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Majah
10-10-2012, 01:59 PM
Hello everyone. I'm the proud mom of several Manchesters. We have had three Mannies with Cushings in the last several years, and lost two of them in the past two years. They were both 15 years old, which is a nice long life for a Manchester. Our first, Champ, had undiagnosed Cushings. Neither our local vet, who is usually very good, nor the OSU veterinary hospital caught the disease. He had all of the typical symptoms, and I suspected it was CSH, but testing returned normal levels so no treatment was given. As it was, Champ had a pretty severe heart murmur and when we took him for evaluation of the murmur, the specialist found a sizeable splenic tumor. Later that day, the tumor ruptured and he was hemorrhaging, so we made the sad decision for euthanasia. In retrospect, our local vet said she realizes now he did have CS. She has been researching the disease since Champ had it.

The other dog we recently lost, just in May, to complications from Trilostane toxicity. We'd been taking her to a specialist because her symptoms seemed to advance rapidly. Based on what I've read from you all here, it seems that she may have had a macro tumor which was made worse by the Trilostane. I had to stop the trilostane on my own because the specialist insisted that Pele stay on it. I think she was just one of those rare cases of a dog that doesn't do well on it. She was never right after that, and had had some other health problems before CS was diagnosed, but it was just heartbreaking to put her to sleep. Her quality of life was gone, she was incontinent of bladder and bowel, weak and just didn't want to eat. We knew it was time but it hurt so much to let her go. This was just last May.

Now, our other old boy, Guinness, is a fastidious and very smart dog. He was diagnosed with CS about 2 years ago. It started with the excessive drinking and hair thinning. He's been doing great on Lysodren, with no evidence of worsening symptoms to me until this past two weeks. He just saw the specialist about a month ago and lab levels were exactly where they should be. (don't have numbers with me, but doc said they were showing within normal limits for the cortisol level.)

Over the past two weeks Guinness has been having a problem with hindquarter weakness. He waits for us to carry him up the stairs and has trouble standing without support. I'm just devastated because he has been doing so well. So my question, after this longwinded introduction is... is it possible that he's experiencing toxicity on the Lysodren? He is such a clean dog, never pees or poops in the house unless he can't help it, and even then, you can see that it upsets him. This morning, he had a pretty runny poo in the house. This is what Pele did when she was toxic on Trilostane. She was knuckling her front paw like Guinness is with his back right leg, and was vomiting and had diarrhea. I'm waiting on the vet to call me back, but at this point I want to stop the Lysodren until the vet can see him. I know he's been on the med for a long time, but I just don't understand why the sudden change in his walking and the GI issues.

Thanks for this forum....

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Squirt's Mom
10-10-2012, 03:25 PM
Hi and welcome,

I only have a minute right now but wanted to tell you that your gut is on the mark - stop the Lyso and have an ACTH done asap - be sure they check the electrolytes, too. Do you have pred? If not INSIST they give you some today.

Please get copies of the last ACTH and this one then post the results here. Too often we see vets who don't know how to read these tests and think the results are normal when they are actually too high or too low.

Hang in there!
Hugs,
Leslie and the gang

Squirt's Mom
10-10-2012, 06:49 PM
Hi again,

First, how is Guinness acting this evening? Have you seen any improvement? any worsening? If he is worse, get him to an ER asap. There is no time to wait for the vet to call back. ;) Weakness, trembling, loss of appetite, diarrhea/loose stools, lethargy are all classic signs that the cortisol has gone too low and this can be fatal so do not wait if he seems worse.

Ok...to answer your question - yes, it is possible for Guinness to need a dose adjustment. This seems to happen more often with Trilostane but it does happen with Lysodren as well. Have the ACTH tests been kept up on schedule? He should be getting one at least every 6 months IF ALL SIGNS ARE CONTROLLED, preferably, every 3 months regardless of signs.

Can you tell us how much Guinness weighs and how much Lyso he gets and how often he takes it? Lysodren is not given like Trilostane so I want to be sure the approach is right for Lyso and not Trilo.

Does Guinness have any other health issues that you know of? Is he on any other meds, supplements, or herbs? If so, what and what for?

What tests were done to diagnose his Cushing's? The available tests that can help in diagnosing are the UC:CR (cannot diagnose, but can rule out), the LDDS, the HDDS, the ACTH, the full adrenal panel from the University of Tennessee in Knoxville, and the abdominal ultrasound. Please post all results here including normal ranges and units of measurement such as ug/dl, mnol/L, etc. Include only those levels that were too high or too low on the general blood work which will show things like ALP, AST, BUN, cholesterol, ect.

The more info you can share, the better. We simply LOVE details so don't worry about the length of your post. ;)

We are here to help you and Guinness in any way we can so never hesitate to ask questions and we will do our best to help you understand. You and Guinness are not alone on this journey - we are right beside you all the way.

Hugs,
Leslie and the gang

Majah
10-11-2012, 10:56 AM
Guinness has been off the Lysodren since Monday and seems to walking with a little more stability than he was a few days ago. Still not normal but better. No more diarrhea, good appetite, but still seems a little depressed. He has always been very interested in his toys and follows us around the house. Now that he can't walk well, he seems blue about that, and that makes me feel bad for him. If I know he's enjoying his life, being all up in our business, then that's reassuring. The depression is worrisome on top of the physical issues.

Yes, the ACTH test is being done every four months. He sees the doc on those visits also. I'm sorry I don't have all of the lab details you asked for. I don't normally ask to take them with me. The specialist did do the extra testing through Univ of Tennessee, but I don't think they did an ultrasound. Wish we had the money to afford every service recommended, but at least we go the bloodwork done. He also takes Denemarin for his liver but isn't on any other supplements or herbs. I forgot to check the bottle for the Lysodren mg. Guinness weighs 20 lbs and is on an alternating regimen of 1/2 tab, 1/4 tab, 1/2 tab, off. Monday was his 1/4 day and we've held his med since then.

He has an appointment with our regular vet tomorrow morning so we'll know more then.

Also, I did look for the confirmation email for my registration here but didn't see it in either of my junk folders. Would you mind to resend it? Thanks!

labblab
10-11-2012, 11:16 AM
Majah, your registration has now been officially approved, so you no longer need to worry about looking for that email confirmation. :)

Marianne

molly muffin
10-11-2012, 10:56 PM
Hello and welcome.
I sure hope that Guinness starts to feel better. Perhaps once this crisis has passed, he'll be back to his old self. Dosage adjustments certainly seem to be the norm, even sometimes with the Lysodren. The test will certainly tell you more. Do let us know how he is doing. I'm sure his spirits will eventually pick up once everything is controlled again.

Sharlene

Majah
10-13-2012, 01:30 AM
Guinness saw his regular vet today. Has been off the Lysodren for a few days but is still weak. She did an ACTH stim test today, said his last cortisol level (done in Sept) was 5.2, which the specialist said was within normal limits. Vet gave him some Pred, which we started tonight. Would it have turned him around that quickly? He seems to be walking a little better tonight, but it could just be that he's been resting all evening. Hoping for the best.

molly muffin
10-13-2012, 11:05 AM
yes prednisone can work quickly that is why it is good to have some on hand when giving these meds for cushings. When do you get the results for today's test?

Sharlene

Majah
10-13-2012, 07:51 PM
Got the results today. Level was 5.0, so it's still showing normal, but clearly he's not feeling normal. Slowly improving, so we're happy about that. He actually picked up a toy today. Vet said she was going to keep him on the pred and continue to treat the arthritis she saw. I will talk to her next week and figure out what they want to do about dosing him on the lysodren.

Squirt's Mom
10-14-2012, 09:59 AM
Hi Majah,

Has Guinness had an ultrasound? If not, it might be worthwhile to get one done before restarting treatment just to make sure there isn't some other cause for the elevated cortisol. My Squirt was diagnosed in early '08 but an ultrasound found a tumor on her spleen and once it was removed her cortisol returned to normal.

Be sure the machine is high resolution and the test is read by someone qualified on that machine.

It would really, really help if you could get copies of all the testing done to arrive at the diagnosis for Guinness before he started treatment and post the actual results here. Cushing's is one of, if not THE, most difficult canine condition to diagnose because so many things can cause false-positives on the testing and so many other conditions share the same signs.

The more info you can provide, the better we can help you both. ;)

Hugs,
Leslie and the gang

molly muffin
11-09-2012, 10:29 PM
How is Guiness doing? Hopefully improving. :)

Sharlene and Molly Muffin