Does my dog really have Cushings? Does he need Trilostane treatment?

[jyl_lapachin]

Hi!
I am so glad that I found this forum. I have been struggling to decide if my dog, Tommy, should start treatment for Cushings (Trilostane). He is a 11-12 year old male Rat Terrier that weighs about 20 pounds. We cannot see any of the clinical symptoms in him, other than he drinks more than 2 cups of water a day (but he always has since we adopted him at about age 2). It was discovered that he had high levels of ALT (132 U/L), Alk Phospatase (1109 U/L) and BUN/Creatinine Ratio (32 ratio), and a low Platelet Count (164 10^3/uL) in the bloodwork that was taken before he got his teeth cleaned.

Based on these analytics, the vet highly recommended that we test him for Cushings. She recommended the ACTH test (which after I did research, decided that was probably a waste of money since it is not very conclusive for the first test?). His Cortisol levels were Sample 1 -- 7.2 ug/dL (1-5 reference range) and Sample 2 - 15 ug/dL (8-17 reference range). The vet told me that the results show that he did not test positive for Cushings with this test

Then she recommended the 8-hour LDS test for Tommy because it is more sensitive. The results for Cortisol Sample 1 was 5.8 ug ug/dL, Cortisol Sample 2 Dex was 7.2 ug/dL, and Cortisol Sample 3 Dex was 8.0 ug/dL. Based on these results, the vet said that he definitely has Cushings and prescribed Tommy Trilostane.

I never felt confident with this diagnosis since Tommy is so active, does not have problems with peeing, he may have a bit of a belly (but it may be my fault for feeding him or his age?), and just seems like a normal, happy dog. I went to another vet for a second opinion and he said that it would be best to treat him before he does start showing signs of the clinical symptoms.

Wanting to do the best thing for Tommy, we purchased the Trilostane, but didn’t give it to him – just wasn’t sure and I did not want to give him toxic drugs unless it was truly necessary.

Would greatly appreciate any feedback or advice that anyone has…

Thanks!!

[Harley PoMMom]

Hi and welcome to you and Tommy,

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

A Cushing's diagnosis can be difficult to confirm, although strong clinical symptoms do make up a huge part of the diagnosis. Tommy's LDDS test results do point to the adrenal type of Cushing's, and the best way to validate this is to have the adrenals visualized with an ultrasound.

Other illnesses, such as diabetes and thyroid problems, do share many of the same symptoms associated with Cushing's and they should be ruled out, have they been?

Could you tell us more about Tommy, such as his weight and does he have any other health issues? Is he taking any other herbs/supplements/medicines? What is the dosage of Trilostane he was rx'd?

Please know we will help in anyway we can so do not hesitate to ask all the questions you want.

Love and hugs, Lori

[jyl_lapachin]

Hi Lori,
Thank you so much for your response! It is very helpful.

More information about Tommy is that he is a 11-12 year old rat terrier that weighs 20 pounds. We aren't certain of his age since we adopted him. After the Cushings diagnosis, he ruptured his CCL and has finally recovered. He is still on metacam to help his leg recover from the CCL injury (we tried natural Traumel, but it didn't work well for him) and Dasuquin (glucosamine supplements).

The vet prescribed 10 mg of Trilostanne, twice a day. We haven't started to give it to him yet.

He has not had an ultrasound and the other conditions that you mention, such as diabetes or thyroid problems have not been ruled out. I am definitely going to look into that more.

Thanks again!

Jyl

[Harley PoMMom]

Hi Jyl,

Trilostane/Vetoryl is one of two medicines most prescribed for treatment of Cushing's. Trilostane is not a cure for Cushing's but is used to abate symptoms associated with Cushing's such as excessive drinking/urinating, and a ravenous appetite. If Tommy does not display strong clinical Cushing's symptoms then, IMO, treatment should not be initiated.

I do recommend having an ultrasound done as it can be a very useful diagnostic tool because it may show abnormalities in other internal organs.

We are here for you and Tommy, please remember that. :)

Love and hugs, Lori

[jyl_lapachin]

Thanks for you fast response Lori,
It is so helpful!!! as this is really stressing me out -- on one hand I want to do the best thing for Tommy but I am not sure what that is...

I am going to take your advice and get him an appointment for the ultrasound and make sure that we can rule out other possibilities first.

Thanks again!

Jyl

[molly muffin]

Hi and welcome to the forum. :)

If you have the blood test that diagnosed the high ALT and ALKP, then can you take a look at it and just post anything else that was abnormal high or low, along with the ranges? I'm thinking that there would probably be a glucose result on it (Diabetes) and maybe a T4 result (Thyroid) that would at least give you an idea.

It's hard to know what to do when the clinical symptoms just aren't there. If there is any chance that there is something else going on, then that should be ruled out first. The good thing is that with cushings, you have time to find out these things and then can start treatment based upon having a good idea of what the problem is and what you need to do for it. Knowledge is your best friend. :)

Welcome again
Sharlene and Molly Muffin

[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 Jyl and Tommy.:)

[Trixie]

I'm not advising to treat or not treat but I will say that when my dog was diagnosed in April she was active and happy too, and nothing at all seemed wrong-except lots of drinking--lots. Walked 2 miles a day..and still does though.
Her regular March check up and blood test showed high liver numbers and that's what got the ball rolling for Cushing's for us.

Looking back now I do think she was probably drinking and peeing more around that time and also panting became more obvious. It was really hard to tell at first because she was active and outside a lot so she would be thirsty and come in and drink a lot, and pant too.
By April it became more obvious that the water intake was not normal and she drank more and more each day.

You might want to measure Tommy's water intake so you can really monitor if it goes up or stays the same each day.
Hope you figure out what-if anything, is going on with Tommy.



Barbara

[goldengirl88]

If it were my dog I would go for the ultra sound, but in the mean time be checking the other diseases it could be that were mentioned above. I truly believe you need to look into the cause of what you are seeing. I would want a confirmation that your dog does in fact have Cushings or I hold off treating also. Blessings
Patti

[jyl_lapachin]

Thank you Lori, Sharlene & Molly Muffin, Kathy, Barbara, and Tipper!!

I really appreciate your replies and value your input. I have a lot of things to think about. I am definitely going to measure Tommy's water intake and make an appointment for an ultrasound. This also gave me motivation to research this further.

I looked as his bloodwork and the results for his glucose and T4 are:
T4: 1.0 ug/dL (ref range 0.8-3.5)
Glucose: 116 mg/dL (ref range 70-138)

I understand from the blood tests that he has had so far so that there is some sort of problem, and it could quite possibly be cushings. I just want to make sure before he starts any treatment... especially since I haven't noticed any clinical signs (maybe I need to pay more attention :)

Thanks again!!

Jyl

[Budsters Mom]

NO signs, No treatment. Neither medications will cure Cushings. The medications are used to control symptoms. They are heavy-duty. If Tommy isn't having any symptoms, he doesn't need the medication.;) When we talk about drinking excessively, we mean buckets full! When we talk about peeing a lot. We mean a river! ;)

[frijole]

It looks to me as if your vet has based her opinion on simply the elevated alk phos levels unless I missed something - the water intake is normal. The acth test indicates not cushings and the LDDS test indicated cushings. The LDDS test is known to have false positives when other illnesses are present.

Examples are my dog Annie who had an adrenal tumor, Leslie's dog Squirt who had a tumor on the spleen, and many other dogs who had thyroid issues and diabetes.

The others are correct - before giving trilostane you really want to be sure of the diagnosis and an ultrasound could help you with that. There is no rush to treat cushings so take your time and make sure you get it right. Kim

[jyl_lapachin]

Hi Kim,
That is what I was thinking. One vet (second opinion) told me that the treatment is helpful now so that he may avoid the symptoms in the future. But the treatment (Trilostane) is very toxic, as you know, and I really don't want to give it to Tommy unless he really needs it. I really appreciate your insight and description of what drinking and peeing a lot means!:)

Thanks!!

Jyl

[molly muffin]

I was sort of the opposite as far as tests go, positive ACTH, negative LDDS test repeatedly and the symptoms aren't there for us either.

We aren't treating anything yet either, but we do monitor blood work regularly to make sure no changes occur that need to be address, so like every 3 months, I get complete blood work done and I'm giving liver support supplements to help with that aspect.

It's always a choice and decision as to when to treat and how, but you do want to be sure that you are treating the right thing. So, it's always better to dot the i's and cross the t's, I think, before heading down that path. Maybe in the future, maybe not.

My two cents, but I do want you to know you aren't alone in trying to figure things out and not always having a clear cut path.

Sharlene and Molly Muffin

[frijole]

Because alot of people read here but don't post I just wanted to respond to your comment re trilostane being toxic. It is a strong drug designed to do a specific thing. When the dose is right and the dog needs it all goes well. But like any drug, if it isn't designed to treat whatever the ailment is - it will fail.

It's strange because when I came to this forum over 8 yrs ago we saw alot of cases where vets didn't even think of diagnosing cushings. Now it's almost the reverse - we see cases where they are rushing into a diagnosis. Like I said - don't fret about treating. If it is cushings then the symptoms will show up and you can worry about treating then.

In the meantime I'd focus on why the alk phos was high. It might be worth doing the blood panel a 2nd time because maybe it's back to normal. Kim

[labblab]

Hello and welcome from me, as well! I just wanted to add a few more thoughts into the mix. It really does seem as though there is a current debate as to the advisability of earlier intervention in dogs suspected of Cushing's. I think the decision can be a very hard call when the testing results and symptom profile presents a "mix."

From what I am seeing, Tommy had a negative ACTH and a positive LDDS. You have reported some abnormal blood results -- what about his urine testing? Was the specific gravity low? Was there any protein in the urine? The reason why I ask about any protein is because Cushing's can be associated with protein loss from the kidneys, and this is a condition that you really do want to jump on rather than allowing it to progress.

Has Tommy been tested for hypertension? How about his cholesterol level? Again, these are issues that have been associated with Cushing's and can cause longterm problems if not addressed.

Also, you note that Tommy is recovering from a cruciate ligament injury. Untreated Cushing's dogs may be more vulnerable to these types of injuries and the healing may be more complicated.

I mention all these issues so that you might look a little bit deeper into Tommy's overall symptom profile. Excessive thirst, urination and hunger are certainly hallmark symptoms. But they are not the only symptoms that may end up warranting treatment for some dogs.

Marianne