14-15 Year Old Beagle "Daisy" Diagnosed with Cushings

[dba4life]

Hello

We have an approx 14-15 year old beagle named Daisy that was just diagnosed with Cushings. She was a rescue so we don't have an extact age.

We are trying to decide on the treatment options. Overall she is still enjoying a very high quality of life right now. However throughout her life she has been very prone to bladder infections. She also has some arthritis symptoms which we believe is probably helped by what the Cushings is doing.

Her main symptom with Cushings is heavy panting and restlessness. She used to be a snuggle dog but now is much more content at the end of the bed at night (as opposed to right in between my wife and I) or on the floor next to the wall.

Here test results were:

Baseline 2.1
4 hour 2.1
8 hour 4.5

The vet is more familiar with lysodrine and recommends that treatment. He will also put her on prednisone for 10days in the beginning to compensate for what Daisy will no longer produce to take her down gradually.

We just want to get a bit educated and looking for advice. What should we ask? What should we watch out for during the treatment period? We feel that treatment is the right approach, but are of course concerned due to her age.

She is also taking:

Soloxine for her thyroid
Potassium Citrate- urine acidifier
Proin 50 - incontinence (this is a new one due to recent accidents)

She also just came off of Cefelexin to treat her latest bladder infection.

Any thoughts and/or advice is appreciated as we will learn more from reading the other posts.

[Harley PoMMom]

Hi and welcome to you and Daisy,

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

Dog's with Cushing's usually have a ravenous appetite and inhale their food. Due to the excess cortisol their kidneys are working harder and therefore they drink buckets of water and pee rivers. Strong obvious symptoms are a huge part of a Cushing's diagnosis and it seems that Daisy does not have the usual clinical symptoms of Cushing's.

Since other health issues, such as diabetes and any thyroid problems, can mimic the symptoms associated with Cushing's they need to be ruled out, have they been?

Using prednisone with the Lysodren during the loading phase is not advised any more due to the fact that the prednisone can mask the signs of a dog being loaded, so I am a bit concerned with your vets experience with Cushing's and the treatment protocols. Here is a link to our Resource Forum that has loads of info regarding Lysodren: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Has a senior wellness blood panel been done recently, if so, could you get copies of the results and post any abnormalities that are listed? How about an urinalysis? If this has been done we would appreciate seeing those results too. Is Daisy taking any herbs/supplements/medicines? How much does she weigh?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and husg, Lori

[lulusmom]

Hi and welcome to the forum.

Lori has gotten you off to a good start and has pretty much covered my questions but I want validate what she said about giving prednisone concurrent with Lysodren. An experienced vet will not do this because, as Lori mentioned, the prednisone will mask any signs of loading. However, that protocol is more likely to be followed if a dog has an adrenal tumor. Adrenal tumors are resistant to Lysodren so much higher doses are usually necessary so prednisone can help with mitigating adverse reactions.

Quite frankly, I would be hard pressed to start treatment on Lysodren period in the absence of polyphagia (voracious appetite) and polyuria (peeing lakes) and polydypsia (drinking buckets). It is changes in these symptoms that will tip you off as to when a dog has achieved loading. Panting and restlessness are big time signs of pain so I would have to think that your vet acted on more than those symptoms to pursue a cushing's diagnosis. Perhaps there were a number of lab abnormalities that were contributing factors??? Any other factors that you are aware of?

The test results you posted appear to be the low dose dexamethasone suppression test (LDDS) and while it is consistent with cushing's, those results don't differentiate between pituitary and adrenal dependent cushing's. Did your vet do any tests, like the high dose dex, endogenous acth or an abdominal ultrasound to determine which form you are dealing with? If not, I would highly recommend that you have an abdominal ultrasound done. This is the best value for your money as it gives the vet a change to see the adrenal glands and surrounding organs for the typical abnormalities seen in cushing's as well as possibly identify other problems. We've had more than a few members whose dogs were misdiagnosed after their vet or specialist identified the real problem on imaging. Any non adrenal illness or serious stress can skew the LDDS, which is highly likely to yield a false positive result.

I am also concerned that your vet has prescribed both Soloxin and Proin. Was a full thyroid panel done to diagnose primary hypothyroidism and how does your vet know that the incontinence is not cushing's related, in which case treatment would resolve the problem. Proin is not without serious side effects in some dogs and I personally would not opt to treat with it until I knew that the problem truly is incontinence vs cushing's. Did your vet do a full urinalysis and culture? Dogs with cushing's lose their ability to concentrate the urine so they pee and drink like crazy. The urinalysis usually shows low specific gravity, very dilute urine and a good number of dogs will have a urinary tract infaction at the time of diagnosis. If urine is dilute, it is very important that a culture be done. We would be very interested in seeing the results of any urine tests.

Sorry for all the questions but the more we know, the better able we can provide more meaningful feedback. We're glad you found us.

Glynda

P.S. I forgot to mention that a good number of dogs with cushing's have low T4 levels but this is usually a transient abnornality that corrects itself with treatment. This is a temporary condition called euthyroid sick syndrome. Thyroid supplementation is not necessary in these dogs as Lysodren or Trilsotane will resolve the problem. This is why I asked if a thyroid panel was done.

[Squirt's Mom]

Hi and welcome to you and Daisy! :)

I see the med Proin these days and my heart just stops. My Squirt, 15 this past Feb., was taking this med starting last Sept. I kept noticing things - respiratory issues, poor sleeping, acting as if she had pain in her belly/groin area, appetite off at times, restless, on and on. Then in March she had a seizure. A friend here sent me some info on Proin and it seems Squirt is one who reacts very badly to this drug; possibly allergic to one of the active ingredients. So when I see a pup taking Proin, I have to speak up and share what was shared with me. ;) Here are some links -

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%

Squirt displayed just about all of these but I didn't associate them with Proin.


http://www.livestrong.com/article/254733-side-effects-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.

She is recovered as much as she will and is much better tho she has been struggling with loose stools and diarrhea since. I can't say for sure this is related to the Proin but am very happy she is so much better. For a couple of months, it was touch and go, tho. I hope Daisy has no problems with it at all; several here have used it and did just fine but I wanted you to be aware just in case.

Hugs,
Leslie and the gang