Steiny has passed - Diagnosis of Cushing's PDH yesterday (14 y/o Bichon)

[steiny]

Our almost 14 yr old Bichon (weight 16 lbs) was seen by an internal medicine vet yesterday and confirmed today that he has Cushing's disease pituitary-dependent. We initially thought many of the symptoms our dog was exhibiting were due to old age and our bad Wisconsin weather. He no longer wanted to go for long walks, slept more, skin on belly was dry and losing some hair. His belly seemed a little bigger to me but thought he was just gaining weight due to his inactivity.

Long story short...we initially took him to his regular vet about a month ago (for an unrelated problem) who did comprehensive blood work and his liver enzymes were very elevated:

GGT 253 U/L Ref Ranges: (3-19)
ALT 613 U/L (14-151)
Alk Ptase 3153 U/L (13-289)
Other abnormal tests:

Albumin 4.5 g/dL (2.6-4.0)
Urea N 35 mg/dL (8-30)
Bile Acids 78.1 umol/L (0.0-12.0)
Cholesterol 505 mg/dL (98-300)
Lipase 835 U/L (109-750)

Normal results for Amylase, Total Protein, Total Bilirubin, Glucose, Thyroid, Calcium, Sodium, Potassium, Hemoglobin, Hematocrit.

Liver enzymes did not improve after being on S-adenysl for 1 month so he saw the internal medicine specialist yesterday who did an

Abdominal ultrasound that showed an enlarged liver, bilateral enlarged adrenal glands (one larger than the other but no tumors seen), and gall bladder debris. Based on these findings and his clinical findings,
he had an ACTH stimulation test done which was reported to be 29.9 (normal 8-17). Our vet does not believe in compounded medications and wants to start him on Vetoryl 10 mg twice a day with food and have ACTH rechecked in 10 days, 30 days, 60 days, and then every 3 months. Very expensive care!

Our dog is eating, pooping, urinating without significant problems...main problems are elevated liver enzymes, some increased sleeping, doesn't want to walk/play as much, pot belly, loss of hair, and skin changes (dryness, brown spots, warts). We have always fed Steiny three times a day due to a reflux problem he's had for many years. The only other medications he is on are famotidine 10 mg every morning (anti-reflux med) and Sentinel (Heartworm medication) He has been getting up much earlier in the morning, 5:00am, wanting to eat and does seem to eat his food a bit faster. He doesn't beg for food (unless he smells french fries :)and his weight has been pretty constant at 16lbs. Should we consider delaying starting medications? Any thoughts would be greatly appreciated. Our nickname for our Bichon is Steiny!
Can anyone share with me, what side effects they have had with Vetoryl. We certainly don't want to make his quality of life worse with undergoing these treatments. He's a home body and is stressed by changes. Our inclination at this time is to proceed with the vet's recommendations. Thanks in advance for any input.

[Harley PoMMom]

Hi and welcome to you and Steiny!

Cushing's can be difficult to diagnose and is frequently misdiagnosed as other illnesses have the same symptoms, such as diabetes or any thyroid or liver problem. Strong and obvious symptoms are a huge part of making a Cushing diagnosis. These strong symptoms include but are not limited to; a ravenous appetite, excessive drinking and urinating, thin skin and usually symmetrical hair loss along the trunk. From your post it does seem that Steiny is not dispalying the clinical Cushing's symptoms, right? A Cushing savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis.

Could you edit your post and include the references ranges and units of measurements to those values you listed...thanks! Also we would especially be interested in the results from any diagnostic test/s for Cushing's. Is your boy on any medicines, herbs, or supplements? How much does he weigh?

Trilostane/Vetoryl and Lysodren/Mitotane are the two drugs generally rx'd for Cushing's. These are strong medications but are life savers for dogs with Cushing's. Usually adverse reactions are only seen when the proper protocols are not followed. Cushing's is a treatable disease but success does depend on keen owner observation along with a vet/IMS that is knowledgeable and experienced in the treatment protocols for Cushing's.

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

Links to info regarding Cushing's and the medications used: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185), Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181) and Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Hugs, Lori

[steiny]

Hi Lori,

Thanks for the welcome and response! I've updated my post to include more information.

Steiny has had a few more problems develop in just the last two days. I hear him softly moaning and awake around 4:00am...usually I just scoop him up into the bed and rub his tummy and he goes back to sleep but I couldn't settle him down. I got up with him and he wanted to eat right away; when he ate, I had to slow him down, otherwise he started choking a bit, like he had trouble swallowing...this is new for him.

He pretty much sleeps all day long. He doesn't have the excessive drinking and peeing that other cushing dogs have but my vet tells me that not all cushing dogs have all the symptoms, some have very few, and those are the ones that are harder to diagnose. Anyway, thanks again for your response and I find this forum so helpful and supportive. I'm feeling a little desperate in deciding tx as he seems to be getting a little worse every day.

[goldengirl88]

Welcome to the forum. So sorry about your baby having troubles. Cushings can cause trouble with the trachea as my dog has problems. It is made up of cartilage and high cortisol weakens it. By chance maybe you are seeing something like that. If so your dog will honk, and make a whistling noise sometimes when drinking as that affects it. Hoping your journey with this gets easier. Blessings
Patti

[steiny]

Hi,

Thanks for the info....do you do anything special for Tipper for his trachea problems? I have Steiny's food and water dishes elevated and I sit down right next to him while he eats just to slow him down. Did being on the Cushing medications help with his trachea problems? He doesn't have problems drinking water; it only occurs with his small, moistened kibble...and what he does when he starts choking is to back away from his food dish and make swallowing motions...goes away after about 15 seconds, he wiggles his tail and goes back for more! I feel awful when he's struggling with the swallowing bit. How was the trachea problem diagnosed with Tipper? I'd hate to have to put Steiny under anesthesia to check it out?
Kelly

[goldengirl88]

I just knew what it was immediately, and she now gets Adequan shots that people use for arthritis on their dogs as it comes from cow cartilage. I can tell when Tipper needs another shot right away. She usually goes every two weeks. The Vetoryl will only help in as much as slowing down any more damage from high cortisol. Sometimes Tipper's collapses and that is when she panics and cannot get air. I rub her throat gently and talk to her to calm her. You will hear the honking noise if it starts to collapse. It is made up of rings and the rings will no longer stand up and collapse. I also put her on Glycoflex III is has green lipped mussels that are good for this too. Tipper does eat out of an elevated bowl and I cut it all up fine as she gets some chicken. She has breathing problems at nite too which this is probably part of that too. Blessings
Patti

[steiny]

Patti,
Thanks so much for your input and I'm sorry you and Tipper have to experience this. Based on what you're saying, I don't think Steiny's trachea is collapsing but I sure would want to do anything I can to prevent this problem from getting worse. How old is Tipper and how long has this been going on for her? Does she get the Adequan shots from your vet? Blessings to you as well.
Kelly

[goldengirl88]

Tipper is going to be 13 on October 4 God willing. She has had this for a few years, but not as bad and not as noticeable. You should also use a harness and nothing around the neck. The vet gives her the shots they are inexpensive compared to other money I spent that did not benefit her. They cost 19.00 a shot she gets two a month, if not I can tell she is starting to make noises and needs one. A Dr. in Arkansas had a lot of success using this on small dog tracheas. Just make sure they only give the correct dosage for the dogs weight is how it goes. You don't want mega doses as they pose a bleeding problem. This dosage is safe and if your dog has any other joint issues, arthritis etc. it will be beneficial that way too. You need a series of 2 shots a week for 4 weeks I believe if I remember correctly for the initial period, then once a month or twice a month boosters. Tipper has been getting this now for many months and it has helped her immensely. The only other alternative is a stent put in their windpipe, which is a bad operation and does not always work out well. Not to scare you but the one of the reasons I did this is their trachea can collapse and they can't breath and it does not open back up- see where I am going with this? Sometimes they can stitch it open partially but that leaves them susceptible to aspirating food into their lungs. You will see a difference after about a month of the shots. Hope this was helpful and I am not meaning to scare you, just give you the facts. Blessings
Patti

[lulusmom]

Hi and welcome from me too.

I only have a minute but wanted to let you know that in all the years I've been here, I don't ever recall seeing a cushdog, without other underlying problems, with the severe elevations in GGT and ALT that you posted. These two liver enzymes are usually mildly elevated and the fact that bile acids are much higher that what we see in cushdogs, as are the cholesterol and triglycerides, I am wondering if your dog has a lot more going on than just cushing's. Gall bladder mucoceles can cause these elevations and Bichons seems to be predisposed to this so if I were you, I would ask the internal medicine specialist if the debris in the gall bladder seen on the ultrasound could be mucoceles and if s/he has ruled this out. Liver support alone will not help with this condition. Ursodiol is usually prescribed.

Glynda

[steiny]

Hi Patti,
Sorry it's been so long since I responded to your very helpful post. I took Steiny in for a second opinion and his cushings was reconfirmed. I really liked this second vet and started Steiny on the vetoryl this am. She also recommended using the adequan injections and he was started on that today as well. I was taught how to give the injections at home & will save quite a bit of money doing them myself. I'm a retired nurse so I feel quite comfortable giving them. I hope they help Steiny as much as Tipper has been helped. I am much more optimistic...here's hoping for the best. Thanks again for your response to my post; I know it can take up alot of time reading and responding to them. Wishing you and Tipper the best.
Kelly

[steiny]

Hi Glynda,
I did get a second opinion and feel confident that Steiny needs to be treated for Cushings. According to the two different vets that looked at his ultrasound, they don't feel he has GB mucoceles. Steiny does have some of the symptoms of Cushings, but luckily not the increased thirst and urination that most cushing dogs have. We started him on the Vetoryl today so here's hoping for the best! Thank so much for your response to my post!

[steiny]

Has anyone used these supplements along with using the Vetoryl to treat Cushings Disease? Would you recommend these supplements? I just started Steiny on the Vetoryl today and will have his ACTH retested in 14 days. He has very elevated liver enzyme levels.
Kelly

[mytil]

Hi and a belated welcome to our site from me. I have just a sec, but wanted to mention these products could contain elements that do not mix well with Vetoryl. IMO I would not use them, especially Cushex Drops. This product has not been proven to do anything.

I am sure others will chime in shortly.
Terry

[goldengirl88]

Have they put your baby on anything for the mucoceles in the gallbladder? I know a number of the people on here have their dogs on Ursidiol as is mine. Blessings
patti

[steiny]

Steiny does not have mucoceles in his gallbladder so they are just recommending the Vetoryl for the cushings.
Kelly

[goldengirl88]

I hope it all works out and his treatment goes well.

[addy]

A belated welcome from me. After the horrid winter we had here in Wisconsin, I dont blame you for thinking that was part of the problem.

Not to nit pick or make you feel uncomfortable but Glynda is one our most knowledgeable sources here on the forum.


with the severe elevations in GGT and ALT that you posted.



Do both vets think that Vetoryl alone will bring these values down along with the other liver elevations? I was just curious.

My Zoe was on Vetoryl for almost 3 years. We had our ups and downs, she also had IBD and other issues as well. Madison has a good teaching vet school. We used the specialists in WVRC in Pewaukee. I think Zoe saw almost every specialist there:)

[steiny]

Thank you all so much for your input. It's important to me to hear all your opinions.

I specifically asked both vets (one has a speciality in liver and gi ds-Lakeshore specialists) and the other graduated from Madison vet school) about Steiny's very elevated GGT, ALT, and ALKP and the possibility of GB mucoceles. They didn't think that was the problem based on his ultrasound results. They said they have seen levels that high in cushings. I hope they are right and not missing something important.

But I have read that up to 1/4 of dogs with mucoceles don't have any symptoms except very elevated liver enzymes so I will definitely keep bringing it up if Steiny's liver enyzmes remain high (Thanks, Glynda for any advice/questions you think I should ask the vet). Einstein's bilirubin and albumin tests are normal and I read that often they are abnormal with mucoceles.

In your experience, once they get the dosing correct with the vetoryl, how soon should I start seeing improvements in his blood work? Do you think he should have his liver enzymes rechecked after 1 month of being on vetoryl? or is that too soon to see any improvement?

[molly muffin]

It takes awhile to get the liver numbers to start coming down, months. I think you are going to want to test liver results, just to get a feel for it and then retest every few months. The specialist can likely set you up on a schedule for testing liver enzymes.

Steiny sure is cute. Love the avatar.

Sharlene and molly muffin

[goldengirl88]

What a cute little fellow Steiney is . Hope it is going well. I know from my Tipper is does sometimes take a while to get the numbers down. It will get better. Blessings
Patti

[steiny]

I just need to feel optimistic for the time being that we'll get our old Steiny back for as long as possible but only if he doesn't suffer, He's been such a good companion..my husband & I are late in becoming dog owners (after our children were grown) and it's hard to imagine our days without him. He's given us so much that now we only want to do what's best for him. Three days on the vetoryl and so far so good. I'll keep you posted after he goes in for his two week check. He's on a very low dose...10mg every 12 hours so I'd expect that they might have to increase his dose but we'll see. Thanks again for all the support.

[Harley PoMMom]

He's on a very low dose...10mg every 12 hours so I'd expect that they might have to increase his dose but we'll see. Thanks again for all the support.

As long as the cortisol level has not dropped too low, the recommendation is to remain at the same dosing level until the one-month mark. This is because cortisol levels have a tendency to continue to drift downward during the early days of treatment, even when the dose remains unchanged.

[goldengirl88]

I too would leave the dose alone for awhile as that is when some people have gotten in trouble by letting their vets convince them to increase and the cortisol drops too low. Keep Steiny safe and stay the course is what I would do. Blessings
patti

[steiny]

Thanks for the advice..I'll definitely leave the dose alone for as long as possible. Already over the weekend, he's becoming picky about eating and has vomited once and diarrhea once. (new symptoms since he's started the vetoryl) Hope his body adjusts to the reduced cortisol levels without too many more episodes. I'm giving him white rice and ground chicken and he's doing better today off his kibble along with giving him generic pepcid.
Kelly

[goldengirl88]

If he is vomiting or diarrhea you must not give Vetoryl to a sick dog. Did you call the vet and advise them of this? Please do not give any more Vetoryl.

[addy]

Hi there, unless you have already spoken to your vet, please withhold the Vetoryl until your vet confirms to proceed with it. Those symptoms can be a sign of cortisol going to low or possibly just side effects but we dont take chances.

[steiny]

Thanks, I should have mentioned that I have talked to the vet twice over the weekend and dropped a stool sample off yesterday. They are encouraging me to call with any changes. So far, no problems today.

[Trixie]

Aww, Steiny is a cutie. Sorry he's not feeling well. My dog Trixie was diagnosed a year ago at age 9. She was started on Vetoryl..we went in with a low dose and for months tweaked the dose. It took her a pretty long time to show improvement. Her liver numbers were also high which is what alerted the vet to a possible problem at the start. We started on liver supplement-Denamarin- and when it didn't change things too much the vet mentioned Cushings. I didn't see too many symptoms at first but then the drinking, panting, hunger etc...kicked in soon after and we went through the testing, ultrasound, etc. She had enlarged liver which caused her to breathe rapidly and also made her restless trying to find a comfortable sleeping position, so her sleep wasn't great. Her worst symptom was excessive drinking/urinating. She sometimes drank 40+ ounces of water a day...it was unnerving.

After one year on medication my dog is doing really well. Her symptoms are controlled. She actually drinks a normal amount of water again! 2 out of 3 liver enzymes are now normal, all remained high for almost a year and the alp is still not all the way normal, and may never be but it's way down from the high, which was close to 3000 I think. Trixie is pretty much back to her usual self, she's active and happy. She never had any adverse effects from Vetoryl. Watch out for vomiting/diarrhea/weakness it could mean your dose is too high.
Hope Steiny is feeling better soon and that the Vetoryl works as well for him as it has for Trixie.

Barbara

[goldengirl88]

Just checking to see how Steiny is today? Any more diarrhea? If so withhold all Vetoryl and let him get straightened out for a few days. Is he eating at all? Drinking ok? Blessings
patti

[steiny]

Hi Barbara & Patti,
It's so good to hear a success story. Trixie's first signs...elevated liver enzymes, is also what led us to bring Steiny in for testing. Did Trixie develop the excessive drinking/urinating before you started her on Vetoryl? Steiny doesn't have those symptoms and I'm hoping he won't still develop them. His drinking/urinating have remained normal.

He's had a good Sunday and Monday. Eating much better (he's loving the white rice, ground chicken and sweet potatoes; don't think I'll get him back to eating his regular kibble!) No vomiting or diarrhea either days. In fact, he usually poops three times/day and yesterday I started worrying when he hadn't gone all day until 8:00pm. Steiny has always had a reflux/sensitive stomach/allergies to wheat, corn, beef, so we have been giving him generic pepcid with his morning meal for about 7 years or so. The vet suggested we give him pepcid along with the vetoryl with his evening meal as well so I don't know if that helped ward off further vomiting??? Anyway, every day that he feels okay, I feel lucky & blessed. Sorry to hear Trixie was diagnosed at age 9 but so happy for you that she's doing so much better. Einstein was just 14 and we've been very fortunate that he's done well until this diagnosis of Cushings. Wish there was more research on this disease. Thanks, Patti, for checking in on us....means alot to know people care! Hope you and Tipper are having a good day.
Kelly

[goldengirl88]

Glad to hear that your Steiny is feeling better now. I hope everything continues to go well for you and him. He is too cute! Blessings
Patti

[steiny]

Steiny has not been doing well on the Vetoryl. I've been in almost daily contact with the vet since he was started on the medication. In fact, he was due for his first ACTH test this am and the vet thinks we should discontinue it completely and not even do the ACTH test. He had a complete lack of appetite this am...took us 20 minutes for him to take a very small amount of chicken. He also has been experiencing diarrhea for two days...gradually getting better on white rice and chicken. He lost 1 lb in 12 days. He's to start on a probiotic today and when his appetite is back and diarrhea gone, try to supplement him with the Demarin and add Milk Thistle as tolerated.

I asked whether or not decreasing the dosage to 10 mg per day should be considered and they felt that dosage wouldn't be therapeutic enough to make any difference with treating the Cushings. The vet said there are some dogs that just can't tolerate Cushing medications. I feel quite sad! I'd like to hear from people who's dogs haven't tolerated the Vetoryl and what they have done instead. Thanks in advance for any advice.
Kelly

[goldengirl88]

Kelly:
This vomiting, diarrhea, not eating are all classic symptoms your Steiny is overdosed. I totally disagree with your vet who is very much misinforming you. Your Steiny definitely needs can ACTH right now!!! He also needs his electrolytes checked. Do you have a rescue dose of prednisone?? If not please get some. This can be life threatening. Please is there another vet you can go to? Don't give any more trilostane please, go to the vets now. This dosage is too high for him.
We will help you thru, this so please no more trilostane. Blessings
Patti

[My sweet Ginger]

Please, listen to Patti and do everything she's advised you to do.
You MUST do an ACTH stimulation test and check his electrolytes like yesterday. There's no doubt in my mind that your Steiny is suffering from low cortisol caused by trilostane overdose.
From what's been written about what your vet has done or lack there of I really hope you will follow the advice of these experienced members. The collective knowledge of this board is amazing and much, much more knowledgable than most GP vets. I've been around long enough to know that much and they pretty much saved my pup which I ended up going against our own GP vet.
Did your vet give you rescue dose prednisone just in case like this?
If not please get some as Patti said and do not give him any more Vetoryl. You may have to look for a new vet if your vet is not willing to work with you. With cushings it really means nothing how nice your vet is or how long he/she has been in practice. Unfortunately a lot of them just don't have enough experience on cushings disease as much as some experts on here.

[goldengirl88]

I am so worried about your Steiny have you taken him to be seen yet? Please let us know what is going on with him. Blessings
Patti

[Harley PoMMom]

Steiny's symptoms sound like his cortisol has dropped too low and an ACTH stimulation test should be done ASAP, if a dog is not producing enough cortisol they need a steroid substitude such as prednisone, this can be a life threatening situation.

I urge to please stop giving Steiny the Vetroyl and to have his cortisol checked along with his electrolytes, this so very important.

I strongly disagree with the vet's statement that 10 mg is not adequate to bring Steiny's cortisol down, on the forum we have seen dogs on this dose and thier cortisol did drop on a 10 mg dose of Vetoryl.

Please do keep us posted.

Sending hugs and healing energy,
Lori

[molly muffin]

Oh dear this doesn't sound good. I'm thinking the same as the others. No more vetroyl, have ACTH and electrolytes tested.

Do hope everything is okay though.

hugs
Sharlene and molly muffin

[steiny]

Sorry I didn't respond sooner. First of all, thank you all for your concern and want to let you know Steiny is doing better. Electrolytes were normal. No further diarrhea today. And ate all of his supper. Followed up with the internal medicine vet for another opinion. Both vets agreed that Steiny needed to stop taking the vetoryl immediately and at this time don't believe he's a good candidate to be on it. Didn't require any prednisone.

From the beginning, Steiny never had the usual bad symptoms of Cushings. Didn't have the increased drinking and peeing. Appetite was hardy but not ravenous. Liver enzymes were highly elevated and based on testing and other symptoms we were advised to try the vetoryl. We debated about starting him on the Vetoryl to begin with and in hindsite, I wished we would have waited or started him on an even lower dose. The vets now believe, Steiny, has more going on than the Cushings but we don't want to put him through anything more for now. We have stopped the vetoryl and will re-evaluate down the road. I'll keep you posted.

[molly muffin]

Oh I am so relieved to hear that Steiny is doing better. How scary though!

Did they say what they think it might be that is going on? Just thoughts I mean, as I know this isn't a good time to test.

hugs
Sharlene and molly muffin

[addy]

I'm glad they told you to stop the Vetoryl. It sounds like they checked electrolytes. Did they run an ACTH test as well?

[goldengirl88]

I am wondering how String is today?? So did he have the ACTH and electrolyte check? Hope he is doing well. Blessings
Patti

[steiny]

Steiny's ACTH was not low, in fact it was still quite high....so we're thinking the problems he was experiencing (mainly poor appetite and bloody diarrhea) were side effects of the Vetoryl and probably some other underlying problems.

He is doing much, much better off the vetoryl. His appetite is slowly returning and had one semi loose stool yesterday with some blood. He actually was a little playful last night which he hasn't been for weeks. I do think the Adequan injections he's been started on are helping also. He's still on white rice and ground chicken. The vet is recommending reintroducing the demarin and milk thistle when he's better which will be hard since he hates taking pills and fishes them out of his food. Three questions:

1. He is allergic to wheat, corn and beef. I need to start him on canned dog food and the vet said to check out Weruva, Tiki Dog or EVO. Does any one have recommendations regarding a good dog food for someone with Cushings and liver disease. I know I'll have to introduce him to anything I get very slowly. He originally was on Nutro Chicken and Rice Senior dry food for years.

2. When he had the ultrasound done, they asked about doing a liver biopsy and at that time I didn't want anything invasive done...in retrospect, I wish I would have had it done. I've been doing a little reading and was wondering if any of your dogs have been diagnosed with vacolar hepatopathy? It is a disease that often is due to/or a result of Cushings.

3. Blood in his stools. A comprehensive stool test (done 1 week ago) came back negative except for the blood. He still had a small amount of blood in his loose stool yesterday. Could this still be a side effect from the vetoryl? or from his straining?

[goldengirl88]

Is there nay history of Steiny having IBD? maybe that is the stool problem? Would you post his ACTH number for us? Hope he is on the mend, every time I look at his avatar it melts my heart. Blessings
Patti

[lulusmom]

Steiny's ACTH was not low, in fact it was still quite high....so we're thinking the problems he was experiencing (mainly poor appetite and bloody diarrhea) were side effects of the Vetoryl and probably some other underlying problems.

He is doing much, much better off the vetoryl. His appetite is slowly returning and had one semi loose stool yesterday with some blood. He actually was a little playful last night which he hasn't been for weeks. I do think the Adequan injections he's been started on are helping also. He's still on white rice and ground chicken. The vet is recommending reintroducing the demarin and milk thistle when he's better which will be hard since he hates taking pills and fishes them out of his food. Three questions:

1. He is allergic to wheat, corn and beef. I need to start him on canned dog food and the vet said to check out Weruva, Tiki Dog or EVO. Does any one have recommendations regarding a good dog food for someone with Cushings and liver disease. I know I'll have to introduce him to anything I get very slowly. He originally was on Nutro Chicken and Rice Senior dry food for years.

2. When he had the ultrasound done, they asked about doing a liver biopsy and at that time I didn't want anything invasive done...in retrospect, I wish I would have had it done. I've been doing a little reading and was wondering if any of your dogs have been diagnosed with vacolar hepatopathy? It is a disease that often is due to/or a result of Cushings.

3. Blood in his stools. A comprehensive stool test (done 1 week ago) came back negative except for the blood. He still had a small amount of blood in his loose stool yesterday. Could this still be a side effect from the vetoryl? or from his straining?

Vacuolar hepatopathy is not a disease, it is a liver abnormality commonly found in cushing's as a result of excess accumulation of glycogen. Almost all dogs with cushing's have vacuolar hepatopathy. This does not mean that a dog has primary liver disease nor does it mean that a special diet low in protein should be given. Did your vet confirm a diagnosis of liver disease?

Other than insufficient cortisol as a result of an overdose of Vetoryl, we've seen few dogs who have had severe gastric upset as a side effect of Vetoryl. More often than not, pancreatitis or IBD has been the underlying cause. I've dealt with both too many times but never with a cushdog on Vetoryl, so my experience doesn't really count. Addy and Lori are our resident experts on these conditions so I hope they will chime in and share their thoughts.

Glynda

[steiny]

His lipase was elevated in May at 835 U/L (normal 109-750). I don't know if that is a significant elevation or evidence of pancreatitis. On his ultrasound, it said pancreas-no significant findings. Also, small intestine and colon had no significant findings. He's never been diagnosed with IBD..could the Cushings have masked this for awhile and then when his cortisol started dropping...he developed symptoms. I really don't know much about IBD.

The vet didn't recommend a diet low in protein...just wanted him on canned food because he's been having some difficulty swallowing. I've read that Cushing dogs shouldn't be on a low protein diet.

Also, vet never said Steiny had liver disease; my mistake. My original post lists his elevated liver enyzme levels and his ultrasound showed "generalized moderate to severe hepatomegaly, multiple small (5-10mm) hypoechoic parenchymal nodules.

[lulusmom]

That is correct, unless a cushdog has severe renal impairment or advanced primary liver disease, they should not only not have protein restrictions but should be fed a diet with a moderate amount of good quality protein and lower in fat. My cushdogs were on a bit higher protein diet and they did exceptionally well on it. At this point, I think it is important to feed the prescription diet your vet has given you. I assume that the canned food your vet gave you was either Hills ID or Royal Canine Gastrointestinal Diet, right? Both of these diets are easy on the digestive system and are very good for dogs with pancreatitis or any other type intestinal disorder.

The Lipase value you posted would probably be viewed by a vet as being rather mild. It is my understanding that these mild elevations are very difficult to interpret so given that the ultrasound didn't show any significant findings, your vet is probably not too concerned with it.

[steiny]

Just an update on Steiny, he's back to eating and pooping normally. I'd like to start him on a good quality canned dog food. The vet hadn't recommended the prescription Hillls ID or Royal Canine. Just something that would be easier for him to swallow and had good quality protein. I'll introduce it slowly.

I guess I feel like I'm back to square one...two vets say he has cushings but he doesn't really have any of the "major symptoms" and didn't tolerate taking the vetoryl. Do you think I should wait until he does develop the major symptoms and then restart him on a really, really low dose? I'm not getting much advice from the vets other than give him the liver supplements Demarin and Milk Thistle which I haven't tried to reintroduce since I wanted to get his gi problems under control. He's a terrible pill taker and the milk thistle capsules I have are huge. I'm hesitant to try anything new, as for the first time in two weeks, he seems back to his pre-vetoryl self. I would take him yet for another opinion but one, Steiny has such terrible car riding anxiety that I think that I don't want to stress him out and two, who can I trust to take him to? I've already taken him to a IM specialist who came highly recommended and the other vet was highly recommended also.

[goldengirl88]

How about if you would open the milk thistle and put it in his food and mix it? If I were you I would watch how he is acting very closely and see if he develops any symptoms. many do not treat until the symptoms start. Also I do not know if it is correct to say Steiny does not do well on Vetoryl, or that he does not do well on too high of a dose. If and when I started him it would only be very low dose due to what has already gone on. Another opinion of his Cushings never hurts. Blessings
Patti

[steiny]

Thanks Patti,
Yes, I agree...the dose may well have been too high.

I did try and sprinkle the milk thistle on his food and it's pretty stinky stuff...he wouldn't eat his food. It might work better if I mix it with some canned food but first I have to see how he tolerates the canned food. If there is anything I've learned through all of you, is to take one step at a time. Otherwise, you don't know what's causing what. Hope you're having a good weekend.
Kelly

[goldengirl88]

Kelly:
I never opened one of those capsules, so I did not know they were stinky. I wish they would make these pills and capsules, smaller so they are easier to disguise.
I give Tipper S Adenosyl and they are round tablets that I can put in a piece of chicken. I hate capsules. Tipper takes one supplement for her heart and it is huge. I put it in chicken, and she barely gets it down. Hope Steiny is still doing well. Blessings
Patti

[Harley PoMMom]

J

I guess I feel like I'm back to square one...two vets say he has cushings but he doesn't really have any of the "major symptoms" and didn't tolerate taking the vetoryl. Do you think I should wait until he does develop the major symptoms and then restart him on a really, really low dose?

With Cushing's the goal of treatment is to control the bothersome symptoms, since Steiny does not display any symptoms of Cushing's, IMO, there is no reason to start treatment.

Hugs, Lori

[addy]

Zoe was diagnosed with Cushings and most of her blood labs were normal, slight elevation in ALKP and cholesterol. She had more problems with "colitis" than with Cushings. I think I mentioned I waited a year to start treating her Cushings. I tried to get her stool issues under control which ended up being diagnosed officially as inflammatory bowel disease through endoscopy and biopsy. I had good control of her IBD before we started Vetoryl and we started at a very low dose and her IBD immediately flared and in the beginning it flared every time I upped her dose.

I started treating Zoe because I felt I was seeing new symptoms and the old symptoms were getting worse. Her blood work also changed.

It could very well be your pup has Cushings as did Zoe. It could also be that you can wait and work on the stool issues and monitor symptoms for the next 3-6 months or more.

You have to look at the whole picture.

[steiny]

Listening to all your advice has really helped me decide to take my time regarding further treatment. Steiny seems to be holding steady...sleeps a lot and continues to be losing more and more fur. Back legs seem to be getting weaker but none of the urinary problems so feel lucky about that.

[goldengirl88]

I think you are being wise. Until Steiny starts to exhibit symptoms I would just be observing and journaling his days for reference. Hope he stays well. Blessings
Patti

[steiny]

I woke up during the night thinking of all the wisdom, experience and caring that comes from a forum such as this....specialists and vets may have the expert training and education but it's not the same as relating to people who live with their dogs and cushings on a day to day basis.

It took me a while to realize that the "experts"...for me, that initially meant the vets, aren't always right or have the best answers.

Just wanted to let everyone know who has read my posts and/or responded how much they are appreciated.

Kelly

[goldengirl88]

Bless your heart, and Steiny's too!

[Harley PoMMom]

Just wanted to let everyone know who has read my posts and/or responded how much they are appreciated.

Kelly

Oh Kelly, I do remember how I felt when I first joined this forum, which was the first time I had ever joined any on-line forum! When Harley's vet told me that my precious boy had Cushing's I was speechless and so very scared :eek::eek: I didn't know anything about Cushing's, which made me even more scared!!

Thank GOD, I found this forum and the wonderful and knowledgeable members here, they have guided me, answered tons of my questons, and have given and continue to give me their loving support....that was 5 years ago, I do hope that I am helping members as much as I have been helped.

Many loving hugs to you and Steiny

[goldengirl88]

I second that. I too was scared to death for my Tipper's life upon learning she had Cushings. It scares the daylights out of you when you know nothing about it, but think your dog is done for. These people sacrifice their time, and love animals so much they have helped me a million times beyond what my vet could have ever helped me with as he knows virtually nothing when it comes to this. My dog is alive today because of the great people on this forum. I made up my mind I would give 2 hours every day to help others who walking in my shoes now. If it saves one dog it is well worth it, but it has saved many. Blessings
Patti

[steiny]

Just checking in. Hope all had a safe and happy 4th of July. Steiny has been off the vetoryl for almost 3 weeks and seems to be back to his pre-vetoryl self.

The only medications he is on now are S-Adenolsyl (SAMe)-100 mg once a day, Milk Thistle 150mg once a day (both recommened because of his elevated liver enyzmes), Pepcid once a day (for reflux) and ichon injections weekly for his arthritis. He's drinking and urinating normally...not excessive at all. The biggest problem (not for him but for my husband and me!) is that he wakes up at 4:30 am and cries until we get up to feed him. He doesn't need to go outside...just has to eat! We'd leave food out for him but because he has a tendency to choke on his food, we have to be right down next to him and slow him down to eat. We've tried giving him his last meal later in the eve...10pm or even later...but doesn't seem to matter..still wants up at 4:30 am to eat. Goes right back to sleep afterwards. He's satisfied to wait for his next meals at noon and 6:00 pm. We just wish he'd sleep in later. I shouldn't complain...his Cushing symptoms are so minor right now compared to a lot of dogs with Cushings especially since he's not on the vetoryl. I'll probably take him in for blood work in about 1 week. His abdomen is still quite large but his weight has remained stable and doesn't seen to have any discomfort in his tummy when we pick him up. Is this early rising a part of Cushings or do some dogs just get there days and nights mixed up as they get older?

Kelly

[molly muffin]

Glad to hear that Steiny is doing okay. Have you tried moving the time back slowly from 4:30. Starting at like 4:45am and just keep inching it back. Even if at first you get up at 4:30, wait a bit to give him his breakfast.
As long as he has water all the time that is the main thing. This sounds rather behavioral since he can wait all day for his next meal if needed. What about cooking greenbeans or something like that to give him as a snack before bedtime?

Sharlene and molly muffin

[steiny]

Hi everybody,

Haven't posted in about 6 weeks....Two weeks ago Steiny was treated for an infected wart behind his ear which now looks like it's healing okay. Today, I took him in because his one eye didn't look quite right and he was squinting and pawing at it. Vet diagnosed it as active coroneal lesion based on staining test. He's now on antibiotic ointment three times per day for 10 days and I need to take him back to have it rechecked. Since he hadn't had his liver enyzmes tested since May, they also drew blood to check his liver enzymes, cbc and pancreas.

I've read that infections can increase in dogs with untreated cushings. Steiny was on vetoryl for about 7 days in June but did not do well on it probably because the dose was too high. I'm thinking it might be good to start him on it again, maybe at 10mg per day. He weighs 16 lbs. The last time he was on 10 mg twice a day and developed bloody diarrhea and lack of appetite. He still doesn't have the increased thirst and urination that most Cushing dogs have but his appetite has increased and he begs for food which he's never done before. However, I wouldn't call his appetite ravenous. Any advice would be appreciated. I will post his blood work results after I get them tomorrow. Thanks.

Kelly

[lulusmom]

Hi Kelly and welcome back.

If it were me, I would not restart treatment until after you get the results of the latest test results. I'll be interested to see if there have been any remarkable changes in the liver values.

Glynda

[steiny]

Hi Glynda,

Just got a call from the vet and sadly all his lab work has gotten worse. I was so upset that I didn't even ask for any specific results but I plan on getting a copy tomorrow. I remember him saying the liver enzymes, bile acid, pancreas were all up from three months ago. He said it was up to me if I wanted to start him back on the vetoryl but at 10 mg/day. I'll try and post again tomorrow.
Kelly

[lulusmom]

Kelly, please do post those results for us. The bile acids done four months ago were already pretty high at 78.0 umol/L, which is at a point that I would think a vet would be questioning whether there is something more than cushing's going on. :confused:

[steiny]

Hi,

I'm going to post Steiny's most recent abnormal lab results from 8/20/2014. His CBC was normal.

GGT 501 U/L (3-19) In May was 253
ALT (GPT) 766 U/L (14-151) 613
Alk.Ptase 4442 U/L (13-289) 3153
Bilirubin and Protein still normal
Albumin 4.4 g/dL (2.6-4.0) 4.5
Glucose 148 mg/dL (74-145) 121
Urea N 41 mg/dL (8-30) 35
Bile Acids Fasting 58.8 umol/L (0.0-12.0) 78.1
Cholesterol 576 mg/dL (98-300) 505
Amylase still normal
Lipase 837 U/L (109-750) 835

These labs were not fasting labs. They were drawn about 1 hour after he had eaten at 6:00 pm and he eats three times/day. It says something on the lab report that increased serum bile acid values in non fasted samples, you would expect the value to be 80-100 umol/L in cases of vascular anomalies ie. shunts or microvascular dysplasia..not sure what that all means.

The vet that did the lab work is not the specialist I took him to back in June. Not sure what to do. This vet says I should try the Vetoryl again at 10mg/day. Sorry this is so long. I'm just confused and trying to figure out what to do. The only enjoyment Steiny appears to be getting out of life is eating and sleeping. Isn't much interested in anything else which makes us pretty sad.
Kelly

[steiny]

My previous lab result posting looks a little confusing. The very last number listed next to the lab results are the results from May. I thought it would be easier to see what had changed in the three months since he's been on Demarin and Milk Thistle. Doesn't seen to have helped much but then again, could his results have been even worse?

Kelly

[molly muffin]

Did they ever do a bile acid test to check the liver? Those results really make me think this might be a bile problem, maybe a blocked duct even, either in addition of rather than cushings.

Sharlene and molly muffin

[steiny]

Hi,

Yes Bile Acids were repeated. Now Bile Acids are 58.8 umol/L (0.0-12.0) Results in May were 78.1 umol/L. So still elevated but down from three months ago. Not sure what to ask specialist about. GGT up, Lipase up, AlpPts. up. With his two recent infections, not sure what to think? Steiny up now..3:30 am. Woke up moaning. Fed him and seemed to make him more comfortable.
Kelly

[molly muffin]

Did they ever look at putting Steiny on any meds for bile duct sluge? Or treating the liver? Ursiodiol is what I'm thinking of for the sludge that might be causing some of the problems?

Sharlene and molly muffin

[steiny]

Hi Sharlene,

No one has ever mentioned trying this medication? Do you know if there are any side effects? I think it might be worthy of consideration. Do you know how quickly it helps?

Because of his most recent infections, the last one being a coronea lesion, I'm wondering also if we should try the vetoryl again to get his cortisone under control. I don't like introducing too many things at once as then I don't know what's causing a problem. I guess I need to address all of this with the internal med. doc but frankly I don't have a whole lot of confidence in vets anymore. Thanks for all your input!

Kelly

[molly muffin]

I would ask the vet about it, in light of the bile acid reports if he thinks a build up of sludge could be the problem and what about addressing that if he does. (this would be the likely medication for it) You could try vetroyl again, but at a lower dose as there was problems last time, maybe even starting as low as 5mg.

Sharlene and molly muffin

[steiny]

After more discussions with the vet, Steiny was restarted on the vetoryl but at 1/2 the dose he previously had problems with. We are now on his 5th day at 10mg every morning with food. Other than a slight decrease in appetite, he appears to be doing okay. I take him back in for bloodwork and recheck of his corneal eye infection on Sept. 2. Hoping this time around we don't have any problems. Thanks for everybody's support.

Kelly

[Squirt's Mom]

Have his signs returned? Was an ACTH performed showing the cortisol was once again high? If the answer to these is "no" PLEASE keep a very close eye on your baby boy. ;)

[steiny]

Einstein is on his 8th day of the reduced dose of vetoryl and so far so good. Had two days, day 3 & 4, where his appetite was a little down but now is eating normally. Actually isn't waking at 4:30 am begging to eat!

Only problem now is that his corneal eye ulcer does not seem to be healing as well as I expected. We see the vet tomorrow to check ACTH levels and restain his eyeball. Do any of you have experience with corneal eye ulcers? He's been on 10 days of antibiotic ointment (three times/day). I have a feeling he will want me to take him to an eye specialist.

Kelly

[Spencersmom]

Having dealt with corneal issues with my dogs, the best coarse of action at this point is to go to an eye specialist! Take all meds with you that Steiny is taking and any records you have so they will have a complete picture of what is going on! This will help them to determine best course of action!

Eye issues can be tricky and can turn very quickly to a real emergency! Been there, done that!!! I would encourage you to be proactive with this so you don't end up with a potentially serious ailment! Not trying to be dramatic, just speaking from experience!

[steiny]

Thanks for your quick reply and advice. I'll know more tomorrow and go from there. I think there is only one eye specialist in our area...hope he's good.

[molly muffin]

I completely agree with Terry. You want to make sure this is taken care of by the best because as she said, it can turn quickly. It also can take a lot of patience and many eye drops on a schedule. I remember that Addy's Zoe went through eye problems last summer and it took all summer of eye drops every few hours, I don't remember how many medications she used, but it was a few to get it back to normal. She did it though and I know that once you get a plan of action by a specialist that you can do the same.
My molly is seeing an eye specialist in a couple weeks for a different issue. I wish you all the luck in pursuing this. We're here with you!

hugs
sharlene and molly muffin

[lulusmom]

I agree that a board certified veterinary opthamologist is probably a very good idea. Corneal ulcers are often difficult to get healed up and sometimes require a procedure called grid keratectomy. They numb the eye and use a q-tip to remove dead cells/tissue which promotes healing. I had a little Chihuahua with horrible corneal ulcers in both eyes. Lord knows how long she had the ulcers. I didn't think they would ever heal but they did. We got the ulcers resolved but she has chronic dry eye so is on lifetime eye meds which is a compounded Optimmune. It's much, much cheaper and lasts a lot longer than a tiny tube of Optimmune. She was my most costly rescue....her eye care was over $3k but she still has her vision. Her forever mom and I became very close friends so I get frequent updates. :D

Glynda

[Trixie]

I"m no help with the eye issue but sounds like the reduced dose of Vetoryl is okay so far. The abatement in symptoms should be gradual and all symptoms will not all go away so quickly. It can take a few weeks or longer to see real improvement, and sometimes a stubborn symptom may hang on for awhile. Hope Steiny continues to improve. :)


Barbara

[steiny]

Thanks everybody for your support. The vet re-stained his eye and it still lit up green so it's still an active ulcer. The vet feels it's improved a little and gave me different antibiotic drops (tobramycin) to give three times/day for 14 days. Luckily, Steiny doesn't seem to be in much discomfort with his eye. I swear dogs have a much higher pain tolerance than humans. I remember scratching my cornea once and I remember it being very painful. I asked him about seeing a specialist and he said it was up to me and gave me the name of a board certified ophthalmologist. I called and the first appointment I could get for him is in three weeks. I'll continue with the drops and if his eye seems to get worse or not get better, I'll beg them to take him in earlier.

We talked about his worsening liver lab tests; specifically the bile acids and ggt. I also asked about putting him on ursodiol for his gallbladder sludge and he wrote out a script for me. The dosage he wrote is for 1/2 tablet (250 mg tablets)so he'll be getting 125 mg once per day. Does this sound like the correct dosage for a 16 lb dog? I didn't get the feeling he was real familiar with ordering this medication that's why I'm asking. He told me to try it out for 30 days. Should his liver values improve in such a short period of time? He did say they found most dogs don't seem to have alot of side effects with this med.

I really don't like starting alot of different stuff at one time...I hope what I'm doing will help and not make matters worse.

According to his labs and how he's doing, we decided to keep him at the vetoryl 10mg/day. Based on everything I've heard from all of you on the forum, I'd much rather be more conservative especially since I had such a scare with him with the first time he went on the vetoryl.

Thanks again and sorry this got so long! I certainly appreciate any and all advice from all of you.

Kelly

[steiny]

Thanks to Glynda, Barbara, Sharlene, Terry and everyone else who has gotten Steiny and me through this so far!

Steiny is on day 15 of the vetoryl and continues to do well, not begging for food at 4:30 in the morning is most welcome. He actually wants to go for longer walks and definitely has more energy. Will see eye specialist in about two weeks to further evaluate eye infection.

So far he's had no problem being on the ursodiol. In your experience, how long are they on this medication before you see any improvement in liver enzyme levels, specifically GGT and ALT? Not sure if it's worthwhile to have them checked along with his next ACTH. They were last drawn on 8/20.:)

[lulusmom]

The last blood was drawn on 8/20 but you didn't start Steiny on the Ursodiol until sometime this month, right? You should wait at least 30 days before checking the liver values again. If your vet recommends that you redo a bile acid test, make sure you stop dosing with Ursodiol three days before the test. The reason for this is that Ursodiol is a bile acid and will affect the test.

[steiny]

Thanks! Good to know. He started ursodiol on 9/2. I'll stop it three days before I schedule the next liver test/bile acid test. In your experience, should the bile acid be a fasting test? It never has been in the past. It's hard to fast a Cushing's dog especially one like Steiny who already has a tendency for reflux if he isn't fed three times per day.

[lulusmom]

Steiny should not have had any food or water for 12 hours before any of the bile acid tests.

[steiny]

Thanks again for the information. Steiny has had two bile acid tests done and neither time was he close to being fasted!!! (I should have known better and questioned it after the first test was done when the lab report I had printed out said "fasting bile acid test". :(

You would think the vet should have instructed me to do so. The results don't mean much if the test is performed incorrectly. The vet that ordered the bile acid tests is not the internal medicine vet/specialist; he's Steiny's general vet whom I'm realizing is not up on current practices.

Kelly

[lulusmom]

Kelly, it sounds like your vet is a perfect example of why we pet owners need to educate ourselves so we can be proactive, knowledgable advocates for our pups. So many of us have been beyond disappointed in our vets and a lot lighter in our wallets because of their failure to properly counsel us on proper treatment and testing protocol. It's a sad state of affairs when we have to educate our vets but better us than nobody at all. At least the next pet owners may not have to deal with the same thing if we step up and beat our vets over the head with supporting documention that shows them the error of their ways.

[labblab]

Hi Kelly, for reference purposes in the future, here's an example of proper intructions for a bile acid test:


The most important aspect of a bile acid test is the fasting beforehand. The dog is required to not eat or drink anything for approximately 12 hours before the test is administered, reports VCA Animal Hospitals. This even includes chews and small treats. It can be tempting for an owner to feed their dog, but it is essential that the canine does not eat during this time in order to get an accurate result.

Once the fast is completed, blood will be drawn from the dog. The dog is then allowed to eat and digest a portion of food and a second blood sample will be drawn two hours later. Both blood samples are tested for the level of bile acids. If the liver is working properly, a fasted dog should have very low levels of bile acids and only a slightly higher level after it has eaten. In a dog with liver disease, both samples or just the sample taken after eating may be abnormal. Depending on the degree of abnormality, your veterinarian is likely to recommend other tests or treatments for your dog with liver disease.

http://www.vcahospitals.com/main/news/pet-news/preparing-a-dog-for-a-bile-acid-test/373

Marianne

[lulusmom]

Thanks, Marianne, for providing Kelly with the supporting documentation to beat her vet over the head with. :D

[steiny]

I'm definitely printing out the documentation you both have provided regarding the bile acid tests! Not sure if I'm brave enough to clobber him over the head or even if I want to go back to him. But thanks to you, I'm better informed if/when they repeat this test. Maybe, if his liver enzymes (GGT and ALT specifically) come down and clinically he continues to improve, the bile acids won't have to be repeated??? Wishful thinking on my part but it's sad that I can't rely on the vet to address these questions. I am so glad to have found this forum.

Glynda & Marianne, how did you get so smart?

[steiny]

Just wanted to let any new readers know that my 14 year old Steiny was diagnosed almost 4 months ago with Cushings and I was really scared of the diagnosis! We had a rough patch in the beginning but with the help of alot of people on this forum, we are doing much, much better. Owners know there dogs best and being new here, I hesitate to give advice, but what was helpful for me was to keep a daily log of how he was doing..mostly logged about medications, his appetite, poops and pees and anything out of the ordinary (good & bad)! I kept it short so it didn't seem like a chore.

I'm happy to report that he's more energetic and playful. We have a ways to go (still working on healing his eye ulcers and getting his liver enzymes down) but am hopeful that we have this Cushing's under much better control! I also think I'm feeling more confident in dealing with the different vets and specialists just because of all the info I've read on this forum.

Kelly

[Dixie'sMom]

Hi Kelly and Steiny :) I'm new to this also and it is such a blessing to have this forum. The folks here can focus and guide us, when we are too torn by emotion to think clearly. I have also been keeping a brief diary and its nice to see that real progress is being made.

Steiny is so cute and he always looks like he is smiling. I'm so glad to hear that he is doing much better. I hope everything continues to improve. I know it such a relief to finally have things under control.

[molly muffin]

I couldn't agree with Suzie more, Steiny always looks like he is smiling in that picture. Such a happy face.

You're very sweet to post for new members. It is awfully scary when we first hear that diagnosis.

Hugs
Sharlene and molly muffin

[steiny]

Hi to everybody,
Haven't posted since 9/18/14. My husband had total left shoulder replacement surgery and we had a death in the family so I haven't been keeping up on the site as much as I'd like to. My husband's recovery is going well so now I'm concentrating on getting Steiny better.

We are going to a new vet; Steiny is having more symptoms of cushings, excessive drinking/peeing and hunger. Is still on the vetoryl but still at 10mg every morning. Also now on ursidiol. All meds since about late Aug/early Sept. Reminder: he weighs about 15.9 lbs.

Latest abnormal lab work done on 10/24:
ALP 2584 (5-160 U/L)
ALT 339 (18-121 U/L)
GGT 181 (0-13 U/L)
Total Protein 8.1 (5.5-.5 g/dL)
BUN 55 (9-31 mg/dL)
Cholesterol 367 (131-345) mg/dL)
Glucose 36 (63-114 mg/dL)
Calcium 11.3 (8.8-11.2 mg/dL)
Chloride 98 (108-119 mmol/L)
Potassium 6.0 (4.0-5.4 mmol/L)
NA/K Ratio 25 (28-37)

Liver enzymes and cholesterol all improved from August. BUN worse.
Creatinine normal at 1.2 (0.5-1.5)

Based on these tests Steiny had a repeat ACTH test this am and urinalysis. He will have fasting two hour bile acid test also. Vet to call me tomorrow with results of ACTH and urinalysis and decide if we can proceed with increasing the vetoryl to better control his symptoms. I am concerned about worsening BUN and very low glucose. He's never had his electrolytes checked by other vets so nothing to compare it to. His past glucose tests have always been in the normal range. This blood work was drawn at about 4pm and he had last eaten a meal at noon. Vet says he's dehydrated. We have water dishes in about every room in the house. Don't know what else to do. I'd like any thoughts or suggestions or questions I should be asking the vet when she calls back tomorrow. Thanks in advance for your advice.

Kelly

[labblab]

Hi Kelly,

Just wanted to check the timing of Steiny's meals and medication dosing in conjunction with the tests that were run today. The ACTH should have been done 4-6 hours after being given the trilostane along with a meal. Was Steiny given his trilo with lunch, with the ACTH following at 4:00? Is that when he usually gets his trilo, at noon?

And then I'm not clear whether the bile acid test was also done today, or if it will be on another day. I'm assuming it is yet to be done since Steiny will need to be fasted for that?

Marianne

[steiny]

I realized my last post was pretty confusing. He's been back and forth to the vet several times so tests were done on different days/different times. Einstein gets up between 4-4:30 am to eat as he's super hungry so it worked out to do the ACTH testing at 9:00am. Still waiting for the results.

Yes, the bile acids testing was done under fasting conditions. Also don't know those results. Vet reported his urinalysis as negative for infection and glucose, urine concentration was okay. It did show some protein in his urine. I don't have a copy of that report yet for specifics. I did find out that the low glucose on his blood work was a lab error and it was repeated. Just waiting now for the rest of the results to see how to proceed. Otherwise, Steiny, appears to be more alert and goes on longer walks. It's just his excessive drinking, peeing and appetite I'd like to get under better control. Thanks for your help...wouldn't be knowing what questions to ask if not for knowledgeable people like you and the others!

[steiny]

Steiny's pre acth test was 7.1 and post 14.0. This is on 10mg vetoryl once in the am. Since Steiny is having increased thirst, peeing and hunger, the vet suggests adding 5mg with the evening meal. We are in the process of checking out compounding pharmacies for this lower dosage.

His bile acids were done...this time fasting. Fasting was 38.1 (0-6.9) and post eating after two hours was 49 (0-14.9) Vet says this is suggestive of liver not functioning normally which could be from the Cushings/gallbladder sludge. Liver enyzmes have been coming down since he was started on ursodiol. Here's hoping he won't have alot of problems with the additional vetoryl.

[molly muffin]

Getting his cortisol down to good levels hopefully will help not hurt the liver.

It's a rough road some days. We just keep on trudging along it, doing the best we can.
You are doing an excellent job of staying on top of a tough situation.

hugs

[steiny]

My vet & I were researching compounding pharmacies for lower dose tristolane and she has used this one in the past. They are more expensive than the one in my area but of interest, is that they offer tristolane in tabs and an oil suspension. This is out of my area of expertise but thought I'd pass this along for you experts to review.

I haven't started Steiny on the additional dosage yet...not sure what I'm waiting for....I guess I'm nervous that he'll have a problem with the increased dosage.

Kelly



http://www.wedgewoodpetrx.com/symptoms/canine-cushing-s.html

[molly muffin]

That is interesting they also have trilostane in treat and chewable tablet form.

thanks for the info

hugs

[steiny]

Happy New Year to all!

Haven't posted since November. Steiny, my 14 1/2 yr. old Bichon was diagnosed with pituitary cushings in May 2014 and initially had a rough start on vetoryl. Was started on too high a dose. He also has some other "issues" probably related to gallbladder sludge, reflux, and abnormal bile acid tests and GGT levels and ???

We were doing fairly well since Nov. 9th on compounded trilostane 10mg in am and 5mg in pm along with daily 250mg ursodiol, 10 mg famotidine and SamE. His ACTH levels were coming down nicely as were his increased appetite and peeing.
10/29 pre ACTH was 7.1 post 14.9
12/14 pre ACTH was 6.3 post 10.5

His liver enzymes, although still quite abnormal were trending downward as well.

We decided since his ACTH was coming down and his symptoms were better controlled that we would keep Steiny on his current meds and not make any increases to the triolostane especially since we didn't want to have problems over the holiday.

Well.....approx. 1 1/2 weeks after his last ACTH test, a few days before Christmas, Steiny started with a markedly decreased appetite and semi-formed, blood tinged stools and vomiting. Trilostane was stopped immediately. Vet didn't think his cortisol level was too low since we hadn't changed his trilostane dosage and it was just checked two weeks earlier. On Christmas Eve...labs done showed he was dehydrated and he was given subq fluids. X-rays and "quick" ultrasound did not show anything unusual except for his enlarged liver. We were sent home with a one week supply of flagyl and diet for diarrhea/gi upset. We had a heck of a time getting him to take the flagyl, famotidine and ursodiol. For the next 6 days, he continued to have a decreased appetite, semi formed dark bms and one scary episode of very dark, blackish vomitus. Vet did not think it was blood since it wasn't "coffee ground" consistency. Hematocrit done on the 24th was normal. During this time, he had one episode of peeing in the house which he has never done.

Happy to report, he's been off the flagyl for two days, appetite has improved markedly and bm's are more normal. The vet is still monitoring him closely for dehydration. Last BUN was 86. His cushing symptoms are not causing problems at this time so not in any hurry to start him back on trilostane. The vet & I think Steiny has something going on in addition to the cushings but honestly, I'm not pushing for more testing. I don't feel I can deal with another bad diagnosis.
Kelly

[Harley PoMMom]

Hi Kelly,

Thanks so much for coming back and updating us, sorry that Steiny had an episode of feeling unwell and glad to hear that he has rebounded back.

Stopping the Trilostane was absolutely the right thing to do. I was just wondering, was the Trilostane that was given to him right after the last ACTH stim test out of a prescription that was just renewed, or from the batch that he has been taking?

Hugs, Lori

[Dixie'sMom]

Hey Kelly. When I saw your thread come up I just had to pop in to see your avatar and Steiny's sweet, smiling little face. I'm sorry to hear that he hasn't been feeling good. Hopefully it was just some random GI upset and not a precursor to any bad news. Please keep us posted on how he is doing.

[steiny]

After his last ACTH test, I had a couple of days left of his trilostane and then had his prescription refilled at the same compounding pharmacy that we used initially. We didn't change his dosage and the compounding pharmacy was recommended by his vet and other vets in the area.

Have others in this forum had difficulty with using compounded trilostane? Steiny was on 10mg in am and 5mg in pm so we had to go the compounding route.

Steiny's appetite is pretty much back to normal; but not begging for food. When he got so sick before Christmas, I stopped all his meds including his ursodiol and famotidine as he wasn't eating. Not sure what caused what but he seemed to get better after restarting the ursodiol and after finishing his flagyl... his gallbladder/liver/GI issues seem to be complicating his cushings diagnosis and treatment.

I'm just appreciating his good days so much more! Trilostane is definitely on hold for the time being. If he's not experiencing any cushing symptoms, is there any reason to recheck his ACTH levels?

Thanks again for your support and input.
Kelly

[Harley PoMMom]

Many of our members do use a compounding pharmacy for their dog's Trilostane, and with success. The cost of brand-name Vetoryl can be expensive so having the Trilostane compounded does save money. Also, sometimes Dechra does not manufacture the Trilostane dosage that is needed, especially for the small dogs. So using a compounding pharmacy does have its advantages.

However, a couple of studies have indicated that some compounded products do not deliver as consistent or effective a dose as brand-name Vetoryl. The most important thing when using a compounding pharmacy is to obtain the medications from a reputable source. Since Steiny's vet did recommend the pharmacy I am sure they are creditable.

Hopefully Steiny's latest issue of not feeling well will be just a single episode, and do keep us updated, please ;)

You're doing a great job, Mom!!

Hugs, Lori

[molly muffin]

Glad to hear that Seiny is rebounding from not being well before Christmas. Boy those kind of things are scary. Stopping the medication was absolutely the right thing to do. We use a compounding pharmacy too, the cost while not fabulous is better than the name brand vetroyl, but the compounding pharmacy does have to be consistent.

hugs

[steiny]

Steiny had another setback. Developed bloody diarrhea and vomiting multiple times yesterday and we had to take him to the ER last night. Received subq fluids again for his dehydration, medicine for nausea and back on antibiotics.

Scary night, taking him to the ER, not knowing for sure if we would be bringing him back home. Stumped as to what exactly is going on.

He was up three times during the night with more diarrhea. Vet says to try deworming medicine so we started that today. Seems to be doing better today; only one episode of diarrhea and ate a small bland meal. He's been very wakeful today and oddly, he's spent the last couple of hours licking at a towel he's been lying on. Seems to be comforting to him so I'm just letting him do it. Yesterday was so, so hard for all of us...running in and out of the house all day/night long with temperature hovering around 0 degrees. Thankfully, today is a better day! Thanks for listening.
Kelly

[molly muffin]

Oh no, not another set back. :( Do they suspect he has some sort of worms picked up? Dewormer can also cause some stomach upset and diarrhea in some pups, so wanted you to know that too. Did they do any testing for parasites?

I'm sure you are all exhausted and scared for steiny. Do hope he makes a turn around here.

[steiny]

Steiny returned from the vet visit today and is doing better. No further diarrhea or vomiting. Less dehydrated but still needed some subq fluids. Decided to keep him on the flagyl, famotidine and probiotics to try and settle down his gi tract. Trilostane and cushings tx. definitely on the back burner as his other problems take precedence.

I don't know if anyone else ever experienced this but as a result of my giving Steiny a bland diet....I may have given him too much baby food sweet potatoes! He refuses rice and is allergic to anything with wheat or beef so a lot of food like boiled hamburger was out. Well...we think too many sweet potatoes is causing some stool incontinence that he's never had before. (I was only giving him about 1 tbsp. mixed with chicken 3 times/day...didn't even think that would cause any problems). Switching him over to carrots, pumpkin and green beans instead hoping that alleviates the problem!!!

As I periodically check in and read about how much help this forum offers its members, I just want to thank everyone involved, again, for all the advice and support. We all just want what's best for our beloved pets and that sure is evident in all the postings that I read.
Kelly

[Harley PoMMom]

Glad to hear that Steiny is feeling better and hope he's back to his ole self real soon. With pumpkin you want the plain stuff not the pie mix, also the one thing with pumpkin, too much can cause diarrhea :(

Hugs, Lori

[steiny]

Taking steiny in for euthanasia in about an hour. bloody vomiting all morning. can't stand the sadness i'm feeling right now. the house will feel so empty. don't want to come home afterward.

[molly muffin]

Oh Kelly. :( I'm so sorry to hear this. I had high hopes that things could be turned around. It doesn't sound like that was possible though.
He is such an adorable little guy and sometimes, the hardest thing for us is the best thing for them and the greatest gift of love to be given. That doesn't make the pain any less though.
Sending you big hugs and strength to get through this.
We'll be here for you.

hugs

[Squirt's Mom]

Oh my goodness, Kelley. :( He sure took a turn for the worse, didn't he. :( I am just so sorry. We are right by your side, sweetie.

[steiny]

We knew Steiny had other issues along with the cushings disease. We will never know exactly what those issues were but we knew he was suffering on/off with diarrhea, vomiting, poor appetite for the past month. Today was the worst-couldn't stop throwing up; actually made it a little easier knowing he would be in peace. The vets office couldn't have been kinder to us. Steiny was so relaxed in my arms...more relaxed than he's been in weeks. My husband gave him his final tummy rub which he absolutely loved. I couldn't believe he was gone...seemed like he was just sleeping. Hard to leave him there. I know he's in a much better place and is now not in any discomfort....how do people get through this? I can still feel him warm and resting across my chest...that's what gives me comfort for the time being.
Kelly

[Squirt's Mom]

Sweetheart, I am so sorry nothing more could be done for your sweet boy. You both fought so hard. I know your heart is in a million pieces this morning, missing that precious face so dearly loved.

How do we get thru this? One second at a time, then one minute, then one hour, then one day....always with the help of friends and family like you have here. This is a safe place to talk, to vent, to cry anytime. It does get better but it takes time. My Squirt had to leave in May and I still cry every day but the pain is a bit less and I can function when for a while I could not.

Take whatever time you need, grieve as you need for as long as you need. There are no rules. Grief is extremely personal. You have lost your baby and no one can know exactly what you are feeling but you will find those who understand here, understand only too well.

Steiny's name has been added to the In Loving Memory thread for 2015 where he will always be remembered as a cherished member of our family here. Please feel free to start a memorial or tribute to your sweet boy in the In Loving Memory section. We would be honored to help celebrate his life thru your memories.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox, Redd, and all our Angels



A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[doxiesrock912]

Kelly, many of us are where you are now.
One day at a time. Grief is different for each of us.

I wish that they would find a cure for this horrible disease.

Hugs to you and your family.

[Dixie'sMom]

Oh Kelly. I don't even know what to say. The last time I read, Steiny was doing better so I was shocked to read that he had taken a turn for the worse. I know that you did everything you could possibly do and ultimately gave him the greatest gift you could -- peace.

I know you will miss him desperately. Please know that you are in my prayers and I'll be holding you close to my heart in the coming days. You'll get thru this and one day will be reunited with your beautiful boy. ((((((Kelly)))))

[judymaggie]

My thoughts and prayers are with you during this difficult time -- try to take a little comfort in knowing that Steiny is now at peace.

[Trish]

I am so sorry to read this, RIP Steiny.... big hugs for you at this sad time xx

[Spencersmom]

Kelly, I was faced with the same heart wrentching decision the day after Christmas and it is tough to come home afterwards! Nothing is the same! Your routine is forever changed!

You are not alone and we all understand where you are right now!!

Deepest heartfelt condolences for the loss of your sweet baby!!

[steiny]

Just a quick note to thank you all for your kind words. Leslie, I printed out the poem you posted and I have read it at least three times. I had periods during today where I kept very busy; then I feel okay and then at other times I crumble into uncontrollable tears. I'm lucky to get so many supportive notes from this forum along with notes from family/friends. My husband is having a real hard time and I'm trying to be supportive for him. We started writing down all the things we want to remember about Steiny. It's been revealing to us that a lot of the cute, fun antics Steiny once did, he hasn't done in the last several months. We didn't truly realize how much he'd changed due to his illness.

[doxiesrock912]

I went through the same thing. Recently adopted Bella and it's odd living with a healthy dog after life was so intertwined with Daisy's needs. I remember things that she used to do that hadn't been done in many months.

[Tina]

Dear Kelly,
I am so sorry to read about Steiny. You and your family are in my thoughts and prayers. My deepest sympathy.

Tina

[Spencersmom]

Much like Steiny, our Spencer lost so much of who he was! While it became the norm at the time, we were so focused on getting him thru each day, we didn't want to think about the inevitable until the obvious could be no longer be set aside!

Thinking about you and your hubs!

[mcdavis]

I'm so very sorry to read that you had to say goodbye to Steiny. As Leslie says just take things one second at a time. It sounds like you made many happy memories with Steiny and hopefully your list will be a comfort to you. I'll be thinking of you and your husband.