America Eskimo almost 11 years old

[otilia]

My dog is America Eskimo almost 11 years old. Feb 3rd he started urinating and drinking lots. The vet ran all different tests, and concluded that it is cushing disease in pitutiary gland. The vet got him on 20 mg of vetorly however the drinking and urination didn't improve. Now he increased the dose to 60mg and it's almost 2 weeks and very little improvement. I found my dog deteoriating, sometimes he trembles, poor appetite, lack of energy. I am just wondering if Lysodren would be better?

[Harley PoMMom]

Hi and welcome to you and your boy! So sorry for the reasons you need us but glad you found your way here.

In order for us to provide you with better feedback we need to know more about your boy. How much does your boy weigh? What test/s were done to confirm your boy's Cushing's diagnosis, and could you post those results? Was a cbc/chemistry blood panel done and if so could you post any levels that are marked high/low with the units of measurement and reference ranges..i.e.ALT 150U/L (5-50)...Thanks! Is your boy taking any other herbs/supplements/medications? Does he have any other health issues? Could you post his ACTH stimulation results?

Poor appetite is not the norm for a dog with Cushing's, these dogs have a ravenous appetite. Did his decline start after increasing the Vetoryl to 60mg? If so, it sounds like your boy's cortisol has dropped too low and stopping the Vetoryl would be needed, I would also put a call to the vet and let them know that he is feeling unwell.

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

Hugs, Lori

[Renee]

Hello and welcome.

It sounds like your dog's cortisol has gone too low. Also, it sounds like your vet is woefully uninformed about cushings and the very serious medications that are used to treat cushings. It scares me that your dog has been diagnosed for less than a month (if the diagnosis is even correct to start with), and already your vet has jumped up the dosage so dramatically.

Please take a look at the helpful resource section, learn as much as you can about this disease, and then find a new vet.

[goldengirl88]

In my opinion the problem is going from 20 mg Vetoryl to 60!! What vet in his right mind does that??? Your vet needs to call Dechra and be instructed on the protocol and proper use of Vetoryl. Please do not give any more Vetoryl. It is making me angry that these vets are using Vetoryl so carelessly. Please tell us what your dog weighs. You can call Dechra yourself. I would be giving no more than 1 mg per pound to start out. If your dog weighs 60 lbs this dosage is correct. The safest way to manage your dog on these drugs is to start low and let the dogs body adjust to the drug. Then if need be increase it in small increments to minimize problems. Did you dog have another ACTH before changing the 20 mg to 60mg? That is supposed to be done 2 weeks after starting a new dose, or changing doses. This vet has acted very careless with your dogs life if this was not done. Blessings
Patti

[molly muffin]

Hello and welcome to the forum.

Did your vet rule out diabetes, thyroid problems, a UTI via a culture? Those things all need to be ruled out before going to cushings diagsnosis.
Cushings typically comes on quite slowly, not all the sudden. Also, poor appetite is not a good sign with a cushing dogs, they have ravenous appetites.

I agree 1mg/1lb is the stated protocol now. Dechra will state this as their preferred starting dosage. Too bad, they won't change their insert in the medication as it really can mess up vets who only read the insert and take it as gospel. It is much better if the vet checks with Dechra directly or you do.

Welcome to the forum and hopefully we can give you feed back to help get this figured out. I know it's tough but the more you learn about all this, the better it will be and the better to consult with your vet.

Sharlene and Molly muffin

[otilia]

Q-Tip my dog's weight was 55 pounds 2 weeks ago.. The first day which we visited the vet kept the dog stayed overnight to do all the blood work, urine and an x ray to his tummy. The blood were baseline. The urine was clear from bacteria. As the vet explained the blood at 2 hours was normal at 4 hours slightly above normal if the max was 40 my dog was at 41 and at 8 hours the same type of result. The vet concluded that was pituitary gland problem. The dog started the vetoryl 20mg and after week and half because I didn't see any improvements with drinking and urinating. We went back to the vet, he decided to get the dog on antibiotic clavaseptin 250 mg 1 pill and half twice a day. The vet rationalization is even though no bacteria was showing in the urine it's possible that there was some. After 5 days without any changes we went back and vet decide to have an ultrasound. The ultrasound show no damage in the liver, kidneys and bladder, so the vet concluded that definitely this is pituitary cushing. The same day the vet also did a urine culture. and we started the vetoryl 60mg. My vet went away on vacation and another vet called me 5 days later to tell that the urine has shown a bacteria and Q-tip had to be on antibiotic for at least 4 to 6 more weeks. It has been almost two weeks with the vetoryl 60mg and the antibiotic and no improvement at all with drinking and urination.
I been searching for answers and trying to help my dog, I ordered on line Adrenal Harmony Gold and for almost two weeks he has been taking half of the daily dosage with 12 hours apart from the vetoryl.
Q-Tip is very lethargic, doesn't go for walks, his back legs some times are very tremulous, and he trembles.
The vet is back from vacation and tomorrow I have an appointment.
My dog gets very stressed when he goes to the vet, I am not too sure if the results for the cortisol are really accurate because of his stress level when he is there. I am going to ask him for all the results.
Thanks so much

[Harley PoMMom]

It's a huge red flag for me that your vet does not have a lot of experience treating dogs with Cushing's and is not knowledgeable about the proper protocols for testing. When a dog starts Trilostane/Vetoryl a dose adjustment is usually not done until the 30 day mark because cortisol may continue to drop until then. Also an ACTH stimulation test should have been performed before any dose adjustment was made. Dechra, the makers of Vetoryl, state in their product insert that when there is a dosage adjustment an ACTH stimulation test should be done within 14 days.

Is Q-Tip (such a cute name!) getting his Vetoryl with food so that it is properly absorbed? If a monitoring ACTH stimulation is performed it has to be 4-6 hours after the dose of Vetoryl is given, is this the protocol the vet is following?

Could you get a copy of those LDDS test results and post them here?

An UTI will cause a dog to drink and urinate more, and if the LDDS test was done with Q-tip having an UTI the results can be skewed.

Does Q-Tip have a ravenous appetite? Any skin/hair issues? If increased drinking/urination along with LDDS test results that could be falsely positive, I question Q-Tip's Cushing's diagnosis. Cushing's is difficult to get a confirmed diagnosis for and a Cushing's savvy vet will perform multiple tests to validate a Cushing's diagnosis.

Please do let us know how things are going, ok?

Link to Dechra's product insert: Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

Hugs, Lori

[bgdavis]

Hi and Welcome,

I have just one quick question. What was Q-Tip's blood glucose reading? Symptoms sound more like diabetes than Cushings'.

Bonnie and Angel Criss

[otilia]

Hi we had to stop treatment. Q-tip was very week shaky and lifeless, no appetite. We went to see a internal medicine specialist in animal hospital. They redid all the blood work ACTH , urine, did another ultrasound and an xray and the conclusion is cushing disease. The doctor recommended that we stop vetoryl. He is been off medication for almost 2 weeks. His appetite is better but not his normal. He keeps on drinking and urinating lots. Now the only another option is to get him on Mitotane. I am going to see the vet tomorrow and we will are going to give it a try. I am afraid because of the mitotane side effects. His appetite is not that great, and mitotane effects the stomach lining. I will cook chicken and see if it works. I got the mitotane through a human pharmacy so it's more affordable. We already spend lots of money without any results. My husband and I found ourselves crying and wondering if this it is right to put Q-tip through this?. I believe the vet and the specialist don't have lots more
alternatives. The specialist suggested to have a MRI, however whatever the results, there is no surgery in Canada, and radiation will have other side effects in addition to the cost.
I am hoping for a miracle with the Mitotane. Thanks for your advise.

[Harley PoMMom]

A 30 day waiting period is generally recommended when switching from Vetoryl to Mitotane (Lysodren) or a recurrence of clinical signs consistent with Cushing's, and a post-ACTH cortisol level of > 9.1.

Hugs, Lori

[Iraklis]

If you can afford an MRI ,i would urge you to do it!
It will answer a lot of questions, and (trust me on this) you won't regret it for one second!

If possible do a biopsy of the liver to check for excessive signs of corticosteroids/cortisol ,as cushings doesn't seem to be the 100% verified diagnosis!

I would not start mitotane...as said before a 30 day waiting period is recommended!

Drinking/urinating will be the least of your worries should he be treated for something he doesn't have.
I understand your frustration and anxiety but take deep breaths and go one very careful step at a time...


P.S. As Dr.Peterson informed me in his blog ,breeds not prone to Cushings (ex. yours or my Husko) many times do not develop all the classic signs of cushings so i think diagnosis has to be 100% verified before starting a drug as dangerous as Lysodren!

[Squirt's Mom]

Do not start the Lysodren until Q Tip is feeling better and completely over this upset. Appetite is a big sign with these drugs and starting off with a decreased appetite is not a good starting point because it can really confuse the picture causing us to miss signs the cortisol has gone too low. Please wait a bit longer before starting the Lysodren. Please.

Has Q Tip had an ultrasound? If not, I think I would have that done before starting the Lyso as well just to make sure there isn't something else going on.

We really need to see some test results. So when you are at the vet's tomorrow ask for copies of all the test results that were done to diagnose the Cushing's in the first place. Call the IMS and ask for copies of their recent tests, too. Include any lab work that shows things like ALP, BUN, CHOL, etc. Then post those results here. We only need to see the abnormal ones (too high or too low) from the blood work that shows ALP, etc. But we need to see all the numbers from any LDDS, HDDS, UC:CR, or ACTH. It would help if you would post these BEFORE starting the Lyso, too. ;)

I am getting concerned about your vet's experience with this disease and the drugs used to treat it. I would like to double check the dose of Lyso they recommend and the instructions you are given for the loading, or induction, phase. Make sure they give you Prednisone to have on hand just in case. Do not leave that office without it UNLESS they can promise you they will be available to you 24/7...just a phone call away. ;) This is not an option with Lysodren - you must have either pred on hand or a vet who will meet you at anytime of the day or night.

I know these drugs sound scary when we read about them. But the fact of the matter is, it's not the drugs that are scary nor any more risky than aspirin WHEN HANDLED CORRECTLY. Aspirin can be fatal if mishandled. ;) And that is my concern - that your vet may not handle things correctly, putting Q Tip at further risk. So please talk to us and post those test results before you give one single dose.

We will be with you all the way.
Hugs,
Leslie and the gang

PS. Be sure to read the following link very well. Many of us have printed it out and hung where everyone could see it easily.

Lysodren Loading and Tips
http://www.k9cushings.com/forum/showthread.php?t=181

[otilia]

I have results from blood work done on Feb 5, 2014.
ALT 104 reference 18-121 IUL/L
AST 46 reference 16-55 IU/L
ALP 677 reference 5-160 IU/L

Endocrinology same time Feb 5, 2014

Cortisol (0hour) 101
Cortisol (4hour DEX) 40
Cortisol (8hour Dex) 61

Urine protein
results 10
Urine Creatinine 3418
Urine Pr/creat ratio 0.3

Urinalysis
colour light yellow
everything was normal

Ultrasound result Feb 26, 2014
Radiology Hepatonegaly
2 Compromised abdominal detail
Ultrasound
1 Mildly enlarged liver but predominantly homogenous
2 Left liver lobe is slightly irregular with 1.5-2.1 nodules
3 Both right and left adrenal glands are mildly enlarged with maintained silhouettes
4 Normal spleen and kidneys.
5 Normal bladder with no caleuliand no mass.
Final impressions: Bilateral adrenomegaly is endocrinopathy (cushing)
no abdominal masses.
Two weeks ago he had a second ultrasound at the Internal medicine specialist. She confirmed nothing else abnormal besides the kidneys mildly enlarged but she concluded it's because of vetoryl.
Thanks for helping.

[Iraklis]

From the looks of it...even if he is a cushpup.......it seems to be at very early stages...
imo, i wouldn't start treatment this early if it is, just keep a closer eye on Q-tip and ask the vet if SAM-e and/or milk thistle would help (they do).

Certainly no mitotane or trilostane at this point!

[goldengirl88]

Welcome to the forum. What did your vet say about addressing the protein in the
urine? I see the Alp is up and that is one of the many indicators we look at with Cushing's.

[Harley PoMMom]

I see from Q Tip's urine protein:creatinine (UPC) ratio test that there is NO protein being spilled into his urine which is great!

I did reread your thread and the only symptoms I could find mentioned are the increased drinking/urinating, is this correct? If so, the UTI can cause Q Tip to drink and urinate more. If Q tip has diluted urine an urine culture and sensitivity test needs to be done so the bacteria is known and the correct antibiotic can be given.

Hugs, Lori

[goldengirl88]

I am so sorry, I must have mixed you up with someone else. I did that twice lately. Blessings
Parri

[otilia]

Q-tip was on 500 mg lysodren for 8 days. He didn't have diarrhea, vomiting but after 7 days on lysodren he lost appetite, so I stopped the lysodren. Now He is not eating for 5 days, he still drinks and urinates however he is very lethargic, no energy , no appetite and this afternoon he vomited yellow liquid. The vet wants to do ACTH test next week. I found my dog so weak he just wants to lay down I don't know if we should keep trying these medications. It's so sad to see my dog this sick.

[Iraklis]

I would not trust this vet...that sounds like Addisonian...

Had he eaten anything or taken any medication when he vomited?

Have you given Q-tip any prednisone/cortisol medication?

imo,I would not treat Cushings already if the only symptom is increased urination...Lysodren/Vetoryl can get you into deep trouble very fast...
Try to get a clear image of what is going on and DON'T rush things...
Cushings ,especially caught this early takes a long time to do real damage...

[Iraklis]

Q-tip also sounds to me like he is either sensitive to these medications or lowering the cortisol uncovers an underlying problem only confirmed by an MRI...

Honestly...save yourself the money thrown on other tests and get a brain MRI...imo

[otilia]

Hi,
Yes I gave my dog presidone 5 mg, I don't know if I should bother with the ACTH test. I understand that you tried everything to save Irakis and in the end nothing worked. My neighbors keep telling me that I shouldn't do anything else, let nature take it's course.. I pray for God to help us. I am feeling so depressed for not being able to help my dog getting better.
Thanks

[Iraklis]

I am Iraklis ,my baby's name was/is Husko. Just to clarify! :p :)

Nooo...Huskos' was such a complicated case mainly because of many screw up by the vets.......Q-tip is nowhere near that!!!
DO NOT lose hope just yet!!!

Many things helped Husko...but most vets would not agree with natural remedies.

imo, since the only problem is excess urination/drinking...and bilateral adrenomegaly is confirmed...try to get an MRI to see what size of a pituitary tumor you are dealing with...

In the meantime i would give some supplements/medication to support the liver (SAM-e/milk thistle) and some melatonin&turmeric&omega-3 (at the appropriate doses) ,assuming your vet agrees of course.
Arte() is another option ,but you should get an MRI first!
(My vets didn't care so the weight of treating Husko was entirely on my shoulders).

btw, did you give 5mg of prednisone once? if not, what was the regime prescribed?

P.S. I hope i am not missing sth because i can't find or think of anything else ,other than Cushings ,causing bilateral adrenomegaly...

[Iraklis]

FYI, because i think your vet hasn't explained sth...

Vetoryl/Lysodren are not cures for Cushings...they are medication to treat only the symptoms of Cushings, through lowering body cortisol.
They do not cure the pituitary.

Q-tip originally only had excess urination/drinking.
Lethargy and decreased appetite came only came during/after Vetoryl/Lysodren.

btw, have you noticed any muscle wasting (most obvious place is the cranium bone protruding too much ,because of jaw muscles wasted)?

[otilia]

You are absolutely right. The first symptoms were drinking and urination. Vetoryl did nothing for his drinking or urinating, and he got so much sick. Lost appetite, became lethargic, now with lysodren he is not drinking and urinating as much however he looks very sick.
I am going to get the natural medication which you suggested.
Thanks for the advise..

[labblab]

Q-tip was on 500 mg lysodren for 8 days. He didn't have diarrhea, vomiting but after 7 days on lysodren he lost appetite, so I stopped the lysodren. Now He is not eating for 5 days, he still drinks and urinates however he is very lethargic, no energy , no appetite and this afternoon he vomited yellow liquid. The vet wants to do ACTH test next week. I found my dog so weak he just wants to lay down I don't know if we should keep trying these medications. It's so sad to see my dog this sick.
Omigosh, it sounds as though Q-tip may be in Addisonian crisis from an overdose of the Lysodren! Not only may he need supplemental prednisone every day, he may also need additional supplemental medication to make up for imbalances in his potassium and sodium levels. Yes, I do think he needs both an ACTH test as well as a test of his basic blood chemistries. Are you continuing to give him prednisone?

Marianne

[Iraklis]

You are absolutely right. The first symptoms were drinking and urination. Vetoryl did nothing for his drinking or urinating, and he got so much sick. Lost appetite, became lethargic, now with lysodren he is not drinking and urinating as much however he looks very sick.
I am going to get the natural medication which you suggested.
Thanks for the advise..

Wait...lablab is right...
That is why i asked if you only gave prednisone once...

At least give him prednisone for a few days (slowly lowering the dose), and if his health declines again after stopping...he could be permanently Addisonian...meaning he would need prednisone every day

[molly muffin]

It is very important to get an ACTH and electrolytes checked as soon as possible. No waiting!! This can be a life threatening situation. He might need pred for a few days, he might need it permanently. This does sound like a crisis. I HOPE you are not continuing to give lysodren? If so, do NOT do so.

Sharlene and molly muffin

[labblab]

How much does Q-tip weigh? The "rescue dose" of prednisone is calculated using a formula of .25 mg. per kg., and each kg. equals 2.2 pounds. If cortisol is too low, this same amount must be given every day. But Q-tip may need an additional supplement, too. I agree with Sharlene -- this can be an emergency situation. If not tonight, can you contact your vet first thing tomorrow? If Q-tip worsens, he may need to be taken to an ER tonight, even.

[Iraklis]

Weight is 55lbs (as per another post)

otilia gave 5mg



I am going to get the natural medication which you suggested.
Thanks for the advise..

Hope you read this before rushing out ,buying the first items you find and give them.
Natural supplements can have side effects too ,if given at wrong doses or the wrong time of day (especially Melatonin).
I can suggest some brands i tried and help with initial doses so you can save yourself some trouble and money.

But first things first...you have to find out if Q-tip is permanently Addisonian or not ,then worry about everything else.

[goldengirl88]

Iraklis:
Tell me about taking the Melatonin at the wrong time of day. I have not seen this.
Patti