5 yr old scottie

[Eversen]

Our 5 yr old wheaton scottie named Guiness had been diagnosed cushingoid today. We had him tested about 10 months ago after showing symptoms but nothing showed up. After routine dental cleaning, raised liver enzymes where shown. After a month of medication for that, they continued to be raised. So for rechecking of that and a recheck of Cushings proved he does have it. I am unaware yet if it is adrenal or pituitary. They have prescribed vetoryl and will recheck levels in 2 weeks. Can anyone help with longevity of living with cushings or prognosis? Any info on vetoryl? Any info to help us cope would be greatly appreciated!

Thanks so much
~Chris, Dani, and Guiness~

[mytil]

Hi you three, welcome to our site. I am sorry your Guiness is having these troubles. Love the name.

I am sorry but I do have a few questions. This will give us a better idea of things.

When you get the chance please post the results of the tests performed that actually had your vet make the diagnosis of Cushing's. Five years old is a bit young to have this, although not completely unheard of. The tests include a LDDS, an abdominal ultrasound as well as an ACTH along with the results of the blood tests.

You mentioned giving some medication for the elevated liver values - what was this medicine?

Can you let us know what symptoms you saw in him 10 mos ago? And how long did these symptoms last?

The prognosis or life expectancy of a cushpup goes well beyond the two years after diagnosis you may have read. We have had many here who have treated for many years after and their pup passed from natural causes well into their teens.

Now, how much does your boy weigh and how much vetoryl was prescribed? Take a few minutes to read through this - http://www.k9cushings.com/forum/showthread.php?t=185 (it will give you information on the drug).

Sorry for all the questions, but it will help me and others in helping you.

Terry

[addy]

Hi and Welcome,

Terri has you off to a good start. As for info on Vetoryl, my Zoe has been on it for 1 1/2 years. We have had our ups and down as Zoe has other health issues as well. There are studies that will tell you the average life span is appx 2 years. We have not found that to be true but it really depends on the dog, what other issues they have and how they respond to treatment. It also matters how much experience your vet has with the drug.

We have many articles in our resource section. The best thing to do know is to learn as much as you can so you can be a good advocate for your dog.

The other important thing is to be sure of your diagnosis and be sure your dog has strong symptoms before treating. Cushings is a very hard disease to diagnose.

I am so glad you found us. We are here for you. Sorry for the spelling errors, dang if I can locate my spell check again;):rolleyes:

[Eversen]

A little background on Guiness. He just turned 5 in July and we have had him since he was 3 months old. We have always had all of his health checks up to date, dental, etc. He has always been a heavy drinker, as he can easily swallow down 2 cups of water in no time. He has had a history of crystals in his urine. For this, our vet recommended royal canin urinary so food. This worked very well for that. He also has the beginning stages of degenerative arthritis, which was found approximately 18 months ago. For this, the treatment was laser therapy every other day accompanied by adequan shot once per week. These treatments have worked very well in which we are now down to laser therapy once every other week as well as an adequan shot once per month. He also takes dasaquin for joints and 1/2 pala-tech cranberry plus tablet for urinary, both daily. Then last December when having his regular checkup, raised liver enzymes were noticed. The medicine that was given for this was denamarin. We also take him to puppy daycare usually 3-4 days per week in which they noticed the excessive water intake. We were then asked to monitor and track his water intake for 2 weeks. When we turned in the results, our vet became a little more concerned. The ACTH test was given then and nothing showed up. We also took him to a specialist to have ultrasounds done. With the ultrasounds, no tumors or masses showed up so nothing out of the ordinary. With this information, we were advised to keep an eye out and retest at a later date. He has had several checkups since and all has been good. In September, he was due for his routine yearly dental cleaning, in which the blood work came back with raised liver enzymes again. When they do the dental, because they clean slightly under the gums, they prescribe the following to prevent infection and a pain killer, clindamycin and metacam. With this prescription, it was thought that this is what caused the raised enzymes. So again, denamarin was prescribed and we were advised to recheck again in 30 days. Which brings us to the current outcome. The ACTH results that I was given is Sample 1 at 8.05 am was 4.2. Sample 2 at 10.05 am after the stem gell was 21.2. He weighs 21.4 pounds. The prescription for vetoryl is 30mg once daily with instructions to recheck ACTH levels in 2 weeks. The only other health concern has been mild seizures. These have been very few and very mild. Normally one maybe every 6 months and lasting 2-3 minutes. During the seizures, he becomes very stiff, his head wobbles back and forth, left to right and also has a glazed look to his eyes. Right before the seizures happen, he also comes to us to let us know that one is coming on. After he comes out, he returns to normal within a few minutes. We have also documented each seizure and length of time. Our vet has recommended no medicine for the seizure unless they become more frequent.
Hope this helps with any additional info that you can give us. Thanks so much for all of your help and advice.

~Chris, Dani, and Guiness~

[frijole]

Thanks for all the info and history. Do you have the ultrasound report (written)? I ask because if you are looking for cushings you want to read specifically the description of the adrenal glands. You can actually tell if it's pituitary or adrenal cushings from the size of the glands. Also you can rule out cushings if they are normal. I'd really be interested in that.

We do have some younger dogs that have had cushings but 5 is young and the acth test 2nd no is just over 21 and that is really borderline high. My concern is that because this disease is so often misdiagnosed and the acth test is prone to false positives if something else is going on... I'd like to see the ultrasound info on the adrenals for greater comfort that this is in fact cushings.

How is your dog's appetite? Cush dogs are ravenous and do not even chew their food. They walk around all day hunting for scraps on the floor. They never leave a bit of kibble unturned. I'm serious. I'm looking for more than water intake and high liver enzymes. Also if you have the blood panel info - it'd be helpful to know exactly what 'high' is. Cush dogs are typically very very high as in 1000's - not 200 (where normal is 150). Lots of diseases cause high liver enzymes.

Not trying to scare you but just want to make sure that your little boy does have cushings before you give the trilostane. BTW there is NO rush to treat cushings - it isn't life threatening to wait to make sure.

Also I am curious why your vet isn't concerned about the seizures. A word of caution - the drugs used to treat seizures do not mix well with cushings drugs. So file that away should it become necessary. Those here that have dealt with it can be of help should you need it.

Thanks for sharing! Kim

[Eversen]

His appetite has always been normal, he isn't ravenous with food. The only time he is ravenous is when treats are involved lol. He does sniff the floor for any "crumbs" however he is not given food scraps of any kind. I have always measured out his food. He currently gets 1 cup per day, and sometimes he leaves some of it at the end of the day. He is a grazer, so his food is snacked on all day. He usually eats the most when we have dinner.
I have looked at the ultrasound report and it doesn't actually state anything about the glands, it says that he has a mildly bright liver, but everything was normal. He does pant easily as well. The results that I picked up today only has the cortisol ACTH on it, no blood panel results.

We have already started giving him the vetoryl, he had his second dose this evening. Is this a bad thing?

The first seizure that he had, he was about 3 if memory serves. Our vet said that unless they are more frequent, he wouldn't recommend medicine for them.

I am really confused now.
Thanks so much!!
~Chris, Dani, and Guiness~

[molly muffin]

You boy sounds almost exactly like my girl. I mean, Really, exactly.

Okay, one thing I'd ask is if you didn't have an LDDS test done, then do so before starting meds. I say that because with the food he is eating to control crystals, you want a diluted urine and that food encourages them to drink more. My Molly is on the same food for the same reason. She was tested 2 years ago for cushings, then again this year, where they did the ACTH and it came back positive for cushings, elevated liver enzymes, ALP and ALT. She doesn't eat ravenously either and she drinks water but not overly so for the food she is eating. I even went so far as to buy the 30mg of vetroyl. An ultrasound even showed some enlargement of the glands and liver, but then the IMS asked for an LDDS test before starting medication. We had that and the call came back. Negative, she suppressed fine for 8 hours. If she hadn't then she would have started the meds. Since she does suppress, she isn't full blown cushings yet and actually my vet says this could all be caused by something else. We have yet to discover which it will be. Having anything else going on, will cause the cortisol to be high on an ACTH. So, I removed her regular food and gave her a different one for a couple days, the water intake decreased.
So, I'd definitely get the LDDS if you didn't already. Keep copies of all your medical tests because you're going to want to relook at them periodically just to know whats what.
Cushings is horrible and Very confusing. It is also incredibly difficult to diagnose and our vet that has seen molly since she was a baby got it wrong. She was adamant in her theory. I was adamant in my stubbornness. Molly by the way is a grazer too on about a cup a day of the Royal Canine SO.
If you've already started the vetoryl, then I don't know if you can have an LDDS test now as the results would be screwered by the medication. One of the others might know more about that.

Sharlene and Molly muffin

[frijole]

Sorry to confuse you but just wanting to be safe. I'd get the blood panel results (that showed the elevated enzymes) and post just those things that are abnormal. Also pls post the range for normal since labs vary. That will help us.

It concerns me that he doesn't appear to have an appetite of a cush dog. That coupled with the acth test result of 21 (borderline) makes me unsure of the dx. Darn I wish the ultrasound report would have mentioned the adrenal glands... if they were doing it for cushings they had to have looked at them. If they are 'normal' then it would lead me to believe it isn't cushings. Cush dogs have enlarged adrenal glands - one or both and that is how you can tell which type of cushings it is.

You asked if it is a bad thing that he's had a couple doses... Short answer is no. That said - continued use will lower his cortisol level (which is it's purpose). If he has cushing's it's a good thing but if he does not it isn't.

Just so you know, signs that cortisol has gone too low (overdose) are lethargy, vomit, diarrhea. Did your vet give you prednisone to give in case? Thanks Kim

[Eversen]

No nothing else was given with the vectoryl. We will be going back next week and I will get the results and post them. Last year when he had the ultrasounds, the specialist thought that since Guiness was on the urinary food, that might be the reason for the heavy drinking. So at that time, he suggested to switch his food to royal canin satiety and support which is what we did. Since then, his water drinking hasn't changed.

So in your opinions, what questions and testing do we need to do from here?

Thank you all so much for all of your help, with this being so hard to diagnose, it is very hard to know which is the next step.

~Chris, Dani, and Guiness~

[frijole]

OK so if I'm following you - it was a specialist that did the ultrasound? And the specialist suggested it was a food issue causing the urination? To me that means the specialist ruled out cushings after doing the ultrasound. I am not there and may not have all the facts so this is all assumption. If the specialist said this while your regular vet has you giving drugs to treat cushings I would suggest you stop giving the trilo/vetoryl until the two can get on the same page.

I would also get copies of the blood panels. The reason for this is that it gives clues as to if something else could be going on. AND that info is what I'd base the next step on. I hate to have you pay for testing that isn't necessary.

To me you did two tests already for cushings. An acth test which is borderline and can be unreliable if something else is going on. Then you did an ultrasound and the specialist didn't come back with a cushings diagnosis. You could point blank call him/her and ask what they saw of the adrenals (since it isn't written up in the report)

The low dose dex suppression test (LDDS) is a possible next step to confirm a cushings dx but i wouldn't do that until I had a look at the blood panel work (post them here) and a discussion with the person that did the ultrasound. Have they ruled out urinary tract infection? Kim

[mytil]

Hi again,

I know it can be confusing - Cushing's always is it seems. :rolleyes:

I would like to comment on clindamycin and the raising of liver enzymes levels - was the ACTH test performed while he was taking this? (I know your vet was aware of the possibility of this and prescribed denamarin.)

Clindamycin can also interact with some pain killers as well in raising enzyme levels.

I would certainly talk with the specialist and possibly he/she can have a talk with the vet who prescribed vetoryl. I think without a definite diagnosis and very clear clinical signs (symptoms) I would not start this med just yet.

If you are able to IMO I would go ahead with the LDDS test.

Keep us posted.
Terry

[Eversen]

We had the ultrasound done last year. Our vet was adamant that he had cushing's then. The symptoms were increased water intake, diluted urine, and raised liver enzymes. I have found another section on the ultrasound that was done and it states that both adrenal were small. It also states that Guiness did not have clinical signs of cushings. The specialist thought that since Guiness was on a urinary food, this could be the reason for the increased water intake. He was also concerned that urinary food when fed long term could lead to pancreatitis. So with that, the specialist suggested to switch to satiety and support food which we did. Guiness has been on this food since then, in which his water intake has remained the same.
The ACTH test was given after the medication following the dental was completed. When the vet did the blood work for the dental, that is when the raised enzymes were noticed. Then we were given the denamarin along with the antibiotic and pain killer. We were given a 30 supply and told that once that was completed to recheck his enzymes. When I told them that it was time to recheck the enzymes, I had them do the ACTH test as a followup as we had not had one done in approx 10 months.
We haven't had any dealings with the specialist since last December when we had the original ultrasound done.
I will get the blood panels next week once he goes back to daycare. I think what my plan of action is going to be talk to the vet next week when I pick him up from daycare. Seeing as he has started on the vetoryl already, will continue for 2 weeks for rechecking. In the meantime, checking for the lethargy, vomitting, and diarrhea and any other changes he may have if he does not need to take the vetoryl. I am thinking as well about getting another ultrasound as to my understanding this will be a major determining factor. Am I correct in my understanding, that the ultrasound will give a more than likely direct answer as to if he has cushing's? I would like to have the LDDS done, however I am afraid that seeing as he has been started on the vetoryl, we will not get accurate results. Chris also had a great idea of doing a journal for Guiness which I will be starting on next week to track everything. Does this make sense and sound like a good game plan?


Thanks so much
~Chris, Dani, and Guiness~

[molly muffin]

The ultrasound is a major factor in that it can show if there is symmetrical enlargement of the adrenal glands or it could show if there is a tumor on one of the adrenal gland. Even if cushings is caused by pituitary tumor, you should see enlargement on both adrenal glads. It is a bit worrisome that there is no enlargement of the adrenal glands on the last ultrasound Guiness had. I actually don't know of any cushings dog that doesn't have them enlarged to some degree since the idea is that they enlarge because they are working constantly producing the cortisol.

Some of the others might be able to comment on whether they know of any cushings dog without enlargement of the adrenal glands.

Sharlene and molly muffin

[molly muffin]

How are things going with Guiness? Hope all is well.

Sharlene

[Eversen]

Guiness now has pancreatitis has been put in hospital until tomorrow. He has been sick over the weekend so when he was taken to day care today, I had them check him out. Will try and keep you posted.

Thanks

~Chris, Dani, and Guiness~

[Squirt's Mom]

Hi ya'll,

Please let us know how Guinness is doing as you can. We have quite a few members who have experiences with pancreatitis and I know they will be happy to share with you.

Sending prayers and healing white light to you and your sweet boy.
Hugs,
Leslie and the gang

[molly muffin]

Oh poor Guinness. What an ordeal. And poor mom and dad too. I'm sure you are scared and worried.
Pancreatitis is one of those things that seems to go along with having a cushings diagnosis. Well, it can happen even without it, but still, it happens too often with cushings babies.

So, they will probably tell you this, but if not, small multiple meals, very bland daily. rice, boiled chicken, maybe 4 small meals a day, is what you are looking to do. They really can't tolerate anything at all that will upset the tummy.

Let us know how things are going and know that we are all keeping your family and Guinness in our thoughts and hearts.

Sharlene and Molly Muffin