Hi I'm new here, my boy has cushings

[Razzia]

May of this year my 9y,o rottie (how has arthuritus) had a bit of hair loss round his neck and flacky dry skin, many test later much confusion and lots of tears it turns out it's cushings, not very keen on my vet at all, she has no experience and no emotion no nothing infact!!!! Anyway she put him on 120veyoryl, I wernt happy with this but vets said it's "text book"!!!! He's 123lb so day 2 on it he went into shock, was very scary and lowered the dose to 60, the 10 day test say his cortisol is at 234, but we have nothing to compare it on, he had every other test apart from that because the hormone wasn't available, anyway he still pants and drinks a lot maybe not as much as before but my problem now is he's in such pain I feel like he was much happier before all this started, he had a quality of life before, he walked fab, got excited, got involved in things, always wanted to go out, and ok he panted a lot drank a lot but e was so happy!, now he can barley walk his arthuritus pain is making his unhappy, i want him to have pain killers but worried of the side affects which will lead another pill to counteract them side affects then another pill an so on and before I no it my boy is rattling! I would just like to know if anyone else is going through the same and have any advice,

[lulusmom]

Hi and welcome to the forum.

I am sorry for the reasons that brought you here but I'm glad you found us. We'd like to help you figure out the best way to help your boy in his golden years but we will need to have a much better understanding of what tests were done by your vet to diagnose your boy. There really is no such thing as a clear cut case of cushing's. It is probably the most difficult canine disease to diagnose, which makes it one of the most misdiagnosed disease. Can you please ask your vet for copies of all tests that were done and post the results here. With respect to the blood chemistry and cbc, we need only see the highs and lows...and please include the normal reference ranges.

When did your boy start treatment with Vetoryl and how many acth stimulation tests have been done since then? Can you please get copies of those tests and post the results here. Please include the date and what dose your pup was one when the test was done. ACTH stimulation tests must be done after the morning dose is given with food. The test must be completed within 3 to 6 hours of dosing. Did you follow these guidelines?

Most dogs with cushing's are at an advanced age when diagnosed so arthritis is a very real complication that can affect a dog's quality of life. Here is a very meaningful response one of our administrators, Marianne, posted to another member regarding this subject.


Hello and welcome from me, too! Terry has already covered the bases re: diagnostic confirmation. But if it turns out that your dog truly has Cushing's, here are a couple more thoughts that I would add re: proceeding with treatment.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of your girl's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for your dog. For instance, if there are significant amounts of protein in her urine, uncontrolled Cushing's may indeed be playing a part and lack of treatment may allow kidney problems to progress, perhaps even rapidly. But again, at her age, I do think you are the best judge as to how uncomfortable her current overt symptoms are to you both, and if they are not bothering her all that much -- as I say, you may want to hold off on treating for the time being. You are both so lucky to have shared all these years together, and given her life expectancy, I realize that extra quality time from this point onward is a gift to be savored.

As far as her lack of response to the Vetoryl -- if she does have Cushing's, this may simply have been the result of a dose that wasn't high enough. Starting doses are based on weight, but subsequent adjustments are often needed once monitoring testing is performed. This is because every dog metabolizes the drug differently, and the optimal dose must be tailored on an individual basis.

Just a couple of thoughts to throw into the mix.
Marianne

We will look forward to hearing much more about your boy.

Glynda

[Razzia]

We had the 10 day test and he didn't have his meds before the test as the vet said nil by mouth and she didn't even mention about giving him the meds before the test so this info about doing the test a few hours after meds is new to me! All his blood testing came back fine his scan on his adreanals was fine he had stool and urine culture that was fine his Urine gravity was very low, this is all I know!

[labblab]

Welcome from me, too! I am very, very worried that apparently your boy has not undergone/exhibited any diagnostic testing that is actually consistent with Cushing's other than a low specific gravity reading on his urine sample. However, there can be numerous causes for that result, none of which are necessarily related to Cushing's.

To add to the puzzle, you say that your dog's adrenal glands appeared normal on ultrasound and there were no abnormalities on his bloodwork. Both of those results are inconsistent with Cushing's: you would expect to see adrenal abnormalities, and there are certain abnormalities of bloodwork that are often seen in Cushdogs (for instance, elevated liver enzymes and cholesterol levels). So all in all, I am troubled that your vet started you off on the trilostane treatment without the benefit of testing data to support the diagnosis.

Then, to compound our concern :o, you were not given proper instructions as to how the first monitoring ACTH test should be conducted. From what you have written thus far, I am assuming you may be in the U.K. If so, the ACTH result you gave us (284) is probably being reported in units of nmol/l. If we convert that number to the common reporting units in the U.S., the result is 8.5 ug/dl. That post-ACTH number is within the broad therapeutic treatment range for Vetoryl, but as you now know, your dog was not prepared properly for the testing. He should have been dosed with the medication along with breakfast on the morning of the test, with the blood draws occuring 4-6 hours later. Here's an excerpt from the U.K. Information Sheet for Vetoryl with this info:


How do I give Vetoryl® to my dog?

Vetoryl® comes in a range of capsule sizes. Your veterinary
surgeon will advise you of the right dose for your dog. We
recommend that you give your dog Vetoryl®
with a meal in the morning, as this will make it easier for your veterinary surgeon.to perform monitoring tests 4-6 hours after dosing.

http://www.dechra.eu/files//dechra/Downloads/Pharma/ClientLiterature/Vetoryl_Client_Booklet_Final.pdf

http://www.dechra.eu/files/dechra/Downloads/Pharma/Datasheets/Vetoryl_Hard_Capsules_for_Dogs.pdf%2008-10-2013.pdf

Since your dog was tested apparently a full day after having taken his last dose of the drug, the effects would have already left his system and so the "picture" the testing gave you was the status of his stimulated adrenal reserves with the drug out of his system. Had the test been conducted 4-6 hours after dosing with a meal, the test result would undoubtedly have been much, much lower. Your dog's result actually falls within the normal range of a dog without Cushing's. From that result alone, we cannot assume that he does not actually have Cushing's. But once again, we don't yet have any test results that truly confirm the disease.

Bottom line, I would be very wary of a vet who starts a dog on Vetoryl without a Cushing's diagnosis that has been confirmed by actual test results. The second huge red flag is that you were not given proper instructions re: preparation for the first monitoring test. If this were my dog, I would stop giving the Vetoryl and switch to a vet who has more experience with Cushing's, and who will go to further effort to first accurately diagnose what is truly going on with your boy.

Marianne

[Budsters Mom]

Please find a vet that knows what their doing! Your sweet baby is being put at risk if Vetoryl has been started without proper diagnostics. This whole scenario scares me.:eek:

Kathy

[Razzia]

I will write down all his results now will take a while so you can see what I'm on about

[Razzia]

Ok here goes, 27/052014 took him to eat cuz had fur loss a small patch on his shoulders,
Skin scape and hair pull, both came back fine.
Urine test, s.g 1.005
Fungal culture negative,
Urine culture negative
Cushings/pyelonephritis - pending urine sample.
Ruled out; steroid excess, incr calcium, decr potassium, decr sodium
Erythrocytosis.
Liver failure?
USG 1.005 1.007 1.004 100.7
T4/ cTSH normal does not support hypothyroidism
Electrolyte screen
Sodium 143.7 nmol 135.0-155.0
Potassium 5.60 nmol 3.60-5.60
Sodium potassium ratio 25.66 low 28.80-40.00
Chloride 107.0 nmol 100.0-116

Endocrinology
Low dose dexamathasone
Cortisol (basal low dose) 136.0 high nmol/l 25.0-125.0
Cortisol low dose 57.9 (4hr)
Cortisol post low dose 84.7 (8hr) high nmol <= 40
Urine antibacterial activity negative

ACTH STIMULATION (vetoryl)
Cortisol pre ACTH 53.0 nmol
Cortisol post ACTH 234.0 nmol

[Razzia]

Eat!!! Means vets sorry,
Also his symptoms are fur loss on both shoulders
Flacky skin like dandruf his back legs shake a little when he's lay down, he's a bit fat but not over weight seemed to have put on in the last year, with out us feeding more.
He pants all day he drinks and wees ALOT!
Last 24 hour water intake was almost 7 litres.
oh I forgot to say he also had a scan it's says:
Kidney scanned no obvious pyelonephritis, think able to visualise adreanal glands and no abnormalities in shape, taken customers for c&s. O to measure 24 hour water intake
SG 1.005
Blood ++++ (cysto sample)
Protein trace
Ph-6.5/7