Fusion - 10 years young Cushing's bullie

[jen]

Hello all! I'm Jen, proud momma to Fusion. He's a 10 years young English Bulldog who was diagnosed with Cushing's about a month ago. He's been taking Vetoryl and it seems to be helping a lot.

I originally took him into the vet due to his bilateral fur loss and paw licking which was causing interdigital cysts. I thought he had developed some allergies in his old age. Turns out he was a Cushing's poster child! Bilateral hair loss, urinating in the house, constant panting, pot-bellied, calcified lumps on his body, refusal to do much of anything other than lay in the corner and snooze. A few blood tests later and it was confirmed.

So far so good on treatment (Vetoryl) aside form it being pretty expensive. The only thing is, he is still urinating in the house - not as frequently - but it is still happening. Could it be a 'habit' now? I may try baby-gating him out of the kitchen area (the only place he pees in the house) and see what happens.

Anyway, I look forward to learning anything I can about Cushing's.

[Boriss McCall]

HI Jen,
Welcome to you & Fusion. I am a bullie mama too! :)
They are the silliest dogs. My bullie Pearl is only 2 1/2. My Boston Terrier Boriss is the one with Cushing's.
Just to let you know he has been on Vetoryl for about 40 days. His first prescription was for 20mg & he was still having accidents while most of the other symptoms were gone. We bumped him up to 30mg 10 days ago & the accidents are pretty much gone. I was like you wondering if he had formed a new habit or just not fully controlled yet. so far so good.. Welcome to the group!
Amy

[jen]

Thanks Amy! That's good to know about the accidents. Fusion is on 120mg of Vetoryl. He had the initial blood work, then the blood check 2 weeks into the meds. The vet said his bloodwork looks perfect, so she wants to keep him at the 120mg. I was suprised that she said they would recheck in 6 to 12 months... everything else I read says 30 days, 90 days, etc. But I trust my vet - they are amazing and really know their bulldogs. He's due for shots, etc in April so I'll have his Cushing's work done again then (at 6 months).

[Boriss McCall]

I am glad he is doing so well. I am not sure I would wait that long if I were you. scary.. Boriss is still going every 2 weeks for the ATCH test. I know one of the reasons is because Boriss had an increase in mg's. But, once he settles on a correct dosage I think I still go back every 2 or 3 months after that. Just be careful & watch for all the signs of overdose. Did you Vet tell you what to watch for?

Do you have emergency Prednisone at home just incase?

People like to see numbers around here. :D will you post your test results? Blood work, ATCH test results, Ultra Sound report.. whatever you have that diagnosed the cushings. Also how much he weighs.

Glad you found us. There are lots of people on here with many years of experience that will give you really good advice & be here for you in a pinch. :)

[jen]

Strangely enough, they didn't really give me any test results for him! I didn't even think to ask either. He weighs around 65 lbs, so the dose seems correct for his weight.

The vet didn't cover with me what to look for in case of overdose... just side effects like vomiting, lethargy, etc and to give them a call ASAP if he shows any (negative) changes.

Guess I should get to reading up on some posts :)

[Boriss McCall]

Definitely study up.. We ended up going to an Internal Medicine Specialist with Boriss because they are so much more informed on Cushing's.

I had to call & get all my test results emailed/faxed to me from my vet. Usually they are really nice & don't mind sending all these reports to patients. Another good reason to have them is if in case you ever had to take Fusion to the ER you will want these test results with you to help them treat him.

Can you get them? It will really help others on here be able to help you & give you good feedback.:)

Which I personally would not have been able to make it without the knowledge of the people on this board.

The side effects you mentioned are all the main ones you have to watch out for. So, I am glad your vet gave you that info. Most vets give a prescription of Prednisone to take home just in case your dog starts having severe negative side affects. I can be very serious if not treated right away. If I were in your shoes I would ask for it if they haven't already given you any.

Please feel free to ask whatever questions you have. There are people on here with more knowledge than most vets. I am not one of those people yet.;) But, I will help in whatever way I can.

[jen]

Thanks again! I will see if they can give me his results - they are usually pretty good about that. Luckily they are open 24/7 for emergency and regular visits. All three of my bullies are faithful patients of my vet clinic.

[Boriss McCall]

That is so good! My vet/IMS is the same way. I would hate to have to take them somewhere new in the middle of the night.

Plus it ALWAYS helps to have a vet that understands bullies. They can be complicated sometimes.;) Pearl has a sore elbow right now. Wish she didn't have joint issues. Luckily no shoulder/hip problems. But, it is sad to see her limping out of bed in the morning & she is not even 3 yet!! They think she might be showing signs of elbow dysplasia. :(

I bet you have your hands full with 3. :D You will have to post some pictures. My Pearl & the last bullie I had have been the most hyper dogs I have ever had. Love them!!

[goldengirl88]

Jen:
First of all hello ,and welcome to you and Fusion. I just have a few minutes, but wanted to express some concern, even though I am relatively new on here. I know you said you trust your Vet and they know their bullys well, but for Fusion not to be tested again for three months does not seem right at all. It might be they are experienced with the breed, but I am finding few vets are experienced with Cushings. Some Vets have never even treated Cushings. They can be the best Vet in the world, but if they are not thoroughly experienced with Cushings you could be headed for problems. I got my Vet to consult with an Endocrinologist, as I did not trust his judgement. Not that he is a bad Vet, but has little experience with Cushings. No Vet comes out and tells you they have little experience with this, as they want your business. When dealing with this disease, I found it is far better to be cautious, than try to back track an undo anything. This disease is the worst to treat of any of the diseases. I would also check with and provide the people on this forum with your test results. They are more up on this than the Vets are. They will always steer you in the right direction. I don't know, but it seemed like a high dose of Vetoryl to start your dog off on, does anyone else think so? I know for a fact the Endocrinologist told me go slow and cautious with doses. My dog was only started on 10mg for that reason. Maybe you could try the boy belly bands, or diapers for the peeing, maybe that would help. I wish you and Fusion the best. I am not trying to lecture, but please proceed with caution, that is the one thing I learned above all. God Bless you both though out this journey.

[jen]

I appreciate your concern! I thought it was strange that she wanted to wait as long to re-test as well.... but figured she knew what was up. She seemed to know a lot about Cushing's... she basically took one look at the fur loss, calcified spots & his pot-belly and knew right away. I could give her a call and make sure I heard her correctly, and also see if I can get his test results.

[lulusmom]

Hi Jen and welcome to you and Fusion (love the name)

You've already gotten some really great information from Amy and Tipper's mom (goldengirl88) so I won't spend time repeating what they've already posted. I just wanted to ask a few questions, make a few commends and share my experience with a vet who is well known throughout So California as the best vet in the U.S. for his knowledge of English Bull Dogs.

He is also open seven days a week so being able to be closer to a vet who could do stims on the weekends was attractive to me. I had been there once with a non-cushdog and was struck by how many EBD's were in the waiting room. This practice has a line out the door every day so I was dumbstruck to see no less than 25 EBD's in the waiting room and outside. I discovered through conversations that this vet is the go to for most EBD breeders in the area as well as other breeders in So Cal. Some of these people drove hours and waited the usual one to two hours to see the vet. I was impressed but that was short lived. I discovered that this vet knew enough to be dangerous to a dog with cushing's. Moral of the story is that because a vet is experienced with a certain breed does not mean they know much about cushing's.

Based on what you've told us thus far, your EBD experienced vet doesn't sound much more knowledgable than the highly respected EBD vet I encountered. You mentioned that you were surprised that after the initial acth stim test at two weeks, your vet said said they would recheck in 6 to 12 months but everything you had read said 30 days, 90 days, etc. I was happy to read your reaction because you were absolutely correct and your vet was absolutely wrong in waiting three months much less six to twelve months. I was disappointed that you dismissed your knowledge and chose instead to place blind faith in your vet because you assumed s/he was right because they know the breed so well. Don't turn a blind eye to or dismiss anything that doesn't sound right to you. Our gut instincts are usually right and most of the things we learn here are supported by scientific evidence with reference material in our Helpful Resources to support it. I have, therefore, never been hesitant to share this information with my vet if I have concerns and want answers to those concerns.

In order to keep my questions and requests organized, I've listed them below in no particular order.

1. Fusion's symptoms most definitely fit with cushing's, especially if the calcified spots were biopsied/cultured and diagnosed as calcinosis cutis. Calcinosis cutis is pretty much diagnostic for cushing's. Did your vet confirm to you that this was calcinosis cutis?

2. Did your vet explain that Trilostane is best absorbed with food and that you need to give Fusion's dose with food?

3. Did the vet explain to you that is very important that you give Fusion his dose of Trilostane with food on the morning of the acth stimulation test and that the test be done within 4 to 6 hours of dosing? If not, what did you do that morning?

4. A perfect acth stimulation test two weeks after dosing would be results showing pre and post stimulated cortisol between 1.5 and 5.5 ug/dl and symptoms greatly improved. This is the therapeutic range that you are shooting for. Trilostane will continue to drop cortisol well into thirty days so if Fusion's results were perfect and within the above range, I would be very concerned that cortisol could continue to drop to risky low levels. We can better figure out if this is a likely scenario once you post the results.

5. Did your vet diagnose pituitary or adrenal dependent cushing's?

Sorry for the long post but I like to hear myself type and nobody has more questions and opinions than I. :D

Glynda

[Harley PoMMom]

Hi Jen,

Welcome to you and your sweet boy, Fusion. So sorry for the reasons that brought you here but glad you found us.

A starting dose of 120 mg, IMO, is pretty high for a 65 lb dog. Also, Dechra does recommend performing an ACTH test 10-14 days after treatment has begun and at 30 days, at 90 days, and every 3 months.
Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days and every 3 months thereafter. At a minimum, this monitoring should include a thorough history and physical examination, ACTH stimulation test (conducted 4-6 hours after VETORYL Capsule administration), and serum biochemical tests (with particular attention to electrolytes, renal and hepatic function)..http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

It would help us a great deal if you could get copies of all tests that were done on Fusion and post any abnormalities that are listed. Can you tell us what symptoms Fusion was displaying that led you or your vet to test for Cushing's in the first place? Is Fusion taking any other herbs, supplements, medicines? Sorry for all the questions but the more we know about sweet Fushion the better our feedback will be, ok?

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

Love and hugs,
Lori

[jen]

In order to keep my questions and requests organized, I've listed them below in no particular order.

1. Fushion's symptoms most definitely fit with cushing's, especially if the calcified spots were biopsied/cultured and diagnosed as calcinosis cutis. Calcinosis cutis is pretty much diagnostic for cushing's. Did your vet confirm to you that this was calcinosis cutis? I'm honestly not aware if they biopsied/cultured these spots

2. Did your vet explain that Trilostane is best absorbed with food and that you need to give Fusion's dose with food?Yes she did let me know that, it was included on the instructions sent home with the meds

3. Did the vet explain to you that is very important that you give Fusion his dose of Trilostane with food on the morning of the acth stimulation test and that the test be done within 4 to 6 hours of dosing? If not, what did you do that morning?That is what we did.... I made sure to ask if it was okay to give him the med the mornign of the test & she explained that they wanted me to. And he was re-tested within 6 hours of his morning pill.

4. A perfect acth stimulation test two weeks after dosing would be results showing pre and post stimulated cortisol between 1.5 and 5.5 ug/dl and symptoms greatly improved. This is the therapeutic range that you are shooting for. Trilostane will continue to drop cortisol well into thirty days so if Fusion's results were perfect and within the above range, I would be very concerned that cortisol could continue to drop to risky low levels. We can better figure out if this is a likely scenario once you post the results.

5. Did your vet diagnose pituitary or adrenal dependent cushing's? He was diangnosed with pituitary dependent

Sorry for the long post but I like to hear myself type and nobody has more questions and opinions than I. :D

Glynda

I answered your questions in red above.

[jen]

Can you tell us what symptoms Fusion was displaying that led you or your vet to test for Cushing's in the first place? Is Fusion taking any other herbs, supplements, medicines?

I took him in originally due to the bilateral hair loss, calcified lumps & bumps, and he was licking his paws a lot. The vet noticed his hair loss, pot-bellied stance, and saw in his chart that he had been in a few times for frequent urination in the house (with no UTI). She said he looked like a 'poster child' for a Cushingoid dog. They did a quick prelim blood test, and I took him back for the 8 hour blood test after which he was prescribed 120mg of Vetoryl. After 2 weeks he went back for more bloodwork to which she said came back "perfect" and she wanted to keep him at that dose.

The only other supplement Fusion takes is Phycox, which is a daily supplement I give him for joint health.

[molly muffin]

Hello Jen and Fusion and welcome. :) (love Fusions picture!, what a cutie)

I think everyone else as covered all the technical areas here pretty well.

There is one thing here that has been addressed, but not quite what I want to say and that is the followup testing. The reasons for retesting at 30 days, etc, are good ones in that cortisol continues to drop normally.

That being said, Fusion is your dog and you seem to have a good relationship with your vet, so I doubt it would be a big deal if you simply said, I think I want to have a test at this point or that point because I want to feel comfortable with what his cortisol is doing and it probably wouldn't be a big deal at all. You can print out the Dechra recommendations on testing too if needed and you want to go in with some documentation. Most vets though are going to be fine with an owners request for more frequent testing.

I'd do it because I'd be a nervous wreck not knowing. That is me though. Hopefully all symptoms will continue to improve too. I think this is doable working with your vet and I assume that your vet if 24/7 probably has an established relationship with an IMS for ultrasounds and consults too if needed.

It's a sucky disease and nothing is ever easy with it. We've had dogs crash at 10 days and some never do. Others have to have major adjustments at 30 days or even 3 months. Literally I think this forum has seen it all. Maybe that is why we all go the cautious route too. We've just seen things happen. We have also seen dogs, living out their lives with cushings, on an established medical plan for years and years, passing at non cushing causes sometime in the future. So, it's not Always scary. :)

Okay now I have just prattled on long enough for a hello and welcome post. :) You'll noticed I do that sometimes. :)

Sharlene and Molly muffin