Need advice on meds

[dixiedog11]

I am new to the site and we just got the news that there is a really good chance our 12 yr old Golden Retriever has got Cushings Disease. She is showing all the classic signs; heavy panting, increased appetite, and increased thirst. She is scheduled for a low dose dex test of the adrenals on Tuesday to make sure but our vet asked me to go ahead and look at the different treatment options. She suggested either Lysodren or Vetoryl. Where the next problem comes in is that she already has liver disease. In doing my research I saw that they both stated to use caution in giving to dogs with liver disease. The profiles of each drug seemed to very similar. Can anyone give me any advice one way or the other on these two drugs? I appreciate any help or feedback.

[Squirt's Mom]

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[lulusmom]

Hi and welcome to the forum.

Dogs with cushing's have elevated liver enzymes, specifically moderate to severe elevations in alk phos with mild elevations in ALT and sometimes GGT. I just want to make sure that you know that these abnormalities are not caused by primary liver disease but rather the accumulation of glucogen due to the high levels of cortisol. This usually causes no clinical problems for a dog and these abnormalities usually improve with treatment. However, they often don't return to normal but again, it doesn't usually cause any clinical problems. Was your dog formally diagnosed with primary liver disease based on a liver biopsy, bile acid test, etc?

It would be really great if you could round up the tests that have been done so far and post the results here. With respect to blood chemistry, cbc and urinalysis, you need only post the abnormal values with the normal reference ranges. The more information you can provide us, the better able we can provide appropriate feedback.

Since your vet has asked that you take a look at both meds, I highly recommend that you access our Helpful Resources section where you will find a wealth of information on both drugs. In the meantime, please let us know if you have any questions.

I'm very sorry for the circumstances that brought you here but I'm glad you found us. We'll do whatever we can to help you help your pup.

Glynda

[goldengirl88]

Hi and welcome to the forum. Sorry your baby is having problems. I was interested in knowing if you have had diagnostic tests done confirming liver disease? If not I am hoping you or the vet are not assuming that from a lab report showing high liver values? Your dog does have some of the symptoms of Cushing's. It is a very hard disease to diagnose so it requires several tests to determine the diagnosis. Please given us the results of your low Dex test when you get them. It is a good idea to always ask for and keep copies of any testing.
As Glynda said most Cushing's dogs have high liver enzymes so we are just not wanting you to think that automatically means liver disease. Blessings
Patti

[dixiedog11]

If not I am hoping you or the vet are not assuming that from a lab report showing high liver values? Your dog does have some of the symptoms of Cushing's.

Thanks for the responses. We are not going off of a high liver enzyme result. Back in October, her liver values did go way up to around 1300, so we did an ultrasound and found a mass on her liver. It was a hard decision since she is 12, but I decided to have it removed. The biopsy showed that it wasn't cancerous. We then started taking denamarin to help supplement the liver. Fast Forward to now, after going to the vet with another issue, I talked to her about how she was acting and she mentioned Cushings Disease. That's what has brought me here. I will see if I can get a cop of the recent bloodworm that was done. She did tell me that the liver values jumped to over 2000.

I will see about getting the rest on Tuesday when I take her for her test. Thanks for your help.

[molly muffin]

We have another dog on the forum, who also has had a couple masses removed from his liver. Flynn. He doesn't have cushings though, as there wasn't any high cortisol values. Have you had another ultrasound to see if any further masses have shown up on the liver as sometimes they do end up with more than one.

We'll definitely be interested in the test results so far and crossing fingers that the LDDS test on thursday will be negative. :)

Sharlene and molly muffin

[dixiedog11]

Dixie is currently at the vet getting her low dex test done. I did get them to give me the results of her blood test and urinalysis.

On 12/26/13:
Globulin 3.9, normal 1.6-3.6
ALT (SGPT) 1084, normal 12-118
Alk Phosphatase 863, normal 5-131

On 2/26/14:
Globulin 4.0
ALT (SGPT) 1927
Alk Phosphatase 727

other high results from 2/26:
Total protein 7.6, normal 5.0-7.4
AST (SGOT) 136, 15-66
BUN/Creatinine Ratio 30, 4-27
Cholesterol 457, 92-324
Amylase 1381, 290-1125
Platelet Count 616, 170-400

Urinalysis from 2/26/14
Specific Gravity 1.012, 1.015-1.050
Microalbuminuria 5.5, less than 2.5

I will update more tonight after I pick her up.

[molly muffin]

Did her liver enzymes go down after the surgery to remove the liver mass?

I'm seeing pretty high values on ALT still, and that is much higher than we normally see in cushings. Have you had a follow up ultrasound done? Many times they do them every 6 months, unless there is a reason and it sounds like there is a reason to do a follow up. Often if they think there are further problems with the liver, they do ultrasounds every 3 months. (I think our other dog Flynn is now doing a follow up after surgery at the 3 month mark).

I would be concerned with these values more of an additional liver problem or other problem rather than concentrating on cushings. That is just what I think from looking at the lab results from a lay person point of view.
Hopefully some of the others will be by to give their input soon too.

Sharlene and molly muffin

[molly muffin]

I wonder if the gall bladder has been checked? If not, then an ultrasound to see if there is any blockage might be useful.

Sharlene and molly muffin

[dixiedog11]

Her liver values went down a little but obviously went back up. We are due for an ultra sound in April, she had her surgery in Oct. The vet wants to see the results of the test today before she decides if she wants to move the ultrasound up or not.

Thanks!

[molly muffin]

Hi I wanted to check in and see what see how things went with the last round of testing. Did the ultrasound get moved up or is it still set for April?

Sharlene and molly muffin

[dixiedog11]

We did go ahead and do the ultrasound. It was not good news. As expected her adrenal glands were enlarged, but they also found that the tumor we had removed from her liver back in October had returned. We are starting her off on a low dose (30 mg) of Vetoryl to see if it will relieve the effects of the Cushings disease. Unfortunately, If that doesn't work, we would probably think hard about putting her down. We can't give her a high dose of the Vetoryl with the liver disease that she has, our vet is afraid that it would do more harm than good so we are trying to do a low dose to see if it works. It is very hard to know when the right time is to put her down. Needless to say it has been a very emotional week for us. And on top of that my wife had to have her spleen removed this week. Thanks for all your suggestions and prayers!

[molly muffin]

Oh my gosh, you have had a very bad week. :( I'm very sorry to hear both that Dixie's liver tumor has come back and your wife had to have her spleen removed. Unfortunately this does happen. One of our members have had liver tumors removed twice so far and a pheo adrenal tumor removed. Do they know if the one that came back on Dixie is benign?

On a very off topic, since your wife had her spleen removed, next year make sure she gets the pneumonia vaccine. Both my mother in law and brother in law have had their spleens removed and it's more important that they get that vaccine due to not being able to fight off pneumonia as easily if they catch the flu.

I hope this low dose of vetroyl works and you'll have Dixie around for a good long time.

Sharlene and Molly muffin

[goldengirl88]

I am so sorry about Dixie's tumor. Do they think they could remove it laproscopically? That would not be as invasive and not so much recovery. Also you said you were starting on a low dose of Vetoryl at 30mg. How much does Dixie weigh? You would probably do best at 1 mg per pound. I am so sorry to hear your wife had her spleen out. I am hoping things turn out well, and your Dixie has more options.Blessings
Patti

[dixiedog11]

Unfortunately, the tumor on her liver is inoperable. It has grown to about 8 in by 6 in. We do not know if it is benign or not. But it has grown to that big since the end of October.

Dixie weighs about 75 lbs. We decided to do the 30 mg of vetoryl for 4 days and the bump it up to 60 mg if it doesn't work. Our vet is afraid that her liver would not be able to handle the high dose so we started out with 30 mg.

I am going to talk to her tomorrow about what our options are. I have noticed that Dixie is getting up a lot slower the last couple of days and she has been walking a little different. The vet did say that when they did the ultrasound Dixie was in some pain so they had to give her a sedative. I am going to talk to her about her pain and try to decide when the humane time to put her down would be. I am tearing up as I am writing this:(

[molly muffin]

Oh my gosh. What a horrible position to be in. My heart hurts for you and your family.
I am so sorry. We are here to support you through this horrible time. If you have any questions we'll try to answer them for you.
One thing that might be better is not treating for Cushing's if Dixie is exhibiting pain. I say that because the higher cortisol actually could be helping her to feel better than lowering it will. We find this with arthritis and other ailments too. So I don't think if it was me I would worry as much about the Cushing's and just concentrate on what will give Dixie the best quality of life. That is something you can discuss with your vet tomorrow.

Sharlene and Molly muffin.

[Trish]

Gosh what a horrid time for you all, you poor thing that deserves a big hug right at the beginning of my post!

My dog has also had liver tumours. I am sorry that Dixies is inoperable? Have you seen a surgeon who has said that? I am just saying this as my dog has had two large ones removed.

The first one way back at the end of 2011. It was found after he collapsed and I always remember rushing to the vets and they told me that it was most likely curtains. As they had seen the large mass on ultrasound. I took him home that night with his IV drip still in and was getting ready to say goodbye. They did not give much hope but said if he was still alive the next day we could biopsy but she was not even sure if she would do it for her own dog. Well he perked up that night, so I did get a biopsy done and it came back benign! :eek: So he was rushed to the surgeon and had most of the left side of his liver removed.

It did have a low grade malignancy in the histology, it was called a Massive Hepatocellular Carcinoma. He also had a few other lumps and bumps in his liver we have monitored. One did grow and he had it removed end of November 2013, it is also benign adenoma or low grade HHC again. It was 9cm which is big for him as he is a fox terrier. This one also grew fast over a six month period like Dixies has.

So I hope Dixie has seen a surgeon as liver masses and often those big tumours can be like Flynn's and removable as he has had done twice now. His liver enzymes have only briefly been under 1000 for ALP since he had his first op over two years ago. Flynn also had adrenalectomy in between his two liver surgeries for good measure, it is amazing what they can get though! I hope this can give you some hope. He is 12 now, the last liver surgery a few months ago, he flew through. Honestly it was like he had something small done the way he recovered. Best of luck getting it sorted out and hope things for your family run smoother!

[goldengirl88]

I was also just curious if you had seen a surgeon for their opinion of removal? I did not ask you if they could tell if it had metastasized? Please keep the faith that your baby receives a miracle. I am praying for you both. Blessings
Patti