New member...here for my 11 yr old black lab mix "Butkus"

[redlight40]

:confused: Hi everyone - I was looking for a dog forum specifically for this disease, and came across your forum. I'm glad you're all here. I'm not sure if my dog has Cushings yet ... she goes tomorrow (7/29/13) for cushings testing where she'll be there all day (her cbc bloodwork showed one of her liver levels over 1000, she's thirsty all the time, shedding like crazy, getting very weak, and is overweight). My vet suspects cushings, and after reading the symptoms, I feel in my gut that is what she has, but I'll know soon enough.

Until then, I wanted to get your opinion on how to treat her if she does. My vet uses the older of the 2 approved meds, which I hear is less expensive and not as effective in some cases. Unfortunately my vet has no experience with the new med, so there's risks of u him using it without having that personal experience. Plus they would have to special order it. I wish I could say money is not issue, but without going into details of my financial situation, I spent over 3,000 this year alone at the vet for my guys and cat/kitten rescues that I do, and in addition to my dog, I have 2 sick cats (after losing one of my cats to kidney disease / failure at the age of 16 after 4 long years of battling it).

My gut is telling me to go with the newer med based on what I read, but I wanted to get people's experiences who actually have used it, or both if that has happened. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm151209.htm

The newest drug (per my understanding) "Vetoryl (trilostane) Capsules, the latest drug approved to treat canine Cushing's, is also the first drug approved to treat both pituitary- and adrenal-dependent Cushing's in dogs. This prescription drug works by stopping the production of cortisol in the adrenal glands. In studies of the drug, the most common side effects were vomiting, lack of energy, diarrhea, and weight loss. "

"Only one other drug, Anipryl (selegiline), is FDA-approved to treat Cushing's disease in dogs, but only to treat uncomplicated, pituitary-dependent Cushing's.

Veterinarians have often used a human chemotherapy drug, Lysodren (mitotane), "off-label" to treat Cushing's in dogs. Lysodren destroys the layers of the adrenal gland that produce cortisol. It requires careful monitoring and can have severe side effects.

"Off-label," or "extra-label," means veterinarians can legally prescribe human drugs to animals for uses not listed on the label, or for other species or at different dosage levels from those listed on the label. But because dogs may react unpredictably to human drugs, says Stohlman, it's beneficial to have treatments available that have been studied in dogs and approved specifically for them."

thank you for any information you can provide!

[frijole]

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[frijole]

Hello and welcome. Glad you found us.

The test you are having done is the 8 hr low dose dex suppression test. Have you had any other testing done besides the blood panel? It does sound like your lab has cushings but please know this disease is so often misdiagnosed that before using either of the drugs (both are quite strong) it is very important to make sure it is cushings. The test you are having done is accurate except in cases where other illnesses are present - in which case it often has false positives. So you might consider having either an abdominal ultrasound or the acth test done just to be very sure. I'll give you some reading on cushings via links at the end of my post.

Re the meds - anipryl is really not used any more except in cases where the other two can't be used. I am sure that your vet uses lysodren. Lysodren and trilostane work differently but their success rate is pretty much the same. Some dogs do better on one than the other.

Trilostane/vetoryl has not been around nearly as long as lysodren. In fact, 8 years ago when I found this site it wasn't even available. Over time the younger vets do tend to prefer trilostane however make no mistake about it - it can cause the same side effects that lysodren can. Troubles from the drugs come from either a vet that is clueless or careless as well as when owners don't pay attention to the instructions they are given. Both drugs have to be carefully administered and the dosing process often needs to be tweaked - in short you have to pay attention and monitor for symptoms. When vets fail to give instructions or patients don't listen dogs can get into trouble.

Cushings is a serious disease but once you get it under control your dog can have a very normal life. My Haley was diagnosed at 12 and she lived another 4 1/2 years on lysodren and never had any issues with cushings. I gave her meds religiously and she was just fine. She died at 16 1/2 of old age - not cushings.

But first we need to make sure your dog has cushings. I'm providing links to what cushings is as well as info on the drugs and diagnosing for you to read. Dont' be afraid to ask questions! Welcome. Kim
http://www.k9cushings.com/forum/showthread.php?t=180
http://www.k9cushings.com/forum/showthread.php?t=5427
http://www.k9cushings.com/forum/showthread.php?t=5428

[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 and you baby. Hugs,

[spdd]

Welcome to the forum. Great people are here to help you out. I've been on for a little while now, and still learning new things to get my dogs problem under control. Although not there yet and it's been quite a journey, they have directed me in what to do, and I have no doubt at all with their guidance you will too.

[Squirt's Mom]

Hi and welcome to you and your baby! :)

We use Lysodren in our house and I couldn't be more satisfied with the results nor more comfortable with the use of this drug. It isn't the drugs that are dangerous, it is how they are used. As long as the vet follows protocol and the parent is educated and diligent, things typically go smoothly as far as the drug's use is concerned. BOTH drugs have the exact same risk factors, BOTH are life-savers. NEITHER is "safe". They simply work differently.

For me personally, I don't like "new and improved" anything. The quickest way for a manufacturer to get me to change brands is to "improve" their existing product. ;) So I was and remain much more comfortable with the long standing use of Lysodren over the new kid on the block, Vetoryl (Trilostane). But that is just me - some folks are just the opposite and are more comfortable with the new.

One of the key things in deciding which drug to try first is to find out which one your vet is most comfortable using and has the most success using. Not all pups can take Lysodren and have to switch to Trilo. Not all dogs can take Trilo and have to switch to Lyso. There are folks here who use both drugs and are happy to answer any questions you may have.

But first, let's get a confirmed diagnosis. ;) When you go to the vet today, start a new tradition of asking for copies of the actual test results on everything she has done from now on. Not the invoice that says what they did, but the actual numbers and comments from all testing. Start a file at home in case you should ever need it - like on vacation, you would walk in the door of a new vet's office with all her info in hand. PLUS that will allow you to better answer the million questions we will be asking. :D

Let us know how the testing goes today - it sounds like the LDDS which is a good place to start.

I'm glad you found us and look forward to learning more about the both of you as time passes.
Hugs,
Leslie and the gang

[redlight40]

Hi FriJole/Moderator: I did click on an email and complete my registration before I posted this thread. Do you see my completed registration now by any chance? If not, I can click on it again I suppose.

re: the testing, I'm not sure of the name, but after reading the acth test info., I think that's what my vet is doing today with Butkus. Perhaps I'm mistaken and it's similar to the 8 hour test (?) though. I will find out when I pick her up. I will also get a copy of her blood test & other results while I'm there (good advice Squirts Mom!) Other than her senior profile bloodwork, urinalysis and stool check earlier this month, no, she has not had any other testing for cushings disease. Today is the first.

Similar to others on the site, I'm a huge animal lover and rescue feral cats and kittens for the past 3 summers while working ft. Because of that and my own sick animals, our vet expenses have been through the rough and my husband is at his limit. He loves our animals too, but his concern is Butkus is an 11 yr old lab mix and their life expectancy is 10-12 yrs, so how much should we put through (i.e. this chemotherapy type treatment) and spend in the process vs. not treating her and possibly managing the symptoms (i.e. pain medication?). Please note, she's already on Rimadyl 75 mg 1x a day because of a diagnosis of arthritis approx. 2 yrs ago. I'm sure that's not helping her liver at this point, but it does seem to help her mobility a little.

Please note, I will go back in vet debt to treat Butkus (just paid almost 4,000 off this year alone) if it's the right thing to do for her, but would really appreciate your feedback on all options.

I miss taking her on longer walks, but I will still walk her every few days around the block because she so wants to go. Where she used to drag me along she can barely keep up with me and I've slowed down my speed tremendously for her.

She usually follows me around the house (we have a 3 floor home) and she will hesitate before taking the stairs, and it's very slow going down.

She's such a sweetheart! Before the doctor suspected she has cushings, we just thought she was slowing down due to her age. Of course, we know differently now.... or at least we think we do

Well, I'm interested in everyone's feedback on treatment options, and also, if anyone here has / had a lab mix that is around Butkus's age when she was diagnosed, what you did specifically. Thank you all in advance!!!!

[frijole]

The test you are having done is not the one with the expensive cortrysyn in it. I'm talking about the acth test which measures cortisol (see the link I provided earlier) You have to do these over and over and over to measure cortisol levels and see if the dosage is working, make adjustments, test again.... that is why the costs add up and freezing it and reusing it can really save you money. Some vets know about it - others not. But just know it won't help you with today's bill. Kim

[goldengirl88]

Hi;
I just wanted to welcome you. Sorry your baby is having troubles. We all struggle with the affordability of treating our babies. If after testing your dog and Cushings is confirmed here are some pointers.
Keep a daily diary of your dog you will need it more than you think.
If you use Vetoryl call Dechra the manufacturer they have vets there on staff to help you and your vet . They will start a case file on your dog. 1-866-933-2472. Get them involved with everything you do to keep you dog safe.
Start on a low dose no matter what the vet says. Go low and you can always raise it after your dog adjusts to the drug.
Please call around and check if there are any other vets or IMS's in the area that have experience treating Cushings. It will save you money, time and heartache. These are powerful drugs and you need someone you can trust to monitor them.
You can get an RX from the vet and go online for Vetoryl. I buy mine at a Vipps certified pharmacy and it is not as expensive as my vet. They have a veterinary pharmacist on staff.
Watch you baby like a hawk if you do start Cushings drugs, that is the most important factor of all. You need to be aware of side effects.
Take a deep breath, as many of us when we first started with this journey were overwhelmed. It will all work out.
Educate yourself on here and anywhere you can find about this disease, you will be your dogs' best advocate.
Listen to the advice on here, these people have more experience with this disease than the vets do. They live and breath this disease.
Good Luck and God Bless you and your baby.
Patti

[frijole]

I just want to clarify that Patti's comment about starting on a low dosage is in regards to trilostane/vetoryl and not lysodren. With lysodren you don't want to do that... but it is way to early to worry about that - let's do the cushing's tests first. Kim

[goldengirl88]

Sorry I should have been more specific, I will remember next time to mention that.
Blessings
Patti

[redlight40]

well folks, I'm really confused, and unfortunately my vet wasn't there when I picked Butkus up. The receipt said "ACTH Stimulation Test" but based on the 4 and 8 hour tests that they said they were doing, it sounds more like the 8 hour test because the ACTH test is only supposed to take 1-2 hours per the website information I read. ??? So I asked my vet to call me in the morning, which I'm sure he will because he will have her results then as well.

In the meantime, I got a copy of her blood test results from 7/9/13 and here are the items that were abnormal:
ALT (SGPT)=249 (RANGE 12-118)
aLK pHOSPHATASE=1133 (RANGE 5-131)
GGTP=13 (RANGE 1-12)
BUN/Creatinine Ratio=28 (RANGE 4-27)
Cholesterol=435 (range 92-324)
Platelet Count=431 (RANGE 170-400)
Differential=absolute (bolded but don't know what that means)

Total T4 = 0.9 0.8-3.5 (normal but thought I mention it since it was close to border and there was a note that said "the total T4 result is less than 1.0. A free-t4 by equilbrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demontstrating clinical signs compatible with hypothyroidism).

Urinalysis:
Protein=3+ (high) Neg
WBC=11-20 (high) (Range 0-3) HPF

She was treated for a UTI with amoxcyllin after her results came back and that's also when my doctor said he suspected cushions.

- do these results help support the possibility that she has cushings? if so, does it help point to which type of cushings she has? I realize more tests are in her future though :(

[redlight40]

ps - I wanted to thank you for the warm welcome and the wonderful resources you gave me. I've been trying to read through it all. It's a lot to take in to be sure =)

[frijole]

Glad you put the thyroid info in there because hypothyroidism mimics cushings. I'd do that test as the lab recommended to rule it in or out. It is WAY cheaper than treating cushings. :)

Re the test - you are spot on - the acth test is 1 to 2 hrs and the LDDS is the 8 hr one. Make sure you get a copy of whatever it is they did. If they charged you for an acth vs the ldds you probably paid more than you should have. Front desks are notorious for making these types of errors.

Good job on your homework! :) Kim

[redlight40]

thanks Kim!
p.s. I posted some pictures of Butkus in album I just created. I didnt know how I could add her picture to my profile or I would have. (in case anyone wants to see her as a pup and more recently) =)

[frijole]

Oh he is so cute. He's a lover... you can tell from his eyes. Here's a link on how to add a photo to your name/profile. Kim

http://www.k9cushings.com/forum/showthread.php?t=2018

[molly muffin]

Hello and welcome from me too. It might be worth it to have another urinalysis and cbc done now that the UTI should be gone. Just so you can verify that the protein (3+) in urine and that the other things have come down. Just something for you to think about.
Things that can mimic cushings symptoms, is glucose (if that isn't abnormal on the CBC then probably not this)
Thyrodism - which is a tad low, but not overly low, and dogs with cushings can have a minor low thyroid result, from what we've seen on here.
Renal issues, which is why I thought it might be worth it to confirm that things are now normal in that regard.

Tara is a 12/13 year old lab, being treated with Trilostane.
Her thread is here: http://www.k9cushings.com/forum/showthread.php?t=4753

I believe we also had a lab in Alaska, about 9-10, being treated with Trilostane.

Trilostane if the popular new drug, and a lot of the younger vets are more comfortable using it, while if you got to an older vet, they are probably going to have more experience with lysodren.

Both drugs can get the job done with a good vet and vigilant owner and a dog can live out a healthy life.
You are however, treating the symptoms, there is no cure, other than surgery. If there are no symptoms that are bothersome to you or to your dog, then it is up to you if you want to start treatment or wait. Waiting does come with risks but more vets don't treat without symptoms evident.

Kim gave you some good links and we have a resource section various articles that you can read.

Resource section: http://www.k9cushings.com/forum/forumdisplay.php?f=10

You're making a good start. It isn't a cheap disease, but once you get past all the testing, it's not as bad.
Sounds like you have a lot going on with your rescues and furbabies. We are an animal loving group around this place. :)

Sharlene and Molly Muffin

[molly muffin]

Oh she is adorable! Dogs and snow, isn't it wonderful. :)

Sharlene and Molly Muffin

[redlight40]

Thanks for the addt'l links Kim =)

Hi Sharlene - sorry to hear about the misdiagnosis re: Molly. The practice of medicine will always be that I'm afraid, because e1 is so different, and no one responds exactly the same to medication. I will read your story when I get back from the barn tonight ... thank you for sharing it!!!
Butkus's Glucose is 109 (range 70-138) so it was normal
- unfortunately I will be shocked if Butkus doesn't have cushings because she seems like a classic case with the symptoms she's experiencing. Heavy panting even when at rest, very thirsty, always hungry, much weaker than even 6 months ago where she's laying flat without moving, can't walk more than a block or so without getting very tired / weak, she's losing hair so much it's flying around our house (and my husbanrd is OCD so he's constantly trying to get rid of it), etc. I have hypothyroidism, and although I know the symptoms can be different in animals, I can't imagine that if she did have it it would be causing all of the symptoms she has, especially with the other abnormal test results.

But... we will know more tomorrow. I will be very happy to know what today's test reveiled and what my vet thinks we should do next. To be continued...

goodnight all

[redlight40]

The first test results are in, and my sweet Butkus does have cushings :( My vest said that her ACTH results are "interesting" because it gave the impression whe was on prednisone her whole life, which of course she was not. By doing the ACTH first, he was able to consult with a cushings expert who suggested she get the 8 hr LDDST test to determine how bad it is and narrow down which kind it could be. So I will be dropping her off at 8 tomorrow (7/31/13). I will also ask them to do another urinalysis ... in addition to seeing if her UTI is gone, is there anything else I should ask them to test with the urine?

Per my vet, her resting cortisol shouldn't have been above 5, and it was almost 10. When she was stimulated it went up (he didn't give me the number and I forgot to ask, but I will get copies of the results when I bring her tomorrow).

Although I'm glad she was diagnosed, and I feel confident she does have cushings although I don't know which kind yet, I still have a heavy heart. She's such a good dog, and I hate to think of her not feeling well with anything other than the aches and pains of old age. Also, after losing my Snuggles not even 2 months ago, I was hoping for some normality at home with my pets ... even if it was just for a little while. I may have mentioned my 2 year old sweetheart Tank may have inflammatory bowel or cancer. He's fighting a URI right now (knock on wood it's getting better though), and the cortizone shot has to wear off (after Fri) so I haven't scheduled is ultrasound yet. But most likely he will get the ultrasound at some point in August. I don't want to lose 3 pets this year.... I don't think I could take that. So I'm praying Butkus is in the majority and doesn't have the cancer related cushings, and that my sweet Tank has inflamatory bowel syndrome since at least it can be treated.

Sorry for the 'whining' and sadness... but to say I'm freaking out right now is an understatement.

[frijole]

OK so you did have the acth test done and not the LDDS. You must get the two numbers - sorry we've been burned too many times before. FYI my Annie had numerous false positives on the acth test and each time her first number was above 10. She did not have cushings - shes was misdiagnosed. Reasons for the first number to be high include dog is stressed before stimulation, the dog's body is stressed prior to stimulation as is fighting a disease (in my case it was a tumor)... so don't assume anything yet.

And if it is cushings' don't feel sad - be glad it isn't a disease that is a guaranteed death sentence. You treat and dogs can live very normal lives. You are on top of the game so you will be fine. Kim

[Harley PoMMom]

The first test results are in, and my sweet Butkus does have cushings :( My vest said that her ACTH results are "interesting" because it gave the impression whe was on prednisone her whole life, which of course she was not.

Dogs that have been taking prednisone for a period of time will usually have a "blunted" cortisol response to ACTH stimulation.

Could you clarify something for me, has Butkus been on any type of steriod?


By doing the ACTH first, he was able to consult with a cushings expert who suggested she get the 8 hr LDDST test to determine how bad it is and narrow down which kind it could be. So I will be dropping her off at 8 tomorrow (7/31/13). I will also ask them to do another urinalysis ... in addition to seeing if her UTI is gone, is there anything else I should ask them to test with the urine?

If Butkus is suspected of an UTI then a LDDS test should not be performed until the UTI is completely gone because many things, including stress, pain, etc...can create false positive results from the LDDS test.


Per my vet, her resting cortisol shouldn't have been above 5, and it was almost 10. When she was stimulated it went up (he didn't give me the number and I forgot to ask, but I will get copies of the results when I bring her tomorrow).

Please do get a copy of the ACTH stim test and post those results. ;)


So I'm praying Butkus is in the majority and doesn't have the cancer related cushings, and that my sweet Tank has inflamatory bowel syndrome since at least it can be treated.

With cushing's there is an 85% chance that Butkus will have PDH (pituitary-dependent hyperadrenocorticism) which is usually a benign, slow growing tumor of the pituitary gland.

Love and hugs, Lori

[molly muffin]

If it's cushings then it can be treated and they can live out a normal lifespan. So no need to go down any other road than the optimistic one. :)

Hopefully Tank will be okay too. Everything Can be bad, and we just always hope that none of them turn out to the bad version. If it's treatable, then it's doable. :)

Sharlene and Molly Muffin

[Trixie]

Sorry to read about Butkus having Cushings. I felt the same worry and panic that you are feeling and I think everyone here had the same. Things will get better!!
If you are going to use one of the medications there are many "experts" here that know so much and will definitely help you through it all.
My dog is on Vetoryl and so far so good. A lot of dose tweaking since we began in April and we're still doing that for optimum control of the symptoms. My vets approach has been low and slow...so we have had no side effects at all thus far. Symptoms have definitely gotten better than they were. Our liver numbers were through the roof...waiting for some test numbers to see if they are (hopefully) lower at this point.
If you end up on Vetoryl/Trilostane there are online options to get better prices, especially for the generic. Everyone shares great info and advice so you've come to the right place.
Loved seeing the photos of Butkis. She looks like a sweet girl! :p

Barbara

[redlight40]

:confused:
Hi e1 - sorry for the delay in posting an update ... it's been a crazy few weeks for me. So, Butkus may NOT have cushings disease .. or, if she does it's atypical cushings as my doctor put it. Here are her 2 test results:

7/30/2013-ACTH pre=9.8 (high) (range 1.0-5.0)-post=12.1 (normal) (range 8-17)

8/1/2013-LDDST (aka DEX?) - 8 hour test 1st/pre= 6.3 (High - range 1-5 ) Coritisol sample 2 Dex=1.1 (range 1-5 I believe per the text below) Coritisol sample 3 Dex=<0.7 This test did not have ranges right next to the text like the ACTH test, but had the following text:

IATROGENIC HYPERADRENOCORTICISM: Resting coritisol is usually between 1-5 with little to no increase in the post-ACTH coritisol level.

HYPOADRENOCORTICISM (HOC): Resting cortisol is usually subnormal (less than 1 ug/dL) or low normal with no increase after ACTH.

POST-LYSODREN: Pre & post cortisol levels after Lysodren loading or while on maintenance Lysodren should be between 1-5 ug/dL.

POST-TRILOSTANE: Pre & post cortisol levels between 1-5 - 9.1 ug/dL indicate optimal control.

handwritten on her report was the following:
Pred
4 hr - should
8 hr >= 1.4

Although her pre test results are above normal, her post simulation/medication results are normal. What should we make of this? He said he did not recommend treatment based on her results.
He did recommend increasing her pain medication because of her symptoms, so she's getting 75 mg in the mornings (in addition to the same at night like she's been getting) and 100 mg of tramadol 2x a day (am & pm). Then he said next month he'll lower the doses and see how she does. It is helping her walk more, and she's not panting nearly as much or licking her paws as much. She's still shedding like crazy though. She did pee in the house 1x last week, but I think it was during a thunderstorm which she's scared of.

thoughts/suggestions? I want to make sure I take everything into account. Thank you!
I'm very interested to know what you all think.

[redlight40]

To Lori: I didn't read your response in time to postpone her LDDST test unfortunately. I'm very curious to hear your response to my previous post where I posted her results though, as well has Barbara, Sharlene's, and anyone else who has a thought/opinion. I guess the practice of medicine is applicable here, since I'm not a doctor but instead a very curious mom who likes to read/research on the internet when it comes to illness.

to Sharlene - thanks re: Tank... his ultrasound is tomorrow morning. I'm praying for something treatable if he has to have anything at al.

All - my name is getting around my community by word of mouth and also my vet's office as someone who helps find homes for cats (rehome, stray or feral). It's interesting as I've only been doing rescues for 3 summers now, and I just stumbled into it after finding 3 kittens in a local amish barn one day and I got concerned because I didn't see a mama cat. Unfortunately what I've learned since then is rescues are overwhelmed, and there aren't enough people who can or are able to help. But I still try and help where I can. I work full time, have 2 kids, 4 animals (2 that are sick), and a sick mom who depends on me completely for everything (she lives alone but I don't think for too much longer). I don't want to take up your time on this site, since this is for dogs with cushings, but if any of you know people in rescues (no kill only please) or who foster, please contact me via email (redlight@ptd.net). Currently it's 98% cats, but I'm thinking of ways to help homeless animals in general in my community (i.e. TNR, rescues, transports, etc.). Thank you! Ricki

[frijole]

She doesn't have cushings. Keep us posted on the ultrasound. Kim

[Harley PoMMom]

I agree with your vet as to not pursuing any treatment for Cushing's because both the ACTH and LDDS test validate that Butkus does not have Cushing's...YAA!!!! So happy for you both.

If Butkus is still having accidents in the house I bet an UTI is the culprit. I strongly suggest having an urine culture and sensitivity test done so the exact bacteria can be known and the correct antibiotic can be rx'd.

Please do keep us updated. ;)

Love and hugs, Lori

[molly muffin]

I agree with the others and not treating cushings at this point. Lets see what the ultrasound shows is anything and go from there. It sounds like your vet has a plan in place (the pain meds and slowly tapering those to an acceptable level).

Kudos to you for helping to rescue animals in your community. There are always too many animals in need of homes and not enough people to help out. Several of our members do help out with rescue work. If you need tips, etc, I'm sure they will be happy to drop you a line.

Sharlene and Molly Muffin