Belinda just started Trilostane, side effects

[BelindasMom]

Hi, my Belinda is a 13 year old female spayed Yorkie who weighs 17 pounds. She has a much larger build than standard Yorkies and is not really overweight, just slightly. She was diagnosed with Cushing's on Thursday and I am supposed to get copies of all the bloodwork and ACHT test Monday. Her littermate sister also had Cushing's and was diagnosed with it in 2009 and passed away in 2011.
We began Trilostane Thursday evening with the liquid form at 35mg once daily. Over the weekend she has developed hind leg weakness, lethargy, a decrease in appetite, and a very severe sounding cough. She was already on a bronchial dilator and the generic Lasix because her heart is very slightly enlarged and was causing some pressure against her trachea resulting in occasional involuntary coughing. She went to the vet 2 weeks ago for allergies in her eyes and ears and the vet noticed a little wheeze in her chest. She was placed on some eye and ear drops and an antibiotic and told to come back in one week. When we came back she could still hear the wheeze and did a chest xray at which time we saw the liver was quite enlarged and the right side of the heart slightly enlarged. Bloodwork showed some elevated liver enzymes, elevated neutrophils, but otherwise fairly normal. So we did the ACTH on Tuesday and were called on Thursday that the results were consistent with Cushing's.
Prior to diagnosis I had assumed the test would be negative as she didn't exhibit the same symptoms as her sister: the big potbelly, the constant drinking, the hair loss. Belinda had begun sliding a bit with her back legs on the vinyl flooring but I had assumed it was age related and she does have arthritis in the spine and hips. She also had begun having accidents in the house. The hair on her lower back might possibly be slightly thinner but I have only noticed it in the last day or so as she has very thick hair to begin with.
This cough is very concerning because she sounds very congested and I am afraid the beginning dose of Trilostane has lowered her cortisol too fast. I am thinking of not giving tonight's dose or else halving it. My vet is not in on the weekends and there is only a 24hr emergency clinic 30 miles from here and I am not certain what they can do for her. She did get up twice during the night to eat so right now her tummy is full. She is walking a bit better this morning and is drinking normal amounts of water. She is alert and responsive and wants to lick my face and cuddle, so she does not seem disoriented in any way. I can just tell she feels unwell and congested.
Does anyone know what I could do for the cough until the vet comes in at 7:30 am? Or whether I should skip tonight's dose or halve it?

[addy]

Hi and Welcome,

I approved this thread so others can start reading and giving feed back. It sound like you have a lot going on with Belinda. Dechra and U.C. Davis have been recommending a starting dose of 1mg per pound to help minimize side effects hoever there are some original Dechra (manufacturer of Vetoryl) that show a higher starting dose which many vets still use.

It is possible her coprtisol is dropping making her allergies worse. It is always so hard to figure out what may be going on when the vets start treating more than one thing at a time.

Could you round up Belinda's test results and post them here? You need only show the abnormal values with the lab's normal range indicated.


We began Trilostane Thursday evening with the liquid form at 35mg once daily. Over the weekend she has developed hind leg weakness, lethargy, a decrease in appetite, and a very severe sounding cough

I am concerned her cough sounds worse as well as her other symptom that have developed. I'm not there to see your dog or know first hand how sick she may seem. My own general rule is if I am ever in doubt, I dont give the pill and if it were me I would not give the Trilostane until I spoke to a vet.

I'm glad you found us.

[BelindasMom]

Her cough is making her feel miserable and I agree that I should probably skip the Trilostane for today and see the vet first thing in the morning. Belinda's allergies were worse this year than ever before and the vet said this year they had seen more allergy cases than at any time in the past. We live in NE Tennessee and pollen counts have been very high.
I don't yet have copies of her labs. The vet was going to talk with me in the morning and get me the copies. I know her organ functions all looked normal except for some elevated enzymes but they were not super high I don't think. I don't know the numbers on the ACTH test.
We have Benadryl here, the plain kind, but I wasn't sure if it was safe to give with the other meds.

[labblab]

Hello and welcome,

I would withhold the trilostane altogether until you can consult with your vet tomorrow. Initial dosing recommendations have lowered during the past couple of years, and Dechra (manufacturer of brandname Vetoryl) is now generally recommending that dogs be started at doses no greater than 1 mg. per pound. So that would only be half of what you are currently giving Belinda. That being said, given her response over the last three days, it does sound as though this dose has been too large for her to handle.

I would not give her any more trilostane at all today in hopes of seeing some rebound, especially since the respiratory issue is a special concern.

Marianne

P.S. I see Addy and I were writing at the same time, so please forgive me for duplicating some of the same info!

[Harley PoMMom]

Hi and welcome to you and Belinda from me as well!




She was placed on some eye and ear drops and an antibiotic and told to come back in one week.

Could you tell us the kind of eye and ear drops the vet has Belinda on?


So we did the ACTH on Tuesday and were called on Thursday that the results were consistent with Cushing's.
Prior to diagnosis I had assumed the test would be negative as she didn't exhibit the same symptoms as her sister: the big potbelly, the constant drinking, the hair loss.


If the eye and ear drops have any type of steroid in them then this could of skewed the results of the ACTH stimulation test.

I am sorry for the reasons that brought you to us but am so glad you found your way here. We will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[Budsters Mom]

Hello to you and Belinda,:)

I am so glad you found us, but I am sorry for the reason that brought you here.:(
You have come to the right place! There are many K9Cushings angels to help answer your questions and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. The more they know, the more they will be able help you and Belinda. It looks like you are off to a good start already, but please keep talking to us.

I have a large, 16 pound neutered Yorkie. His allergies erupted right after starting Trilostane. As his Cortisol level dropped, his allergies flooded back. Could Belinda's coughing and wheezing issues be due to allergies? Just a thought.....
Hugs,
Kathy and Buddy:)

[Bo's Mom]

Hi and welcome to the group. I just wanted to comment on your baby's name....I LOVE IT. But, I am not partial am I. :D:D:D:D
Just wanted to say welcome and ask away. There are a wonderful group of angels who will definitely chime in with an answer.

[BelindasMom]

The eye drops are called Neo-Poly-Bac Hydro Opti Ointment and it does have a topical steroid. The vet said it wasn't really systemic and didn't think it would change the tst results. The ear drops are called Positex and are an anti-fungal, anti-baterial. I don't know if they have a steroid but she and her late sister have used it a number of times. They both have been prone to ear infections.
She slept and stopped coughing for about 3 hours but now is up and coughing again. We are deciding whether to take her to the ER to see if at least they can give her a cough suppressant of some type because it is making her very unhappy.

[Harley PoMMom]

The eye drops are called Neo-Poly-Bac Hydro Opti Ointment and it does have a topical steroid. The vet said it wasn't really systemic and didn't think it would change the tst results. The ear drops are called Positex and are an anti-fungal, anti-baterial. I don't know if they have a steroid but she and her late sister have used it a number of times. They both have been prone to ear infections.
She slept and stopped coughing for about 3 hours but now is up and coughing again. We are deciding whether to take her to the ER to see if at least they can give her a cough suppressant of some type because it is making her very unhappy.

One of the ingredients in Positex is Prednisolone, which is a steroid.

Oral, topical, and ear/eye drops that contain any form of a steroid can skew ACTH stimulation tests. Here's a excerpt from IDEXX Laboratory Services:
Both topical and systemic glucocorticoids should be withdrawn for 14 days before diagnostic evaluation of the HPA.

This information can be found here: http://www.idexx.co.uk/publicweb/en_GB/animalhealth/laboratory/smallanimalprotocols/hpaaeval.jsp

Another quote from Dr Peterson's blog, Dr Peterson is a renown Cushing's expert:


My dog has clinical signs of hyperadrenocorticism and now other nonrelated illness − now can I test?

If the dog has any or all of the clinical signs of hyperadrenocorticism, yes, you should proceed with testing of the pituitary-adrenal axis. However, it is necessary first to ensure that the dog is not being exposed to exogenous glucocorticoids, including topical glucocorticoids on the eyes, ears or skin.

This article is located here: http://endocrinevet.blogspot.com/2011/02/diagnosing-hyperadrenocorticism.html

My non-cush furbaby, Bear, has a collapsed trachea which makes him cough, he takes Tussigon and Brethine and they really help with his cough.

Reoccurring ear infections can be a symptom of Hypothyroidism, has Belinda been checked for any thyroid issue?

Love and hugs,
Lori

[BelindasMom]

I am really concerned now that she might be misdiagnosed. Nobody even mentioned the eye or ear drops being a problem at the vets and normally I am happy with my vet because we moved to this one when my other Yorkie developed Diabetes and Cushing's because they had way more experience with it than the vet I had before. She basically just brushed me off and really wanted me to go somewhere else because she didn't seem to want to use Trilostane when the Lysodren didn't work.
I am definitely not giving any more Trilostane until we go to the vet office in the morning. I want to ask a lot of questions and look at the lab results and even if she does have Cushing's I think her starting dose is too high.

[Squirt's Mom]

When you talk to the vet, ask for copies of the test results and post them here. We can help you look at them and perhaps offer some insight. ;)

[BelindasMom]

I will post the results when I get them tomorrow. Right now she is resting comfortably and snoring so we have decided to just stay home and keep an eye on her unless something changes. The ER won't have any of her medical history or test results and I know it will really stress her if we go there.
Do you know if there is something genetic/hereditary about Cushing's? Her littermate had it so I was wondering. I know Yorkies are one of the breed more prone to it.

[molly muffin]

Hello and welcome to you and Belinda.

Most of us now keep copies of all test results in a home file. You might want to ask your vet for copies of all tests going back a number of years. I asked for 2 years worth when I started keeping my file. Make sure that it is far enough back to include all diagnostic testing for anything Belinda might have or have had medicine for.
I've had a couple of ER trips for various things and always go in loaded with my file, just in case. :) Much easier now that I have my IMS at the ER clinic. LOL
It's true, there is a chance that the cushings diagnose was incorrect. Even with vets that are pretty well informed, they might miss something or not get it correct. I think they like you to not being on any of these steroids, topical included for a period of time to eliminate the possiblity of it messing with the ACTH results. The other thing is that long time prolong use of steroids can cause a type of cushings that will normally go away once all steriods are stopped. (sorry, one more thing to keep in mind :))
Maybe find out exactly what is causing the coughing, that seems to me to the be the absolute Most important thing right now.
I hope Belinda is better today and tomorrow. You said the coughing starting with the start of the vetoryl? I'd leave it off and see if the coughing goes away. Could be allergies, could be something else.

Sharlene and Molly Muffin

[BelindasMom]

I will ask for all the copies in the morning. Belinda has never really had any illnesses until now. She hadn't been to the vet since last June for her yearly checkup. The only problems she had prior to this was a UTI in January 2012 that was having trouble clearing up. They ran a lot of bloodwork and an ACTH then and it was negative for Cushing's at that time. We finally determined she needed an estrogen supplement as her bladder was relaxing too much and letting bacteria in. She has been on a very tiny dose of estrogen every 3rd day since then and has not had another UTI since. The only other time she was really sick was after being given a Comfortis flea tablet and she had a very bad reaction to it and spent 2 days in the hospital on fluids for vomiting/diarrhea. But basically she has been a sturdy, chunky, healthy little girl. It was her sister, who was also the tiniest of the litter, who had multiple health problems. The cough comes and goes. She slept for several more hours and did not cough but while up running around she will start to cough, sometimes so hard it gags her a little. It is not vomiting, just a gagging sound and sometimes a little spit-up that looks like clear saliva. If she sits still she doesn't cough. She is alert and perky and giving me kisses so she is not feeling so bad that she is disoriented or lifeless or uninterested in things, and that is very good. We are skipping the Trilo dose and telling the vet we want to start with a lower dose, like 1mg per 1lb body weight. Her sister's highest dose was 35mg in the last year of her life, so I assume we probably started at 15-20mg but honestly cannot remember at this time.

[BelindasMom]

Hi, we are waiting for the vet's office to get unlocked this morning to have Belinda checked out but I did want to let you know that she greatly improved after I withheld the Trilostane yesterday. She wanted to eat all her supper last night and all her breakfast this morning and she is much more energetic. Yesterday she didn't want to do much of anything but today she actually ran around outside and is much steadier on her feet. So I truly do think she was on too high a dose. The cough still sounds fairly bad but she is not coughing as often as yesterday. Hopefully I will get some answers this morning and I will get copies of all her lab results and we will have a better idea of what's going on. I appreciate everyone's comments, advice, and support. It makes me feel less alone with everything that's going on.

[addy]

Glad to hear Belinda is feeling better. Let us know how the vet visit goes. We are right beside you all the way.:)

[BelindasMom]

I have her ACTH results and also the complete blood workup they did.
On the ACTH the beginning result was 4.5, ending result 18. This is only one point over high normal and the independent lab who did the test has written that it must be 20 or above to indicate Cushing's in a dog. It also states false positives can be found if the dog is stressed (she was screaming and panicking like she always does at the vets), or if you have been on any kind of steroid (the eye and ear drops she was taking). It also says these results must be viewed in light of any clinical signs of Cushing's (she has none unless you count a few pee accidents on the carpet lately). I am very upset that the vet prescribed 35mg Trilostane based on this test. They advised taking her completely off it and going to the other vet hospital for an ultrasound and then rethinking everything. I don't know if I want to continue with this vet practice or not. I usually deal with the main vet there who owns the business, but he has 3 other vets working for him and he has not been available the past week or so since this started. I assume out of town/vacation. If I do return there I would want to deal with him instead of this other lady. She could not answer all my questions and seemed to brush off the idea that the eye and ear drops had raised the level. Certainly if the level was really high I could see her point but in my opinion it could go to 18 possibly as a result of the meds and the stress Belinda was under. She is terrified of doctors. She screams dramatically whenever we go. I am going to post her bloodwork results next in a separate post as it is timing me out when I write long posts.

[BelindasMom]

Okay, the blood panel done 4-19-13. I will post the high or extra low results but could post all if needed. Most were pretty normal.
LYM-1.04 low
MONO-1.15 high
BASO-.34 high
PLT-626 high
PCT-.62% high
GLU-186 high (she had just eaten because we did not know we were doing bloodwork, and she was stressed, so I am unsure about how to interpret this one)
BUN-35 high but with normal creatnine of 1.2
GLOB-4.6 high
ALT-157 high
ALKP-670 high
GGT-26 high
TBIL-1.1 high
CI-105 low
All other values well within normal range. I have no idea what some of these abbreviations stand for but I'm sure many of you do. I forgot to mention she is also on Denamarin since this test was done because of the elevated liver enzymes.
Thanks so much!!!

[SoggyDoggy]

Hi, Just having a look here and the first thing anybody else will ask, is could you pretty please edit you post with the reference range numbers for the tests you have indicated above? If you put them in brackets, then others will be able to give you more direct advice by seeing how far out those results are.

As for the recommendation of the Ultra sound, I would second that!

And reading about your vet is like listening to my own story! The owner of the practice and her offsider are the only two I will speak to in my vet clinic, the other two are incompetant and really stuffed up my boys initial treatment. I asked for reading material on 3 different occasions and never got anything! Also, if they had explained the ultra sound to me properly at the time, I would have had it done and maybe saved myself some much later headaches. That is another story, but if you are questioning the cushings, then I highly recommend the ultra sound! It will certainly be able to rule cushing's in or out for you, as well as to check out the other abdominal organs.

On a separate note, if your browser is timing out when you write posts, you can tick the "remember me" box when you log in, or alternatively, save your password string in your browser when you log in, that way you are never logged out. That's what I have done, it's not great security, but then I'm also the only one who ever uses my laptop, so that's easy for me.

[BelindasMom]

I will post those ranges when I get a bit more time, it might be this evening because I am at work now after spending the morning at the vets. If I have the chance I will post them from work. Thanks so much for looking at these for me!

[BelindasMom]

Here it is, it took less time than I was expecting!
LYM-1.04 low (1.05-5.10)
MONO-1.15 high (0.16-1.12)
BASO-.34 high (0.00-0.10)
PLT-626 high (148-484)
PCT-.62% high (0.14-0.46)
GLU-186 high (she had just eaten because we did not know we were doing bloodwork, and she was stressed, so I am unsure about how to interpret this one) (70-143)
BUN-35 high but with normal creatnine of 1.2 (BUN should be (7-27)
GLOB-4.6 high (2.5-4.5)
ALT-157 high (10-100)
ALKP-670 high (23-212)
GGT-26 high (0-7)
TBIL-1.1 high (0.0-0.9)
CI-105 low (109-122)
All other values well within normal range. I have no idea what some of these abbreviations stand for but I'm sure many of you do. I forgot to mention she is also on Denamarin since this test was done because of the elevated liver enzymes.
Thanks so much!!!

[Harley PoMMom]

I have her ACTH results and also the complete blood workup they did.
On the ACTH the beginning result was 4.5, ending result 18. This is only one point over high normal and the independent lab who did the test has written that it must be 20 or above to indicate Cushing's in a dog. It also states false positives can be found if the dog is stressed (she was screaming and panicking like she always does at the vets), or if you have been on any kind of steroid (the eye and ear drops she was taking). It also says these results must be viewed in light of any clinical signs of Cushing's (she has none unless you count a few pee accidents on the carpet lately)

Since Belinda has not been displaying obvious symptoms of Cushing's and with a high normal result on the ACTH stimulation test, I really don't think that the Cushing's diagnosis is accurate either.


I am really concerned now that she might be misdiagnosed.

I really do believe she was misdiagnosed too. Some of the elevations on her blood panel could be due to the steroid use and her enlarged heart.

Sending you both huge hugs, Lori

[BelindasMom]

I forgot to mention that I asked what the results had been of the previous ACTH in January 2012 when she had that stubborn UTI. The vet said her starting results were 1.0 and ending was 2.0 but that cannot be right for an ending result! She didn't give me a copy of that one. She said, "This is a significant change from last year." 2.0 would be too low wouldn't it for an ending result?

[molly muffin]

It seems very strange in light of the latest ACTH test, but you can't tell much without seeing the test itself, if it was done by the same lab, and what the lab remarks were.
Did Belinda have a UTI or was she just coming off a UTI at the time of this latest ACTH? Some of the values like they could be due to an infection and of course, the steroid could over time raise some levels too. Allergies too can cause a rise in some levels. I don't think there is enough here to say definitely cushings at this time.

This one site that tells you a little more about blood test and what they might mean. Keep in mind that any one given enzyme being raised isn't a definite and you have to look at the whole picture.
http://www.acreaturecomfort.com/caninebloodwork.htm

You don't have to do an ultrasound right this moment, but over all an ultrasound is a good way to find out what the organs look like and can find potential problem areas, or areas to keep an eye on.

Sharlene and Molly Muffin

[frijole]

I forgot to mention that I asked what the results had been of the previous ACTH in January 2012 when she had that stubborn UTI. The vet said her starting results were 1.0 and ending was 2.0 but that cannot be right for an ending result! She didn't give me a copy of that one. She said, "This is a significant change from last year." 2.0 would be too low wouldn't it for an ending result?

:D I bet they did a different cushings test the last time - the ldds test. there are 3 numbers but the numbers are low like that. Wow that vet sure isn't paying attention if thats the case. Well as you noticed a dog that was diagnosed as not having cushings last year wouldn't have results of 1.0 and 2.0 :D WOW. Glad you found us. Kim

[BelindasMom]

I really think the vet got ahead of herself with this one. We are gonna take a step back and re-evaluate what we need to do. It's possible she is borderline Cushing's or may develop it in the future but based on just the one test I don't think we can possibly assume she has it now. I am wondering about the ultrasound, whether that is an urgent thing or not. I am concerned about the enlarged liver for fear of cancer but I know there won't be much we can do if that is the case. I may plan it within the next week or two as a precaution.
She ate well this evening and enjoyed hanging out in the yard barking at things. She even ran a bit, so the legs are much much stronger today! She normally is a very curious and energetic little girl and it makes me happy to see her personality coming back.
Please comment on anything you think I should do or shouldn't do and if you have any thoughts about the bloodwork. It is a great help to me to be able to talk with all of you.

[Harley PoMMom]

A Cushing's savvy vet will perform two diagnostic tests to validate a diagnosis of Cushing's. So, I believe, I would not pursue any more tests for Cushing's until Belinda starts showing strong clinical signs of this disease.

The ultrasound can be a great diagnostic tool as it gives a look at the internal organs. The one thing with Belinda is that her adrenals could be enlarged because of her heart issue as any chronic illness can cause the adrenals to be enlarged. So if you do decide to have an ultrasound performed, I just wanted to inform you about this because enlarged adrenal glands do not always mean Cushing's.

Please do keep us updated, ok?

Love and hugs,
Lori

[BelindasMom]

A Cushing's savvy vet will perform two diagnostic tests to validate a diagnosis of Cushing's. So, I believe, I would not pursue any more tests for Cushing's until Belinda starts showing strong clinical signs of this disease.

The ultrasound can be a great diagnostic tool as it gives a look at the internal organs. The one thing with Belinda is that her adrenals could be enlarged because of her heart issue as any chronic illness can cause the adrenals to be enlarged. So if you do decide to have an ultrasound performed, I just wanted to inform you about this because enlarged adrenal glands do not always mean Cushing's.

Please do keep us updated, ok? i


Thanks for this info! I didn't know that the heart issue could enlarge the adrenals so that is something good to know. The vet sent all Belinda's info over to the hospital that does all their ultrasounds and I'm going to call them today to schedule it. I am trying to schedule it on a day I can take off work so that I can take her on home afterwards. She gets very stressed if she has to stay in a kennel for a while after a procedure so I don't want her getting upset. I will see what the ultrasound shows and go from there. I have heard really good things about this doctor who will do the ultrasound. Based on what it shows I expect him to make recommendations for where to go next. I did find 2 internal medicine vets in my local area so the next step might be to get one of them to take a look at Belinda and all her test results. Both of them say they are taking new patients so if I need them I know they will be available to work us in. I will update as soon as I know more.
I appreciate all your help, you are awesome and you are really a big help to me! I am praying for all your furbabies and hoping for really amazing results from all the treatments they are getting.

[BelindasMom]

Ultrasound is scheduled for May 8th at 8am because that is my day off. Hoping for good results and that nothing scary comes up.

[Harley PoMMom]

Wishing you and Belinda the best of luck with the ultrasound and we will be waiting anxiously with you for those results. ;):)

Love and hugs,
Lori

[Budsters Mom]

I am so glad you decided to get an ultrasound done! It gives a really good picture of exactly what you are dealing with. :)I had one done for Buddy. It was money well spent!

Great job Belinda,
Hugs,
Kathy and Buddy:cool:

[molly muffin]

My IMS is at the vet hospital who did our ultrasound, so if an IMS does the ultrasound you can get some good feedback at that time.

Good luck!!

hugs,
Sharlene and Molly Muffin

[SoggyDoggy]

Excellent work. Roll on the 8th hey? I do hope it gives you the answers to what's going on and that everything is easily resolved. I will be crossing fingers for you!

[BelindasMom]

I have a question regarding Belinda recovering from the 35mg of Trilostane she was on last week. Her appetite still isn't all the way back to normal, although all the leg weakness is gone and she is interested in everything going on around her again and has had no more nausea and also no more coughing. Until her ultrasound on Wednesday I won't have any more test results but was wondering if I should be concerned. She is eating and she is interested in food to the point of staring at us and begging when we eat our people food, but she is only eating about half her normal amount. She does enjoy it though and is keeping it down with no problems. Last night she ate most of her food but I had to start out feeding it with a baby spoon and after a few bites she stuck her head in the bowl and began eating on her own. I am thinking she probably knows how much food her body needs right now and that if encouraged to eat more she might have some indigestion problems.
I believe her allergic cough got worse while on the Trilostane because it dropped her cortisol too low. On Monday she was prescribed a cough medicine in addition to her bronchial dilator pills which was to be used on an as-needed basis every 8 hours. But she only needed the first two doses and has not been coughing since.
Currently I have serious doubts about her having Cushing's at all as she really exhibits no clinical signs other than the enlarged liver and elevated enzymes, but I am assuming that the good look at her adrenal glands with the ultrasound will rule it in or out. He is going to especially look at those. If neither of them is enlarged wouldn't that completely rule it out? Or could she still be borderline or atypical Cushing's? I am confused :)

[Trixie]

I don't know enough to advise on your confusion re Cushings or not but I just want to say so I'm happy to read that Belinda is feeling better-eating some at least and begging-that's a great sign and no more leg weakness! yay! I hope the ultrasound will give you some answers and will help figure things out. Too bad about the cough but glad to hear she is doing pretty well otherwise. :)
Barbara

[Harley PoMMom]

Currently I have serious doubts about her having Cushing's at all as she really exhibits no clinical signs other than the enlarged liver and elevated enzymes, but I am assuming that the good look at her adrenal glands with the ultrasound will rule it in or out. He is going to especially look at those. If neither of them is enlarged wouldn't that completely rule it out? Or could she still be borderline or atypical Cushing's? I am confused :)

If neither adrenal gland is enlarged that PDH is not likely or it is in the very early stages.

One thing to remember, chronic illnesses can cause the adrenals to become enlarged so even if they are both enlarged, because of no clinical symptoms, the diagnosis of Cushing's is unlikely at this time.

Love and hugs, Lori

[molly muffin]

As Lori said, chronic problems can cause the adrenals to enlarge and produce more cortisol, more cortisol can cause the liver to enlarge too. (I know we're in that same boat, of mildly enlarged adrenal and liver, but not a symptom of cushings) It makes it difficult. However, based on how Belinda responded to the Trilostane, I wouldn't have her on it to lower the cortisol unless she was displaying some very definite cushings signs. When considering treatment for cushing and lowering the cortisol, you have to look at the big picture. The big picture is that it wasn't a good experience. If symptoms Did show up, then I would probably try her at a very low dose of vetoryl and see how that plays out and if she has the same response at a lower dose, but I don't think that is something to consider at this time.

hugs,
Sharlene and Molly Muffin

[BelindasMom]

Belinda had her ultrasound done yesterday at the big vet hospital and he was unable to see either adrenal gland. He kept trying but he said it seemed to make her very uncomfortable and he feels he would not be able to see them without putting her under anesthesia which he did not think was a good idea just to see the adrenals because he also agrees that she is very unlikely to have Cushing's. He said she simply does not have the appearance or symptoms of a Cushing's dog (she has beautiful thick hair, no potbelly, although she has always been a curvy girl). After shaving her belly you can definitely tell she does not have the Cushing's belly. He pretty much disregarted the ACTH results based on the two topical steroids she was still on and the fact that the results were under 20 which could have been caused by the steroids, stress, or many other factors.

He says almost her entire liver has an abnormal appearance and he honestly is not sure what it is. He didn't see anything that looked like distinct tumors or masses but the whole liver is enlarged and inflamed looking. Only a biopsy can tell us for sure but he stressed that it is completely optional. Due to her age and the lack of liver disease symptoms he didn't know whether I would want to subject her to a biopsy or not. He says we also have the option of continuing to treat the liver enzymes with the Denamarin and of course there are dietary changes and other supplements that help with liver function.

I am not sure how to proceed from here. I realize that if she has liver cancer there is little we can do other than keep her comfy as long as possible. However I kind of have my doubts about it being cancer. If she had it so badly that the entire liver was affected, wouldn't there be symptoms? We have a relative right now with terminal liver cancer and he has jaundice, pain, and very little appetite. Belinda's appetite has now come all the way back to normal and she is eating her whole meal and licking the bowl clean. Her drinking, eating, sleeping, and elimination habits all seem normal. She enjoys walking in the yard and barking at the neighborhood. The vet seemed kind of puzzled that her liver could look that inflamed without causing her to feel ill but she doesn't seem to feel unwell.

Do any of you know of other conditions that could cause this and what treatments are used? Thanks!

[Squirt's Mom]

If I were you, I would forget all about everything right now other than loving that sweet girl! This ultrasound report and the comments from the IMS are very comforting and reassuring to me. If he had seen anything that was concerning, I don't think they would have been so open-ended about what do to next - they would have let you know more needed to be done.

The liver is a truly wonderful organ. It is one of the hardest working organs in the system, always working to filter and keep the blood pure. Any impurities that enter the system are addressed by the liver at some point. It can take a whole lot of pounding and keep on ticking. It even has the ability to regenerate, to heal itself of, much of the damage it can sustain. The enlarged appearance noted on the ultrasound could easily be a result of the Trilostane - a drug her system didn't need after all. ;) For your info, but not so you can now worry about cancer ;) -

http://pets.webmd.com/dogs/liver-disease-liver-failure-dogs

Enjoy your sweet girl to the fullest, be grateful Cushing's is not part of her life today - BUT you cannot leave here! Ya'll are family now and we will want to know what is going on with you. So you cannot disappear just because it seems Belinda does not have Cushing's - you are STUCK with us! :D

Hugs,
Leslie and the gang

[BelindasMom]

Thanks for the link to the article. It was very interesting. Thankfully she doesn't have any of the symptoms listed so hopefully whatever is going on is still at a reversible stage. I am keeping her on the Denamarin for the liver and I have researched some dietary guidelines for dogs with liver problems so I can give her the correct foods to help keep her healthy. It's a mystery as to what has caused all this but I know she couldn't possibly have gotten into anything toxic. If you looked up "Overprotective Mom" it would have my photo LOL!

Her late sister once had to take a medicine called Ursodiol for a while to cleanse her liver and reduce the acidity or something like that. It was a year or two before she got Cushing's. On ultrasound they said it looked like the liver had "sludge" in it. The meds cleared it up and it stayed cleared up although it was still enlarged for the rest of her life. Cushing's would have contributed to that also. I am wondering since they were from the same litter if maybe this is some kind of genetic thing. My own medical doctor said it was possible they were born with overly large livers to begin with. I wonder if that could cause problems? I know it causes some crowding of other organs but I wonder if the liver isn't as efficient to begin with if it was abnormally large since birth.

I plan to stick around and see how all your furbabies are doing and pray for those who are having problems and those who have lost their sweet furbabies. You guys have been so helpful to me and many of you have way more medical knowledge than I do. With animals as well as humans you really have to be proactive in your own medical care. It really pays to research every medicine prescribed and to check for problems in mixing it with other medicines too. Unfortunately mistakes happen with vets and human doctors alike, partly I think because they are so busy and partly because they are human and humans make mistakes.

I will update you if we learn anything further or if Belinda begins to have any symptoms. Right now she's napping with a full tummy.

[Simba's Mom]

Sending hugs and prayers!

[molly muffin]

So glad to hear that this isn't something crisis type with Belinda and the vet certainly didn't give off that vibe from what you said. Molly too has an enlarged liver, mildly, and many things can cause them to enlarge. Sometimes they stay enlarged and other times they don't. I have her on a supplement like you have Belinda on and it seems to be helping. I just keep monitoring the liver values on her tests to keep an eye out. Otherwise nothing else to be done at the moment. We're enjoying it while we can. :)

Nothing like a nap with a full tummy. LOL
hugs,
Sharlene and Molly Muffin