Lucy - miniature schnauzer - just diagnosed with Cushings

[LucyDog]

Hi, everyone. I am so excited to find this forum. My sweet mini schnauzer, Lucy, was just diagnosed yesterday with Cushings. She's had a run of health issues:

Bladder stones - 8 months old
Repeat UTIs - probably 10 or more
Spelectomy, benign tumor - 11 years old (May 2014)
Liver failure - 11 years old (August 2014)

(Bless her heart, looking at that list!) So, yesterday, she had the official Cushings test, which came back positive. Believe it or not, I'm relieved. I was concerned we were at the end, you know?!

Even though I'm relieved, I've read enough about medication adjustment to be a little scared. She started Vetoryl 30mg today.

So, what do I need to know? How can I make my baby's adjustment to meds better and her overall quality of life great?

Lucy is my heartbeat. I was single with her for 8 years of her life - she has gone through job loss, moves, boyfriend breakups, and more with me. She now has a loving Daddy who takes awesome care of her. She's such a joy!
https://fbcdn-sphotos-b-a.akamaihd.net/hphotos-ak-xfp1/t1.0-9/1470291_10152075120249739_2006494400_n.jpg

[Dixie'sMom]

Hi Lucy's mom. Your little girl is beautiful. I'm sorry to hear she is having so many health problems. I can't help you with any of the Cushing's questions because I'm new to this myself. We are still undergoing testing, so I should know something by the end of the week or Monday on my little lady. I just wanted to say hello and we will learn together, ok? Hugs!

Suzie

[LucyDog]

Thanks, Suzie. She's a doll for sure. We just had to include her in the wedding photos. :-)

Hope your tests turn out well and that you get answers. I was so scared with NO answers. Even though I don't like that it's Cushings, I am glad that there is something to treat Lucy. Hoping for Dixie to have something curable and easy, though! Hugs to you too.

Just realized I never included my name in my original post. I'm Ashley, and we live in Arkansas.

[Harley PoMMom]

Hi Ashley,

Welcome to you and Lucy from me as well! So glad you found us and we will help in any way we can.

Cushing's is one the most difficult endocrine diseases to get a confirmed diagnosis for and it is often misdiagnosed. When a dog has a non-adrenal illness, such as liver disease, false positive results can be created on all tests for Cushing's.

Could you get your hands on copies of all tests that were done on Lucy and post any abnormalities that are listed along with the reference ranges and units of measurement...thanks! Was an ultrasound done? How about an urinalysis? If any of those tests were done could you post those findings too? Can you tell us what symptoms Lucy has that led you or your vet to test for Cushing's in the first place? How much does she weigh? Is she taking any other herbs/supplements/medications?

Cushing's is a treatable disease but success in treatment does depend on keen owner observation and a vet/IMS that has the knowledge and experience treating Cushing's.

And by the way, what a beautiful photo of Lucy and her parents! Any questions you have, please do ask them, ok?

Hugs, Lori

[LucyDog]

Thanks, Lori. Great advice - I'll have to follow up with her vet.

For now, I can answer some of the questions without the numbers. I know she had the ACTH test done as a confirmation, but leading up to that, here was her progression.

She's always had insatiable thirst, and she had problems with leaking urine frequently. She's been treated for UTIs in quite a succession most of her adult life (stones when she was 8 months old, but UTIs were confirmed not stones).

In May, she began a very rapid decline. Over the course of 4 hours, she went from walking around to near death. Because of that, we were sent to a different vet with great credentials. He did an ultrasound and saw a large splenic tumor that was pressing on her bladder on one end and stomach on the other. Surgery was immediate, and removal and pathology on the tumor showed benign (only 20% chance it would NOT be cancer - so praise God it wasn't!)

I have to pause here and say our new vet is amazing. After surgery, he took our baby home and put her in his Master Bathroom for 4 nights. He even had a camera focus on her. He is always loving on her when she's there, and he's very thorough and kind - and great with a worried mommy like me!

From there, recovery has been rocky. The surgery was mid-May, and mid-June, she was back in the doggy hospital. She'd been prescribed Batryl for a UTI, and we changed her food, and we gave her heartworm medicine. The combination caused hemorrhagic diarrhea. She spent 2 more overnights getting fluids.

Last week, she was giving us fits eating. I should mention this dog is the FUSSIEST EATER EVER! She acted overall poorly, so I took her to the vet clinic. Our favorite vet was on vacation, and we saw his partner. He told me they might have misdiagnosed the cancer (GRRR!) which led to a weekend of me worrying that she was dying. Hemangiosarcoma of the spleen gives a dog about 3 months, so if a misdiagnosis had occurred, it would be near the end. That day, the horrible vet took her blood and her liver enzymes were in the 300s.

When our regular vet got back three days later, she would not drink water or eat, so I took her back in. He did an ultrasound and her liver was quite enlarged and her blood levels had risen to the 500s despite being on sAme (s-Adenosyl). At this point, he called me and told me he felt it was Cushings. The next day, yesterday, we did an ACTH test and it came back positive for Cushings.

Other symptoms I might not have listed:
Lethargy
Hot body but no temperature
Blindness (this is likely due to her liver not functioning currently)
Fussy eater - NOT an overeater, which I find odd

Thanks again!

[addy]

Hi and Welcome,

I am sorry for all poor Lucy and you have been through. My goodness that is quite a lot.

The thing is no one test for Cushings is perfect. here is a quote from an endocrinologist:


You are correct that the ACTH stimulation test has the best test specificity of any of the 3 screening tests. In other words, you would be less likely to falsely diagnose a dog with Cushing's based on the results of an ACTH stimulation test than you would using the LDDST or UCCR tests.

That said, none of these screening tests for Cushing's are very good diagnostic tests when we are evaluating dogs with known nonadrenal disease. The "best" diagnostic test for Cushing's disease is and always will be a good history and physical examination.


I may be missing something here but the symptoms you just wrote of Lucy not eating or drinking water don't match up for me. When did Lucy go blind? Could you write down the results of her blood tests that were not normal along with the normal range listed by the lab?

Cushings is a disease that is hard to diagnose and is frequently misdiagnosed. I am not criticizing your vet, please don't take this the wrong way. We just always need more information to give meaningful feedback and we ask a lot of questions.

I am so glad you found us and I know others will be along soon.

[LucyDog]

I'll work on getting the lab results tomorrow. I didn't ask for a copy when we left - just trusted the test. :-) I'm sure he'll be happy to provide them.

The not eating and drinking was a sudden onset symptom of the enlarged liver. Normally, she drinks excessive amounts of water. She isn't a big eater, but she also hates her food (like hates, hates, hates). She's been on Hills W/D for probably 6 years due to the UTIs, along with CitraK to keep her urine alkaline. That combination just repulses her food-wise. When we offer other foods, she scarfs them up quickly. Recently, after the event last month with the diarrhea, she was put on Hills I/D. She also hates it. So, I'm not sure the food thing has much to do with it.

I'll try to get lab results ASAP. Thanks again for being so attentive - very helpful!

[Harley PoMMom]

Oh my, you and your sweet girl have been through a lot. :( Increases in drinking and urination along with inappetence can be attributed to a liver issue. Dogs that have Cushing's generally have a ravenous appetite, they are like a hoover vacuum cleaner looking for any crumb that they can scarf down!

How was Lucy's liver disease diagnosed? How much does she weigh?

I was wondering, were the adrenal glands visualized on the ultrasound?

Another reason I would be skeptical with starting Lucy on medication for Cushing's is that it is recommended that Vetoryl not be given to dogs that have kidney or liver disease.


Do not use VETORYL Capsules in animals with primary hepatic disease or renal insufficiency.

This excerpt can be found in Dechra's product insert: Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

Gosh I am sorry that sweet Lucy has had to go through so much, I am so glad that Lucy has such loving parents.

Hugs, Lori

[Squirt's Mom]

Hi and welcome to you and Lucy! :)

I'm on board with doubting this diagnosis. With all Lucy has going on, the ACTH WOULD be positive whether she has Cushing's or not because the stress from other issues would cause the cortisol to rise - which is a normal response to any stress, internal or external. Also, liver values cannot be used to diagnose Cushing's - only as a clue along with many other clues. There is no one definitive test for Cushing's. It is one of, if not THE, most difficult canine disease to correctly diagnose. And in the face of all that Lucy is facing, elevated cortisol is expected...and your vets should know this. :confused:

My own Squirt had the LDDS, HDDS, ACTH, UTK panel and 2 ultrasounds and she was STILL misdiagnosed as having the pituitary form when she had a tumor instead. ;) Please, I am begging you, do not start treatment on your sweet girl just yet. Chat some more with your new family here and we'll go from there.

Hugs and belly rubs,
Leslie and the gang

[LucyDog]

Hi, Everyone! I was able to get a copy of Lucy's records today, as we ended up back at the vet for vomiting and diarrhea (poor puppy). So here are the numbers:

Cortisol Pre ACTH 13.1
Cortisol Post ACTH 29.4

Additional abnormal blood counts:
RBC 4.36 M/ul LOW
HCT 29.7% LOW
BUN 37 mg/dL HIGH
ALT 336 U/L HIGH

She has been on Vetoryl 30 mg now for 11 days. She has vomited 1x the last 3 days in a row and has been experiencing diarrhea. Yesterday, her liver counts were re-tested and had continued to climb, so she's also on S-Adenoysl for liver. Additionally, she was put on Diawin for diarrhea and is on Proin for incontinence (though I've withheld it due to the amt of medication she's on).

Thoughts? I'm concerned about her vomiting. She's drinking water, so she's hydrated, and she's eating, though not super well. I just don't want her to be miserable. :-(

[flynnandian]

those cortisol numbers are really high, pre and post.
but vomiting and diarrhea does not sound good,
how much does lucy weigh?
starting a mini schnautzer on 30 mg vetoryl sounds too much, especially with this symptoms of vomiting and loose stools. it looks like you [your vet] over dosed her.
if it were my dog i would stop the vetoryl immediately till the symptoms are totally gone, and after that start on a much lower dosage.
low and slow is what we like on this forum!

[Harley PoMMom]

Those results are from her diagnostic ACTH stimulation test, which would of been before Vetoryl treatment started, right?

Vetoryl should not be given when a dog is presenting signs of being unwell and vomiting is definitely a reason to stop the Vetoryl.

Vomiting and diarrhea are symptoms of a dog's cortisol going too low and only an ACTH stimulation test would show this.

Since Lucy is acting ill I would stop giving her the Vetoryl and call the vet and let s/he know that Lucy is not feeling good.

Let us know how things are going, ok?

Hugs, Lori

[lulusmom]

Hi and a belated welcome to you and Lucy.

I am very concerned that your vet has misdiagnosed Lucy and even more concerned that your vet has failed to counsel you on the serious drug you are giving Lucy. Had he done his job and told you what to look for if cortisol drops too low, you would not be telling us that you are still giving Lucy her Vetoryl dose. Stop it now! As others have already mentioned, all of these symptoms are signs that Lucy's cortisol has dropped too low. If she continues to get worse, you need to get her to an er. Dogs who are overdosed often times end up in hospitals on IV fluids.

With respect to the lab results you posted, any non-adrenal illness can yield false positive acth stim test results and I'm not seeing cushing's or liver failure in the other abnormalities you posted. Can you please edit your post and include the normal reference ranges? If your vet formally diagnosed Lucy with liver failure, Vetoryl should not have been prescribed. Since the lab results you posted don't indicate liver failure, what was going on that your vet would think Lucy was in liver failure? When did Lucy go blind and did your vet tell you why she went blind?

Wow, I'm just really concerned about your girl. We've had more than a few mini schnauzers misdiagnosed here so combine that with the conflicting information you have posted and my concern is almost off the chart.

Glynda

[molly muffin]

Hello, I just want to welcome you to the forum and add my concern to the others. Do not give vetroyl Ever to a dog that is vomiting and diarrhea. This is in the realm of the results could be very very bad.

In addition I agree, that I am suspect of the cushings diagnosis, based on the labs you posted. That doesn't really point me to cushings. And never ever more than 1mg/1lb to start with. This is just basic stuff. Schnauzer's can be very hard to diganose with cushings, as they are a bit trickier than some other breeds.

We really want to see you and Lucy get the help you need and for Lucy to get better. How are things today?

Sharlene and molly muffin

[Trixie]

Just finished catching up on your posts. Sounds like Lucy has been through alot..and of course you too! I also have a mini schnauzer and so many of them have these gastric issues along with other things that make diagnosing Cushings even more complicated.

Even though you trust your vet please listen to the people on this board and definitely do not give your little girl any more Vetoryl while she's vomiting and has diarrhea. It's a strong drug and must be used conservatively. 30mg is TOO much for your dog and if the diagnosis is not correct then it's really dangerous that she's on it at all, let alone a hefty dose of 30mg.

My dog was diagnosed with Cushings and we started with only 12mg of Vetoryl a day and that was broken up into two doses of 6mg so that she wouldn't get too much at one time.

It sounds like your girl has a lot going on and it may be that the Cushings diagnosis and starting meds was a little rushed into.
I saw her photo and she's just the cutest schnauzer, I hope she is okay today.

Barbara