Buie, Lab mix with Cushings

[Jim M]

Hi, my name is Jim, I live in the NY Metro area, and I have a beautiful 8 year old Black Lab mix, her name her Buie. We had notice since the beginning of the year that she has been gaining quite a bit of weight (she went from 70 lbs. to over 90), our vet at the time said that we needed to put the dog on a diet. In the past we would just fill her bowl and she would eat whenever the mood hit, she was always in excellent shape, and loved to run and talk long walks.

Well after controlling her diet for 3 months we went back to the vet and had her weight checked again, and since the last visits she had gained another 6 pounds. At this point I ask to vet to please run some test, because I did not believe that the weight gain was a result of lack of exercise or her diet. They ran complete blood and urine tests, and they came back and said they believe she has Cushing disease. Since that initial test, she was in for a full day of tests (not sure of the exact name) which confirm Cushing’s, and later on for an ultrasound to determine what type. This came back inconclusive, so after consulting with a specialist, it was determine she had the pituitary-dependent Cushing’s.

The only outward signs that she has Cushing’s are her bot belly and at times she is breathing very hard. She has a good appetite, but she is content to eat what we feed her, and she doesn’t seem to be drinking more water than normal, we were measuring her intake and it was well below what a normal dog her size would drink. She is not having any accidents or any other signs, her coat is still beautiful, thought we do see a bit of dandruff which she never had. There will be times when she will take her normal walk (1 mile or more), but there are days when she just wants to go in the yard and back in! She also is getting a lot of urinary tract infections, in fact vet just called and she has another.

Vet want to start her on medication, from what I’ve been reading it looks like using the low does, twice daily treatment of Trilostane seems to be one of the best treatments? Is she ready to go on medication at this time, with so few of the symptoms showing.

Test Results that I do have are the following:
ALT (SGPT) 164
Platelet Count 440
Differential Neutrophils 10703
Lipase 762
Alkaline phosphatase 612 (only one extremely high)

Protein .2
PH 7.5
WBC 11-20

These were the only blood and urine results that were high.

Thanks,

Jim

[Harley PoMMom]

Hi Jim,

Welcome to you and Buie, sorry for the reasons that brought you here but so glad you found us.

If Buie has had the "all day" test done this is more than likely the low-dose dexamethasone suppression test (LDDS) and if could you get copies of those results and post them here that would be of great help to us. Also, were there any findings on the ultrasound? Were the adrenal glands visualized?

Does Buie have any other health problems? Was/is she taking any other herbs/supplements/medications? Other non-adrenal illnesses do share many of the same symptoms of Cushing's, such as diabetes and thyroid problems, were these both ruled out?

I assume that the vet wants to start her on Trilostane/Vetoryl, could you tell us what dose the vet prescribed and is the dose going to be given once or twice a day?

Along with a ravenous appetite dogs with Cushing's usually do pee rivers and drink buckets of water but all dogs are different. So once all the test results are posted we should be able to give you more meaningful feedback, ok?

We are here for you so ask all the questions you want.

Hugs, Lori

[goldengirl88]

Hi Jim welcome from me too. I am so sorry Buie is having troubles. I wanted to ask if she has had a thyroid panel done? My dog has Cushings, and also developed a slow thyroid. She was gaining weight so I had her tested. Cushings dogs do tend to gain weight, but can have thyroid problems also. Were there any issues going on with Buie when she had the Cushings test? If so it can skew the numbers and create a false positive. Cushings dogs are prone to infections, eye, ear, urinary etc. because Cushings affects their immune system. I am just wondering if part of what you are seeing is thyroid as it has similar symptoms? I would ask your vet next time you go about this. Hope all goes well. Blessings
Patti

[Jim M]

Thanks for the responses,I'll try and answer the questions to the best of my ability.

I'm still waiting to get the results from the LDDS test.

Besides the occasional infections, Buie has been pretty healthy.

Trilostane/Vetoryl - 30mg. 2x's a day. She started Friday night and seems to be doing OK.

Ultrasound:

Abdomen - Liver: Homogenerous parencyma with mild increased echogenicity and granular appearance.Normal hepatic volume. Hepatic and portal veins are normal

Gail Bladder and Biliary Tree - Normal GB wall and duct. Normal volume and minimal sludge

Spleen - normal size

Lymph nodes - none detected

Bladder - Normal bladder wall. No calculi or masses. Normal volume and appearance.

Kidneys - Symmetrical, normal size, shape and marked increased echogenicity. Poor architecture due to hazy medulla with extensive pelvic scarring and dilated left pelvis. Decreased corticomedullary ratio.

Adrenals: Weight 89 WPL. Left adrenal(.86 cm): Right adrenal (.83 cm)

Stomach - normal wall thickness and density. Ingesta filled stomach
Intestines: Normal wall thickness and density
Assessments:

Kidneys R/O inflammation, Pelvic scarring, - dilation c/w Prior Pyelonephritis, chronic interstitial nephritis & +/- concurrent glomerular nephritis

Adrenals R/O normal size,shape and density c/w normal vs very small % of PD - HAC patients (< 5%) have normal Adrenals on ultrasound.(* concern: if we treat this patient for cushing's disease, I suspect the PU/PD concerns will not improve due to the changes noted in both kidneys.

Buie's regular vet actually questioned if she had Cushing's since she is really not showing too many of the signs. He felted her belly and said if was not bloated, she is just putting on weight, her coat is good, and her appetite and drinking seems to be normal She will also go 10 hours before she even asks to go out. But he was going on the recommendations of the specialist he was talking to.

Thanks again.

[lulusmom]

Hi Jim and a belated welcome to you and Buie.

I would have to agree with your vet about the cushing's diagnosis because other than the elevated liver enzymes, I don't see enough evidence in any of the tests to justify starting treatment in a dog whose only symptom is obesity. Hypothyroidism is more likely to make a dog fat and can cause the same liver abnormalities on blood chemistry and ultrasound. Can you check Buie's blood chemistry and let us know if T4 was included and if so, please post the results, including the normal reference range. Did the specialist who confirmed the diagnosis see Buie or was this someone your vet consulted with over the phone?

Can you please check the urine results and see if you can find the Urine Specific Gravity (USG) and post the results, including the normal reference ranges? It would also be helpful if you could edit your prior post and include the normal reference ranges for the high values you provided earlier.

I look forward to your response.

Glynda

[Jim M]

Glynda,

Thanks for the reply.

Yes T4 was included, it was 1.3, reference range is: 0.8 – 3.5

Specialist was only phone consultant, did not actually see the dog.

USG – 1.021 reference range is: 1.015- 1.050

For the earlier high results

ALT (SGPT) 164, reference range is: 12-156
Platelet Count 440, reference range is: 170 - 400
Differential Neutrophils 10703, reference range is: 2060-10600
Lipase 762, reference range is: 77-695
Alkaline phosphatase 612 (only one extremely high) reference range is: 5-131

Protein .2, reference range is: NEG
PH 7.5 , reference is: 5.5 – 7.0
WBC 11-20, reference is 0 – 3

Jim

[Harley PoMMom]

Hi Jim,

The use of VETORYL is contraindicated in dogs that have kidney issues. And with Buie not presenting any Cushing's symptoms, if this were me, I would stop giving Buie the Vetoryl/Trilostane.

Hugs, Lori

[jxeno13]

Hi and welcome, Jim and Buie! I'm glad you found your way here...and sorry your Buie is having problems. MY Eli had started at 22 lbs and gained to 30 lbs in no time, even after cutting his food and treats down, gained even more weight. But, like the previous ladies have said just gaining weight, doesn't point to Cushing's. I wish that's all there was to it with Cushig's disease. Once all your test results are posted, the senior members, (who really know their stuff) can help you out immensely. You didn't start the Vetoryl yet, did you? I'd kind of wait a bit..until all other possible causes can be ruled out. jmho

[lulusmom]

Hi Jim,

Based on everything you have posted, I have to agree with Lori and say that I would be hard pressed to justify treating with Vetoryl (Trilostane). The goal of treatment is to remedy problematic symptoms and aside from being overweight, Buie has no symptoms associated with cushing's nor does she have the usual organ abnormalities seen on imaging. I noted this on the ultrasound comments: (* concern: if we treat this patient for cushing's disease, I suspect the PU/PD concerns will not improve due to the changes noted in both kidneys.) A USG of 1.021 could be due to cushing's but it could also be due to early renal disease, which the ultrasound seems to support.

I am not a vet professional but it looks to me that the kidneys could be Buie's biggest issue. I also believe the results of the urinalysis indicate an active infection. Did your vet do a sediment and urine culture and did he put Buie on an antibiotic?

If Buie were my girl, I'd discontinue the Vetoryl and strongly consider having her seen by an internal medicine specialist. Since your vet isn't convinced that Buie has cushing's and would not have initiated treatment if not for a telephone consult, he shouldn't hesitate to give you a referral. You can check for specialists in your area at www.acvim.org or it may be possible to get a name from members if you let us know what city you reside in or near.

Glynda

P.S. The all day test you mentioned in a prior post sounds like the low dose dexamethasone suppression test (LDDS). This test takes a full eight hours to do. Can you please get a copy of the results and post them here? There should be three numbers, a pre or resting cortisol, a four hour cortisol and an eight hour cortisol.

[jxeno13]

Just checking to see how Buie was doing. I hope all is OK. :)

[Jim M]

Thanks again for the replies.

I've gotten all of her test results, the all day test was called Cortisol Serial 3(DEX), there are 3 results.

Sample 1: 4.3

Sample 2: 2.4

Sample 3: 3.8

Currently she is still on the medication, I have a call into the vet to discuss it. She seems to be doing pretty well, seems to be enjoying her walks lately.

We have a top Cushings doctor (Dr. Mark Peterson ?) within 45 minutes who I was thinking about getting a second opinion from, is this the way to go or should I be look for one specializing in Internal medicine?

Thanks so much,

Jim

[Jim M]

Glynda,

Checked your link, could not find any doctors in my area. I live in Westchester County, New York, which is in the lower Hudson Valley, about an hour outside of New Your City. If anyone could recommend an internal medicine specialist in the area it would be much appreciated.

[jxeno13]

Hi Jim!

Just my 2 cents worth. If you can get an appointment with Dr. Mark Peterson or someone at his clinic that would be where I'd go without a doubt!

My own IMS is 2 hours away from where I live (my regular GP Vet is 5 min. away and they work together)....and I, myself drive 100 miles to my own regular doctors. If that helps you any in a decision.

[Jim M]

Actually the office of Dr. Peterson has an Internal Medicine department so I will stay with that office, it only 45 minutes or less and the office seems to have quite a bit of coverage on the net.

[goldengirl88]

I will second Sharlene's suggestion on Dr. Peterson. He is the original Dr. I consulted with for my Tipper. When I look for a Dr, for myself I look for the best. When Tipper became ill I followed the same rule, I went for the best. You will do good to go to Dr. Peterson. Blessings
Patti

[jxeno13]

I'd stay at that clinic too as well then. 45 minutes is nothing. I drive that to the next town just to eat, shop and get gas. Where I live now has nothing...rural towns sometimes can for the birds. I've seen his website. He's all over the place. :D

[lulusmom]

Hi Jim,

Dr. Mark Peterson is a renown internal medicine specialist and frequent contributor to Dechra's continuing education for vets. Dechra is the manufacturer of Vetoryl. We have lots of Dr. Peterson's publications in in our library and we routinely quote him on this site. A good many of us also follow his veterinary blogs. If you can get in to see him, go for it!

Glynda

[jxeno13]

I think you have your answer, Jim. :D

[molly muffin]

Oh wow, you can't beat going to see Dr. Peterson if you need an IMS. He really does know his stuff, forward, backwards and inside out. :)

Sharlene and molly muffin

[goldengirl88]

Have you decided on where you are taking Buie? Hope you get it all worked out, as I know what it is like not to have any specialists since we are rural. Blessings
Patti

[goldengirl88]

Just wondering how Buie is doing? Have you taken him in to see anyone? Hope everything is ok. Blessings
Patti

[Jim M]

Sorry for the delay in replying to everyone.



Spoke with Buie’s doctor on Thursday, he feels that all dogs with Cushing’s will have some issues with their kidneys, but he felt the low dose that he prescribed and the condition of her kidney would not cause any issues. After discussion with my wife who is a profession friend of the Vet for many years, I agreed to keep her on the medication short term and to monitor her very closely.



With that said:



Buie is showing some signs of doing better. She wasn’t eating a lot, but she would eat everything in her bowl and then finish up whatever the smaller dog would leave , now she is content to eat the majority of her food and leave the smaller dog’s food alone.



She also seem to have a bounce to her step, something even my daughter notice when she was over. When I would be getting home, Buie would either sit on the porch or would get up and walk over to my car, now she is jumping up when she sees me and will trot over to the car, not running like the old days but definitely improvement. I realize there probably could be many factors in this, including just a ‘good’ day, but as I said above I will keep a close eye on her for anything that may be an issue.



Everything else seems to be the same, she is still very good with her bladder control, she sleeps the night and then some before she wants to go out, and is left home for a good 8 hours a day without any issues. Her water consumption is also been very consistent, between the dogs, they are drinking approximately 3 quarts of water a day, which I think is a bout an average amount.

Planning to bring her in for tests later in the week, will try and be more timely with my posts. I really appreciate your comments and if it were just my decision she would be seeing Dr. Peterson already, but I'll put in the time I promised and then will move forward. Thank you so much for all your caring.

[goldengirl88]

I am so glad Buie is having some good times. That is what all of us do this for, to hear that a dog is having a good quality of life. Blessings
Patti

[molly muffin]

Excellent news and nothing wrong with monitoring to see how things go with the option to see Dr. Peterson being there as a backup.

Sharlene and molly muffin

[Jim M]

Update on Buie:

Have been monitoring for the last two weeks while she started her medication, all was going well until Friday when she started getting sick to her stomach and she stopped eating, she is on 30mg Trilostane (these are the pills and not Vetoryl capsules). Had actually talked to vet the night before at a function, and he said he didn't need to see her again until early August which I thought was odd for a dog starting treatment for Cushings!

Placed a called to the vet on Saturday morning when she still refused to eat, although the office was open, I never got a call back.

As of Sunday morning she is OFF the medication, eating a little (ground turkey), and is fairly happy, though not really wanting to walk. Monday morning I am placing a call to Dr. Peterson and hopefully be able to bring her in to see him sooner than later. We are also going to switch the regular vet for our animals, as the lack of response and somewhat careless attitude has upset us. Will follow up after we see Dr. Peterson.

Thanks,

Jim

[goldengirl88]

Jim :
So glad you stopped the trilostane. Please don't resume until seeing Dr. Peterson. I would leave that vet practice too if it were me. Such a cavalier attitude with just starting these meds and doesn't want to see him until August? He should be getting a stim test in 10-14 days after starting. Refresh me again n how much Buie weighs?? When he knew your dog was obviously in distress from starting the trilostane he should have seen the dog asap and accessed him to see if his cortisol went too low too quickly. Bad attitude for a vet starting a dog on trilostane. Dr. Peterson will be the answer to your problems, he is the top expert in his field. Blessings
Patti

[Jim M]

Buie will be off the medication until she visits Dr. Peterson. She is currently about 99 lbs, up from 65-70 in her prime. That was the other issue with the vet, he said it was just old age (8?) and eating to much. I was the one who had to insist on test being done.

Thamls

[goldengirl88]

Good idea to see Dr. Peterson and once and for all get to the bottom of these issues. With this weight and being on 30mg Vetoryl things should have been ok so I would wait to see Dr. Peterson before doing anything else with this dog, as something is not right here. Blessings
Patti

[Jim M]

Dr. Peterson unfortunately is no longer excepting new patients at this time. I am on a waiting list, but also researching other Internal Medicine Vets in my area. Dr. Peterson's office would not offer any recommendations.

[goldengirl88]

Oh to bad that is really disappointing. I would called a few times a week and sort of bug them about on the waiting list to get an opening. Blessings
patti

[molly muffin]

Oh fooey, did you find another specialist in the area? There is a place in Manhatten, called Animal Medical Center. One of our other members is taking her dogs there and they are suppose to be rather good.

Sharlene and molly muffin

[goldengirl88]

Hope you have some luck finding someone. I personally would bug the receptionist at Dr. Petersons to get you in. Blessings
Patti

[Jim M]

Hi,
Went to a local Internist today for a second opinion, after looking at the results he determined that Buie did have Cushing's, but from the test results and physically checking Buie out , he determine since the 'high' test were minimally over the upper limit and that she otherwise was in pretty good health, that she is in just the preliminary stages of Cushings. He recommendation was to take care of her urine inflection rather than the Cushings, and to stay off any medications as long as possible. He also recommended working on her diet to help her lose some weight. I am going to follow his plan and continue to use him for Buie.

He also felt that her kidney were fine, except perhaps there could be an infection caused by her urinary infection.

Buie by the way is feeling much better after her weekend episode.


Thanks,

Jim

[Harley PoMMom]

Hi,
Went to a local Internist today for a second opinion, after looking at the results he determined that Buie did have Cushing's, but from the test results and physically checking Buie out , he determine since the 'high' test were minimally over the upper limit and that she otherwise was in pretty good health, that she is in just the preliminary stages of Cushings. He recommendation was to take care of her urine inflection rather than the Cushings, and to stay off any medications as long as possible. He also recommended working on her diet to help her lose some weight. I am going to follow his plan and continue to use him for Buie.

He also felt that her kidney were fine, except perhaps there could be an infection caused by her urinary infection.

Buie by the way is feeling much better after her weekend episode.


Thanks,

Jim

Hi Jim,

I believe this is a really great plan! Glad to hear that Buie is doing well, please do keep us updated! ;)

Hugs, Lori

[goldengirl88]

So glad to hear that Buie was seen and you have a Dr. that wants to get the other issues taken care of that need resolved. Cushings is a slow moving disease and you can just be watchful of the symptoms increasing. Glad you finally got some resolution. Blessings
Patti

[Jim M]

Just an update on Buie:

She has been off the medication now for 10 days, and is doing great! Her urine culture came back negative so now we are on a program to just reduce her weight. We’ve been doing the Dog Park every day where she is interacting with all the other dogs, and then she will take a walk willingly around the whole park, everyday just seems to be better. Will be on vacation with her for 2 weeks, so I ‘m hoping to see continuous progress with her.

Her new doctor is really good, has followed up a few times already to make sure she is doing well off the medication.

Thanks once again for all the support, will follow soon.

Jim

[lulusmom]

I love hearing great updates so thanks, Jim, for taking the time to let us know how your precious Buie is doing. Keeping fingers and paws crossed that she'll continue to do well.

Glynda

[Jim M]

Just a quick update on Buie, she is doing extremely well since she went off the medication, she looks good, her bloat has seemed to slowly decrease, and I've got her jogging with me up to a 1/4 mile at a time. I am very happy were she is at now, hope through her diet and her exercise she will continue to feel better as good or better then how she is feeling now. Thanks again to everyone on the site for it's wonderful support.

[addy]

Good news- we love to hear that.

Jogging 1/4 mile is really good!!!!!

Go Bluie

[molly muffin]

So good to hear that Buie is doing much better and even enjoying jogs with you again.

Sharlene and molly muffin

[Jim M]

Without being on Cushing medication, is it possible for Buie to lose some weight? She is on a weight control diet (Blue Buffalo), getting plenty of exercise and as I had mentioned in my last post, she is even jogging with me at times! Overall she is in great spirits and seems to be doing well, her weight is really the only signs of Cushings she is displaying. I had originally thought that she was losing weight, but when I brought her in for her last visit, she was only maintaining her previous weight. She should ideally be around 75 lbs, currently she is close to 100.

Original we tried to cut her regular food she was on 20%, but when the vet notice the weight not going down, suggested the weight control dog food which we are giving her (stated 3 weeks ago).


Thanks,


Jim