Koko

[Lorna Estrada]

Hi, I am Lorna and my coton de tulear was diagnosed yesterday with cushing's disease in his pituitary glands. He is 7 yrs old and weighs 24 lbs. For now my vet recommends three mg twice a day and 20 mg of KMR lignan once a day. In 4
months he will have another blood test.
I don't know a lot about cushings but I have been researhing this for the past few dsys and I fear for my baby's health..

[addy]

Hi and Welcome,

A big hi to you and Koko. I have a Koko as well.

We all come here scared to death; the unknown is pretty terrifying. Your first step was writing this post, soon you will be learning all about dogs with Cushings and you are sure not alone anymore.

We usually try to ask about tests, what lead to the diagnosis, what symptoms your Koko had and has.

If your vet has started Koko on lignans, I am guessing an adrenal panel was done at University of Tenn Knoxville. Could you post the results? Are the 3mgs twice a day of Trilostane?

The part that has me confused is there will be no more testing for 4 months. Usually, if a dog has elevated cortisol and is started on even a low dose of Trilostane (Vetoryl brand name) we need to monitor the dogs cortisol and it seems like 4 months is way too long. It is usually done within 2 weeks, sometimes 30 days tops.

Could you tell us more?

[Lorna Estrada]

Koko had a blood test in 2011 and his ALK Phospatase was 362.
Last Friday I brought him to the vet because he was licking his paws a lot and the vet said it was allergy. He did not want to give Koko steroids without checking his alkaline levels. When tested it came up as 1636, a lot more than a few years back. He suspected cushing's disease so he recommended a low dose dexamethasone suppression test.
The results were:
Cortisol Series 3 Result
Time 1 900
Time 2 100
Time 3 500

Cortisol sample 1 16.2
Cortisol sample 2 6.6
Cortisol sample 2 7.3

The vet said the results of the test were indicative that Koko has pituitary cushings disease.
Other results of his blood test were:
Total Protein 8.0
Albumin 4.6
Globulin 3.4
A/G ratio 3.4
AST 21
ALT 77
GGT 14
Total bilirubin .01
BUN 21
creatinine .09
BUN/creatinine ratio 23
Phosphorus 3.8
Glucose 107
Calcium 11.6
Magnesium 2.1
Sodium 151
Potassium 4.4
NA/K ratio 34
Chloride 113
Cholesterol 316
Trigliceride 566
Amylase 352
Lipase 293
CPK 144

His urinalysis test was ok, the only hig results were :
Protein 1+
Occult Blood 3+
Cast/LPF 11-20

[Lorna Estrada]

Koko is not taking any prescription medication yet. My vet says to start him on 3 mg melatonin 2x a day and 20 mg lignan once a day. Then he will get another blood test in 4 months to check his alkaline levels again to see if he is improving.

His symptoms are:
drinking lots of water, about 4 cups a day
always hungry
potbellied
doesn't want to walk too much as he used to

[Squirt's Mom]

Hi and welcome to you and Koko! :)

It would help us a great deal if you would edit the lab results to include the normal ranges for each one. Different labs use different ranges of normal so it helps to see what your lab calls "normal". ;) You'd think there would be a standard, huh? Sure would be easier! LOL

I am quite confused by your vet's approach. The lignans and melatonin will do nothing to control the cortisol, which is the enemy in true Cushing's. The lignans and melatonin are used to treat a form of Cushing's in which intermediate hormones are elevated but the cortisol is normal. There is only one lab we know of that does the testing for this form and they are at the University of Tennessee in Knoxville. So if Koko's blood was not sent to UTK confirming that he has Atypical and not true Cushing's, you vet is off base with this approach. Melatonin does have the potential to lower cortisol but not the amounts found in a cush pup. ;)

In addition, the melatonin and lignans won't help with alkaline levels, either. In short, from what we know so far, your vet seems woefully lacking in knowledge and experience treating Cushing's, which is the highest risk factor in Cushing's and the cause of most problems treating the disease....an inexperienced vet with little knowledge of the disease or it's treatments. So if I were you, my first order of the day would be to find another vet and get a second opinion asap. I will commend your vet on NOT starting Koko on either Trilostane (Vetoryl) or Lysodren (Mitotane). For that he deserves a pat on the back. ;)

Looking forward to seeing the edit on the lab values and learning more about you and your sweet boy. I'm glad you found us and want you to know you will not be alone from this point forward. You and Koko are now members of our little family here and it is one heck of a family! :)

Hugs,
Leslie and the gang