Vetoryl question; Diagnosed today with Cushing's

[Homer's Dad]

Hi everyone,
I'm new to this forum and new to Cushing's Disease. My dog, Homer,
was diagnosed today based on the results from his LDDS. Homer is a Basset Hound, we think about 7 years old. He showed up at my office 4 years ago after wandering around the campus -- I work at a University--for 10 days or so, so I really don't know his early history.
In the past 6 or so months, he's been drinking and urinating excessively, and most recently has been showing some signs of muscle weakness and malaise. His appetite has actually been lower than normal, and he shows no other obvious symptoms. Here's my situation: I need to attend a 2 day training session this Thursday and Friday and will be gone 13 hours each day. Should I wait until the weekend to start the medication? After reading up on it, the possibility of side effects has me more than a bit anxious. Also, I have to attend a conference next week and will be gone most of the week during which time Homer will be boarded. He gets great care at his "doggy lodge", but I'm still concerned about starting a new medication and leaving town for 6 days. Thoughts?

Also, until (hopefully) the medication starts to work, should I restrict his water intake? I've been trying to do that some and he wakes me up in the middle of the night wanting water. He'll drink until he vomits if I just put a full water bowl down.

Thanks for your thoughts. I lost both my parents in December and the thought of losing Homer is beyond my emotional limits right now!

--John (aka Homer's Dad)

[frijole]

John,

Glad you found us! First off there is NO need to rush treating cushing's so go do your thing and don't worry one bit.

Second - I would love it if you could post your test results from the LDDS test. Reason being you mentioned symptoms weren't real strong and your dog doesnt have an appetite (which is #1 symptom with cush dogs). This test can have false positives when other illnesses (known or unknown) are present. This is why most do more than one test to confirm the diagnosis prior to giving drugs.

So holding off will allow you time to get us the LDDS test results as well as any blood panel work that was done.

Also just to be safe - please give us your dog's weight and the dose of vetoryl/trilostane that your dog was prescribed. Did you also get predisone to have on hand in case of emergency?

Here's a link to info about cushings as well as vetoryl. Our library is full of articles to get people up to speed. Thanks, Kim


http://www.k9cushings.com/forum/showthread.php?t=185
http://www.k9cushings.com/forum/showthread.php?t=180

[frijole]

I see you asked about water intake. Sorry to tell you but you must keep water out at all times. Water isn't causing your dog to urinate - with cushing's their bodies are using up too much water and therefore they NEED the water. Obviously you might want to pick up a bowl if you are concerned he'll vomit. Let him catch his breath and then put it back down.

Sorry about your loss - that is real tough. Trust me, Homer can live a very normal life. This is not a death sentence. Key is getting up to speed, making sure the dx is accurate and having an experienced vet.

Note - other illnesses that are often overlooked are diabetes, hypothyroidism - similar symptoms to cushing's.

Kim

[Homer's Dad]

Thanks Kim, I'll get the detailed lab results and post in the next day or 2. Homer is down to 55 lbs. He's lost 4 pounds in the last few months.
The vet suggested we start with a dose which is a bit on the low side for his weight, so going to start him on 60 mg Vetaryl. His Kidney functions were good, glucose level normal, but liver enzymes were a tad elevated. Also his creatinin and BUN levels were within normal limits. After 4 and 8 hours, his Cortisol levels were still above 10 micrograms/dl. His baseline was also above 10. (Numbers based on my recall of talking with the vet). Yes, got some prednisone if needed.

[addy]

Hi John and Welcome,

No need to rush starting treatment and gosh, a Cush pup has a hard time dealing with stress. I sure would be worried about starting Vetoryl and then boarding Homer.

Kim has you off to a good start. We look forward to your test results and wish you a warm welcome. You'll find a caring, knowledgeable group here with tons of support.

Glad you found us.

[SoggyDoggy]

Hi John, welcome to the forum, but sorry that Homer is not well.

I'm still very new to this myself, but one thing I've learnt is that Cushing's can be similar to so many other things when diagnosing, which is what makes it so difficult. My reason for saying that is, was the LDDS the only test that was run for the diagnosis?

As for the rush to start treating with trilostane, another week isn't going to hurt Homer, and he would be better off with you there watching over him and caring for him, so I personally would hold off until you get back and are around for a stretch.

We look forward to hearing more about him, and whenever you have questions, post them, no matter how small or even potentially ground breaking. This place has been a saviour to my sanity, helping me out so much. Even being around other people (even if online only) who understand that strong attachment to a pet is helpful, none of my friends get it, so here is my haven.

Good luck and keep us all posted.

Naomi and Fraser.

[Homer's Dad]

Thanks everone for your support and comments. I greatly appreciate it.
I'll be back. --John

[molly muffin]

Hi John and Homer! Welcome!
Just going to second, third the recommendation to wait to start medications until a time when you'll be around for a bit to keep an eye out. Especially those first couple weeks. Cushings is usually a slow progressing disease, so no rush there. Did they check the thyroid too? I didn't see you mention but did the vet talk about also getting Homer on a liver supplement?
I'm so sorry, it sounds like you have been through a lot in the last couple months. Hopefully we can get Homer all sorted out and on a good plan for continued care.
We all come here scared to death after hearing about cushings and then reading up on it, which can end up terrifying a person even more. We know, we understand, we've all stood in your shoes. So, welcome again.

Sharlene and Molly Muffin

[Boriss McCall]

Hi John,
Welcome to you & Homer.
I am so sorry for your loss. That is a lot to take in. I am sure you do feel overwhelmed right now. I lost my father in a car wreck right before Christmas many years ago. It makes the holidays hard.
:(

I am with everyone else. I would take my time starting the treatment for Homer. Just to give you hope my dog has been on Vetoryl for almost 5 months now & he is doing great. Like others have said this does not have to be the end.
Be careful about limiting water intake. My vet said to let them drink as much as they need.

We are all here to help!

[lulusmom]

Hi John,

I'm just one more member who thinks you should put off starting treatment; however, I'm going a bit further and say that unless your vet has validated the LDDS and determined which form of cushing's Homer has, I wouldn't start treatment until this has been done.

With only liver enzymes being slightly elevated and his appetite being off lately, he could have some GI issues brewing. ALKP is the liver enzyme that is usually moderately to severely elevated with cushdogs but ALKP can also come from the gut. The LDDS is usually the diagnostic test of choice but it is easily skewed by a non-adrenal illness or even high level of stress. I'm not sure when the LDDS test was done but if it was done while Homer was not eating well, results could be false positive.

Even if your vet has all his/her ducks in a row and has done a conscientious job of testing, I personally would want Homer eating normally again before starting treatment. In the words of Dr. Edward Feldman, a world renown endocrine expert, "a cushingoid dog without a healthy appetite is a sick dog and you never start treatment on a sick dog." If your vet remembers much about his short stint on the endocrine system in vet school, s/he will know who Dr. Feldman is.

Looking forward to seeing the results of all testing done by your vet. FYI, the LDDS test results you posted don't appear to be suggestive of pituitary dependent disease so Homer could be in the minority of cushingoid dogs with an adrenal tumor. An abdominal ultrasound is usually done to check the adrenal glands and surrounding organs. If pituitary based disease, the adrenal glands are usually bilaterally enlarged and if an adrenal tumor, one gland is larger than the other, with the other being smaller or even atrophied. The liver is usually also enlarged on imaging.

Glynda