Oscar the Doxie Excessive Urination, Already Diagnosed with Cushing's

[luvdox]

Greetings! I'm new here - my name is Heather and I'm mom to 5 furbabies. Oscar, our sweet blind male doxie, was diagnosed with Cushing's about a year ago. Prior to that he had been diagnosed with Pancreatitis. So, he has been on special food and pumpkin for the Pancreatitis and Vetaryl for the Cushing's. He seems to be feeling better and the last few blood tests have shown his Cushing's to be well under control. His levels have actually been perfect, thank goodness!

However, he still has issues with excessive drinking and urination. We have done every test imaginable to eliminate other causes, including testing for kidney disease. He is not a psychogenic (not sure I spelled that correctly!) drinker as this behavior just started about 2 years ago; he will be 14 years old next week. At this point, my vet believes he may just be one of the few dogs who remain symptomatic for Cushing's even though the blood work is perfect.

I certainly don't want to over-medicate Oscar, but his degree of excessive drinking/urination just doesn't seem to be "normal" for Cushing's. He's been through all of the thyroid tests and everything came back normal, as did the test for an UTI. I'll discuss the possibility of atypical Cushing's with my vet, and she feels that it could be Diabetes Insipidus but said that we can't really accurately test him because the Cushing's would throw-off the results. I did read though that the oral Desmopressin could also help Diabetes Insipidus and I had asked her when we should see changes to know it's helping and she said it should be between 2-4 days. If it doesn't have an impact within that time-frame, I'm taking him off of it.

We pen the dogs in the kitchen with baby gates when we go to work, and they have a big slumber ball in there and plenty of room to walk around and "stretch" their legs, and every time we come home, there are multiple accidents. Sometimes, since he's also blind, he walks in it and/or lays down in it and recently we've caught him drinking it. We have a water-proof mattress pad cover on the bottom of the slumber ball to protect the bedding, but he occasionally does it on top or on the sides. We think he may have a touch of dementia as well, and have him on an antioxidant supplement just to try to slow it down a bit. I don't believe he's in pain or unhappy, but I know him and it just doesn't seem right.

So, my vet, who I personally think is wonderful and fantastic, did a ton of research and recommended that we try him on Desmopressin. At this point, we're willing to try anything. Has anyone here had any experience with this drug, or anything similar? Any feedback would be greatly appreciated. Thanks so much!

Heather R.
mom to Kenda, Laney, Misty, Oscar, Radar, and Tanner

[frijole]

Heather

I have no knowledge of Desmopressin. Sorry. Welcome to our group and hopefully others will chime in later.

I'm curious as to Oscar's weight and the dosage of trilostane. Do you happen to know the results of his last acth test? I used "pet pads" that I bought off of Amazon that are cloth and reusable. Somehow dogs know to pee on them and they absorb the odors and wetness... at least that way if he would pee on them he wouldn't be able to walk in it or drink it.

Lastly - a stab in the dark but you mentioned he is blind. Are you sure he doesn't have SARDS? It is often confused with cushing's. Here's a link:
http://www.k9cushings.com/forum/showthread.php?t=213

Kim

[luvdox]

Hi Kim! Thanks for your response! Oscar is around 24 pounds, he has always been a lunker. Given his frame and length though, he is not obese, but could stand to lose a couple. We've always been challenged here - he had been down in the back twice before we got him out of rescue so he's always been pretty sedentary which increased even more when he went blind. Oh, and he has Progressive Retinal Atrophy and went completely blind long before he was even diagnosed with the Pancreatitis or Cushing's.

He gets 10 mg of Vetaryl every day except Friday when he receives 30 mg. Not sure off the top of my head what the results of the last ACTH were, but the vet said that they were the best yet, the levels were perfect.

We have tried everything for the urination - belly band which he wriggles out of when he scoots back onto the slumber ball, pads which he thinks he's completely on but isn't really (can't see them!), even the Peekeeper which resulted in a shower and a load of laundry. We've just decided that it's less work to simply clean up the pee (it's just on old linoleum anyway). We actually don't much mind the cleaning, I just don't think this is normal!

[frijole]

That is an unusual dosing regime - the dose is low and the friday exception is something I have never seen. I am wondering if his cushings is in fact not under control which would explain the urination. Have you ever since commencing trilostane increased the dosage?

Nothing against your vet but we've seen it before numerous times when they said "results are fine" but they are not within recommended guidelines. The problem often is because "normal" for a non cush dog is much higher than "normal" for a dog treated for cushings. Just do me a favor and find out when the last acth test was and get the two numbers from the test. I'll sleep better at night if I can rule out the obvious. :)

Thank you! Kim

[goldengirl88]

Hello:
Welcome to the group. Could you possibly try doggie pants or a belly band with him. It would make things a lot more sanitary, and he would not be able to drink the urine and step in it. They are prone to infections with Cushings so I would want to keep him as cleaned up as possible if it were me. I am sure drinking his urine cannot be good either. You are doing a lot to help him, and I commend you for all you are doing. Keep up the good work and he will be with you much longer. Blessings
Patti

[Budsters Mom]

Hello and welcome from me too!
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. We will do all we can to help, but be ready for lots of questions! So again, welcome to you, Oscar and the rest of your pack!:D
Hugs,

[molly muffin]

Hi and welcome from me too. :)

I find the dosing really strange too. Not one we have every seen. The idea of Trilostane is to keep the cortisol as regular as possible and to do that, the manufacturer and most endocrinologist suggest you use 1mg/1lb starting dosage daily, or divide it into twice a day. Then retest after 10 - 14 days to see where the cortisol is at and adjust if needed.

Has your vet done any follow up ACTH tests to see if the cortisol is controlled? Controlled would be a post number below 5. ug and up to 9.0 if symptoms is controlled.

Maybe you can talk to your vet and ask him. You can also call Dechra and let them know what your dosing right now is and get their input. They have techs and specialist on staff that can work with your vet to make sure that Oscar gets the best care possible.

The key is to have a good vet and specialist and everyone working together as a team and you are the leader of team Oscar. It doesn't sound like with the excessive urinating still going on that Oscar is currently controlled. So that is an idea to look into.

Sharlene and Molly Muffin

[doxiesrock912]

Talking from experience. Daisy saw three vets before we took her to an IMS specialist and are finally on the right track.

She's an 11.5 lbs, 9 year old miniature dachshund and she takes 7.5 mg of Trilostane twice a day. We do not skip a day and do our best to give the meds as close to 12 hours apart as possible to maintain a level that will continuously control the Cushings.

[Trixie]

I don't have much insight to offer, but just wanted to say I love your avatar photo!! SO cute! Is that Oscar in the photo??
My dogs most pronounced symptoms were drinking/peeing too. We're still working on tweaking the dose as she's not yet controlled. Hope you can figure out what's going on with Oscar. The experts here have a lot of knowledge I'm sure you'll get some good advice. :)

Barbara

[goldengirl88]

Heather:
How is the baby doing today? I still don't understand his dosage either.I have never heard of upping the dosage on one day. Did you ever ask the vet his reasoning for this, and where he got this from as I am curious. Hope all is well.
Patti

[luvdox]

Hi Barbara! That's actually Tanner, my very first doxie, who I lost suddenly to an aneurysm. His passage, though devastating, led to my adoption of Oscar, which led to my significant involvement in doxie rescue. So Tanner touched not just my life but all of those I have helped to save!

[luvdox]

Hi Valerie! What is an IMS Specialist? I love my vet but agree it's best to have a whole team! Thanks!

[luvdox]

Thanks to everyone who has responded to my question! It seems the most frequently asked question is around Oscar's dosage, specifically the one day of a higher dose. My vet was trying to introduce a very slightly higher weekly dosage so we attempted the one higher day and rechecked his levels after 2 weeks. Prior to this schedule, his levels had started creeping towards the bad Addison's end of the spectrum (I'll have to get the exact numbers though). Since he's been on this schedule, his levels have been perfect. I'm not sure why it works, but it seems to be. And, I'm religious about getting him tested and have even asked for extra ACTH tests when I thought he seemed off so I have no issue with asking for another, or just asking questions in general.

If his levels are good, could this be hurting him in any way? Thanks!

[Budsters Mom]

Hi,
An IMS is an internal medicine specialist. They specialize in endocrine disorders such as Cushings and diabetes to name a few. Not all GP vets are up to date with Cushings protocol. It can still work if they are willing to learn and work with you. Please feel free to ask for clarifying questions if unsure about anything. We are never offended. Xxxx

[labblab]

Thanks to everyone who has responded to my question! It seems the most frequently asked question is around Oscar's dosage, specifically the one day of a higher dose. My vet was trying to introduce a very slightly higher weekly dosage so we attempted the one higher day and rechecked his levels after 2 weeks. Prior to this schedule, his levels had started creeping towards the bad Addison's end of the spectrum (I'll have to get the exact numbers though). Since he's been on this schedule, his levels have been perfect. I'm not sure why it works, but it seems to be. And, I'm religious about getting him tested and have even asked for extra ACTH tests when I thought he seemed off so I have no issue with asking for another, or just asking questions in general.

If his levels are good, could this be hurting him in any way? Thanks!
Please, please, please get the exact numbers for all of Oscar's monitoring ACTH tests and post them for us, OK? As others have already noted, his dosing schedule is odd. Honestly, it is beyond odd. I have been a member of Cushing's-related forums for over a decade now, and I have never ever heard of one single vet -- anywhere in the world -- who dosed a dog with trilostane in this manner. It just does not make any sense given the manner in which the drug works (exiting the body within 12-18 hours after dosing). What day of the week have Oscar's monitoring ACTH tests been performed? If they have been performed on a Friday, you will have gotten a totally skewed result due to the fact that he received a significantly higher dose on that day and his cortisol level may look "fine" although it ranges much too high every other day of the week. And if the testing is performed on another day, it will not indicate how low Oscar's cortisol may be going on Friday.

Lysodren, the alternative drug that is used to treat Cushing's, does remain active in the system for a longer time and "maintenance" dosing is indeed based upon a weekly drug total. But because of its shorter effective action in the body, trilostane is dosed on a daily basis rather than on a cumulative weekly total.

Since Oscar remains symptomatic, the first step is definitely to obtain those monitoring ACTH testing numbers. The desired therapeutic goal for a dog being treated with trilostane is much lower than the "normal" range that is printed on most lab reports. So that is why we are especially suspicious when we hear that a dog's test result is "great" even though symptoms remain.

Thanks so much for getting us those numbers!
Marianne

[doxiesrock912]

Marianne,

sometimes. as in Daisy's case. The right dose of Trilo needed to completely alleviate her Cushings symptoms is too much for her to handle. So, the numbers will not be textbook perfect but close enough.

Dr. Morgan said that her quality of life is more important than having what they consider to be ideal numbers.

[labblab]

Valerie, I have posted a reply to your comment on your own thread.

Marianne

[Squirt's Mom]

Hi and welcome to you and Oscar! :)

An IMS is an Internal Medicine Specialist but not everyone needs to have an IMS on their team nor can all afford an IMS. In addition, most IMS's will not treat your baby on a regular basis but are for special uses only - hence the name "specialist". ;) If your baby is a particularly complicated case then an IMS is needed. Some GP vets can't do the testing needed for Cushing's so the IMS will do those and let the GP vet knows the results are. There are cush pups who never see an IMS and never need to. ;)

Hugs,
Leslie and the gang

[molly muffin]

I do want to echo what Leslie said. I ended up with an IMS for two reasons.

One my vet doesn't have the ultrasound equipment, and since I wanted an ultrasound, that had to go through an IMS.

The other reason was that because my vet wanted to put molly on 30mg of vetoryl (higher than is recommended by the UofDavis studies), and she had no symptoms, I wanted a second opinion from an expert on what we should do and how to proceed in our specific case.

Each case is different obviously, every dog is different. If you happen to have a knowledgeable, experienced vet in dealing with cushings, who knows the protocols for the drug, or is willing to learn them, and who will work as a team with You. Then there might never been the need for an IMS.

If you feel that you and Oscar need an expert, then find an IMS. This is not a slap in the face to the vet. Most are willing to work with an IMS, but the best vet around, might not be one who is experienced in cushings.

As for control of the cortisol. Again, every dog is different. You start with following the protocols, 1mg/1lb (when dealing with vetroyl, different for lysodren) and you are aiming for a Post ACTH number that is around or just under say 5., with Dechra saying that if symptoms are controlled, then up to 9. ug.
Then you adapt as necessary for what fits Your Oscar the best, where does he seem to do good at.

But that is getting the cart before the horse and just some background information, as we'd need to actually see the ACTH test results to know what they are and where Oscar is good at and if controlled.

:)
Sharlene and Molly Muffin