Moe, an 8yr young poodle mix

[MoesMommy]

Good Morning.
My name is Kim, I adopted Moe from a rescue three years ago. He is an 8 years young poodle mix who did not have the best start in life. He was turned into animal control extremely matted with a mouth full of rotten teeth. Moe rescued me at a very low point in my life and has been my best friend ever since. Two years ago Moe was having diarrhea and vomiting. He was lethargic and completely unlike his normal self. I rushed him to the vet and after blood work his liver enzymes were off the chart. After being hospitalized for three days his numbers came down and he has been fine ever since. Fast forward two weeks ago... He was vomiting and was straining to go poop. When he was able to get something out it was mostly blood. My regular vet was closed so we rushed to the 24 hour vet up the road. His liver enzymes were so high they had to do a retest just to make sure they were seeing correctly. After X-Rays and keeping him on fluids for the weekend he showed improvement. He was picked up and taken to the regular vet that offered and ultrasound. Of course I said yes! It turns out his gall bladder was severely inflamed and full of sludge. We were given Ursodiol and a liver supplement, with a recheck scheduled for two weeks. After the second ultrasound his liver and gall bladder both showed signs of improvement but his liver levels had become very high again. My vet recommended the The Low Dose Dexamethasone Suppression Test and when I picked him up that afternoon got the crushing news that my boy had pituitary cushings. My vet is very familiar with cushings and explained everything to me. He also told me that we were looking at only 8-12 months left with my baby. I am devastated. Moe is 9lbs and since yesterday has been taking 10mg of Vetoryl with a full meal in the morning, back in two weeks for a recheck. He is also is still on Ursodiol and also has been given Vetri_Liver for liver support. My vet also told me about the University Of Tennessee studies by Dr. Oliver and suggested Melatonin and lignans which I have since ordered. He has been fine with the exception of trying to eat grass both last night and a little this morning. No vomiting, I guess just an upset tummy? Sorry for the long intro but I wanted to share with you everything. I plan on asking the vet to fax his tests tomorrow so I can post. Thanks so much for your time. I look forward to any information you would be willing to share.

[MoesMommy]

Also to mention, he is now on Royal Canin Hepatic dry food and Royal Canin low fat gastrointestinal wet food. He has sweet potatoes and green beans for snacks now. No more snasauges :( Now, knowing a little more about cushings I see signs. Excessive drinking, back legs shaking...

[Squirt's Mom]

Hi Kim and welcome to you and Moe! :)

My brother has a dog named Moe that I love, but he's a BIG boy, a Burmese Mountain Dog. My Squirt absolutely adores him and he accepts her worship gracefully. :D

First, I'm a bit concerned about the LDDS results since they were done during the same time that he was having issues with his gall bladder. The LDDS is notorious for giving false positives when there is another illness present.

Also, the current recommendations for the starting dose of Vetoryl is 1mg per KILOGRAM of body weight. (Studies since this drug came out recommend a lower starting dose than what is printed in the manufacturer's brochure.) At 9 pounds, Moe weighs 4.09 kilograms so the starting dose would be closer to 4mg, not 10mg. At his weight, you will need to have the drug compounded to get that small of a dose. Moe may do just fine on the 10mg too - we have seen pups on massive doses of Vetoryl do alright. BUT just in case, please keep a very close eye on him over the next day or so and if you see nausea/vomiting, loose stools/diarrhea, loss of appetite, lethargy, get him to the vet ASAP for an ACTH and to have his electrolytes checked. Did the vet give you any prednisone to have on hand at home just in case of a crisis? If not, call and ask for some when they are open again.

As for the cruel comment that Moe will only have a few months left with Cushing's - that is flat WRONG. With proper diagnosis, treatment and monitoring, cush pups can and DO live out their normal life-spans and beyond, passing from things completely unrelated to Cushing's. Canine Cushing's is NOT a death sentence but simply a change in your life's routines. Yes it is scary at first, boy do I remember that! But you have found the very best place to be - the knowledge and hands-on experience found here is astounding and the moral support is unbeatable. You and Moe are family now and we will be with you all the way.

It would help us a great deal if you would get copies of the actual test results for Moe and post them here. We need to see all the abnormal, too high or too low, results on the lab work that shows things like the liver enzymes (ALP, ALT, ect) INCLUDING normal ranges and the little letters that follow the numbers. Also all comments from the ultrasound about the condition of the organs they saw. And the LDDS report along with the comments from lab as to how to interpret the results. Different labs have different normal ranges and bases for interpretation. ;)

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

PS. Be sure to check out the Helpful Resource section for lots of good information on Cushing's as well as the Vetoryl (Trilostane) Moe is taking.

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

[MoesMommy]

Thank you for replying. I will get try and get all his paperwork first thing in the morning. I was not given any prednisone but will monitor him and call the vet first thing in the morning.

[Squirt's Mom]

BTW - my Squirt was 10 the first time I heard the word "Cushing's" - she was 15 the 25th of Feb this year. ;):):cool:

[MoesMommy]

That is wonderful!!!!

[goldengirl88]

Welcome to the forum:
I too like Leslie feel this dose is way too high for Moe to start out on. Too many times the dog is started on a dosage higher than it should be and the dog body has a reaction to it by dropping the cortisol level too low. It is called Addisons and can be fatal. That is why Leslie is asking you about prednisone. If he goes too low you have to have it to give him. I would get him on the compounded 4-5 milligram to start. He will then have to have an ACTH test to see where his cortisol number is. Then you tweak it from there. When you start low the dog's body can better adjust to the drug and it does not tend to plummet the cortisol level like when you start high. You are you dogs best and only advocate. If this vet is experienced in Cushings as you said, he would not have instructed you to use the 10mg, he would have given you prednisone, and he would never have told you your dog would live for 12-18months. The best thing to do is come on here and ask questions, these people know this disease inside out, where as many vets are lacking in the basic knowledge of it. We are here to guide and help you, you can trust the people on here know what they are doing. You can have your vet call Dechra the manufacturer of Vetoryl, and get help on what the proper protocol, testing etc. is for this drug. I am sorry your baby is not well, but please make sure you have a diagnosis by LDDS, ACTH, urine and ultra sound. You want to make sure your dog has Cushings before ever administering these powerful drugs. Blessings
Patti

[molly muffin]

Hello and welcome from me too. The main thing that is life threatening is getting the gall bladder sludge cleared out, so it doesn't cause a blockage. Cushings, if indeed Moe has cushings, is manageable and dogs often live out their normal lifespan with treatment.
It is entirely possible that when Moe gets sludge buildup, then the liver is working very hard, the toxins aren't clearing and the liver enzymes go up. Now that you know he is prone to this, you will not how to monitor for it and to have that checked regularly.
Keep an eye on Moe for any signs of lethargy, vomiting, diarrhea, not drinking, etc and at the first sign, boogie into that vet and get the ACTH test done. He might do okay on 10mg, or it might be too much, so you'll have to be real vigilant about seeing how he is doing. At least you have a 24 hour ER nearby if needed, that is always good.
When you have your regularly scheduled ACTH, give him his medicine in the AM, as normal with a bit of food, then the test should be done withing 4 - 6 hours of the AM dose. They like to start about 4 hour and finish at 5 I think for optimal results.
Moe can do fine, with proper treatment. He is still in the prime of his life and with a vet looking out for him and medication and now you know about that gall bladder, lets go with the optimistic outlook and expect Moe to be around for a good long time. :)

I love optimism! Welcome to the forum.
Sharlene and Molly Muffin

[addy]

Hi and Welcome !

My Zoe was diagnosed 3.5 years ago and has been on Vetoryl for 2.5 years.

I'm not quite as alarmed at the 1 mg per pound starting dose but do keep a watchful eye on Moe and when in doubt withhold the dose. Every dog is different and will react differently and if anything else is going on it can get tricky to tweak doses, which sometimes need tweaking.

There are studies out there that give the vets the "2 year" life span quote. How well a dog does depends on what else may creep up while treating the disease, how educated the vet is on the use of Vetoryl and how good of voice we become for our pups. To become a good advocate you need to learn as much as you can, never follow a vet's advice blindly, ask questions and know your pup.

We are all terrified when we first arrive here. The more we learn, the less scarier it all becomes.

[spdd]

Just want to welcome you to the forum. There is excellent advice on here, believe me. I was so scared with the Cushings diagnosis when I first heard it, I researched of course and came across this site. The people on here are unbelievable with their concern, knowledge and genuine caring.

They'll give you all the info you will ever need, especially once you post those test results.

Good luck to you, and don't listen to a short term prognosis if indeed it is Cushings. Many dogs on here have lived extremely long lives with Cushings under control.

[MoesMommy]

Thanks to everyone for your responses. Moe had his second dose this morning and is running around as happy as can be. I swear, you would never guess that there was anything wrong with him :). I will call the vet in the morning to ask some questions

[goldengirl88]

I just wanted to make sure I told you to feed Moe before the ACTH testing after he is on the Vetoryl. I f you fast him it will skew the test results and can overdose the dog. Make sure he eats. Blessings
Patti

[MoesMommy]

Yes, thank you

[molly muffin]

Kim, great that he is running around and being silly. I just love it when they do that. This is all great news.

It's a tricky ride, that's for sure, but definitely doable. I think much can be told by how they act and I am so glad that you had the ultrasound done. They can sure be a god send when it comes to telling you what is going on inside their bodies. I forgot to ask, but you mentioned that on the ultrasound showed his liver and adrenals to be much improved. Where they enlarged (liver and adrenals?) I'm just curious about that and when you say improved does that mean they are returning to a normal size already?

Sharlene and Molly Muffin

[MoesMommy]

Sorry about that. His second ultrasound showed his liver was no longer enlarged and his gallbladder was vastly improving. I believe what the vet saw on this second ultrasound was enlarged adrenal glands which lead him to want to test for cushings. When I call the vet tomorrow I will request both ultrasound reports as well as blood work. It was all a blur and a lot of information so I am not sure what I remember is 100% accurate.

[Bo's Mom]

I just wanted to extend a welcome to this wonderful group. You will find we all share a common bond and that is the love of our fur friends...and probably many other things.:p
I also wanted to comment on what a cutie Moe is...I just looked at his pictures.

[molly muffin]

uh oh, did someone say pictures!!! :) Ran to look at them, very, very cute!

Oh my gosh, Kim, I was the same when the vets started talking cushings and details of this and that. Quite overwhelming indeed. Then I came home and cried for days. How can you take all that technical jargon in when you are stressed out and fearful and just...everything. It's too much.
One suggestion that I took to heart and it really did help me was that I needed to start my own folder at home, with copies of all of mollys test results, ultrasounds, everything. I asked my vet for copies of all test results for the last 2 years. I have since reviewed that folder many, many times and any time that I have had to go to the ER I take the folder with me, just in case there is anything they need to know. (Course they now have their own file on my molly, but I still take it)
Anyway, sorry, got off track there. It will come in so handy. You can look at results and compare to past testing for the same thing and see what progress is being made, where you might want to concentrate on, etc. If someone asks a question, you can whip that folder out and know the answer in no time at all.
I actually post all abnormal test results on my mollys thread on here, so I can go back and look it over. It's hard to keep things straight sometime or remember what I thought was going on at one point.

Another thing that you can do is to keep a journal of anything that you notice specifically, level of activity, how much moe eats or drinks, if he acts "off" or if he is being normal playful self.

Remember we are thinking long term here, so next year, you might want to look back and see how things really were in the month of october of this year. You can also use your thread on here to keep track of the same sort of things. There are a number of possibilities.

Wow, okay, you'll find I can write a book if left to do so. :)

hugs,
Sharlene and Molly muffin

[goldengirl88]

Kim:
I just wanted to say that gallbladder sludge can make an animal real sick and not want to eat. I have a cat and a dog with this problem, they are both on Ursidiol. I hope you get Moe feeling better. I looked at his pictures and he is so cute. Good Luck Blessings
Patti

[MoesMommy]

Thank everyone! I just received reports from the vet. Before I start posting can you tell me what numbers I should be posting? Just want to make sure I give correct information :D

[Squirt's Mom]

On the test(s) that shows things like ALP, ALT, BUN, CHOL, etc. we want to see the values that are too high and those that are too low. Be sure to include the normal ranges for each value along with the little letters that follow the numbers - it will look something like this:

ALP 1300 150 - 400 ug/dl (EXAMPLE)

On the LDDS we would like to see all three numbers given along with the comments on how the lab interprets the test.

On the ACTH we would like to see both numbers given - again with the little letters and normal ranges.

Any other tests given lately we would be interested in seeing as well.

(Different labs use different normal ranges and sometimes how the LDDS is to be interpreted. ;)

[MoesMommy]

Thanks! Running into a meeting but will sort through and post as soon as I get back

[MoesMommy]

7/14/11:
HCT: 57.6% (37.0-55.0) High
HGB: 18.7 g/dL (12.0-18.0) High
ALT: 899 U/L (10-100) High
ALKP: 215 U/L (23-212) High
TBIL: 1.5 mg/dL (0.0-0.9) High

5/25/13:
ALT: 108 U/L (5-107) High
ALKP: 160 U/L (10-150) High
T4: 0.9 ug/dL (1.0-4.0) Low
Monocytes: 2.5% (3-10) Low

9/26/13:
ALT:545 U/L (10/100) High
AST: 82 U/L (0-50) High
ALKP: 619 U/L (23-212) High
GGT: 31 U/L (0-7) High

Ultrasound Findings:
Gallbladder is normal in size. The gallbladder walls are Hypoechoic and severely thickened up to 13mm. The liver parenchyma is within its normal limits. The liver margins are mildly rounded. The DDX for the gallbladder include sever inflamation, infection and mucinous hyperplasia. The small and large intestines, pancreas and mesenteric lymph nodes are within normal limits. The stomach is filled with a mild to moderate amount of fluid.

Gallbladder culture findings from aspirate:
No aerobic growth, no anaerobic organisms isolated.

10/16/13:
MCV: 61.1 fL (61.6-73.5) Low
BUN: 7mg/dL (7-27) Low
ALT: 859 U/L (10-100) High
AST: 148 U/L (0-50) High
ALKP: 920 U/L (23-212) High
GGT: 18 U/L (0-7) High

Ultrasound findings:
The fax did not come through well so I am picking up a copy at the vets today.

Liver Findings from aspirate:
The aspirate contains significant numbers of hepatocytes. The hepatocytes appear amture and well differentiated. They do not demonstrate evidence of atypia or criteria of Malignancy. The hepatocytes display evidence of a vacuolar hepatopathy consistent with the accumulation of glycogen. This condition is frequently associated with the administration of Corticosteroids or high levels of glucocorticosteroids. Additional causes include the administartion of anticonvulsant medications. In older dogs nodular hepatocellular hyperplasia or hepatic adenomas can display similar vacuolar changes. No evidence of infection, inflammation or malignancy is observed. Histopathology may be useful in ruling out a mild infiltrative or inflammatory disease and is recommended if clinically warreanted

10/18/13:
SNAPshot Dx:
Baseline cortisol: >10.0 ug/dl
4 hour post low dose dex: 0.8 ug/DL: 0.8 ug/dL
8 hour post low dose dex: 2.1 ug/dL

[molly muffin]

The numbers are all consistent with liver issues, which could be a result of the inflammation and infection in the gallbladder. This would also cause the cortisol levels to be higher and could make the LDDS invalid. The LDDS, Moe suppressed below 1.0 at 4 hour and just barely out of range at the 8 hour. So I'm not overly convinced of cushings, as LDDS can show positive in the presence of any other sever illness. (such as the gallbladder).

I'd continue to monitor Moe carefully, and then I think I'd want another blood panel done at the same time they do the ACTH test.

How is Moe doing today? Still running around and playing?

Some of the others will be along too and can give you their thoughts on the test results.

hugs,
Sharlene and Molly Muffin

[frijole]

Those numbers just don't look like cushings to me - I can't get over the high ALT numbers and the other illnesses. Your dog's symptoms are not screaming cushings unless I missed something. I wouldn't treat until more tests were done - namely an acth test and/or an ultrasound that views the adrenal glands. The one that you had done focused on the gall bladder. By chance did they get a peek at the adrenals and just not write it up?

I'm going to link you to 'intro' info on cushings and ask that you read it and think about whether or not your dog has some of the symptoms. Understand there is NO RUSH to treat a cush dog so don't feel like you can't take the time to get it right. Hang in there. I had a cush dog and then I had a 2nd dog that was misdiagnosed so I know first hand it can happen even if you are experienced. So look at the symptoms. Thanks. Kim
http://www.k9cushings.com/forum/showthread.php?t=180

[Squirt's Mom]

Mornin',

Here is some info on those liver values -


Liver value info -
This is the quick and dirty breakdown of some of the most important liver values:

• ALKP is important in metabolism and is found in liver cells.
High levels indicate bile duct obstruction, Cushing's, liver disease,
certain cancers and may be due to certain drugs such as steroids or
phenobarbital. Low levels indicate starvation or malnutrition.

• AST is important in the breakdown and elimination of nitrogen.
High levels indicate muscle damage, heart muscle damage, liver
damage, toxin ingestion, inflammation and various metabolic
disorders. Low levels indicate starvation or malnutrition.

• ALT is also important in the metabolism of nitrogen and is most
often associated with the liver. High levels indicate liver damage,
toxin ingestion, Cushing's disease and various metabolic
disorders. Low levels indicate starvation or malnutrition.

• GGT is also important in nitrogen metabolism and is found
within liver cells. High levels indicate bile duct obstruction, liver
disease, pancreatitis, Cushing's and can be caused by high levels
of steroids. Low levels indicate starvation and malnutrition.

• Bilirubin is a bile pigment and is the end product of red blood
cell breakdown. High levels typically result in jaundice and can be
due to bile duct obstruction, gall bladder obstruction, liver disease
and rapid breakdown of red blood cells. Low levels are not considered
clinically relevant.

I'm looking forward to seeing what the ultrasound has to say and hope they did get to see the adrenals.

On the SNAP test - is there any info on how to interpret those results?

How is Moe this morning? How are YOU this morning? :D

[MoesMommy]

Morning!
Thanks everyone for your input. Moe is awesome! Running around, playing.... I missed a call from the vet last night. She is not Moe's primary but she was there when they did the second ultrasound. She is going to try me back today. Some notes from Moe's second ultrasound...

A mild amount of echoic bile is within the gallbladder. The liver is normal in size with midly rounded margins. The echogenicity of the liver may be midly decreased. A cranial portal Lymph node is midly large 10x13x24mm and heterogenous characterized by anechoic areas most suggestive of cysts. DDX for the liver findings include normal, active hepathophy, inflamation, infiltration, infections, ect. The DDX for the lymph node findings include: reactive node, benign cysts and less likely metastic neoplasia.

His gall bladder wall on 9/26 was 1.31cm, on the second ultrasound on 10/16 it was 0.12

[MoesMommy]

Sorry, on the snap test the interpretations are as follows...

4-hour<1.5ug/DL or <50% of baseline and 8 hour>1.5ug/dL and <50% of baseline

[goldengirl88]

Kim:
What are they going to do about the Gallbladder sludge? Tipper is on Ursidiol and that has helped her and brought her values down. Blessings
Patti

[MoesMommy]

Hi!
Moe is on Ursidiol for his gallbladder. I had a long talk with the vet last night. From his second ultrasound both gallbladder and liver look great, almost normal now. Of course the liver shows signs of scarring from it being overworked by the overproduction of cortisone. The aspirates of both showed no sign of disease. The presence of the vacuolar Heptopathy is what lead to them to test for cushings as everything else was ruled out. My vet and I are on the same page, they really take their time to make sure I understand everything. Moe goes back in on 11/1 for his ACTH so fingers crossed!! He is bouncing around loving life. We went on 4 walks yesterday and he could not be happier! Thanks everyone for all the support. I will be checking in!

[molly muffin]

That is really great to hear Kim. I'm so glad that the gallbladder and liver are both looking much better!
whoo hoooo! I am sure from the way Moe is acting that everything will be fine. Is the vet going to reevaluate if he thinks that cushings is still in play or not or is he pretty sure that it is?

I know you are probably like the rest of us, just get Moe up back to his normal cheerful, happy self. Sounds like you guys are doing really well in that regard too. I wonder if you might have caught this gall bladder problem really early in fact, as many of the pups we see with gall bladder issues can take awhile to clear up. Whatever, the reason, we'll take it and again, super glad things are going so well with you and Moe.

Sharlene and Molly muffin

[goldengirl88]

Great to hear Moe is doing so well. Hope he continues to improve. Blessings
Patti

[molly muffin]

Hey there :) Moe still having a good time today? :)

Sharlene and molly muffin

[MoesMommy]

Morning!
Yes, Moe is doing great! He has started to slow down on his food eating, does not finish breakfast but he has always been like that. I will continue to check in and let you know how his test goes on 11/1. Thanks so much for being so wonderful!

[addy]

Hi Kim,

Glad to read the good news. I hope Moe continues to do well! we will look forward to his ACTH results on the 1st:)

[MoesMommy]

Hi everyone. Just an update on Moe...
He is doing well, being Mr. Picky when it comes to his food but other than that great. We just finished a long walk and play session. Now he is sleeping beside me.
I got in the results from his test on Friday and not where we had hoped.
Baseline 3.9 ug/dL
Hour later 23.1 ug/dL
We are moving him up to 20mg with retest in four weeks. He had his first dose of the 20 this morning and all seems good so far :)

[molly muffin]

Drat. Hoped that post number would have been better. The main thing though and what is most important is that he is doing good, playing, eating okay (although picky) and over all not showing any problems. Keep an eye on him and retest in about 2 weeks again.
Remember that cortisol levels can continue to drop even after the 30 day mark.
Great to hear from you again!

hugs,
Sharlene and Molly Muffin

[MoesMommy]

Yes, I am trying not to let it get to me but I was hoping for better. I am just going to try and focus on how well he seems to be doing and that he is happy. Thanks so much

[molly muffin]

Well don't get discouraged. It can take time and tweaks to get that good dosage and the numbers were you want them. :) Barbara has been doing this for like 4 months with her Trixie and I think she is just now to the point of being happy with things. We'll know more after the next ACTH test, so you aren't alone by any means.

hugs,
Sharlene and Molly Muffin

[MoesMommy]

Morning all!
I hope everyone had a great Thanksgiving. I am happy to report that Moe's ACTH test was on Friday and he was right where he should be! YAY! I don't have the results with me but his pre was 3.something and his post was 6.something.... YAY! He goes back in January for a full blood workup. As far as how he acts...you would still never know there is anything wrong with him :)

[Squirt's Mom]

WOOHOO!! Way to go Moe and Mom! :D

[grapey]

Those are good numbers! Great!!

What a cute picture of you two.

[addy]

Congrats!!!:D:D:D

[molly muffin]

Yay!!!! Way to go Moe!! This is really wonderful news!!!!

Happy Thanksgiving and now a Merry Christmas too. :)

hugs,
Sharlene and Molly Muffin