these side effects subside once he gets used to it??? Or could these "side effects" actually be that his Cushings is so advanced that he's already near the end? If this is the way he will act for the rest of his life, I almost feel it's cruel to let him go on this way. I CAN'T BEAR THE THOUGHT OF LOSING HIM YET, HE'S MY 1ST CHILD & WE ARE JOINED AT THE HIP! Can anyone give me insight as to whether Vetoryl has helped or hurt their dog? I don't mind the constant eating, drinking & peeing symptoms...I just want him to look & feel happy & alert again. HELP, PLEASE, Anyone...I also researched a natural supplement called Supraglan. Does anyone have experience with that either???

Squirt's Mom

08-11-2012, 05:03 PM

Hi and welcome to you and Winston! :)

For right now, stop the Vetoryl. It doesn't cause any harm to stop then restart this drug and it's better safe than sorry. The fact that he still has interest in food and treats is a good sign so I'm not overly worried about an overdose but am a bit concerned about the combination of the seizure meds with the Vetoryl. We have several members who have dealt with both conditions and I hope they will be by soon to share their experiences with you. But for right now, no more Vetoryl, 'k? ;)

Has he had loose stools or diarrhea? Any nausea or vomiting? Can you tell us how much Winston weighs?

Take a deep breath, you are not alone any more. You and Winston are part of our family now and this family sticks together. You can talk to us any time, as often as you wish, someone is almost always around. We will be here to help you in any way we can.

Hang in there!
Hugs,
Leslie and the gang

jmac

08-11-2012, 05:13 PM

Hi there,

I am so sorry to hear about what is going in with Winston. You have to the right place for help. First, we need as much info. as possible. Can you get the results of any blood work and tests that were done and post the abnormal values, with the reference ranges? Also, how much does Winston weigh? Can you tell us what symptoms of Cushing's you're seeing?

Our experts will be along soon to help. Right now, I have a few thoughts. First, he may not have Cushing's and the Vetoryl is causing this. Another possibility is that his cortisol has dropped too low, which can cause lethargy, among other things, like not wanting to eat. Did the vet give you prednisone in case of an emergency? Third, I think I've heard other members say phenobarb may not be good with Cushing's meds.

I am not an expert, and others will give better advice, but if I were you I would not give Vetoryl again until you hear from others on the site. In the meantime, please give us as much info. as you can so we can help you. Also check out the resources section of our site.

I'm so sorry things are not going well right now, but we will do everything we can to help you.

Julie & Hannah

Harley PoMMom

08-11-2012, 05:30 PM

Hi and welcome to you and your boy,

A dog taking Phenobarbital can have many of the same symptoms as a dog that has Cushing's Disease, such as excessive drinking/urination, increased appetite, and elevated liver enzymes.

Cushing's is one of the most difficult endocrine diseases to diagnose because there is not one test that is 100% accurate at diagnosing Cushing's and any non-adrenal illness can create false positives on Cushing tests.

It would help us a great deal if you could round up copies of all tests that were done on your boy and post any abnormalities listed with their reference ranges and units of measurements...e.g. ALP 50 U/L (5-150.)

Please know we are here to help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

winston's mama

08-11-2012, 08:03 PM

Thanks to you all for your fast response.. to answer as many questions as possible: Winston weighs about 19.5 lbs. He has not had any vomiting, & no diarrhea. He has had some slightly loose stools, (no blood) but he's seemed to have that issue on & off for most of his life. I did also switch his diet this week from Purina Dog Chow to the Halo Holistic dog food hoping that may help boost his immune system.
He has EVERY sign of Cushings: started with EXCESSIVE water intake, INSATIBLE appetite, (which both my vet & I thought were due to the Phenobarbitol.) He initially gained some weight (about 9-10 mos ago) so my vet suggested we put him on a diet of 1/2 cup food per day, plus cooked green beans as a snack...That went on for 6 months, & he did achieve a healthier weight, but that's when I really noticed he had lost mostly muscle mass. So next time we went to the vet we discovered he had lost 4 lbs since we had been there about 2-3 mos prior. (He's always been a stocky, muscular little tough guy but his hips & shoulders had shrunk, his spine was starting to protrude, plus he still had a pot belly even after losing weight.) His hair has been thinning for a while too. He pants sometimes so bad that I fear he may suffocate...He also can't jump on the couch anymore which is where he has spent most of his life, on my lap! Within the last few months he doesn't even seem interested in me anymore which breaks my heart.
As far as the diagnosis: I took Winston the our family vet for an eye ulcer as soon as I noticed his eye was red & inflamed. She put him on Tobramycin drops & antibiotic ointment. I did everything as directed, but his poor eye got worse with each passing day. So back to the vet we go to get the Opthalmic serum & other treatments. Still, his eye got worse. It appeared as his eye ball was melting, like something from a horror movie. So, I rushed him to the Emergency vet. The ER vet took one look at him & suspected Cushings, so they did the ACTH stimulation test, which suggested Cushings. Then did ultrasound of his adrenal glands which looked ok. That's how they arrived at diagnosis of Pituitary based Cushings.
My family vet also did a "wellness panel" of blood when we initially went in for the eye problem. It was negative for diabetes & heartworms. She said all the other levels were ok (not sure what all they tested exactly but i'll find out) The only thing that was out of whack was his liver enzymes were high. Again, we figured that was due to the Pheno.
I will get copies of blood test & get back to you...
Again, thank you all...I need all the help I can get right now!!!
Stacey, aka: Winston's Mama.

winston's mama

08-11-2012, 08:17 PM

Also...Winston has been on the Phenobarbitol & Potassium Bromide for about 5-6 yrs now. I understand that it can cause some side effects similar to Cushings...BUT...he's been a happy & hyper little boy his whole life, even on the Pheno!!! His energy level really started to go down significantly within the last 6-9 months. He hasn't been able, nor wanted to jump on the couch for probably about 4-5 months now. That's another reason I feel his Cushings diagnosis is probably accurate.
Vet also mentioned that Cushings is probably why his eye is not healing properly. He still has a horrible ulcer & it's been 17 days now of aggressive drops & meds. (He's also on oral Doxycycline pill for the next 10 days.)
Poor little guy, I cry every time I look at him...
Thanks again...
Stacey, aka: Winston's Mama

molly muffin

08-11-2012, 08:53 PM

Hi and welcome Stacey and Winston,

I don't know how normal it is to start out on twice a day Trislostane, usually you would start with once a day, 10 mg, etc. Move to twice a day only if once a day isn't working and it looks like the Trilostane is leaving his system too soon. I too have heard some of the other say that phenobarb and Trilostane is a bad combination. So that is something to consider too.

I think the test you want for confirmation of the Cushings result is LDDS and it could be he is Atypical cushings, in which case, the test would need to be sent to the U of Tenn, to verify that.

One of our members just went through this eye ulcer situation, which was very bad and hopefully she'll be able to stop by and let you know exactly what they had to use in the end to start seeing some positive results. It too didn't clear up with the regular prescribed drops.

There are a lot of members here who have gone through this and will be able to share their experiences. One thing I know is that starting out and getting the right dosage,waiting for symptoms to start to clear up is a process. So, I would expect and hope that once this is all sorted out that you would start to see a noticeable difference. It does take some patience to get there.

I'm glad you found this board. Coming here and talking about it with others who have gone through this is what caused me to ask for the LDDS test for molly, which showed she had not gone into a cushings state yet. At first they were ready to start her on 30mg of Vetyrol immediately and that would not have been a good option since the last test showed negative. I think the Atypical might be reasonable to check into since Winston has been on these meds for so long and and that could lead to the cushings diagnosis.

These are just all things to put into your "gathering information" process and consider. Not definitive by any means.

I'm very glad that you found us.

Welcome and hugs,
Sharlene

labblab

08-11-2012, 09:33 PM

Hi Stacey,

By any chance, was Winston taking any eye medications that contained steroids at the time he was tested for Cushing's? If he was, those medications could have falsely elevated the ACTH results.

If it is the case that the Cushing's diagnosis is accurate, it is true that phenobarb is probably not the best seizure med to combine with trilostane due to interaction effects since they both involve the liver. Potassium bromide does not have the same risk of interaction, so it may be the case that your vet might want to try to slowly wean Winston off the phenobarb and exclusively onto the potassium bromide. Given the severity of his seizures and the great control you've had up to the point in time, however, I understand why you'd hate to rock the boat. :o

If you end up sticking with both drugs, though, I'd encourage your vet to contact the manufacturers of Vetoryl (brandname trilostane) in order to find out how the combo of phenobarb and trilostane might alter recommended trilostane dosing.

A few more questions: how much does Winston weigh? You might have said already, but somehow I missed seeing it. Also, you've mentioned it was the ER vet who started Winston on the trilostane. Is he continuing to monitor Winston, or is that being turned over to your regular vet. Does your own vet have any prior experience with the drug? Has either vet talked with you about the importance of monitoring ACTH tests once a dog starts trilostane treatment? And finally, do you know whether Winston has ever had any abnormal thyroid test results. I know that phenobarb itself can skew thyroid readings. But some of Winston's symptoms could also be caused by low thyroid, and I am just curious whether his thyroid results have been normal or not.

Given Winston's negative reactions to the first days of dosing, I agree with Leslie that I would withhold the trilostane for the time being until you've had the chance to gather some more information.

Thanks!
Marianne

winston's mama

08-12-2012, 12:13 AM

Hi Sharlene, I also have read that Vetoryl is supposed to be given once daily. The leaflet that comes in the box even says in capital letters: ONCE DAILY...
I plan to question the emergency vet as to why he put winston on 2 pills daily???

I also read a comment from someone who's dog had Atypical Cushings & he too learned so through University of Tenn. He said his dog would've probably died had he given the Vetoryl without his pursuing further testing...This is so scary but I'm so thankful for all the advice & knowledge everyone has shared. I think I will pursue that test as well. Do you mind sharing with me what it cost you?

I hope to hear from anyone with the eye ulcer issues. Winston was taken off Tobramycin drops (which i think he's possibly allergic to, the eye got worse over a 9 day usage period) & the ER Opthamologist put him on Ciprofloxacin, Atropine, & Opthalmic serum they spin from the dogs own blood. He was getting drops rotated hourly for a full 4 days while in the hospital & his eye seemed to stabilize somewhat. I don't know at this point if we'll be able to save the eye, but he's in no shape for any surgery right now so it's a waiting game.

I also specifically asked both the ER vet's internal medicine specialist about any contraindications between Pheno, Potassium & Vetoryl...& he stated they should be fine to use together??? Not so sure I believe him. I also read somewhere else that Vetoryl can be dangerous with potassium supplements, but again, the ER vet said no. UGH!!!

I'm so glad I found this forum, I've already learned so much & have discovered lots of questions I need to ask my vet. Thanks so much for your advice!!!

winston's mama

08-12-2012, 12:34 AM

Hi Marianne, Winston was not on any steriod drops at the time of his test, only Tobramycin drops & Neobacimyx ointment...My vet said to stay away from steroid drops as they can make ulcers worse.

I am SCARED TO DEATH to take him off the Pheno because it took almost 3 yrs of dose adjustment & then addition of Potassium Bromide before the seizures finally subsided. I feel if he has another seizure, he won't make it this time...You make an excellent point about contacting the manufacturer to see about drug interactions & dosage with these 2 drugs together. I plan to check on that myself!

Winson weighs approx 19.5 lbs...& I also plan to check with my vet about running thyroid tests. That sounds like a smart idea. The ER vet wanted me to follow up with him after 3 weeks of treatment on the vetoryl, but...I'm thinking I may just follow up with my regular vet instead. I called my regular vet today since I was so worried about Winston's symptoms & he flat out said, "If I was treating him, I would start him on 5mg once daily & work our way up very slowly..." Anyway, I plan to make an appointment for Monday so I can have all my questions answered by my vet I've known for the last 8 years. My vet may not be a "specialist" but I feel that they are honest & not out to rip people off by pushing certain medications.

I'm so overwhelmed right now, I have pages of notes to ask the vet!
I thank you for your advice & hope I can report back soon with good news.

molly muffin

08-12-2012, 12:56 AM

Hi Stacey,

I totally get where you are coming from. I'm actually pretty happy to hear your vet say once a day 5 mg to start. As I always think it is easier to adjust up than down.

The thread for Addy and her dog Zoe that has the eye ulcer, only given the all clear today (yea, we're all pretty excited about that :) ) is here:
http://www.k9cushings.com/forum/showthread.php?t=2070&page=240

She says what Zoe was put on, just go back a few pages from the last one to find it.

I didn't have the Atypical cushings test yet, as that wasn't a consideration for molly. She hadn't been on any type of meds that might cause that, although not saying it has been ruled out yet, due to her weird lab results. We're still in diagnoisis phase of what is going on with her. I've had yes it is cushings and now no it isn't.

However, Squirt I know is atypical, so check out Leslie's thread for information here:
http://www.k9cushings.com/forum/showthread.php?t=633&page=51

There are 3 pages of information in our Resource section that it would also be beneficial to browse through:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Okay that is enough homework pages for one night. I don't want to overload you or freak you out. This is scary enough as it is. The main thing is to get it figured out what is going on with Winston and what the best options are for treatment to get him back to himself and able to enjoy his wonderful life.

Hang in there!
hugs,
Sharlene

labblab

08-12-2012, 08:20 AM

Hello again, and thanks so much for this additional information. I have a non-Cushpup who suffers from a seizure disorder, so I totally understand your hesitation about altering Winston's medication since it has allowed you to control his episodes. My girl has been successfully controlled with phenobarb for about a year and a half now. Here's the link, though, for Dechra's "Contact Us" page for either you or your vet. I do think it's a good idea to ask their advice about any issues to watch for when combining phenobarb with trilostane. The technical reps at Dechra used to be very willing to talk directly to pet owners, but members have recently reported to us that they now prefer to communicate only with vets. But there certainly is no harm in you trying.

http://www.dechra-us.com/Default.aspx?ID=365

As far as the once vs. twice daily dosing of trilostane, there is quite a bit of debate as to which is the better route to go. There are a number of specialists and researchers who believe that twice daily dosing is actually a better way to keep cortisol levels controlled more consistently throughout a 24-hour time period. But as you have read, the manufacturer still recommends beginning with once daily doing, and as Sharlene says, only making a switch if a dog's symptoms do not resolve or rebound before the end of the day. The bottom line is, there is nothing wrong with twice daily dosing although it is somewhat more inconvenient for the owner to routinely and consistently dose that way. However, since I assume you are already dosing Winston twice daily with the phenobarb, you are already used to having to abide by a twice daily dosing schedule. And if you are indeed dosing Winston twice daily with his anti-seizure meds, it may be best to dose him twice daily with the trilostane, too. It is recommended that diabetic dogs be dosed twice daily with trilo so as to keep their endocrinological systems more consistently controlled throughout a 24-hour time period, and that may also be helpful for a seizure dog, too.

As far as testing for Atypical Cushing's, I don't believe that would be useful for Winston right now. It involves the very same test that he already had performed -- the ACTH stimulation test. The difference is just that in addition to analyzing the cortisol, the lab at U. of Tennessee also analyzes the levels of all the other adrenal hormones as well. If a dog's cortisol level is normal but other adrenal hormones are elevated, then the diagnosis of "Atypical Cushing's" may be applied. However, if the cortisol is elevated as was the case for Winston, then the diagnosis is conventional Cushing's, regardless of the status of the other adrenal hormones. In fact, if the cortisol is elevated, it is most likely that other adrenal hormones will also be elevated, too. So the bottom line is that, since Winston's first ACTH showed elevated cortisol, there really is no reason to repeat the test for additional analysis.

So if it were me, before starting back on the trilostane, I'd wait until my vet could talk with a technical rep at Dechra so as to to get the best info possible in terms of recommended dosing when used alongside phenobarb.

Marianne

addy

08-12-2012, 03:13 PM

Hi,

I just went through six weeks of an eye ulcer with my Cush pup. i will start by saying having an veterinarian opthalmologist is really important. Melting ulcerrated corneas are very serious. Zoe's was not to that point but we had a lot to fear as she has dry eye disease, crystal deposits on her cornea most likely from Cushings and chronic conjunctivitis. The ulcer was on top of the crystal deposits which made the likelihood of healing not so good.

Aggressive antibiotics were needed for Zoe's eye as we started to see yellow ribbons indicating the start of infection. It was also important to keep her eyes moist. We had to treat the other non ulcer eye as well so a spontantous ulcer did not occur there also. Zoe also had secondary glaucoma in the ulcerated eye. Glaucoma in dogs is very painful.

Meds included:
Tacrolimus .02% solution for dry eye disease and to keep the eyes moist. Cyclosporine 2% solution was also used in the non ulcer eye. The cylocpsorine could not be used in the ulcered eye.

Flubiprofen was used for inflammation both eyes
EDTA 1% solution to break apart the crystals both eyes
Genteal Gel to keep eyes lubricated both eyes
Cefazolin and Oflxacin for infection ulcer eye only
Serum- ulcer eye only
Neo Poly Gram- for infection non ulcer eye only
Tropicamide- ulcer eye to dilate pupil, help with pain, help with glaucoma
Dorzolamide for eye pressure ulcer eye only for glaucoma

It was very, very important Zoe did not rub her eye and we could not miss one single eye drop. Some meds were 4 times a day, some 3 times a day, some twice a day. It was very important to control her pain which we did with Tramadol.

In the beginning, prognosis was guarded and eye vet thought surgery would be needed.

Were you given a diagnosis of melting ulcerated cornea? Do you know how deep the ulcer is?

I credit the agressive antibioitcis and serum for helping save Zoe's eyes. It was a lot of work. We had a full time job of medicating her eyes and watching her like a hawk. We made sure she got a lot of rest. I used the tramadol to knock her out.

Yesterday, six weeks later, we were finally told the ulcer was healed, the dry eye disease is now finally under control, the conjunctivitis controlled. She has scar tissue in the middle of her cornea and she has a hard time seeing through it ( like she is near sighted) He is hoping that will thin out as time progresses.

We were at the vets every 7 to 10 days for monitoring. The cornea crystals remain a potenital problem for Zoe.

Hang in there. It is a hard road especially if you are juggling other health issues.

winston's mama

08-12-2012, 03:19 PM

Thanks ladies again, for all the helpful information...i did decide to stop the vetoryl for now. His last pill was over 18 hrs ago. He seems a bit less lethargic, but still way too lethargic for me to think he's feeling ok. He seems to be having a hard time breathing mostly when he lays down to rest, he can't get comfortable & flops around trying to find a position where he can breathe easier. His last stool was looser too, not diarreah, but closer to it.

He is on Doxycycline pills for his eye, 50 mg every 12 hours, so i decided to look up the side effects on that med...now I'm even more scared...it says it can cause confusion plus if you notice difficulty breathing to call the vet immediately...I wonder if his lethargy & breathing issues are due to the Doxycycline rather than the Vetoryl???

He really just seems so depressed & miserable that i feel he may be close to the end...I think he may have had cushings for quite a while & it's already taken quite a toll on his little body. I've just learned about this disease within the last week, I've never heard of it before, so with all the research I've done these past few days I'm really suspect that Winston has another serious underlying issue that is a result of the Cushings.

I plan to take him to his regular vet tomorrow & see what other blood tests we can run to check any organ functions we haven't already tested. I've got a whole sheet of notebook paper full of questions to ask my vet. I'm wondering if he's too far gone for Cushings meds to even help at this point...

I've never had to go through watching a pet age & fight diseases before, plus the feeling of thinking I can't go on without him... It's the worst feeling ever.

My heart goes out to everyone who is battling this with their beloved pets...
It really can take it's toll on you. I truly appreciate your support.
Stacey, aka: Winston's mama

addy

08-12-2012, 03:22 PM

Stacey- I think we were typing at the same time. Please see my post before yours regarding my Zoe's eyes.

winston's mama

08-12-2012, 03:51 PM

Hi Addy, i must have been typing my last post just as you were...

I'm glad to hear that Zoe's ulcer has healed, 6 weeks is a long time to deal with all the drops!

Winston went to his regular vet for the ulcer the first day I noticed some irritation. They gave him Tobramycin drops 3x per day & neobacimyx ointment applied at bedtime only.
He seemed to be doing ok, but about 3 or 4 days into treatment the eye suddenly got WAY worse. I thought he could be allergic to the drops? It was a Sunday that I woke up to find his eye appeared as if it was melting, like something from a horror movie...so i rushed to the emergency vet where they switched his eye drops to Ciprofloxacin, atropine, & opthalmic serum they spin from the dogs own blood.
They kept him in the hospital overnight so they could administer these drops every hour...then he saw their Opthamologist the next morning. He told me he would not be a good candidate for surgery since they suspected Cushings...(which we were still waiting on the test results to come in) & he also said the corneal surgery where they place the lens over the eye only has a 50% success rate of healing properly. So they kept him in the hospital for almost 4 days & continued with the drops aggressively on the hour.
He's home with me now but Im sticking to a strict schedule of the same drops but only every 3 hours or so now. (Only from about 7:30 am til whenever I go to bed...they said I don't need to stay up all night.)
As far as the diagnosis for the eye, all I know is it's a severe ulcer & he has a strep infection as well as Serrattia. He said Serrattia is very rare, but that's about it. (I still need to look that up online, I've just been so busy...) So I must stick with this drops schedule for at least another week & see how his eye looks then. We go back to the Opthamologist in 4 days.

Thanks for sharing your story of what Zoe's treatment plan was, it sounds like you have you hands full as well but as long as her ulcer has healed that's one less thing to worry about! Good luck!!!
Stacey, aka: Winston's mama

addy

08-12-2012, 04:38 PM

It sounds like you are in good hands. The dog serum is an eye saver in my opinion.:):):)

I know the drops are hard but it is worth the work. Zoe's eyes looked really bad too, when she could open them. The third eye lid covered most of her eyes and the rest of them were rolled in the back of her head. eek:

You are doing the right thing. I will be praying for good updates in four days:) The Cushings can make the road a bit longer to travel.

I am sure glad you found us.

labblab

08-13-2012, 11:43 AM

Stacey, I hope Winston's vet visit goes well today and you are able to some anwers that will help guide your path forward. Since you are wondering about twice-daily trilostane dosing, I just wanted to alert you that we've just started having a related conversation on another member's thread. You might want to stop by and see how that conversation develops. Here's a link to the reply that starts off the topic:

http://www.k9cushings.com/forum/showthread.php?p=80079#post80079

Marianne

winston's mama

08-13-2012, 05:42 PM

Hi again everyone...I am posting the results of Winston's "wellness profile" done on 7-26-12

This was done this first day he was taken to my family vet when his eye ulcer started...

CHW NEG
ALP 2119* 20-150 U/L
ALT 177* 10-118 U/L
TBIL 0.3 0.1-0.6 MG/DL
BUN 7 7-25 MG/DL
CRE <0.2* 0.3-1.4 MG/DL
TP 5.5 5.4-8.2 G/DL
ALB 2.2* 2.5-4.4 G/DL
GLOB 3.2 2.3-5.2 G/DL
GLU 103 60-110 MG/DL
CA 9.7 8.6-11.8 MG/DL
PHOS 5.0 2.9-6.6 MG/DL

QC OK
HEM 0 LIP 2+ ICT 0

now the ER vet ran an ACTH STIMULATION TEST ON 8/7/12:
Cortisol Serial 2 (ACTH)
Time 1 11:05 Cortisol sample 1 9.3 1.0-5.0 mg/dl HIGH
Time 2 12:15 Cortisol sample 2 32.3 8-17 mg/dl HIGH

So....I'm pretty sure Winston was under stress the day he was tested, as he had a HORRIBLE melting eye ulcer & he was in pain. Plus he HATES being confined to a cage & barks non-stop if he wants out. Plus he had spent the night in the hospital getting eye drops every hour the evening before they did the ACTH test.
I KNOW HE WAS STRESSED!!!
Could that have possibly caused such high readings???

Ugh!!! I'm so confused & stressed. Winston goes to his regular vet in the morning so I can get some more answers & get my vets opinion on what the ER Internal Med Specialist recommended for treatment.

As of now, I still haven't given him any more Vetoryl. I am suspect that his severe lethargy & unresponsiveness may have been due to stress, lack of sleep & pain in his eye. Maybe it wasn't because of the Vetoryl??? I plan to get my vets opinion on all this tomorrow but would love to hear anyones thoughts on all this.....

Thanks again for all your support! I think this forum is wonderful & I'm thankful I found you all!!!

Stacey & Winston.

labblab

08-13-2012, 05:55 PM

Stacey, I'm sorry to tell you that yes, stress and other nonadrenal illness can definitely increase a dog's cortisol level and skew the results of an ACTH stim test. It is very unfortunate that the ER vet chose to test Winston under those conditions. :(

You do need to talk this over with your vet, and perhaps opt to perform either a repeat ACTH or a LDDS under much less stressful circumstances. I know these tests are quite expensive, so this is not the news you wanted to hear. But I'd be very surprised if the ACTH reading was accurate given the situation you've described. That's not to say that Winston does not have Cushing's. But I just don't think you can count on those results as being reliable.

Marianne

lulusmom

08-13-2012, 05:59 PM

winston's mama

08-13-2012, 07:00 PM

well then, I guess that's another question for my vet tomorrow...

Also, I noticed on Winston's ALP it read: 2119???? While normal max is 150.

That sounds EXTREMELY ELEVATED TO ME!!! His vet mentioned that his "liver enzymes were high" but they didn't seem all too concerned. ???

The ultrasound results also mentioned his liver was enlarged.

I've been researching these symptoms online now which also has me suspect of liver disease... I know Pheno can take it's toll on your liver & he's been on it for about 6 yrs now...

Thanks again for everyone's input... We'll see what the vet says tomorrow.

molly muffin

08-13-2012, 11:27 PM

Stacey,

Molly had a postitive ACTH test and my vet was ready to put her on 30mg of Trilostane right then and there. I asked to see a specialist and get an ultrasound, mildly enlarged liver and adrenal glands. (consistent with possible cushings as was the ACTH) However, the specialist recommended an LDDS and WTH, normal . She suppressed for the full 8 hours at < 1 which is absolutely normal. So, no Trilostane for her and now we're trying to figure out what is going on with her raised ALP's and high ALT's.
I'm starting her on a milt thistle supplement next week after I get back from a work trip to Montreal.

So, that was long, wasn't it. Sorry. So, my suggestion based upon what happened with molly is the LDDS test to confirm he really cannot suppress. The poor little guy has an awful going on with him and that has to all be figured out. I do know that sucks. Yea, might want to recheck the ALP/ALT's at the same time.

I'm sure he was very stressed at the time of the ACTH test. One thing is to make sure and get this eye situation under control. That's really important right now too. Oh gosh, it's all imporatant and I really do Not want to stress you out. So, there you go. LDDS to confirm cushings or not.
If cost is going to be over the top, even a UCCR test to check. It can't confirm cushings but it can rule it out.

Hang in there!
Hugs,
Sharlene

lulusmom

08-14-2012, 12:03 AM

Hi Stacey,

I just wanted to drop by to share an abstract of a study on the effects of phenobarbital on the liver.

J Vet Intern Med. 2000 Mar-Apr;14(2):165-71.

Effects of long-term phenobarbital treatment on the liver in dogs.
Müller PB, Taboada J, Hosgood G, Partington BP, VanSteenhouse JL, Taylor HW, Wolfsheimer KJ.

Source
Department of Veterinary Physiology, Pharmacology and Toxicology, School of Veterinary Medicine, Louisiana State University, Baton Rouge 70803, USA.

Abstract
Long-term administration of phenobarbital has been reported to cause hepatic injury in dogs. Phenobarbital induces hepatic enzymes, and it may be difficult to distinguish the effect of enzyme induction on serum liver enzyme activities from actual hepatic damage. The hepatotoxicity of phenobarbital and the impact of enzyme induction on serum liver enzyme activity were investigated prospectively in 12 normal dogs. Phenobarbital was administered for 29 weeks at 5 mg per kilogram of body weight (range, 4.8-6.6 mg/kg) PO q12h, resulting in therapeutic serum phenobarbital concentrations (20-40 microg/mL). Serum alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), fasted bile acids (fBA), total bilirubin, and albumin were determined before and during treatment. Lateral abdominal radiographs, abdominal ultrasounds, and histopathologic examinations of liver tissue obtained by ultrasound-guided biopsy were performed before and during treatment. Radiographs revealed a moderate increase in liver size in most dogs. Ultrasonographic examination revealed no change in liver echogenicity or architecture. No evidence of morphologic liver damage was observed histopathologically. ALP and ALT increased significantly (P < .05), GGT increased transiently, and albumin decreased transiently during the study. There were no significant changes in AST, bilirubin, and fBA. These results suggest that increases in serum ALP, ALT, and GGT may reflect enzyme induction rather than hepatic injury during phenobarbital treatment in dogs. Serum AST, fBA, and bilirubin, and ultrasonographic evaluation of the liver are not affected by the enzyme-inducing effect of phenobarbital and can therefore be helpful to assess liver disease in dogs treated with the drug.

PMID: 10772488 [PubMed - indexed for MEDLINE]

You'll note that the abdominal ultrasound showed liver enlargement and both ALT and ALKP were very elevated, yet there was no liver injury due to the administration of phenobarbital. That may be the reason why your vet isn't too concerned with the very high ALKP.

I have seen another study that showed that phenobarbital does not have any affect on adrenal function tests such as the LDDS and ACTH stimulation test so it appears the pheno had nothing to do with Winston's abnormal acth stim test.

Glynda

winston's mama

08-14-2012, 11:06 AM

Hi Sharlene, that's interesting about Molly's test results...I'll be sure to ask my vet about the LDDS & WTH test.
This is so confusing...
Does that mean they have ruled out Cushings for Molly?

Does she show any or many of the symptoms of Cushings though?

Winston has pretty much every symptom associated with Cushings, but he's just so lethargic & withdrawn (and having trouble breathing when he lays down) that I suspect there's something more serious happening with him in addition to Cushings...

Thanks for the info.... take care.

winston's mama

08-14-2012, 11:14 AM

Hi Glynda, thanks for the study info on Pheno...

That kind of gives me some hope... maybe that is why neither vet seemed worried about his HIGH enzymes??? I'm going to have my vet check Winston's Pheno blood levels too just to be safe. I didn't realize that Pheno levels don't need to be quite as high for therapeutic maintenance when it's combined w/ Potassium Bromide...
I feel like I'm studying for vet school with all the info I've researched this past week.

Getting ready to go here shortly.... thanks & take care.

molly muffin

08-14-2012, 07:48 PM

Hi Stacey,
As far as typical symptoms go, molly has the pot belly, the IMS thought she had some thinning of hair. I won't really know though until after I let it grow out from the last grooming session. (she doesn't shed and gets a really think underlayer of hair that can knot like crazy, but the top is always very fine and practically straight) I don't see anything else personally.
So, the LDDS has for now, ruled cushings out, with the possibility that she's heading into it and not only was it caught early but actually at the point where she can still suppress, but that may only last for a few more months or even a year (that would be lucky), otherwise, we're looking at something else, liver, etc disease. It's just a wait and see at the moment.

Hopefully they can figure out what is going on with Winston.

hugs,
Sharlene