Suggestions Appreciated

[cooperf]

I have a ten year old shih tzu mix dog named Cooper, that was diagnosed with Cushings. He was diagnosed through blood work that was sent to a lab at the University of Michigan. The recommendation from my vet was to put him on Vetoryl 10 mg. He never experienced the symptoms that I see listed on this forum, except he was constantly looking for food and he had a bloated belly. Since being the meds, which has been about a year now, he has lost all his hair on his tail and has thinning throughout his coat. He also has developed cysts all over his body, which he gnaws at until they bleed. The vet recommended instead of giving him the Vetoryl every day to go every three days, which I have been doing for a month now. I don't see any improvement. He is pretty inactive and does not want to move much, still has the bloated belly, and is always looking for food. He drinks a bit, but not like what some of you describe your dogs doing. Any suggestions are greatly appreciated.

[Harley PoMMom]

Hi and welcome to you and Cooper,

Sorry for the reasons that brought you here but glad you found us.

Strong symptoms do play a huge part in the diagnosis of Cushing's, and with Cooper not displaying obvious clinical signs of Cushing's I question Cooper's Cushing's diagnosis. What tests did the vet perform to diagnose his Cushing's? Could you get copies of Cooper's ACTH stimulation results and post them here...thanks! Has diabetes and any thyroid issue been ruled out?

Was an ultrasound done, and if so, could you post those findings.

If Cooper is showing signs of being unwell than the Vetoryl should be stopped and an ACTH stimulation test should be done. Is Cooper vomiting, does he have diarrhea?

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

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.

I second everything that Lori said. Every three days of vetroyl doesn't really help much, as the cortisol will go up for 2 days, down for 1, etc.

Has he been checked recently for diabetes and low thyroid? I'd definitely want those options checked out. Also as Lori mentioned can you post any abnormal blood work, high/low with range? That would help us to give you feedback.

It does seem there might be something else going on, either in addition or alternatively to cushings.

Welcome
Sharlene and molly muffin

[cooperf]

I picked up the lab results this morning. They were done 4/1/13.

Total Thyroxine (TT4) 16 range (11-60)
Total Triiodothyronine (TT3) 0.4 L range (0.8 - 2.1)
Free T4 by dialysis 11 range (6 -42)
Free Triiodothyronine (FT3) 4.9 range (1.2 - 8.2)
T4 Autoantibody 10 range (0-20)
T3 Autoantibody 6 range (0-10)
Thyroid Stimulating Hormone 21 range (0 - 30)
Thyroglobulin Autoantibody 6 range (0-35)

Endrocrinology Interpretation:
The combination of normal concentrations of T4, free T3 and TSH provides good evidence that this dog is not hypothyroid. The decrease of T3 in this profile more likely reflects a metabolic response to nonthyroidal illness, rather than hypothyroidism. The normal thyroid autoantibody results further decrease the likelihood of pathologic changes in the thyroid glands.

Also this test was done:
Cortisol Serial 2 (ACTH)
Time 1 Pre
Time 2 Post

Cortisol Sample 1 3.0
Cortisol Sample 2 6.9 (LOW)

The test above was done in December 2013, so Cooper had been on Vetoryl for about a year.
There has been no ultrasound done or other blood work. Also, he is not vomiting nor does he have abnormal stools. He is getting the Vetoryl every third day (10mg).
Cooper was seen a few weeks ago because he had gnawed on one of his growths and lost a quite bit of blood - the vet cleaned it up and gave him two antibiotic shots. Thank you for everyone's help.

[Squirt's Mom]

Would you mind editing your post to include the normal ranges for each value listed? Different labs use different norms so it helps us a great deal to see what that lab calls "normal". ;)

[Squirt's Mom]

Cortisol Serial 2 (ACTH)
Time 1 Pre
Time 2 Post

Cortisol Sample 1 3.0
Cortisol Sample 2 6.9 (LOW)

Also, was this the ACTH done to diagnose or was it done after starting treatment with Vetoryl?

[cooperf]

I posted the lab results and ranges in my original posts - thanks in advance for suggestions.

[molly muffin]

Okay, so based on the ranges, the thyroid is normal. The ACTH was in December 2013 and Cooper has been on vetroyl for a year. What glucose checked?
If the amount for the ACTH is in measurements of ug, then Cooper is not low. Normal range for a dog on vetroyl/trilostane is up to 9.0ug if symptoms are controlled and below 5.0ug if not controlled for the post.
Normal range for an ACTH are entirely irrevelant for a dog on treatment vs before treatment. I sincerely hope your vet is not basing his "low" on normal range. Most labs on the result will have a different range listed for vetroyl or lysodren treatment.

Frankly, I think the every 3 days is worthless. If this was his ACTH while on 10mg daily, then that was an appropriate treatment plan. If loss of hair was going on, then he might have even needed a small increase at some point. I would have the lump biopsied to see if they are lipomas or something else. I had to do this with my shih tzu/lasso mix dog, as she has started to get lipomas now. She just turned 10.

Sharlene and Molly muffin

[cooperf]

I am a bit confused about Cushings. Cooper was tested and put on the meds basically for a bloated belly. He was not experiencing any other drastic symptoms. Since being on the Vetroyl he has developed the cysts and his hair has thinned drastically (his hair on his tail is completely gone). Are these side effects of the medicine, or symptoms of the Cushings? Do I keep him on the Vetroyl, or take him off? I feel the medicine is causing more harm than good, but I also feel I do not know enough about the disease and what the side effects can be. Any clarification is appreciated? Thank you.

[Renee]

If you feel the medicine is making things worse, then by all means, you should definitely stop.

There is a wealth of information on this site to help you learn more about cushings, proper protocols, and treatment.

I agree with the others that have posted - you are wasting time and money dosing every three days.

[molly muffin]

I don't think I'd be using cushing meds if the only symptom was a bloated belly, personally.

Sharlene and molly muffin

[Harley PoMMom]

Strong clincial symptoms make up a huge part of the diagnosis for Cushing's. The medications for Cushing's are to abate symptoms they are not a cure for Cushing's. If Cooper does not have the obvious Cushing's symptoms I would not give the medication either.

Hugs, Lori

[goldengirl88]

I too would be hesitant on giving Vetoryl in this instance. It is just not clear cut in my mind that something else is not going on here. I know from going over this with my bet that skipping days with no Vetoryl only enables the cortisol to rise on the days nor given, so this is really not considered good management in my opinion. If you continue to give it, I would think about a lesser amount given every day to be consistent to see if that will help the situation. Blessings
Patti