Emily - 13 year old JRT

[MechaAlice]

I'm new on this board, so hello everyone! I am an LVT with a 13 year old JRT who is newly diagnosed with Cushings. Her pre ACTH was 7 and her post was 49. She has super cushings. I have been in vet medicine for 12 years. I am using compounded trilostane at 11mg/ml twice a day. She (Emily) goes back for another ACTH stim on wednesday.

[Harley PoMMom]

Hi and welcome to you and Emily!

I was wondering if you could tell us more about Emily's history, so I will start with some questions! :eek: What symptoms did she display that lead you or your vet to test for Cushing's in the first place? How much does she weigh? What test/s were performed to diagnose Emily's Cushing's, and could you post those results? Was a chemistry/CBC blood panel done, and if so, could you post those levels that are marked high or low with their units of measurement and reference ranges? Is Emily taking any other herbs/supplements/medications? Does she have any other health issues? Was an urinalysis done, and if so, could you post those findings? I am sorry for all these questions but the more we know about sweet Emily the better our feedback will be, ok?

Looking forward to hearing more about your girl.

Hugs, Lori

[MechaAlice]

What symptoms did she display that lead you or your vet to test for Cushing's in the first place?
Emily had been PU/PD for a few days. She was also shaking a lot and had trouble getting on the furniture. She had gained a little weight and was generally less active.

How much does she weigh?
Emily is a small JRT, she weighs 11 lbs.


What test/s were performed to diagnose Emily's Cushing's, and could you post those results?
I did an ACTH stim. I was pretty sure she had Cushing's by this time, so for cost reasons I went with the stim rather than a low dose dex est. Her pre was 7.9 and her post was 47.4.


Was a chemistry/CBC blood panel done, and if so, could you post those levels that are marked high or low with their units of measurement and reference ranges?
At the time of her stim I redid a chem/CBC/UA that I had done in December as part of her annual BW. Her CBC was normal. Her UA showed she had a urinary tract infection, which we already knew and were treating. Her chem showed elevated:

Chloride- 103 (108-119)
TCO2- 30 (13-27)
ALT- 399 (18-121)
ALP- 660 (5-160)
GGT- 43 (0-13)
Cholesterol- 377 (131-345)


Is Emily taking any other herbs/supplements/medications?
Right now Emily is only taking Heartgard and Trilostane. I stopped her joint supplement (synovi G) briefly between blood tests to see if that was affecting her liver values. She also has a seresto collar. No other medications currently.


Does she have any other health issues? Was an urinalysis done, and if so, could you post those findings?

She has no other health issues. She has always been a healthy dog. I did do a urinalysis, she had urinated in the house twice, which is highly unusual for her. She had a UTI at that time, I don't have the results available, but she did have a urinary tract infection and was treated for that.

I am sorry for all these questions but the more we know about sweet Emily the better our feedback will be, ok?

Thank you! I don't mind the questions, and I would love any feedback. As a vet tech I have treated lots of Cushing's patients, but this is the first time I have dealt with it first hand. It's amazing to me that I didn't see the pot belly Emily developed. I attributed her symptoms to aging. It's just surprising to me what you don't see in your own house!
http://i83.photobucket.com/albums/j316/MechaAlice/emilybed.jpg (http://s83.photobucket.com/user/MechaAlice/media/emilybed.jpg.html)

Her Cushing's belly: http://i83.photobucket.com/albums/j316/MechaAlice/emilybelly.jpg (http://s83.photobucket.com/user/MechaAlice/media/emilybelly.jpg.html)

[Squirt's Mom]

Did she have the ACTH while the UTI was active? If so, the results may be skewed. The signs you mention are part of Cushing's but some of the most common are not mentioned - voracious appetite, hair loss, muscle loss, exercise intolerance, panting. Was an abdominal ultrasound performed? This test saved my Squirt's life during the diagnostic phase by finding a tumor on her spleen that was responsible for her elevated cortisol and positive tests. Once the tumor and half her spleen were removed, the cortisol returned to normal.

Cushing's is one of, if not THE, most difficult canine condition to correctly diagnose because so many other condition share the same signs and can cause false positives on the tests. So it is always best to do as much testing as possible before starting any treatment to rule out other causes. But, I'm sure you already know this as a vet tech. ;)

I'm glad you found us and look forward to learning more as time passes. We are a Lysodren house so I don't usually participate on Trilo (Vetoryl) threads very much but I did want to welcome you and ask about the timing of the test with the UTI.

Hugs,
Leslie and the gang

[MechaAlice]

Did she have the ACTH while the UTI was active?
The ACTH was done after her treatment for the UTI.

The signs you mention are part of Cushing's but some of the most common are not mentioned - voracious appetite, hair loss, muscle loss, exercise intolerance, panting.

I forgot to mention this. Emily has been eating EVERYTHING. I was baking cupcakes one day and she stole a stick of butter off the counter. She eats dust bunnies. She attacks her food, and will eat anything. She has muscle loss in her rear limbs, which I had attributed to her aging. She shakes constantly. The hair on her belly is sparse. She doesn't play with her toys much. A couple of tosses and she's done. Again, I just thought it was age related. She does not pant, which I am thankful for. I have not done an ultrasound yet, finances are a factor, vet techs do not make much, and US would be another $400 on top of the other test costs I'm doing. And I just spent $600 on my 13 YO Chihuahua (Cody) who had pneumonia last month. I'm currently waiting to see how the medication goes. She has another stim tomorrow, after 2 weeks on Trilostane.

[Harley PoMMom]

Strong obvious symptoms do play a huge part of a Cushing's diagnosis, which Emily does have and along with her high post on the ACTH stim test, I too think that Cushing's is the culprit. However, I would of liked to see another test done to validate her Cushing's diagnosis such as the LDDS test. The LDDS, ACTH stimulation, and/or the UC:CR are the tests that are usually performed to diagnose Cushing's and since there isn't one test that is 100% accurate at diagnosing Cushing's multiple tests are used to confirm a Cushing's diagnosis. The one factor with the LDDS test is that it has the ability to differentiate between adrenal or pituitary based Cushing's.

With Trilostane/Vetoryl it needs to be given with food to be properly absorbed. Also, the timing of the ACTH stim tests are important, the ACTH test should be performed 4-6 hours after the dose of Trilostane/Vetoryl is given.

We have a Resource thread that has a wealth of information regarding Cushing's, here's a handy link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Within our Resource thread is information about Trilostane/Vetoryl, the link: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Feel free to print anything out. ;) We are here to help in any way we can so do not hesitate to ask all the questions you want.

Hugs, Lori

[goldengirl88]

Welcome to the forum. I too have a JRT with Cushing's. Her whole body shape looks different now from the Cushing's wasting her muscle. She is still pretty active for all she has been through. Are you not getting the LDDS test? I started Tipper on 10 mg and she has had several dose changes in the last year and a half. She was in excellent health before this and walked miles a day. I think that being in shape really helped her. I hope all goes well with your baby. Blessings
Patti

[MechaAlice]

Thank you all for the welcomes! I am really learning a lot reading this board!

[molly muffin]

Welcome to the forum!

The others have got you started with the questions and you've actually already answered them. Awesome.

It sure does sound like the symptoms and the ACTH match cushings. Don't really like the high other values as normally we typically see, the ALKP go up and a the ALT maybe a bit. The others though, would definitely like to see more normalized. Is this the first time these values have been off from normal?

With the starting dosage, and I don't know what your clinic normally does, but Dechra the manufacturer now likes to start at the low end of 1mg/1lb dosing. The dogs seem to adjust to the cortisol drop and do better if they are brought up more gradually. So, keep an eye out, in case Emily is sensitive and drops too much too fast. (we're worry warts here)

Welcome again
Sharlene and Molly muffin

[MechaAlice]

[QUOTE=molly muffin;142563]Welcome to the forum!
Is this the first time these values have been off from normal?

Her normal senior bloodwork showed high liver values in all of these areas. I had just started a new joint supplement and I stopped it to see if that made a difference. It did not.

With the starting dosage, and I don't know what your clinic normally does, but Dechra the manufacturer now likes to start at the low end of 1mg/1lb dosing.

I am using compounded trilostane from wedgewood. Not the brand name vetoryl.

Thanks again for all of your knowledge, I had no idea that there was so much that I didn't now about Cushings!

[Harley PoMMom]

Trilostane is the active ingredient in Vetoryl. So, when one uses compounded Trilostane they still can use the protocols from Dechra.

[Harley PoMMom]

I am using compounded trilostane at 11mg/ml twice a day. She (Emily) goes back for another ACTH stim on wednesday.

I am assuming that Emily's Trilostane is in a liquid form? How many ml is she taking? Since she weighs 11 lbs her starting dose should be no higher than 11mg.

[MechaAlice]

I am assuming that Emily's Trilostane is in a liquid form? How many ml is she taking? Since she weighs 11 lbs her starting dose should be no higher than 11mg.

It is in a bacon flavored liquid. She takes 1 mL twice daily with food. I have pred on hand if I need it but so far she's shown nothing but improvement. No accidents in the house for a week and tonight she keeps bugging me to play with her toys.

[Harley PoMMom]

It is in a bacon flavored liquid. She takes 1 mL twice daily with food. I have pred on hand if I need it but so far she's shown nothing but improvement. No accidents in the house for a week and tonight she keeps bugging me to play with her toys.

So glad to hear that Emily is doing so well!!

Hugs, Lori

[MechaAlice]

So glad to hear that Emily is doing so well!!

Me too. She has been my companion for 13 years. She is my best friend. I know that her time is going to eventually come to a close but I'm just not ready yet. She has really showed some improvement on the trilostane. Right now she is squeaking a toy that I have no idea where it came from. (I'm housesitting for the next two weeks) and she is having a great time!

[molly muffin]

Love to hear that she is feeling good enough to play with her toy! :)

Sharlene and Molly muffin

[goldengirl88]

That sounds great a bacon flavored liquid. What dog could resist that?? It is so good to hear that she is perking up. Blessings
Patti