Need advice on medicating pituitary Cushings for my Gracie (12yo mini Schnauzer)

[GraciesMom]

Hello all,

I want to start by saying... I am so glad to find this community. I see how many "newly diagnosed" posts there are, just today. It makes me cry inside, for all of us! But, it does make me glad to know that we're not alone, and that there are people who may be able to help us.

My little mini Schnauzer Gracie was diagnosed about a year ago with Cushing's but has been largely asymptomatic until just recently, when her fur loss has picked up, potbelly showing, etc.

Here is the info our wonderful vet sent us: "Her ALP continues to elevate each time- it was mid-800s last time, now it is 1168 (normal is <142). Her other liver enzyme, the ALT is staying the same in the mid- normal range. This particular lab gives us more liver enzymes than any other lab that we have previously used and the numbers are mixed...some are normal, others are quite high. Her bilirubin continues to stay low normal, which is great news... Her kidney values are still within normal range, so again, good news on that front. Her CBC is normal- so not anemic, no evidence of infection, etc. Thyroid: she is still very slightly elevated; her T4 is 3.7, normal is 0.5-3.4, Much better than previous, but still elevated."

We have tried homeopathic things to help (diet, milk thistle drops, acupuncture... heck, we'll try just about anything for her if it means she can stay healthy and happy!), but have foregone any chemo treatment because to this point she has been fairly asympotmatic - no real excessive urination/thirst, she's still really playful and energetic, etc. But, based on her physical signs and bloodwork, she is getting progressively more symptomatic for Cushings.

The main drugs we know about (mitotaine or trilostane) have potentially really horrible side effects. We'd like to help her health in any way we can, while of course avoiding anything irreversible or which could have big negative impacts if at all possible.

I would love some advice...

[Squirt's Mom]

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[molly muffin]

First I'd like to say hello to you and Gracie and welcome to the forum. We are all here because of this dreaded disease in our furbabies.
Can you tell us what test were done to originally diagnose cushings? Did you have the ACTH and LDDS? Ultrasound? Have you in the past year while treating with milk thistle etc, continued to have her cortisol levels checked to see where they are at?
If those tests have not been done recently, they probably should be done, so you know what her cortisol is doing and what affect the milk thistle is having.
Unfortunately, if the ACTH and LDDS confirm that Gracie is full blown cushings, then to bring the cortisol down once the milk thistle is no longer working, the only two options are the mitotaine or trilostane.
If treated by a vet who is quite familiar with the medicines, the testing and the latest research then these can be used safely. We have members who have done both. I would say the majority are currently on vetroyl (Trilostane). The key to using these drugs and reducing risks is a knowledgable vet, who will work with you, constant testing to monitor drugs affect on cortisol and starting low and moving up as needed, not starting high and risking giving too much. If those things are followed then Gracie can live our a normal life span as a happy little dog.

Others will be by to say hello in a bit.

Sharlene and Molly Muffin

[mytil]

Hi and welcome from me too! Sure am glad you found us.

You mentioned she was diagnosed a year ago and has not shown any of the symptoms until recently. I agree that we need to see the results of the tests performed (LDDS, ACTH) that diagnosed Cushing's.

Cushing's is not a kind or nice disease and it takes strong medicine to keep the excess cortisol from internally causing damage to the organs. It is very much like the strong meds that are prescribed for humans - given properly, tested frequently to adjust dosage and treated by a knowledgeable vet, it is safe.

Here is a link that talks a bit about what happens internally to an untreated Cushpup - (I apologize the links need to be updated, but the material in quotes gives you the gist of it) - http://www.k9cushings.com/forum/showthread.php?t=195.

To treat or not to treat is a person decision and I am not trying to dissuade you just making sure you have all the information to make a decision.

Here is another link where you can read up more on Cushing's. Our motto here is "knowledge is power.":) http://www.k9cushings.com/forum/showthread.php?t=180

Terry

[frijole]

Are you sure it is cushings that is causing the elevations and not something else? Some cushings tests have false positives when something else is going on (happened to me)

I used lysodren to treat my girl Haley for 4 1/2 yrs. She passed away of old age at 16 1/2. Lysodren is an awesome drug if you use it right. And if your vet gets the dosage right ;) Trilostane is equally as effective. It isn't the drugs causing the problems - it's that the dosages are wrong in most cases. Don't sweat treating for one second. That said I wouldn't rush to treat a dog without symptoms.

I guess if it were my dog I would probably have an ultrasound done (on a high resolution machine so you might have to go to a specialist). It is a big bang for the buck look at what is going on with the organs. It could be that there are tumors that could easily be removed. I think it is worth looking into. With liver elevations that high something is going on and you don't have cushings symptoms so guess what? I suspect it isn't cushings. ;):D

Kim

[addy]

Hi and Welcome from me too:):)

As if you dont have enough links to read here is another one:

http://veterinarynews.dvm360.com/dvm/Medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663

Dr. Feldman is a well known endocrinologist and guru of all things Cushings.;) He discusses treatment of this disease in a question and answer article.

My pup, Zoe, was diagnosed in June 2010. We did not start treatment until the following year. She too had mild symptoms and she had IBD which we needed to get under control before treating her Cushings.

You need to be sure of the diagnosis and think about the commitment to treat your dog, emotionally, fianancially, and from a time stand point. You also need to consider if you can put up with the symptoms that most likely will get worse if you do not treat.

Lots to think about:) Glad you found us.

[GraciesMom]

First I'd like to say hello to you and
Can you tell us what test were done to originally diagnose cushings? Did you have the ACTH and LDDS? Ultrasound? Have you in the past year while treating with milk thistle etc, continued to have her cortisol levels checked to see where they are at?
If those tests have not been done recently, they probably should be done, so you know what her cortisol is doing and what affect the milk thistle is having.

OK, I was able to get some more background from my husband, John. He works from home and is the one who does a lot of the vet appointments as a result. She did have both the ACTH and LDDS tests, as well as an ultrasound, all of which confirmed the Cushing's diagnosis. We checked her cortisol levels at that time, but we have NOT checked them since.

The ACTH and cortisol would be done before we started any treatment, as I understand they are required before beginning treatment.

I am relieved to hear that the treatments can work and that Gracie might have a chance at a few more quality years as a result. One of the things that you don't have easily when confronted with this type of circumstance is a lot of opportunity to talk to people who are going through the same thing. It is a blessing to have all of you.

Sounds like our next steps are going to be getting her full screening and making the decision on which medicine to go with.

[frijole]

If she isn't eating like a little piggy and drinking tons of water I would not treat. Here is why - problems with the drugs happen if you don't know if the cortisol is dropped. You look for changes in appetite and reduction in water. If your dog has none of these symptoms you have nothing to monitor and you could easily miss something and end up with an overdosed dog which you don't want.

To make sure we are on same page - lots of water is above normal amounts. Dogs on the average drink an oz per lb so if your dog weighs 16 lbs - 2 cups of water a day. Lots would be double that or way more - cush dogs drink water because their kidneys are using it up and they are dehydrated. So if the kidneys were at risk you'd know.

Food - cush dogs tend to inhale food and not chew it. They don't leave any kibble/food in the dish. They scrounge around all day in search of anything that might have fallen to the floor.

Hope this helps. Again, the specialists in the field (world wide specialists) all agree that if there are no symptoms - don't treat. Trust me the symptoms will show up if she has cushings and then you can start. Don't rush into it. Kim

[addy]

My little mini Schnauzer Gracie was diagnosed about a year ago with Cushing's but has been largely asymptomatic until just recently, when her fur loss has picked up, potbelly showing, etc.

Does she still jump in the car, on the bed, on the couch?


She did have both the ACTH and LDDS tests, as well as an ultrasound, all of which confirmed the Cushing's diagnosis. We checked her cortisol levels at that time, but we have NOT checked them since.

Do you have the actual lab work from those tests so you could post the results here?


Sounds like our next steps are going to be getting her full screening and making the decision on which medicine to go with.

If it were my pup, I would want to confirm the tests from a year ago and retest her with possibly including an ultra sound if you can swing the cost.

Without overt symptoms, it can get confusing. Cushings is seldom an emergency that we need to rush into treatment for.