Rio, 13yr old bichon/poodle with possible Cushing's

[Evey]

Hi there. I'm new to the forum and I'm really glad that I found you (and it!). I'm a little overwhelmed by all the information and also slightly emotional about the thought of my little guy having Cushing's, as I'm sure every person on here is with their lovely little pups.

Rio just turned 13 years old a few weeks ago. At the end of last year I noticed he was leaking urine while he slept - my vet put him on Propalin and although I believe it helped at first, he still leaks if he isn't let out ever few hours - oddly enough he can make it through the entire night without leaking, it's more during the day. He's always been a big pee-er (not in the house, always outside). I then started to notice he was quite thirsty and drinking a lot more than usual, he was losing some muscle tone in his hind legs and his belly was a little more rounded. He's always been a solid dog, but his tummy is definitely more "droopy" than it was a few years ago.

He's been getting a routine blood test yearly now for the past 4 years and last year we did the Cortisol ACTH Test as well as a High Dose Dexamethasone Suppression Test and with both the vet was not convinced that he had Cushing's but suspected that Rio may get it in the years to come.

This week Rio was back in for his routine senior wellness blood test and his ALP levels were more than doubled from last year and seem remarkably high. These are his numbers that were high:
Biochemistry - Globulin: 46.6 g/l (Norm: 18-38), Protein (T): 89 g/l (Norm: 51-72), ALP: 1909 U/L (Norm: 4-141), ALT: 139 U/L (Norm: 6-118), Creatine Kinase (CK): 569 U/L (Norm: 35-529), Amylase: 1550 U/L (300-1400), Lipase: 707 umol/L (20-560), Hemolysis: 3+, Lipemia 3+
Hematology - RBC: 4.7 10^12/L (Norm: 5.4-9), HGB: 116 g/L (Norm: 129-203), HCT: 0.31 L/L (Norm: 0.35-0.60), MCHC: 380 g/L (Norm: 300-376), Platelets: 626 10^9/L (Norm: 143-550)
Cortisol (Base): 323 nmol/L (Norm: 30-300)

Last year - ALP: 733 U/L, ALT: 148 U/L with only a slight rise in his Protein (T).
Dexa Test last year - Base: 228 nmol/L, 4hours: 38.9 nmol/L, 8hours: 28.6 nmol/L

Rio has a history of being anemic, but other than that he's been healthy and hasn't had any problems - vet said his heart and lungs sound great. He weighs in at 15.6lbs and is not overweight by any means. He isn't lethargic, he still loves going on his walks (though doesn't last quite as long as his 2year old "sister", especially in the heat) and he loves food (but always has). He is prone to warts and has several at the moment, his fur is kind of thin but I haven't noticed much hair loss and I'm the one who grooms/shaves him. He also has the beginnings of cataracts.

Since adopting him at 2.5years old, Rio was switched onto a holistic food. Currently he is eating Oven Baked Senior Weight Management (http://www.ovenbakedtradition.com/en/natural-dog-food) mixed with Carna4 (http://carna4.com/). I supplement his dinner with Dr. Maggie's Skin and Coat (http://drmaggie.ca/prod_skin_ingredients.html) as well as BioVet Senior (http://www.biologicvet.net/products/biosenior/). He gets fresh fruits and veggies and I will admit to giving him some of our food as well plus healthy dog snacks.

Today Rio was in for another ACTH test so we should be getting the results early next week. The vet said that if he does test positive for Cushing's he wants to put him on Vetoryl. I'm not opposed to medications, but I'm also someone who does prefer to take a more natural approach if possible.

I'm sorry this is so long! I'm just worried. Any advice, suggestions... anything really to narrow down how I can keep my little boy healthy and strong is very much appreciated. Thoughts on medications or any of his levels... a switch in food/feeding... what to feed more of or less of (or not at all)... any thoughts are great.

Thank you so much in advance!

[Budsters Mom]

Hello and welcome to you and Rio,

You have come to the right place! There are many K9Cushing's angels standing by to help 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. Others will be popping in shortly to welcome you also. :)

So again welcome to you and Rio,

Kathy and Buddy:cool:

[Harley PoMMom]

Hi and welcome to you and Rio,

So sorry for the circumstances that brought you to us but very glad you found your way here.

Could you do us a favor and edit your post and add the reference ranges to Rio's abnormal levels, Thanks! I also noticed that on Rio's Biochemistry panel that Hemolysis: 3+, Lipemia 3+ were noted which can alter some of those results.

Cushing's is a slow progressing disease and it is definitely not a death sentence for a dog. Cushing’s is a treatable disease. Delivery of competent and humane medical care by a skilled GP and/or specialist experienced in the diagnosis and management of Cushing’s has a significant impact on patient survival and well-being. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Other illnesses share some of the same symptoms as Cushing's such as diabetes and thyroid problems, have these two health issues been ruled out?

Is Rio on any other herbs/supplements/medicines? Was an urinalysis done, and if so, could you post those findings?

Dechra, the makers of Vetoryl, verbally recommends a starting dose of 1mg per pound of a dog's weight. So with Rio's weight being 15.6 lbs, if this were me, I would start him on 10 mg of Vetoryl. Here is a link to information about Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) Let's get all the information we need about Rio before we talk in depth about treatment, ok?

Please know you are not alone on this journey as we are here to help you and Rio every step of the way. Ask all the questions you want and we will help in any way we can.

Love and hugs, Lori

[Simba's Mom]

Hello and welcome to you and Rio, so glad you found this site...you will get lots of info and encouragement too...settle in, we are here for you!

[Trixie]

Glad you found this board! I was certainly happy to come upon it myself a few weeks ago. I'm a little too new to comment on the test results and numbers, still trying to educate myself on all this too. I will say that if you do end up choosing the medication that everyone here will be a huge support and will help guide you through. I don't know what I would have done the last few weeks without all the hand holding I found here!
My mini schnauzer started Trilostane/Vetoryl 3 weeks ago (a low dose twice a day) and so far so good. No side effects for her so far and just the last day or so we think that we notice a very subtle decrease in symptoms. My dog is still doing long walks everyday and has plenty of energy..pretty much herself.
Hope all the responses will help you and Rio...I think we all know exactly how you feel!!
Barbara

[Evey]

Thank you so much. Honestly, reading all of the responses has brought tears to my eyes - the kindness and help is so so so very much appreciated by myself and also by Rio. Every single comment, please know that it means the world to me. Already this forum has been heaven sent. Kathy and Buddy, thank you for the warm welcome. Lori, thanks for asking questions and providing answers. Simba's Mom, your support is so greatly appreciated. Barbara I'm so gld that your little girl is doing well on the Veotyrl! That's great to hear and I'm so glad for you guys.

To Rio's results: at the bottom of his results it does state that the 3+ Lipemia/Hemolysis can alter results... I wasn't quite sure what to make of that, as the wording they used was (unfortunately) above my understanding (I've never been a sciency person). I've edited my initial post to put the normal ("Norm") range that his results should be in. The ALP is ridiculously high...

Diabetes was ruled out as he was tested within the same blood panel and everything was normal range. I don't believe that he was tested for the thyroid (I don't see any T3/T4 readings on his results) so I can definitely ask about that when I get the results from his ACTH test this week.

Rio does get the BioVet Senior supplement (Ingredient list can be found here -> http://www.biologicvet.net/products/biosenior/) 4 times a week, he gets hemp hearts 3 times a week, he gets a glucosamine/chondroitin tablet and he gets a small squirt of Dr. Maggie's Skin and Coat Omega Fatty Acid liquid as add ons. Also, he has been getting Propalin for the last couple of months to help his urine leaking (though I don't really think it's making a difference anymore so I'd really like to get him off of that).

He had an urinalysis done when I first started noticing his leaking getting worse and the results came back normal. I can get the exact test and values next week for sure. If there was a special test they had to run through his urine to check for Cushing's I don't know if they did that. I will ask!

[Harley PoMMom]

Love your avatar! Rio sure is a cutie pie, and bless you for giving him a forever home.

Just to put your mind at ease, we have seen dogs with higher ALP levels than Rio's, some at over 2000!! Anything and everything can elevate the ALP.

Another question :eek: Was a HDDS (high-dose dexamethasone suppression test) or LDDS (low-dose dexamethasone suppression test) done? Usually vets perform the LDDS test over a HDDS test.

The symptoms you have described; the increased drinking/urination, rear muscle wasting, and pot-bellied appearance are clinical signs of Cushing's. Cushing's is one of the most difficult diseases to get a confirmed diagnosis for and strong symptoms do play a huge part in the diagnosis of Cushing's. But dog's with Cushing's usually have dilute urine (low USG, which is urine specific gravity) and Rio's is not, correct?

I would definitely ask the vet if any thyroid problems are ruled out and post those ACTH stim results when you can.

We are here for you and Rio, and if you have any questions at all, just ask, ok? ;)

Love and hugs, Lori

[molly muffin]

Hello and welcome to you and Rio. Ack! Why do our canadian vets go straight to 30mg dosage. Mine suggested the same thing due to a high ACTH test. I ended up going to an IMS, who said, no start lower, and get it compounded if you need to. However! An LDDS test was not supportive of cushings and we've now had 3 LDDS tests total over 2 years, so haven't started treatment yet.

This looks like an LDDS test (Low Dex) which is usually one of the diagnostic tests used.
However, ACTH, LDDS can have false positives if something else is going on.

Looking at your results, what jumps out to me, and I'm by no means a vet, just seen a lot of test results on here, is that I'd want the vet to look more closely at whether or not a pancreatic episode could be ongoing, perhaps mildly, if Rio hasn't had any vomiting, diarrhea, etc and unable to eat, but still you have Amylase and Lipase both raised, ALT (which is liver origin) can be raised due to something with the pancrease Globulin and Protein increase could be do to infection, inflammation, etc
Just several things make me wonder about that and not all dogs have symptoms consistent with having an pancreatic episode.
Any ACTH test could be false positive if there is something else going on.
So, I'd definitely want the vet to look into that further and if you aren't comfortable with only that option another possibility and I opted to do this, is to ask for an ultrasound consult because you're worried about what else might be going on if not cushings.

Okay that is enough to get you started and trying not to overwhelm you. Cushings though is a slow progression disease, so you should have plenty of time to explore if something else is going on with Rio, who really is a darling. :)

Welcome to the forum!!!
Sharlene and Molly Muffin

[Evey]

Thanks Lori! Rio is a total sweetie pie and one of the happiest little dogs. He loves everyone, everything and every type of food I've ever given him :p

On the test results that I have it says it has interpretations for both a low and a high dose Dexa test? Here are the readings:
Cortisol (Base): 228 nmol/L (Norm: 30 - 300)
Cortisol (DEXA) 4hrs: 38.9 nmol/L
Cortisol (DEXA) 8hrs: 28.6 nmol/L

None of his numbers were flagged/bold as to show something too high or too low. With these results my Vet stated that the pituitary was responding and he had high/normal cortisol. This test was done in September of last year. Also, I do not have a copy of his urine results but I will get them next Saturday. I will also bring up thyroid with him (I actually have hypothyroidism myself) for sure! Thank you!

Hi Sharlene (and Molly Muffin!). Thanks so much for the warm welcome :)

One of the things my vet mentioned as well was possible pancreatic issues. Rio has a great appetite - he poops anywhere from 3-5 times a day (when we first adopted him he sometimes went up to 8 times a day because of the crummy food he was on, so he's always been a big pooper - sorry for the TMI!) and very rarely, if not only once or twice a year, does he have diarrhea or vomiting. He has a super good appetite and over the past couple of years the only thing I've noticed is that he does try to break into garbage bins and/or he does scavenge for food around the house when we aren't home. We've had to baby gate him in the front hall again so he doesn't get into trouble, which we haven't had to do for nearly 9years. About 2years ago he broke into a box of macadamia nut chocolates - the only saving grace was that it was milk chocolate and he didn't chew so he pooped out all 20 nuts with no issue (that x-ray was super fun to see. Sigh).

I have absolutely no issues asking for my Vet to look further into any pancreatic issues! Thank you so very much for the suggestions!

[Simba's Mom]

I'm pretty sure they can do a snap test for the panceratis, that would prob help....your little Rio is a sweetie, loves those cookies :) take care!

[lulusmom]

Hi and welcome to you and Rio.

Can you tell me more about Rio's history of mild anemia? Anemia is not a condition, it is a symptom of a condition that a vet needs to identify in order to treat it. Did your vet determine the cause of Rio's anemia and if so, how did he treat it? Actually I'm not well versed in how hemolysis may affect specific blood values so I'm not sure if Rio is actively anemic and the hemolysis is due to an immune mediated condition or if the blood specimen was compromised during the draw or lab processing. If I were you, I would sit down with the vet and discuss this.

Can you please get a copy if the urine results? Most dogs with cushing's have very dilute urine which is why the pee so much and then drink so much to keep up with peeing. Urine specific gravity is low and a good majority of dogs will have a urinary tract or bladder infection at the time of diagnosis. The immune system of a dog with a condition causing anemia will be just as compromised as a dog with cushing's so urinary tract infections are common.... and urinary tract infections are the most common causes of incontinence. If urine is dilute, it is very important that a urine culture is done as this is the only way to identify the bacteria involved. Did your vet do a culture?

Was Rio on any medications at the time blood work was done? Is he taking any medications currently?

Glynda

[Squirt's Mom]

Hi and welcome to you and Rio! :)

One thing that hit me hard was this -


Also, he has been getting Propalin for the last couple of months to help his urine leaking (though I don't really think it's making a difference anymore so I'd really like to get him off of that).

The reason it hit so hard is my baby just went through a terrible time which I believe has been solely due to this drug - called Proin over here in the US. She had a seizure about 6 weeks ago and had a very difficult time getting back on her feet. For quite some time prior, I had been noticing little things that were off with her but we could never find a reason for them. A dear friend told me about the Proin and since taking her off of it, a month ago today, my baby is improving - something I had not believed would happen. She is still not right and may never be but she is better.

I'm begging you, get Rio off this drug today. Here is some info about it -

http://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/UCM296349.pdf


Table 6: Adverse reactions in the 28-day placebo-controlled clinical study
Adverse Reactions
PROIN
-
treated (N=123) (first number)
Placebo (N=61) (second number)

Emesis 20.3% 8.2%
Hypertension (≥ 160 mm Hg) 19.5% 14.7%
Anorexia 16.3% 3.3%
Body weight loss (≥5%) 16.1% 6.8%
Proteinuria 13.0% 8.2%
Anxiety/aggression/behavior change 9.7% 3.2%
Diarrhea 7.3% 9.8%
Polydipsia 6.5% 9.8%
Lethargy 5.7% 1.6%
Musculoskeletal disorder .2% 1.6%
Insomnia/sleep disorder 2.5% 0.0%

My Squirt displayed nearly all of these effects after starting the Proin.

http://www.livestrong.com/article/25...ects-of-proin/

Allergic Reaction


Dogs that are allergic to phenylpropanolamine or any of the components of Prion should not be treated with this medication. Improper use of Proin by hypersensitive dogs may induce a severe and potentially life-threatening allergic reaction. Symptoms of a hypersensitive reaction in dogs include weakness, seizures, pale gums, facial swelling and difficulty breathing. Dogs who exhibit any of these side effects after taking a dose of Prion should be transported to an emergency veterinarian clinic immediately.

Oddly, Squirt has had very little leaking since stopping the Proin. We stopped for about 10 days after the seizure and she started flooding, not leaking, in her sleep so we started it back on a less frequent dosing schedule before I learned about the drug and stopped it for good a month ago.

I just had to speak up about this drug so you, too, are aware of it's dangers. I have since learned this drug has been banned in some countries because of the horrible side effects.

Hugs,
Leslie and the gang

[Dodie]

Welcome to you and Rio. He looks like such a sweetie! You've come to the right place here. The people are wonderful, very caring, and extremely helpful.

Dodie & Molly

[Evey]

Thanks Simba's Mom! :) Rio is such a little lovebug. I'm going to ask about the test for sure! My vet should be calling me tomorrow with the results from the last test we did so I'll chat him up then!

Hi Glynda! Thanks so much for the welcome. Two years ago on his routine bloodwork Rio was slightly anemic - his levels were around 4.2 when the normal range is 5.4-9.0 . I put Rio on a natural senior vitamin/mineral mix and last year he was back up in the normal range. This year he is back at 4.7 (Norm: 5.4-9.0). I've actually planned on doing a full blood panel again in about a months time to get a reading on everything once again just to make sure something wasn't compromised (as you said). I will get the copy of his urine results on Saturday for sure and I will see what tests they ran on him and definitely get back to you! The only "medication" he is on was the Propalin (for his urine leaking). Other than his regular vitamins/omegas and glucosamine/chondroitin pill.

Hi Leslie and thank you so so much for all that information! I had read the warnings in the package of the Propalin before giving it to Rio and was a little hesitant (as I hate giving him any sort of drug that isn't really necessary other than the fact that he does leak where he naps). I actually only would give him 1-2 doses a day when 3 were recommended. I stopped giving Rio the Propalin on Saturday and he's been on and off again leaking when he is totally relaxed. Oddly, he doesn't leak all night.... just during the day and his naps? Weird. But because of all that information you've provided me I'm looking into alternate ways to control this little problem. I'm so truly sorry to hear about the effect Proin had on your little Squirt! That's awful! I've been looking into something called HomeoPet Leaks No More (http://www.homeopet.com/leaks-no-more), but right now I am giving him a break from everything and just making sure he naps on a blanket when possible. Again, thank you so much!

Hi Dodie and Molly :) I'm overwhelmed with how helpful, nice and caring everyone is on here. It's been a scary process of trying to learn as much as I can and this forum has saved my sanity. Thank you so much for the lovely welcome.

[Evey]

Sorry for the double post... I just heard from me vet.

He said that Rio's results for the ACTH are highly suspicious - his resting Cortisol (Base) was back in the normal range, but was at the higher end. The second reading (after being injected) from an hour later was up super high. I didn't get the exact numbers (I'm bringing Rio back in for a follow up on Saturday so I'll get a copy then), but he did say that he'd like to start Rio on Vetoryl. I was really hoping that this test wouldn't yield these results so I was a little emotional on the phone with my vet and didn't ask many other questions when I probably should have. But, like I said, I will be going in on Saturday so I will get more information then - and I'm bringing a notepad with questions so I don't forget anything.

[molly muffin]

Remember, 1mg to 1lb, no more. Also, you don't have to start anything until you are comfortable with the decision. Rio isn't in any crisis at this point, so you have time if you want to take it to think about it and learn as much as you can.
My vet, sold me 30mg for my 19lb molly. I didn't start it because I decided I wanted more testing. Her ACTH was high too. I also got a consult for an ultrasound and talk to an IMS. After that I opted to not start her at this point. She just doesn't have the symptoms and every LDDS test came back negative. Which made me question the high ACTH. So, there you go. Another LDDS test, still negative and I'm still waiting. It's been 2 years since the very first time my vet said cushings. I have her liver values monitored regularly and I get full blood panels run a couple times a year at least just to keep an eye on anything.
She's taking the Hepato Support supplement and we'll see where her liver values are on the next test. They'd come down on the last one and that is the only off in her values.
So don't panic. It's not what you want to hear of course, but you should have time to learn and make a decision on if you want to go forward with treatment yet or not. You know Rio better than anyone and you are his voice, just go with your gut instinct.

Hugs,
Sharlene and Molly Muffin

[Evey]

Thanks for the encouraging words!

I was at the vets today with Rio and got some copies of his tests that he's had done, including the urinalysis a few months back.

First of all are his latest ACTH test results.
Coritsol (Base): 268 nmol/L (Norm: 30 - 300)
Cortisol (ACTH) 1hour: 719 nmol/L
Cortisol (ACTH) 2hours: 879 nmol/L

The Vet said from these results he would put him on Vetoryl - he suggested the 30mg, but because of everything I've been reading here I said I'd be more comfortable on a lower dosage. Rio is only 15.6lbs.

These are his results from his urinalysis from September last year.
pH: 6.0 / Specific Gravity: 1.020 / Glucose: Neg / Nitrite: Neg / Blood: Neg / Bilirubin: Neg / Protein 0.3 g/L (1+) / Leukocytes: Neg / Epithelial Cells: 0-1/hpf, transitional

There are a few more things but they were either "Negative" or "None seen". Not sure if these help at all.

I'm getting the other Vet at the clinic to go over Rio's results as well over the years. He said he'll give me a call early next week with his thoughts as well. In the meantime, I've been looking into changing Rio's diet as well as adding in some vitamins and minerals and milk thistle. Any thoughts? :)

Thanks in advance!

[molly muffin]

Hi, I'm just going to transfer the nmol to ug for our members who are more use to seeing results in that format.

First of all are his latest ACTH test results.
Coritsol (Base): 268 nmol/L (Norm: 30 - 300) = 9.7 ug
Cortisol (ACTH) 1hour: 719 nmol/L = 26.0 ug
Cortisol (ACTH) 2hours: 879 nmol/L = 31.8

Have they ever done an ultrasound on Rio?

I'll be interested in seeing what the other vet thinks.

At 15.6 lbs, I'd probably start out at around 15mg (compounded) which would be more the 1mg/1lb that we like to see as a starting range. Is he thinking once a day dosage or twice a day? At most I wouldn't want to go over 20mg as a starting dose. You never know how a dog will take to trilostane, some need more, others less, so that is why the current range I just mentioned is recommended.

The LDDS certainly shows no suppression. Question is whether they think it is pituitary or adrenal based, did the vet say? (this is where an ultrasound can be beneficial) I had to ask my vet for a referral to get one done by an IMS at the vet er. Not sure what you have in your area or what cost would be either for that. Mine with a IMS consult was around 700 CAD at the end of that visit.

Happy Mothers Day
Sharlene and Molly Muffin

[doxiesrock912]

Daisy weighs 11.5 lbs and she's on 7.5mg twice a day. We just reduced from 10mg twice a day and her cortisol went too low.

Every dog responds differently, please err on the lowest dose.

[Evey]

Hi Sharlene (and Molly Muffin of course!) - I've never done an ultrasound on Rio, but the Vet has said (as do the results) that his is Pituitary-Dependent Hyperadrenocorticism. Also, he was looking at doing a once a day dose on the 30mg Vetoryl. I completely agree with your dosing instructions. I've opted for the 10mg capsules - just waiting on the other Vets input. Hope Molly Muffin treated you very well on Mother's Day! :)

Hi Doxiesrock! Thank you very much for your input. I will definitely start lower with Rio and go higher if need be... I feel much more comfortable with that idea as well! Love to your Daisy as well!

[doxiesrock912]

Whichever dose you choose, twice a day tends to work best (in my case) because the meds don't stay in the system for very long.

[Squirt's Mom]

An ultrasound saved my Squirt's life by finding a tumor on her spleen. Removing that tumor proved that all five of the cushing's tests she had which said she had PDH were false-positives - the tumor was causing elevated cortisol, not the disease. So I cannot recommend the ultrasound enough for all cush pups. It is the one test that gives the biggest bang for the buck.

[Evey]

Thank you all for your advice - I apologize for being absent for a while.

It's been a crazy few weeks here and Rio was put onto 30mg of Vetoryl. I spoke with my vet quite in depth about the dosage and ultrasounds and whatnot, and it was concluded that he would try the 30mg dose and come back in a couple weeks to see if there was any change.

I have to say that about 5-6 days in Rio was back to his normal self - he wasn't leaking, he wasn't drinking nearly as much, he was peppy and he downright refused to pee when we'd send him out (we got used to sending him out every hour or so and he was lasting much longer). He also lost his "bloated" look (I'm assuming because he wasn't holding in so much water). Then, back to about day 13-14 he was back to drinking up a storm, peeing and he had a large urine leak on my bed while napping. He also started waking me up around 6am (he was sleeping until about 8am the other days with no issues). He went in for his ACTH test yesterday and his results were as follows:

Cortisol (Base): 734 (norm = 30-300)
Cortisol (ACTH 1hr): 1017
Cortisol (ACTH 2hr): 928

I was shocked. A month ago before the Vetoryl his base Cortisol was 268. He's never had such a high Cortisol level! I wasn't able to talk in depth with my Vet today (I didn't have his previous records handy to compare resting cortisol) but he was suggesting 60mg of Vetoryl a day... said to start 30mg in the morning and 30mg at night.

I don't know, I just have this bad feeling. Any idea why would his Cortisol levels would increase so drastically? I couldn't find anything helpful in the paper in the Vetoryl box. Thank you!

[molly muffin]

I find that really strange that the cortisol would have Risen so much when medication was started. Did you ever get that ultrasound?
I'm rather wondering if something else could be going on.

A quick recap from last test prior to treatment to this one:


05-11-2013 posted date before medication

Coritsol (Base): 268 nmol/L (Norm: 30 - 300) = 9.7 ug
Cortisol (ACTH) 1hour: 719 nmol/L = 26.0 ug
Cortisol (ACTH) 2hours: 879 nmol/L = 31.8 ug


06-08-2013 on 30mg vetoryl

Cortisol (Base): 734 (norm = 30-300) 26.60ug
Cortisol (ACTH 1hr): 1017 = 36.86ug
Cortisol (ACTH 2hr): 928 = 33.63ug

In Canada they often use a compuonded agent for the ACTH testing, and do two draws instead of one for a POST number.

Lets see what some of the others think, but if it is affordable to do so, I'd get an ultrasound.

hugs,
Sharlene and Molly Muffin

[frijole]

Did you already rule out diabetes and thyroid issues? I agree it doesn't make sense. Kim

[addy]

Could it be a lab error or the stimulating agent was bad? Makes no sense at all, seems like a lab error.

[labblab]

By any chance, did you start a new box of medication at that two-week mark when the symptoms all started rebounding again?

Marianne

[Evey]

Never got the ultrasound - they don't have one in the clinic where he goes and would have to have someone come in and do it so it's based on that technician's schedule. I am in the process of seeing if I can get that sorted out, but my Vet seemed to think it was a "waste of money" (so to speak), as he believes it to be pituitary based.

He was tested for diabetes and that was ruled out. Also, last we checked his T3/T4 levels were fine. The vets recommended a full blood panel again at least a month after being on the Vetoryl so we haven't checked since early May.

Rio has been on the same box of 30mg since the start. They are in packages of 10 and the box contains 3 of them. So he started to rebound a little after we started the second package of 10, but it all came in the same box so I would assume they are all the same batch?

It does seem like a lab error or something going fudged up somewhere. It just doesn't sit right...

Thank you for all the replies!

[mytil]

How are things going with you and Rio?

Terry

[Evey]

Hi there. Not sure if people will remember me from a few years ago - so first off... hello!

An introduction to my boy, Rio.
Rio is my 17year old Bichon/Poodle mix. He was diagnosed with pituitary based Cushing's Disease in May 2013. At the time, Rio's liver values were also off the chart (1900s when normal range had 121 as high). He was put on Vetoyl 30mg twice a day and did very well on it.

February 2015, Rio had his first seizure. He didn't have his next one until October 2015. He was put on Potassium Bromide twice a day, as with his liver issues we could not handle Phenobarbital.

February 2016, Rio was diagnosed with acute renal failure. The Vets didn't think he'd make it, but with fluid therapy we did at home he bounced back. During this time we took Rio off of Vetoyl (after speaking to the Vets and the medication company). His liver values ended up going back towards the normal range once off Vetoryl. Rio had a couple seizures in 2016, but not a ton.

Now, February 2017 (everything seems to hit him in February! I have no idea why) Rio had the first of a few seizures. Lately I've been noticing his Cushing's symptoms returning. He has thinning hair on his back, bum and tail, his muscle mass on his back legs is lower and I notice some hind end weakness, his skin has some flakes/scabs, he pees a ton and his tummy is only slightly pot bellied. Because of the Cushing's, Rio still has a hearty appetite (which I'm glad about, as kidney issues can cause loss of appetite) but doesn't seem to overdrink.

My question (after all that) is this: Rio has been having more frequent seizures lately. He had one 18 days ago then just had another this morning. I've been getting mixed answers from three different Vets (one being a holistic vet) about if Cushing's could be the cause of his seizures... and now that his Cushing's has been untreated for over a year and his symptoms are returning, could it be increasing his occurance of his seizures too? Are Cushing's dogs more prone to seizures? Is there anyone else dealing with kidney disease and Cushing's in their older dog? I'd like to treat his Cushing's to help relieve some of his symptoms (and maybe his seizures?)... but am worried about putting him back on Vetoryl and causing his kidneys more damage. Is there anything else that can be recommended?

Rio eats home cooked meals - chicken, yellow or sweet potatoes, carrots, cottage cheese, blueberries, banana, pumpkin, green beans, coconut oil, egg whites, turmeric, ginger, salmon oil... sometimes KD stew or Gastro food if he has tummy issues.
He is only on Potassium Bromide twice a day at the moment, no other meds.

Thank you so much for any advice. And for reading that all! I want to do right by my boy - he's such a little fighter - and we appreciate any help :)

[labblab]

Welcome back to us, although I'm very sorry for Rio's seizure problems. I apologize that nobody has had a chance to respond to you yet, and especially that right now I have only a moment to write, myself :o. But I definitely want you to know we are happy to have you back with us once again, and you should soon be getting more replies. I will be coming back later, too. ;)

Marianne

[molly muffin]

Hello and welcome back. He's been doing really good for a long time it seems, and I'm very sorry to hear about the Acute Renal failure. My dog too developed renal failure.
As you know, because I'm positive your vet will have discussed this with you and you've done your own research, acute kidney failure as the disease advances can be the cause of both the seizures becoming more frequent and the increased in water intake and urination symptoms. Often this goes hand in hand with a loss of appetite. I'm not sure if he is having any loss of appetite though as you didn't mention that.

The makers of vetroyl don't recommend giving a dog the medication when they are having renal insufficiency issues.

I think that from what you have said that you are doing everything possible that can be done for Rio at this point. The increased frequency of the seizures is most concerning I think as it can indicate that the kidney disease is advancing.

I'm sorry not to sound more positive, you have done such an excellent job with Rio over the years, but I don't know if the cushings Can be treated at this point, if it would do more harm than good. :(

[labblab]

I'm so glad that Sharlene had the chance to reply to you; she's provided some very helpful info. As she's noted, there is a specific warning against giving trilostane to a dog who suffers from abnormal kidney function because the drug may not be metabolized/excreted properly. So the current status of Rio's kidneys would have a lot to do with whether or not the trilostane could be safely resumed.

As far as seizures and Cushing's, the one link of which I'm aware is the possibility that an enlarging pituitary tumor might be putting pressure on areas of the brain that could trigger seizure activity. In that situation, however, you'd likely see other neurological issues, too -- things like confusion, circling, loss of appetite, pressing the head against hard objects, etc. In that situation, trilostane treatment actually might not be the best option because higher levels of circulating cortisol may help to reduce swelling and inflammation of the tumor and surrounding brain tissue.

One other possibility that occurs to me is to ask whether Rio's thyroid function has been checked recently. Hypothyroidism is not uncommon in Cushpups, and low thyroid levels can prompt seizure activity. I'm guessing this is not the cause for Rio, because low thyroid levels would likely have been noted on general blood chemistry panels before now. But I just wanted to throw that possibility out there, as well.

As Sharlene says, you've done a great job of advocating for your little boy, and I'm surely sorry that you have this added worry about his health.

Marianne

[Harley PoMMom]

Hypertension can also cause seizures and it is detrimental to the kidneys. Has Rio's blood pressure been checked recently?

[Evey]

First off - thank you all for your detailed and amazing responses. We both truly appreciate all the help and suggestions. :)
I apologize for the delay in response - things have busy.

Molly Muffin - yes, both my Vets have mentioned that the kidneys could be causing the seizures frequency. Unfortunately with Rio's different issues, it's hard to pinpoint the cause of them. And his appetite is great. The only times he's lost his appetite was when he was initially diagnosed with kidney issues and a couple months ago when he had a case of colitis. Otherwise he eats four meals a day plus snacks in between (he doesn't have a pot-belly, but has lost muscle mass).

Marianne - he actually does have some signs of a possible brain tumour. He does head pressing at times and does circle. He also gets head bobbing/dizzy spells a day after seizures occur. All these side effects pass in a day or so and he's back to normal. Good to know that Vetoryl may make it worse - one vet mentioned that the increased cortisol may actually be "helping" with some of his issues. I just worried that Cushing's may be causing the seizures too. I couldn't find anything about Cushing's and seizures while I was doing my research, so was curious if just Cushing's dogs are more prone to them. It's a fine line, I guess.

Rio is due to have another trip to the Vets. Unfortunately the last time we tried to get blood from him was a horrible experience - he ended up pretty traumatized (as did I, and I work at the Vets!) and we just left it. He's never had a thyroid issue before, but it may be worth looking into - thank you!
He's never had low blood pressure but has had a little iron deficiency in the past. I will ask about checking blood pressure. Thank you Harley PomMom.

Thank you all again for the support. I think part of coming back to ask questions is to talk to people who understand the struggle. I just want to do the best for my boy, and thank you for helping him too :)

[molly muffin]

I am less inclined to think the seizures are due to the kidney disease and it progressing now that you have explained that he is eating fine (something that they seldom do when kidney disease progresses) and the signs of the brain tumor, circling, etc, could mean that is more likely to be a cause of the seizures than kidney disease progression.

It really is a matter of elimination and trying to narrow things down when they have multiple issues going on. Makes it tougher.