Multi health problems with Cushing

[Pizza Tse]

Hello! I am Pizza's sister and I write for my lovely dog 'Pizza'! :)

I am so glad to find this forum! Your suggestions is very much welcome!

Here is a long story for my dog 'Pizza'. He has several health problems that make the situation more complicated.

Pizza is a 13 years old male mini-schnauzer with various health issues. He suffered from pancreatitus in mid August 2012 which almost took his life. Fortunately, he has recovered. The vet also exclaimed on his survival. It is really a miracle!

Pizza weighs 8.6 kg. Though he is old, he actually acts normally like a baby and love living in our family. His more obvious symptoms are: ask for food all the times, steal food from rubbish bins, panting, not sleeping well and pee a lot, so we walk him 5 times a day. He also has muscle wastage on both legs. It seems that his eye sight has degraded a bit and his ears are not that sensitive.

He has diagnosed to have the following problems:
1. Chronic Kidney disease (with 20% function)
2. Mitral & triscupid regu. (post congestive heart failure). endocardiosis
3. Arrythmias
4. Myelopathy
5. Enlarged prostate
6. Enlarged Andrenal gland, High ALKP index ( Cushing's Syndrome confirmed)

He is now having the following medication:
1. Vetoryl 150mg once
2. Fortekor 5 1TAB once,
3. Vetmedin 1.25mg twice,
4. Ernafil/ Sildenafil 50mg 1/4 TAB 3 times,
5. Furosemide 20mg 1/2 TAB twice,

Regarding tothe use of Vetoryl, his ALKP and ACTH Test:

28 Oct: ACTH Base line: 145nmol/L; After test: 511 nmol/L (Normal: 170 - 470) Cushing Syndrome possible
19 Jan: ACTH Base line: 250nmol/L; After test: 752 nmol/L (Normal: 170 - 470); ALKP: 1589; Vetoryl 60mg
29 Jan: ACTH Base line: 170nmol/L, After test: 409nmol/L (Normal: 50 - 200); ALKP: 967; Vetoryl 90 mg
8 Feb: ACTH Base line: 89 nmol/L, After test: >276 nmol/L (Normal: 50 - 200); ALKP: 1038; Vetoryl 120mg
20 Feb: ACTH Base line: 195 nmol/L, After test: 470nmol/(Normal: 50 - 200); ALKP: 655; Vetoryl120mg
7 Mar: 150mg Vetoryl

Dog Food: Nutra - Karma Organic Dry Dog Food

Supplements:
1. Vetri-Science Coenzyme Q10 Dog & Cat Supplement Coenzyme Q10 – 10mg
2. Vetri Disc capsule
3. Formula CV of Rx Vitamins

He had done ACTH tests. However, the test shows that the Vetoryl has some but not very great effect on Pizza. With the medication, he has no more panting and he can sleep well. At present, a senior vet suggests Pizza to use Lysodren. But I am hesitate with Lysodren as Pizza is already suffering from Kidney disease. I am also concern with the dosage (i.e. 150mg Vetoryl) which seems very high as compared with other case I found from the forum. Vetroyl is not good for dog with renal insufficiency and taking ACE inhibitors. So, I am worried for using Vetoryl or Lysodren.

Pizza will do ACTH test in early April again and I have to decide which medicine to be used. I am curious if Retinoic Acid or any homeopathic treatment can help. I hope Pizza can live longer and comfortably in our family.

Many thanks!!!

[Squirt's Mom]

Hi and welcome to you and Pizza! :)

I love his name! :D

Pizza's case is certainly complicated and I won't attempt to advise on the Vetoryl but will let others who use it comment. We are a Lysodren house. ;)

In reading your post, I don't see any testing to diagnose the Cushing's other than this comment -


6. Enlarged Andrenal gland, High ALKP index ( Cushing's Syndrome confirmed)

I hope Pizza was not diagnosed based only on an enlarged adrenal and elevated ALKP? :eek: Surely he had tests specific to Cushing's like the LDDS, HDDS, and / or ACTH? If not, please do not give any more of the Vetoryl right now.

If he has had any of those tests to diagnose the condition, would you mind posting those results here?

Non-adrenal illnesses, of which Pizza has more than his share, can cause the adrenal glands to enlarge and the ALKP to elevate. Neither of these things are diagnostic in and of themselves for Cushing's. So if he has not had any of the tests listed above, I am concerned about the validity of the diagnosis.

I'm glad you found us!
Hugs,
Leslie and the gang

[Pizza Tse]

Hello Leslie and the gang,

Thank you so much for the reply! This forum is so informative and enrich my understanding of cushing. I shall spend more time to learn from different cases.

Pizza has done ACTH tests, but the results seems not that good. I have edited my first post, so the the ACTH tests are more obvious to read. It is strange that his ALKP drop but not much drop in cortisol.

Pizza will meet the vet on 3 April, 2013. I don't know whether we should switch to Lysodren. Lysodren scares me as it kills kidney cells. Yet Pizza has renal failure. :eek: My decision seems like a gamble.:confused: 150mg Vetroyl also seems to be a heavy amount for a small dog like him. :(

Best,
Vivian

[Squirt's Mom]

Thanks, Vivian! I am still not clear, tho, what tests Pizza had before starting the Vetoryl. That is the important info right now to be able to get a better picture of what was used to initially diagnose the Cushing's. The ACTHs posted are after the Vetoryl was started on Jan. 19th. What tests did he have before Jan. 19th?

Hugs,
Leslie and the gang

[doxiesrock912]

Hello,
Has Pizza been seen by an IMS vet? If not, I would urge you to find one asap. The dosage of Vetroyl seems extremely high and I have recently determined that too many general practice vets do not know enough about Cushing's.

Daisy will be seeing Dr.Megan Morgan at Cornell in Stamford CT. If you tell us where you're located, maybe someone can suggest an IMS specialist in your area.

Cushng's is not easy tto diagnose and when other health conditions exist, that makes things more difficult as tests can be skewed by the other illnesses or medications.

I've only been on this site for a few weeks and you definitely found the right place!

[Pizza Tse]

Thanks, Vivian! I am still not clear, tho, what tests Pizza had before starting the Vetoryl. That is the important info right now to be able to get a better picture of what was used to initially diagnose the Cushing's. The ACTHs posted are after the Vetoryl was started on Jan. 19th. What tests did he have before Jan. 19th?

Hugs,
Leslie and the gang
Hi Leslie,

I have just added and amended the data. The original one is misleading. Sorry for that! So here is the right one. Pizza had the ACTH best before given the Vetoryl except the one on March.

28 Oct: ACTH Base line: 145nmol/L; After test: 511 nmol/L (Normal: 170 - 470)Cushing Syndrome possible
19 Jan: ACTH Base line: 250nmol/L; After test: 752 nmol/L (Normal: 170 - 470); ALKP: 1589; Vetoryl 60mg
29 Jan: ACTH Base line: 170nmol/L, After test: 409nmol/L (Normal: 50 - 200); ALKP: 967; Vetoryl 90 mg
8 Feb: ACTH Base line: 89 nmol/L, After test: >276 nmol/L (Normal: 50 - 200); ALKP: 1038; Vetoryl 120mg
20 Feb: ACTH Base line: 195 nmol/L, After test: 470nmol/(Normal: 50 - 200); ALKP: 655; Vetoryl120mg
7 Mar: 150mg Vetoryl; no test (Vet on leave)

In fact, the results of the ACTH test are not that accurate as I recently found out that there is an misunderstanding :confused: between us and the vet. We gave Vetoryl at 8 pm instead of the morning. So, the ACTH tests were conducted almost 19 hours after taking the medicine.:( So we give Pizza Vetoryl in the morning in these two weeks. I hope the results is more representative. I am so sorry for Pizza. :(

Best,
Vivian

[Pizza Tse]

Hello,
Has Pizza been seen by an IMS vet? If not, I would urge you to find one asap. The dosage of Vetroyl seems extremely high and I have recently determined that too many general practice vets do not know enough about Cushing's.

Daisy will be seeing Dr.Megan Morgan at Cornell in Stamford CT. If you tell us where you're located, maybe someone can suggest an IMS specialist in your area.

Cushng's is not easy tto diagnose and when other health conditions exist, that makes things more difficult as tests can be skewed by the other illnesses or medications.

I've only been on this site for a few weeks and you definitely found the right place!

Hi doxiesrock912,
Thank you very much for your suggestion! I am from Hong Kong. My vets come from here (http://www.peaceavevet.com.hk/main.php). No IMS specialist here. That's a good suggestion to find one!

[Harley PoMMom]

Hi Leslie,

I have just added and amended the data. The original one is misleading. Sorry for that! So here is the right one. Pizza had the ACTH best before given the Vetoryl except the one on March.

28 Oct: ACTH Base line: 145nmol/L; After test: 511 nmol/L (Normal: 170 - 470)Cushing Syndrome possible
19 Jan: ACTH Base line: 250nmol/L; After test: 752 nmol/L (Normal: 170 - 470); ALKP: 1589; Vetoryl 60mg
29 Jan: ACTH Base line: 170nmol/L, After test: 409nmol/L (Normal: 50 - 200); ALKP: 967; Vetoryl 90 mg
8 Feb: ACTH Base line: 89 nmol/L, After test: >276 nmol/L (Normal: 50 - 200); ALKP: 1038; Vetoryl 120mg
20 Feb: ACTH Base line: 195 nmol/L, After test: 470nmol/(Normal: 50 - 200); ALKP: 655; Vetoryl120mg
7 Mar: 150mg Vetoryl; no test (Vet on leave)

In fact, the results of the ACTH test are not that accurate as I recently found out that there is an misunderstanding :confused: between us and the vet. We gave Vetoryl at 8 pm instead of the morning. So, the ACTH tests were conducted almost 19 hours after taking the medicine.:( So we give Pizza Vetoryl in the morning in these two weeks. I hope the results is more representative. I am so sorry for Pizza. :(

Best,
Vivian

Vivian, I am quite concerned for your boy since the ACTH stim tests were not performed in the correct manner. Vetoryl has to be given with food the morning of an ACTH stim test, also the ACTH stim test HAS to be done within 4-6 hours after the dose of Vetoryl is given, if these protocols are not followed then the results are skewed. How is Pizza feeling, any vomiting, diarrhea, lethargy, how is his appetite?

[Pizza Tse]

Hello Harley PoMMom,

Thank you for you concern. Pizza looks good. After taking the medicine, he has no more panting, he sleeps better and no more increase in weight. It seems that there is no side effect on him. He still follows my mom around, ask for food all the times and pees a lot.

I am still confused if Vetroyl helps him since the dosage of 150mg seems high for a small dog (8.6kg) like him despite the vet told me that it is ok for a dog to take at max 40-50mg per kg.

:confused::confused::confused:

Best,
Vivian

[Simba's Mom]

Welcome to you and Pizza, hope you get the answers you need, no question is too big or too small, settle in and remember we are here for you!

[molly muffin]

Hi Vivian. I just wanted to check in and see how you and Pizza are doing.

Hope all is well.

hugs,
Sharlene and Molly Muffin

[Pizza Tse]

Hello Simba's Mom and others!

Pizza has done two ACTH tests on April 3 and April 20. This time Pizza did the test about 4 hours after taking Vetoryl and the results should be reliable.

Here is his results:
April 3: ACTH Base line: 61 nmol/L, After test: 78nmol/L (Normal: 50 - 200); Then, he took 60 mg Vetroyl daily.
April 20 : ACTH Base line: 121 nmol/L, After test: 121 nmol/L (Normal: 50 - 200); Strange to see that the base line and after test level is exactly the same!

Pizza also did a whole blood test on April 3 and he was found to have low RBC, HCT and HGB. So, his dosage of Vetoryl was reduced from 150 mg to 60 mg daily. He did the test again on April 20 and his RBC, HCT and HGB raised a bit, but still below normal range. So, the vet decided to stop his Vetoryl for a week and then will start with 20 mg daily.

Apart from the higher than normal level of Urea and K, Pizza doesn't show any adverse symptoms. Lucky that he is still ok. 150mg Vetroyl really make me very worried for him as he has both congestive heart failure and renal deficiency.

[molly muffin]

Hello and good to hear from you. That is good to hear that Pizza is being monitored regularly with ACTH test. That is very important always, but especially in light of Pizza's other health issues.
Pizza isn't having any symptoms of cushings? I can understand wanting to bring the RBC and other values up to a normal range. It is a delicate balancing act. Is Pizza still eating okay? No vomiting or any other adverse reactions?
Let us know how things continue to go and give Pizza a belly rub for us. :)

hugs,
Sharlene and Molly Muffin

[Pizza Tse]

Hello all,

Pizza has done anther ACTH and whole blood test yesterday.

May 11 : ACTH Base line: 87 nmol/L, After test: 84 nmol/L (Normal: 50 - 200);

RBC 4.93 (Normal 5.65 - 8.87)
HCT 32.2% (Normal 37.3-61.7)
HGB 10.8 g/dL (13.1 - 20.5)
ALKP 375 U/L (23-212)

His RBC, HCT and HGB is still below normal. His ALKP is reducing from 474 U/L to 375 U/L. So, the vet further reduced the dosage of vetoryl fro 20mg to 10mg daily. The vet said that his RBC goes under normal probably as a result of mild Addison's problem.

Pizza still has a very good appetite, but his hind legs get further weaker. His muscle on the leg has gone! He has less panting now and he has no other Cushing's symptoms.

It will be a big problem if he cannot walk. Can anyone suggest how I can improve his legs?

[Harley PoMMom]

Pizza has done anther ACTH and whole blood test yesterday.

May 11 : ACTH Base line: 87 nmol/L, After test: 84 nmol/L (Normal: 50 - 200)

Let me make sure I am reading this right, baseline 87 nmol/L (3.15 ug/dl) and a POST of 84 nmol/L (3.04 ug/dl), that is a post number, right? If so, they are really good numbers!


It will be a big problem if he cannot walk. Can anyone suggest how I can improve his legs?

Weakness in the rear legs can take some time to improve. Maybe hydrorobics in the bath tub where Pizza can swim. I believe, also, I've heard about trying to have them walk backwards helps but I have no experience in doing so.

[doxiesrock912]

Make a loop with ladies hose or something comfortable that is long enough to loop under Pizza's midsection and you can hep to support his weight while walking.

I know someone who used this method and it helped to improve their dog's strength.

[frijole]

Hello all,

Pizza has done anther ACTH and whole blood test yesterday.

May 11 : ACTH Base line: 87 nmol/L, After test: 84 nmol/L (Normal: 50 - 200);

RBC 4.93 (Normal 5.65 - 8.87)
HCT 32.2% (Normal 37.3-61.7)
HGB 10.8 g/dL (13.1 - 20.5)
ALKP 375 U/L (23-212)

His RBC, HCT and HGB is still below normal. His ALKP is reducing from 474 U/L to 375 U/L. So, the vet further reduced the dosage of vetoryl fro 20mg to 10mg daily. The vet said that his RBC goes under normal probably as a result of mild Addison's problem.

Pizza still has a very good appetite, but his hind legs get further weaker. His muscle on the leg has gone! He has less panting now and he has no other Cushing's symptoms.

It will be a big problem if he cannot walk. Can anyone suggest how I can improve his legs?

Please help us understand - originally you were giving 160 mg then 120 then 60 then 20 and you are now at 10 mg? The original dose was way too high but it appears the vet is a bit confused about this drug. Just looking for dosing clarification. Kim

[Pizza Tse]

Let me make sure I am reading this right, baseline 87 nmol/L (3.15 ug/dl) and a POST of 84 nmol/L (3.04 ug/dl), that is a post number, right? If so, they are really good numbers!



Weakness in the rear legs can take some time to improve. Maybe hydrorobics in the bath tub where Pizza can swim. I believe, also, I've heard about trying to have them walk backwards helps but I have no experience in doing so.

Yes, you are right. The numbers are fine.

Pizza learnt to swam in a pool with a life-saving jacket last year. He was so scare. This year, he has congestive heart failure, I am not dare to take him to swim.

[Pizza Tse]

doxiesrock912, Thank you for your good ideas. Pizza's hind legs are walking like he is drunk. Something that can hold his lower body can help. He probably needs to lose weight to reduce the stress on his legs.

Kim, Pizza was started with 60mg on Jan 19. It was unfortunate that we misunderstood the time between the the perscription time and the ACTH test. So, we gave Pizza Vetoryl much longer time before the ACTH Test. As a result, the test results show a very high cortisol value and a high dosage of Vetoryl (i.e. 120mg and 150mg) were given to Pizza. Later I read more information from this forum and found out Vetoryl should be taken 4-6 hours before ACTH test. So, Pizza's true cortisol value was much lower. The dosage of 120 mg and 150 mg were given because of our misunderstanding. I am so sorry for Pizza.

It is now his low red blood cell that worries me.

[Trixie]

Hi Vivian,
I cannot help with the numbers as I am still learning about the testing results myself. I hope Pizza is doing okay now. So happy you have gotten him off the very high dose. I hope he continues to feel better. I wish I had an answer about his legs and walking...maybe someone on the board will have a suggestion.
Barbara

[molly muffin]

Oh poor Pizza. I know that was a rough patch to get through and the high dosage didn't help. So many vets do not seem to be aware of the proper protocols involved with both diagnosis and treatment.
Hopefully things will settle down and Pizza will be fine.
I am not sure about what is causing the low RBC issue. Did the vet discuss this with you at all? Infection, etc, can cause this to occur. Pizza has a few things going on though so it's hard to know for sure.

Sharlene and Molly Muffin