10 Year old Westie/Pomerian Mix Diagnosed with Cushing

[jetsdrog]

My five year old westie/pomerian mix was just diagnosed with Cushing Disease today. We switched vets and the new vet spotted it right away and tested him. His positive results came back today. He has all the symptoms except for the hair loss and skin irritation. He is a wonderful dog and we hope that now he has been diagnosed he will start feeling better soon. We will be using a medication to block the hormone production, I believe this is the trylostain, our vet is ordering it and it should be ready for us in a few days. We are very sad he has this, we just want him to feel better. After thinking back we believe it started about 2 years ago. I wish we had known sooner.

[Squirt's Mom]

Hi and welcome to you and your baby! :)

First, take a deep breath - Cushing's is not a death sentence and many Cush pups live out their normal life span, and beyond, in relative good health, passing from things unrelated to Cushing's...like simple old age many times. ;)

There are three keys to success when dealing with Cushing's -

1) a knowledgeable and diligent parent (that's you! ;) )
2) an experienced and Cushing's savvy vet who is willing to work with you as a team
3) having a family by your side (that's us! ;) )

We will help you learn what you need in order to give your sweet baby the best chance possible and we will be by your side every step of the way. Ya'll are never alone on this journey.

A good habit to develop right now is to get copies of all testing done from here on out and keep a file at home. You want copies of the actual test results, not the invoice saying what they did. This file will come in very handy in the years to come plus if your baby should ever need to see another vet, like on vacation or if you move, you will walk in the door with all the info in your hand. Plus it will help you answer all the question we ask! :D Yeah, questions. We do like to play 20 Questions with new folk so here we go -

How old is your baby?

How much does he weigh?

Does he have any other health issues that you know of?

Is he on any medication, herbs, supplements, etc?

What test(s) were done to diagnose the Cushing's?

Has an abdominal ultrasound been done? (If not, I strongly recommend one if at all possible before starting treatment)

Were diabetes and hypothyroidism ruled out? (These are just two of the diseases that mimic Cushing's)

Ok - that's enough to get us started. :)

If you would get copies of the test(s) done so far and post the actual results here for us that will help us a great deal in helping you and your sweet boy. Be sure to include the little letters behind the numbers (ug/dl, mnol/l, etc) and any normal ranges given on your paperwork.

I'm glad you found us and look forward to learning more about you and your sweet boy as time goes by.
Hugs,
Leslie and the gang

[jetsdrog]

Thank you so much. my name is Jeanette and we live in Reno, NV. I think we found a really good vet. Our other dog (Rocky - Italian Greyhound) had gotten attacked about a month ago and we went to the animal hospital closest to our house because he needed attention fast. Dr. Cassie was on duty and she was awesome with him. She did an awesome job stitching him up and he hardly has a scar. Anyway we really liked her and Brady was due for his dental cleaning so we set up an appointment. She scheduled his pre-op blood work and asked if she could do an extended panel and a urinalysis. She suspected he had something going on so once we got the results back from that test she called and said he might have cushings and scheduled the all day test. Diabetes and hypothyroidism were ruled out. My apologies that I don't remember all the test names and what not. I will get the results and post numbers. Anyway I believe this was not a chance encounter meeting this vet, God was at work for sure. We asked why she thought our vet didn't pick up on this and she said this was the first time she saw him and had nothing to compare him to. And she suspected cushings as soon as she saw him.

Here are the stats on Brady:
1. 5 Years old
2. Pomerian/Westie mix
3. His current weight is 24.7 pounds (which is a lot for such a little guy)
4. He has been diagnosed with Luxating Patellas and takes a maintenance dose of Glucosamine

5. His Cushings symptons are:
a. Hiding under the bed from 5:30 pm until morning
b. Serious Weight gain
c. Excessive Hunger
d. Excessive drinking
e. Excessive urinating
f. Excessive panting
g. Stopped jumping on furniture, up into the car, etc.
h. Pot Belly
i. Discolored dark skin lower extremities

I will request his results and post them when I get them. He has not had an ultrasound yet. I will ask the vet about that.

I am so glad for this site, thank you all for being here!

[molly muffin]

Hello and welcome, those do sound like cushing symptoms. Leslie has asked some good questions and it always helps to see the lab results.

I will just add that the starting dose for trilostane should be around 1mg/1lb. The insert on the medication says a higher dosage, but that has never been changed and the experts are now recommended that for safety it is best to start low and go up if needed, rather than starting high. Every dog is different and you don't know for sure how any one will react to any medication.

Welcome to the forum
Sharlene and molly muffin

[jetsdrog]

Can you please let me know why an ultrasound is needed? What exactly would it be looking for?

Thank you,

[Squirt's Mom]

An ultrasound can go a long way toward determining and confirming whether it is pituitary or adrenal based Cushing's. Also, problems with an organ like the spleen, say a tumor on that organ, can cause false-positives on ALL the Cushing's tests so an US is one of the best all around tests to have in the diagnostic phase in my book. Of course, one saved my dog's life by finding a tumor that was causing her cortisol to be elevated - meaning she did not have Cushing's at that point ( 5 false-positive tests!) and treating a disease that did not exist could have put her life at further risk on top of the tumor we wouldn't have known about without the US. ;)

[jetsdrog]

I have Brady's results, he is starting the trilostane today. His vet is starting him at 10mg. He will have another blood test done 2 weeks from today. Hopefully the med helps him and he doesn't have any adverse reactions.

Blood Panel - 8/15/14 (Only abnormal readings listed)
Alk Phoshatase 330 (High) Normal 5-131
Platelet Count 587 (High) Normal 170-400

Urinalysis - 8/15/14 (Only abnormal readings listed)
Specific Gravity 1.013 (Low) Normal 1.015-1.050
Occult Blood 1+ (High) Normal negative
RBC 4-10 (High) Normal 0-3

Blood Test - 8/20/14
Cortisol sample 1 11.4 (High) Normal 1.0-5.0
Cortisol sample 2 Dex 4.7 (High) Normal 0.0-1.4
Cortisol sample 3 Dex 5.7 (High) Normal 0.0-1.4

[Harley PoMMom]

With these test results and along with Brady's symptoms it sure sounds like Cushing's to me. :( I am glad to see that the vet is starting him at 10 mg, for Brady's weight of 24.7 lbs the 10 mg of Trilostane is a very good place to begin treatment.

Just to clarify for me, Brady's next ACTH stimulation test is already scheduled in two weeks? Also has the vet mentioned that Brady has to have the Trilostane with food and that the ACTH stimulation test needs to be done 4-6 hours after the dose of Trilostane is given?

Here's a link with this information and more: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Hugs, Lori

[jetsdrog]

Yes I am giving him the trylostane with his breakfast in the morning. We have already scheduled his test for 2 weeks. She talked to me to about the med schedule to make sure I am giving it in the morning so she can do the test within the proper time frame. He did very well on the med today, no adverse side affects. I hope it stays like that.

[molly muffin]

He should do very well starting at that dose. His picture is very cute. Those ears just make him look interested in everything going on around him.

Sharlene and molly muffin

[jetsdrog]

Thank you, he is a cutie. He had such a great evening yesterday. He was outside with me while I was grilling and he had every toy pulled out of the toy box and played with each one like they were long lost friends. Still working on getting him to put them away lol, but I gladly picked them up. Normally around 5:30 pm he goes and hides under the bed until morning, but last night he stayed up with us until 7:30. He was a joyful little fella for sure and seemed more like his old self. I don't know if the medicine would work that fast the first day, but it did my heart good to see him like again. :)

[jetsdrog]

Hello all, So Brady has been on his 10 mg of Tilostane since Wednesday morning. He hasn't had any negative side affects at all. He appears to be feeling better already. He has more energy, stays up with the family longer in the evening. His hunger and thirst seems to be less. We went camping this weekend and went on a few hikes and he did great. I am really liking what I see so far. He is more like his old self. He has his 2 week test on Wednesday, 9/10, it will be interesting to see his test results and compared to his previous numbers. I will post the results once I get them. We are glad to see our Brady acting more like a five year pup and we are looking forward to him feeling even better as time goes on!:):):) Thank you everyone for your support of us.

[molly muffin]

Oh that is great the he is out hiking with the family and hanging in there so much better. What wonderful news to hear. :) :) Sounds like a wonderful weekend for the whole family

Sharlene and molly muffin

[Squirt's Mom]

Great news! :cool::cool::cool:

[Harley PoMMom]

He has his 2 week test on Wednesday, 9/10, it will be interesting to see his test results and compared to his previous numbers. I will post the results once I get them. We are glad to see our Brady acting more like a five year pup and we are looking forward to him feeling even better as time goes on!:):):) Thank you everyone for your support of us.

Just wanted you to be aware that if Brady's ACTH stim results at that 2 week mark are higher than Dechra's published reference range, which are 1.5 ug/dl - 5.4 ug/dl, that a dosage increase is usually not done because a dog's cortisol can continue to drift downward during the first 30 days of treatment.

I am so glad that Brady is doing so well with his treatment!!

Hugs, Lori

[jetsdrog]

Thank you all for the good wishes and that information regarding his coritsal levels still downgrading after 30 days of treatment.

We continue to see improvement in Brady and no adverse side affects. He stays out with the family until after 7:00 pm every night now. Last night he and our other dog Rocky had a great game of chase around the house :D

[molly muffin]

Wonderful. He sounds like he is feeling much better. :)

Sharlene and molly muffin

[jetsdrog]

Here are the results of Brady's ACTH after two weeks of being on the trilostane:

Time1 Pre 8:45
Time2 POST 950
Cortisol Sample 1 6.1 (High) 1.0-5.0
Cortisol Sample 2 7.1 (Low) 8.0-17.0

According to the vet he is responding very well to the 10mg dosage of Trilostane. He will be retested in 30days. The vet is very happy with these results.

He is getting back to his old self more and more!:D

[labblab]

I think those numbers are great, too, for the first monitoring test!

Hooray for Brady!!!!!!!!!!!!!!!!! :) :)

Marianne

[pansywags]

Yay for good news!

[molly muffin]

Those are good numbers for the monitoring test. Yay!! :) The range though is not correct for the post, when you are on trilostane (vetroyl) then it is like 1.8 up to 9. ug if the symptoms are controlled, and 5.0 if it isn't. So, really he isn't low at all on the post number. :) It's right where he needs to be.

Sharlene and molly muffin

[jetsdrog]

Brady continues to do well with his treatment plan. He has lost 1 and 1/2 pounds so far! We are very happy with his progress, his energy levels are way up. :D

[jas77450]

yeah'!!!!!!L

[molly muffin]

That is wonderful!! You're doing great!

hugs

[jetsdrog]

I forgot to post Brady's last ACTH results:

Coritsol Sample 1: Results 4.3, Reference Range: 1.0-5.0
Coritsol Sample 2: Results 6.0 (LOW) Reference Range: 8.0-17.0

[addy]

Not sure what that reference range is, perhaps this lab has a different range. :confused::confused:

Normally those numbers would be fine as long as symptoms are controlled and it sounds like they are.

Good job!!!

[labblab]

That reference range refers to the expected "normals" for dogs without Cushing's when the ACTH is being used as a diagnostic test (instead of as a monitoring test after treatment has begun). ;)

Marianne

[jetsdrog]

So we had a little set back in regards to Brady's latest ATCH test (I don't have a copy of the results yet), his levels were up and my vet was concerned and consulted with another vet. They decided to up his trilostane to 15 mg. We will be doing another ATCH test in two weeks. We have noticed some of the cushing symptons returning: hiding under the bed, increased panting and drinking, ravenous hunger. He did lose another 1/2 pound though which is good, he now weighs 23.4, I will post his numbers as soon as I pick up the test results. :(

[jetsdrog]

I haven't posted anything on this site for quite some time. My Brady (10 years old) has been using Vyterol (sp) for the past 3 years and his Cushings has been under control with a few minor medication adjustments over the years. We went to a new vet last month (his moved out of state) and his Alkaline Phosphate Liver enzyme was over 2000 the vet said over 200 is high, so his is off the charts. The vet took an x-ray and his liver is extremely large and his gall bladder is enlarged as well. The x-ray showed some crystallization, which could be from his gall bladder or liver. Next step is do an ultrasound and most likely a biopsy. The vet said that since his cushings has been controlled over the last 3 years that these test results are not normal. She consulted with a internal vet specialist. I was wondering if anyone in the group has had this happen to their cushing dog and what the diagnosis was. We are trying not to worry but it sure doesn't sound good to us. Sounds pretty serious. Thank you.

[labblab]

Welcome back to you and Brady, although I’m very sorry about these new worries. You’ll see that I’ve merged your new post into your original thread about Brady (and I’ve updated his age in the thread title, as well ;-).

Can you tell us what dose of Vetoryl he’s currently taking, as well as the results of the most recent monitoring test of his cortisol level? It’s been our experience here that even after being treated for Cushing’s, the Alk Phos level may never return back into normal range. It’s true that 2000 is elevated, but I’d wonder where that stands in relation to previous testing. Has it remained pretty consistent at that level for these past three years, or has it recently started rising even higher than it had been before?

I cannot argue with the value of performing an ultrasound in order to check things out. But if Brady is behaving normally and has not sprouted any visible symptoms of new illness, I do wander whether these findings are simply consistent with abnormalities that were caused by Cushing’s and have been present for quite some time. In other words, I’m thinking they may not be a new, sinister development. But the ultrasound should help provide additional clarity, and we’ll surely be anxious to learn what you find out.

Do keep us updated!
Marianne

[jetsdrog]

He is currently taking 30mg, 15 in the morning and 15 in the evening. He has been doing very well, 6 months ago we started him on CBD oil to help with his arthritis and mobility pain issues. On the CBD oil he has been like a different dog. I will be calling the vet today to discuss and I will get his numbers from his last few tests. Thanks

[Harley PoMMom]

Just be aware that CBD oil will raise liver enzymes, especially the ALP. I'm including a link to a study titled: "Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs" and was published July 23, 2018 which shows those results. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065210/ Here's an excerpt from that study:
In conclusion, this particular product was shown to be bioavailable across the small number of dogs examined in the PK portion of the study, and dogs with OA receiving this industrial hemp extract high in CBD (2 mg/kg of CBD) were perceived to be more comfortable and active. There appear to be no observed side effects of the treatment in either the dogs utilized in the PK study at 2 and 8 mg/kg, or dogs undergoing OA treatment for a month duration. There were some dogs with incidental rises in alkaline phosphatase that could be related to the treatment.