Kiley Bear, 6yr old Mini Schnauzer diagnosed with Cushing

[DTullos]

Our precious Kiley Bear was diagnosed with Cushing’s this week. The vet gave us options and suggested we just medicate her since the other options were so expensive. So far she is doing great on Vetoryl and will be going back to the vet in 6-8 weeks for follow up blood work. Are there any specific things we need to be watching for while starting this new medication or things pertaining to the disease specifically?

Thanks
Diana & Kiley Bear

[goldengirl88]

Welcome to you and Kiley. Glad all is going well. Could you tell us what symptoms Kiley presented with? Please give us a brief summary of her health, her age and weight. You will also need to keep copies of all her tests. To better help you could you post Kiley's abnormals from her tests with the normal scale provided by the lab as all are different. We can see what is going on and better help you after seeing them. Did your vet give you a rescue dose of prednisone?
In the event Kiley's cortisol goes too low, you need to watch for vomiting, diarrhea, lethargy, can't stand up, won't eat. If these happen do not give any more Vetoryl. What dosage, and how many times a day does Kiley get Vetoryl?
If Kiley exhibits any signs of going low you would give her the prednisone, and go to the vets and have an ACTH done and electrolytes checked. This can be a life threatening situation, so you need to do this. If she was started out on a low dosage of 1mg per pound, she will be able to adjust to the drug better, and the changes with her cortisol level. When did the vet want to re test her? You will get great help and support here. This forum has a lot of experience and compassion. Hopefully you will join our discussions so you can be a great advocate for Kiley. Blessings
Patti

[Trixie]

Hi Diana,
I have mini schnauzer too, she was diagnosed a year ago. This forum is incredibly helpful. It would be great if you can tell us more about your pup...what symptoms you noticed, what tests were done to diagnose your dog, how much she weighs and what strength of the dose she is on? The current recommendation for a starting dose is 1mg per pound of your dog. Starting with too high a dose is usually what starts problems for most dogs.

Did you just start your dog on Vetoryl? It's important to have an acth test done within 10-14 days from the day you started giving the medication. Perhaps you have already done this? If not, waiting 6-8 weeks is not recommended...you have to carefully monitor he level of cortisol when first starting on vetoryl because if that level sinks too low your dog can be in danger.

Did your vet alert you to the adverse effects of this drug? You would want to stop giving the pill immediately if your dog got weak, had vomiting and/or diarrhea, or got extremely lethargic.
Maybe you already know all this....
My dog has been on Vetoryl for one year and is doing very well. I hope you can fill us in on more details about Kiley Bear.

Barbara

[Trixie]

Looks like Patti & I posted at the same time...sorry for the repeat info! :D

Barbara

[Harley PoMMom]

Hi and welcome to you and Kiley Bear,

It looks like Patti and Barbara have gotten you off to a good start, those questions they have asked are very important and the answers will help us to provide you with more meaningful feedback, ok?

I am providing a link to our Resource thread where we have a wealth of information regarding Cushing's and I am also providing a link to our Vetoryl/Trilostane information: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) and Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Hugs, Lori

[DTullos]

Kiley Bear is a lovable 6 year old full blood Mini Schnauzer. Here are her stats:

Weight: 15.6 lbs
She has the potbelly, but we thought the weight was from having her fixed and the fact that daddy brings her cheese burgers home (he cut that out thankfully).

Symptoms:
Started guzzling water about 6 months ago. About a year ago she started having breathing problems and hassling. We just figured it was from allergies. Two months ago I had taken her into the groomer and that afternoon to the vet for her rabies shot. For the next 3 days she threw up and for about a week she had problems with her left front shoulder. Then 2 weeks ago she vomited and had bloody stools for 2 and a half days. The vet said it was from allergies and gave her meds and special GI food that cleared it all up. I started having major concerns with the bloody stool and started to do research. I originally took her into the doctor for her drinking issues and had her tested for diabetes. She wasn't diabetic but her liver enzymes were elevated so the vet suggest Cushing's and tested her for that.

Test:
Oxygen, blood sugar, kidney, protein, and electrolytes are all great numbers (per vet).
ALT - 124 (liver enzymes)(pre test)
ALKP - 297 (liver enzymes)(pre test)
Total T4 - 1.5
Cortisol - Pre ACTH 2.9
Cortisol - Post ACTH 26.6

Meds:
1 pill per day Vetoryl 30 mg

[molly muffin]

Hello and welcome to the forum. at around 15lbs and 30mg of vetroyl, you are about 2mg/1lb, we see less problems and like people to start at 1mg/1lb.

Keep a very close eye on her, any signs of lethargy, not eating, vomiting, stop medication and immediately get ACTH test. (do not give any more vetroyl if those occur) We see too many dogs have problems and Schnauzers can be sensitive, or resilient you never know.

Welcome again
Sharlene and molly muffin

[Trixie]

As you probably know many schanuzers are predisposed to high trigylcerides, hyperlipidemia, and pancreatitis. They do best on a low fat diet...so good thing there are no more cheeseburgers, they could give your girl some very bad digestive problems. Bloody stool is usually not a symptom of Cushings.
Your starting dose is a little high...even though her post acth is high, a safer place to start would have been 20mg.

How long has it been since you started the medication?
She would need another acth 10-14 days after starting to see her pre and post numbers and check that the dose is correct for her.
You know the side effects so you have to watch and be careful.
My dog was 15 pounds when diagnosed and we started on 12mg a day. Hopefully the 30mg will be okay for your dog but observe her carefully for any adverse signs.

Barbara

[goldengirl88]

I would have started your Kiley off on 10 mg of Vetoryl. This would have eliminated some of the worry as she would have been on a much smaller dose for her body to get adjusted to having. If it were me, I would got to 10 mg. If that is not enough to control her after her ACTH I would then go to that dosage of 10 mg twice a day. It is just much better to start low and go up. Your dog is on twice the amount of 1mg per pound. Barbara on here has experience with schnauzers, and things pertinent to them, and she will tell you for safety sake start low. Hope you are both well and look forward to seeing some pics of Kiley.
Blessings
Patti

[Harley PoMMom]

Was the ACTH stimulation test the only test used to diagnose the Cushing's? If so, I am a bit worried as there just isn't one test that can accurately diagnose Cushing's so a vet needs to perform multiple tests to validate a Cushing's diagnosis.

The vomiting and bloody stools can be attributed to a GI issue or also could be an allergic reaction to the rabies shot, either way the vet should not of done any testing for Cushing's until Kiley Bear was better. Any kind of stress or non-adrenal illness can cause false positive results on all tests for Cushing's.

How is Kiley Bear's appetite? Does she have any hair or skin problems? Is she taking any other herbs/supplements/medications? Could you tell us what medication the vet put Kiley Bear on for the allergies? If this was a medicine that had any type of steroid in it the steroid can interfere with all tests for Cushing's. Does she still have breathing issues?

I am sorry for all these additional questions but we sure want to provide you with the best feedback we can, ok?

Hugs, Lori

[lulusmom]

Hi and a belated welcome to you and Kiley Bear.

Others have done a good job of providing excellent information but as usual, I am going to be a pest and ask additional questions and provide my comments which you can find in blue text below:


Kiley Bear is a lovable 6 year old full blood Mini Schnauzer. Here are her stats:

Weight: 15.6 lbs
She has the potbelly, but we thought the weight was from having her fixed and the fact that daddy brings her cheese burgers home (he cut that out thankfully).

Symptoms:
Started guzzling water about 6 months ago.

Dogs with cushing's drink tons of water, not because they are thirsty but because they are peeing lakes as their kidneys have lost their ability to concentrate the urine. They drink to stay hydrated which is why we tell members to never withhold water from their dog as they can dehydrate quickly and die. Was Kiley urinating excessively and was she having accidents in the house? Did you take her to the vet at that time and have a urinalysis done? If so, were the results normal and if not, what did your vet determine the cause to be? Did Kiley's water intake improve any in the followng year?

About a year ago she started having breathing problems and hassling. We just figured it was from allergies.

Was she seen by a vet for this to rule out heart or trachea problems? Was Kiley overweight at that time? If so this could explain the panting (hassling) and noisy breathing.

Two months ago I had taken her into the groomer and that afternoon to the vet for her rabies shot. For the next 3 days she threw up and for about a week she had problems with her left front shoulder. Then 2 weeks ago she vomited and had bloody stools for 2 and a half days.

Allergies to what? Did your vet do a full blood chemistry and complete blood count at that time? Did he rule out pancreatitis via a Spec cPL Test? Mini Schnauzers are genetically predisposed to pancreatitis and if Kiley Bear is overweight, that is a double whammy. Mini Schnauzers are also genetically predisposed to hyperlipidemia, which also puts them at even greater risk of pancreatitis so if Kiley has high lipids in her blood, she now has a triple whammy. Given all those predispositions, I would think a Spec cPL would have been a definite consideration, most especially if amylase and/or lipase and/or cholesterol and triglycerides were elevated on the blood chemistry.

The vet said it was from allergies and gave her meds and special GI food that cleared it all up.

What meds were prescribed? Were any of them prednisone or prednisolone?

I started having major concerns with the bloody stool and started to do research. I originally took her into the doctor for her drinking issues and had her tested for diabetes. She wasn't diabetic but her liver enzymes were elevated so the vet suggest Cushing's and tested her for that.

When was she tested for diabetes? Did your vet do a comprehensive urinalysis at that time, including a culture? Urine Specific Gravity (USG) is usually part of the urinalysis and USG is almost always low in dogs with cushing's and diabetes.

How long after Kiley's gastro intestinal problems did your vet do the blood chemistry that showed elevated liver enzymes and how long after that was the acth stimulation test done?

Test:
Oxygen, blood sugar, kidney, protein, and electrolytes are all great numbers (per vet).

Were there any other abnormalities that perhaps the vet didn't mention to you, such as amylase, lipase, cholesterol, triglycerides? Was there any mention of hemolysis on the lab results? If you don't have a copy of the actual blood tests, can you get your hands on them to make sure we have all of the abnormalities posted?

ALT - 124 (liver enzymes)(pre test)
ALKP - 297 (liver enzymes)(pre test)

These are mild elevations, which could have been caused by stomach issues. Additionally, I can't help but think that if Kiley's excessive drinking is due to cushing's, I would have expected those liver values to be much higher considering she's been symptomatic for at least a year. ALKP is a liver enzyme that is triggered by excess cortisol but it also comes from the gut. If these values were from blood tests done while Kiley was sick or not completely well, they should not have been used as the sole reason to test for cushing's. Without timelines and complete test results, I do have concerns about an accurate diagnosis.

Total T4 - 1.5
Cortisol - Pre ACTH 2.9
Cortisol - Post ACTH 26.6

Was additional testing done to validate the acth stim test and to determine which form of cushing's Kiley has? The best tests would normally be an abdominal ultrasound or endogenous acth test. Were either of these done before your vet put Kiley on Vetoryl?

Meds:
1 pill per day Vetoryl 30 mg


Our precious Kiley Bear was diagnosed with Cushing’s this week. The vet gave us options and suggested we just medicate her since the other options were so expensive. So far she is doing great on Vetoryl and will be going back to the vet in 6-8 weeks for follow up blood work.

My concern with the diagnosis just increased greatly as your vet is not following proper protocol for monitoring Vetoryl treatment. The manufacturer recommends the first stim test be done at no later than 14 days post dosing. This is a serious drug that while not supposed to have a cumulative effect, drops cortisol quickly initially and continues to lower cortisol for the first 30 days and sometimes beyond. The second stim test should therefore be done at the 30 day mark. ACTH stimulation tests are expensive and your vet can save you money by using less of the stimulating agent, cortrosyn, and storing the remainder for future tests. With Kiley weighing about 15 pounds, I suspect your vet could get more than seven acth stim tests out of one vial of stimulating agent. It is well worth your while to ask your vet if he is aware that you do not need to use the entire vial of cortrosyn. If not, provide him with a copy of Dr. Mark Peterson's blog for veterinarians where he provides instructions on how to reconstitute the agent and store for future tests. The agent should last for at least six months which amounts to hundreds and hundreds of dollars saved. You can find this information at http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Can you explain what improvements you have seen with treatment?


Are there any specific things we need to be watching for while starting this new medication or things pertaining to the disease specifically?

Others have probably already answered this question but duplication in this case is a good thing. Vetoryl must be given with food for proper absorption. The acth stimulation test must be completed within 3 to 6 hours after the morning dose is given with a meal. If you are giving Kiley her dose in the evenings and your vet is not open 24 hours, you will need to switch her dosing to the morning. To do so safely, you will need to skip the evening dose the night before you start her on morning dosing.

Thanks
Diana & Kiley Bear

Sorry for this voluminous post but the more information you can give us, the better understanding we have of Kiley's medical history, which will help us help you get Kiley Bear stabilized safely.

Glynda

[DTullos]

Thanks everyone for your input!!

Our vet doesn't want to see her back for 6-8 weeks to retest, should I call him about that? For her allergies the vet suggest that we give her Benadryl as needed and to keep her feet washed when we go out. Other than that an the occasional baby aspirin she isn't on any other meds. As for the Vetoryl 30mg she has been on it for 5 days and seems to be doing great. She is a fat chick so any table food she can guilt Daddy out of she will eat. She doesn't really eat much of the dog food unless we put gravy(dog) on it. Her water consumption and hassling while breathing as really slowed down a lot, and her energy actually seems to have gone up.

Tipper's Mom I put a few pictures up.

Thanks again everyone!

[DTullos]

Wow Glynda that was a lot to take in.

She has never had any testing done until this last week. When she had her first bout of vomiting the vet just said she was upset from being at the groomers that morning and then in to get her rabies shot that afternoon. The last time she had the vomiting and the bloody stool he said it was just from allergies and gave her two meds and the GI food. I will get the names later for those meds. He never saw her or tested her for any thing at that point. This was just a week prior to her being tested for Cushing's.

When I took her in for the diabetes test he just did a blood test on the glucose meter but nothing else. As for her weight she is suppose to be between 9-12 lbs so she is only 3 lbs over weight which is a lot for her little body.

I am thinking I may need to find another vet and get a second opinion. Doctor Smith is great though.

[Squirt's Mom]

Vetoryl is a very powerful drug and should never ever be given without the proper testing and confirmed diagnosis. These drugs can cause permanent damage to the adrenal glands resulting in the opposite disease called Addison's...even death. PLEASE keep a very close eye on Kiley Bear for any signs of change in appetite, especially nausea / vomiting, loose stools / diarrhea, and / or lethargy. If you see ANY of these, get her to a vet ASAP. That could be a life-threatening situation and cannot wait.

I pray your girl continues to do ok but we would all feel much better if your vet had done his job correctly. ;)

[Squirt's Mom]

And yes, she CANNOT wait 6 weeks for the ACTH - it must be done 2 weeks after starting the med. :)

[lulusmom]

Hi Diana,

I know that cushing's is very difficult to wrap your head around so no doubt my post had your head swimming. Sometimes I am my own worst enemy when I try to cover everything in one post. Information overload can be overwhelming, paralyzing members. Having shared my life with three cushdogs, I do remember the feeling of being a deer in headlights. :D My intent was to point out some legitimate concerns, based solely on the little information you have provided, about what I perceive to be your vets failure to do adequate testing and failure to follow proper protocol for monitoring treatment. Your answers to my many questions can provide a lot more insight into your vet's approach to diagnosing and treating Kiley Bear. Cushing's is the most difficult canine disease to diagnose, which makes it one of the most misdiagnosed diseases. Kiley had a lot of things going on just a week prior to the acth stimulation test and my concern is that without doing additional validating and differentiating tests, the acth stim test could have been a false positive result.

Would it be easier for you if I list my questions so that you can answer them one at a time?

[DTullos]

Thanks Glynda for being patient with me.

My husband called the vet today and spoke with a vet tech, he why they wanted to wait 6 weeks. They said if we wanted we could come back in 2 weeks for follow up testing. However they never answered why such a high dose.

My question is this...we started her meds on the 26th so her follow up would be next Friday. We have to be out of town from Wednesday till the following Tuesday, will it be ok to take her back in the following Wednesday which will be almost 3 weeks? While I will have a house/dog sitter she doesn't feel comfortable taking her to the vet for me unless it is an emergency. Or since she has only been on the meds 5 days can I stop giving it to her for now and then restart it when we get back so she doesn't have any issues while we are gone?

The stomach meds given to her on 4/8 were 1/2 pill of Metoclopramide 5mg for vomiting 2x day, and 1/2 pill of Metronidazole 250mg 2x day to heal her intestinal tract. She only took the Metoclopramide for 2 days and took the Metronidazole for 7 days. Her Cushing's testing was done on the 24th could this have been to soon after taking the other meds?

The Vetoryl, Benadryl (as needed), baby aspirin(as needed), and the meds mentioned above are the only meds she has ever taken.

Oh and if you want to list any questions please do and I will answer them for you.

Thanks again for all your help.
Diana & Kiley Bear

[DTullos]

Should I be giving Kiley any vitamins or supplements with Vetoryl? I normally feed her homemade dog food (Rice, Chicken/Hambuger, Peas & Carrots) and then she eats Beneful IncrediBites when I don't have time to cook for them. She is only 6 years old so I don't think she really needs older dog supplements just yet.

Also she tends to dip her head in her bowl then on the floor several times before eating when I feed her kibble but not with home cooked meals. And she on occasions will kick her hind legs out to the side/back....could these be caused from a neurological issue?

Thanks
Diana & Kiley Bear

[Renee]

I am sure you will get a lot of answers to this question, but I am going to go ahead and jump in with my opinions. I've been doing dog rescue for quite a while, homecook off and on for my own dogs, and have treated many dogs with allergies / food issues, so I have done a good amount of research on this subject.

First - there is no special diet just for cushings dogs. They can be prone to weight gain and pancreatitis, so a low fat diet is recommended (but not required). No diet will 'cure' cushings, or even have a significant impact on controlling symptoms.

A normal healthy dog can go quite a while on an incomplete diet without adverse affects. An immune compromised dog, like one with cushings, really should not go long on an incomplete diet. What you are describing is an incomplete diet, but it is a good basis for a homemade diet, if you want to go that route.

The most important (I cannot stress this enough) supplement a dog needs when being fed a homemade diet is calcium. When you feed cooked meats, the dogs is not getting calcium. Calcium is in the bones and egg shells, not the meat. You have to supplement the calcium based on the amount of food you are feeding. Fish oil is probably the next most important supplement needed. After the calcium and fish oil, most other supplements are up for debate. Some people feel that if you feed a healthy variety of food, your dog will get the nutrients and vitamins it needs. Others are more inclined to add a vitamin mix, just to have that safety net that their dog is getting what they need. When I home cook, I use a complete vitamin mix.

Your kibble choice is probably not very enticing because (forgive me, not trying to be offensive), it is very low quality and full of corn, wheat and by-products. A good, high-quality kibble or canned food would be much healthier and probably much more enticing to Kiley Bear.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about vitamins and supplements into Kiley’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[goldengirl88]

I just wanted to add that if you are not wanting to do a cooked diet you a looking for a medium protein, low density food. Cush dogs are prone to gaining weight which only exacerbates their situation. Blessings
Patti

[Trixie]

Loved seeing your photos of Kiley Bear, she's a cutie :D.
How is she doing today? Just so you know...and YOU can tell your vet because clearly he/she does not know--but doing an ACTH test 10-14 days after started Vetoryl is the protocol, it's not the choice of the owner, it's what MUST be done.
You can find evidence for the vet to read on many websites but perhaps it's best to start with the company that makes the drug. Your vet may need a little lesson on this disease and the drug he/she prescribed..the link below explains this. You have to be proactive if you want to do this right. Check out this page and maybe forward it to your vet.

http://www.dechra-us.com/Cushings-Syndrome/Veterinarians/Monitoring-Schedule-1.aspx

This test is very important! You are taking chances with the life of your pup if you don't check where the levels are after being on this medication for 2 weeks. There is no other way to know. You also have to be sure that the vet understands how to do the test properly. You must have it done 4-6 hours after your dog has it's dose of Vetoryl with food. So whatever time you give the pill...you have to test 4-6 hours after that. If they don't do it correctly your money will be wasted and you still won't have the proper picture of your dogs cortisol level. It's really, really important.
Be careful about the fat content you give your schnauzer, the bloody diarrhea and vomiting could be more than allergies. Most schnauzers and especially those with Cushings are prone to pancreatitis. My dog had an attack in Feb. and trust me you do not want your dog to go through this..and she's already on a very low fat.
I hope Kiley Bear is doing okay..how many days is she on Vetoryl now? Have you seen any change in her symptoms?

Barbara

[Harley PoMMom]

Renee is correct in that if a home-made diet is used exclusively than it needs to be balanced, however, if the home made diet is used with kibble as just a supplement than the dog is getting enough vitamins/minerals from the kibble.

When someone asks what dog food is best I say that if the dog is doing well on their current food which is balanced, meaning no abnormal lab levels, nice firm stool etc. then there really is no reason to switch it especially when starting treatment because that can be another variable that would need to be ruled out if the dog starts acting unwell...JMO ;)

If you do decide that you want to change Kiley Bear dog food I recommend you look at this web site for ideas: DOG FOOD ANALYSIS (http://www.dogfoodanalysis.com/dog_food_reviews/)

Hugs, Lori

[DTullos]

*I love making my furbabies homemade food. I will start putting calcium and flax oil in it to make sure they are getting more nutrients. As for the kibble I will look for a better brand. I normally just put it down in case they get hungry latter in the day.

As for Kiley Bear she is doing great. Her water intake has gone down and the hassling is almost gone for the most part. She is also being really cuddly and loving again.

Thanks everyone!!!
Diana & Kiley Bear

[molly muffin]

What great photos Kiley Bear is adorable!
So glad to hear that you are seeing improvement.

Sharlene and molly muffin

[DTullos]

I just wanted to add that if you are not wanting to do a cooked diet you a looking for a medium protein, low density food. Cush dogs are prone to gaining weight which only exacerbates their situation. Blessings
Patti

I love cooking for my furbabies!

[lulusmom]

You can buy the supplements you need in one bag. It's called Missing Link and you can find it in most pet supply stores or online. Just add it to your home cooked meal. Most dogs love the taste.

http://www.amazon.com/Missing-Link-Ultimate-Skin-Supplement/dp/B002TAOYK6/ref=sr_1_2?ie=UTF8&qid=1399089243&sr=8-2&keywords=missing+link+supplement

[DTullos]

Super Thanks I will order some this weekend.

[Renee]

You can buy the supplements you need in one bag. It's called Missing Link and you can find it in most pet supply stores or online. Just add it to your home cooked meal. Most dogs love the taste.

http://www.amazon.com/Missing-Link-Ultimate-Skin-Supplement/dp/B002TAOYK6/ref=sr_1_2?ie=UTF8&qid=1399089243&sr=8-2&keywords=missing+link+supplement


This is a good supplement, but it does not have the needed calcium, so that will still need to be added to the homecooked food.

[DTullos]

Any suggestions on where to order the Vetoryl 30m a little cheaper? We currently pay $75.00 a month for it at the vets.

[lulusmom]

I've provided links below to the most competitive, trusted online pharmacies. I use California Pet Pharmacy for other medications and they make it easier for me. If I need a refill, I tell them and they call the vet for approval.

http://www.valleyvet.com/ct_detail.html?pgguid=057ae20c-efea-490b-b89e-562663425dfe&ccd=IFP003&mr:trackingCode=51EBA264-3C81-E211-BA78-001B21631C34&mr:referralID=NA&mr:device=c&mr:adType=pla&mr:ad=15165202363&mr:keyword=&mr:match=&mr:filter=34301608963&gclid=CK-I6bOEtr4CFQdbfgodB1cAkg

http://www.allivet.com/p-2591-vetoryl-capsules-30-mg-30-ct.aspx

http://www.californiapetpharmacy.com/ve30caco.html

[Renee]

I use California Pet Pharmacy too, and they have been nothing but excellent. And, shipping is free over $75, so I always order multiple boxes.

[DTullos]

Thanks for the links. I actually found Pet Rescue RX and ordered from them. They donate all of their profits to the rescue of your choice. I was able to get Kiley's medication for only $59 with free shipping and the profits will go to the Mini Schnauzer Rescue of Houston.

Here is the URL if anyone is interested
www.PetRescueRx.com