Just diagnosed - medicinal treatment vs natural/homeopathic

[Edward]

Hello everyone,
Our 8 year old boxer was just diagnosed as cushingoid last week and i'm supposed to meet with the vet and pick up medication this evening.
Symptoms began to show in April with excessive drinking weight gain. After initial bloodwork the vet was leaning more toward hypothyroidism so he's been on medication for that for about 3 months. The potbelly went away but his excessive drinking, urination, bladder control, panting, and skin irritations have all gotten worse.
I'm not sure yet what medication is being prescribed but after reading a bit i'm concerned about the side effects.
Has anyone tried or have opinions on the more natural treatments such as Cushex or Adrenal Harmony Gold?
I'm just not sure how to proceed at the moment, I guess I'll get more info from the vet this evening.

Thanks for any input!

[pansywags]

Hi Edward, I'm sorry to hear about your boy's diagnosis. I'm a boxer lover, your boy is so handsome!

The general consensus is that the natural treatments have not been observed to be helpful in dogs with Cushing's symptoms and that you are better off saving your money. Like you, I was terrified of the medical treatments and their side effects but after hanging around here for awhile I realized that with an informed vet and informed, actively involved owner (which is you! you came here, which is the best place you could possibly be right now) carefully managed medical treatment can be very successful in managing the symptoms of Cushing's.

In order to help advise, we'll want to know more about the symptoms that brought you to this diagnosis, what testing was done and what the test result numbers were (for abnormal results only). It's best to start a home file with copies of all the vet records.

Welcome, we look forward to hearing more about both of you.

[Harley PoMMom]

Hi and welcome to you and your boy from me as well! Since your boy is taking thyroid supplementation has his levels been checked recently? The reason I ask is if his thyroid levels are too high than this can cause increases in drinking and urination.

I would not waste money on Cushex or Adrenal Harmony Gold, because they simply do not have cortisol lowering abilities, Cushing's is when a dog's body is making excessive amounts of cortisol. Trilostane/Vetoryl and Lysodren/Mitotane are the two drugs generally prescribed for canine Cushing's disease. These are strong medications but are life savers for dogs with Cushing's. Usually adverse reactions are only seen when the proper protocols are not followed.

Cushing's can be difficult to diagnose and is frequently misdiagnosed as other illnesses have the same symptoms, such as diabetes or any thyroid or liver problem and need to be ruled out. Getting copies of all tests that were done on your boy and posting any abnormal values here would be a great help to us. Is your boy taking any other herbs/supplements/medications? Does he have any other health issues? How much does he weigh?

Please know we are here to help in any way we can so do not hesitate to ask all the questions you want ;)

Hugs, Lori

[Edward]

Here are the latest blood-work results; (abnormal)
ALKP - 177 U/L (Normal 5-160)
BICARB - 28 mmol/L (Normal 13-27)
GGT - 14 U/L (Normal 0-13)

And then last week he had a DEX suppression test
Cortisol Pre-Dex 4.9
Cortisol 4hr Post-DEX 5.4
Corisol 8hr Post-Dex 7.1

Casper is an 8 yr old boxer, weighs 65lbs. He is currently on Thyroid meds (Soloxine 1mg twice a day) and and antibiotic for some pretty severe skin sores that came up recently (Ciprofloxacin twice a day).

He's been showing all the symptoms for Cushing (excessive drinking, panting, urination, restlessness, increased appetite, thinning hair, skin sores, etc)
The vet prescribed Vetoryl at 60mg per day (1 capsule) and we started him on it last night. The vet also recommends to keep him on the Soloxine for the time being.

Are there any side effects I should be concerned about or looking for?

[Harley PoMMom]

We usually see high elevations in the ALKP in dogs with Cushing's, I have seen ALKP in the thousands! Glad to see that Casper's ALKP is not that high.

Casper's LDDS test results are indicative for Cushing's but do not tell us whether it is the adrenal or pituitary type. Has the vet mentioned about getting an ultrasound done? An ultrasound may be able to show what type of Cushing's Casper has, it also gives a peek at all of the internal organs and may show if there are any irregularities.

Casper's starting dose of 60 mg is a reasonable dose for his weight of 65 lbs, however, if he were my dog, I would of felt more comfortable starting at 40 mg instead. Sometimes a dog will fell yucky when the elevated cortisol is lowered rather quickly, this is known as corticosteroid withdrawal syndrome, and usually happens during the first 10 days of treatment, clinical signs include weakness, lethargy, and/or loss of appetite. If this would happen simply stopping the Vetoryl should help.

Hypoadrenocorticism, this is when the cortiol has dropped too low, can develop at any dose of Vetoryl. The symptoms of this are: vomiting, diarrhea, and/or lethargy, if Casper would display any one of these symptoms than the Vetoryl is stopped and an ACTH stimulation test may be needed to be done.

I am providing a link to Dechr'a product insert which where you will find information regarding Vetoryl: Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

If you have any questions please do not hesitate to ask them. ;)

Hugs, Lori

[Squirt's Mom]

Hi,

In the Helpful Resource section you will find a link with some info on Vetoryl (Trilostane). Here is the link -

http://www.k9cushings.com/forum/showthread.php?t=185

And from the patient / owner brochure -


ADVERSE REACTIONS:
The most common adverse reactions reported are poor/reduced appetite,
vomiting, lethargy/dullness, diarrhea, and weakness. Occasionally, more
serious reactions, including severe depression, hemorrhagic diarrhea,
collapse, hypoadrenocortical crisis or adrenal necrosis/rupture may occur,
and may result in death.

If you see any of those signs listed in the first sentence, stop giving the Trilo and call the vet.

Did the vet give you any prednisone? It isn't as critical with Vetoryl / Trilostane but it is still prudent to always have some on hand just in case. Vetoryl / Trilostane has a very short life in the body and is usually leaving the system in a few hours. So pred isn't always needed. ;)

Is the LDDS the only test he's had to diagnose the Cushing's? When was the thyroid function last checked?

[Edward]

HarleyPomMom - The vet hasn't mentioned an ultrasound yet, what would he be looking for in the ultrasound? Thanks for all the other information, i'll keep an eye out for any of those side effects. How would we find out if it's pituitary or adrenal?

Squirt's Mom - He did not give me any prednisone, should i request some from him? Besides the Low Dex test, he has had normal blood work done twice, most recent about a month ago and the vet was checking his Thyroid levels as Casper had been on the Thyroid meds for about 8 weeks at that point. I think the diagnosis comes from the tests and all the symptoms he has been showing. The vet says at this point he is confident in the diagnosis.

I just hate watching the effects Cushings has been having on Casper and want to do what i can to improve his quality of life.

Thanks again for everyone's help!

[lulusmom]

Since LDDS test does not tell us if Casper has pituitary or adrenal dependent disease, your vet should do an abdominal ultrasound to validate the LDDS as well as make the differentiation between pituitary and adrenal. If it is pituitary, both adrenal glands are usually enlarged but they can normal in size as well. If there is an adrenal tumor, one gland will be enlarged and the other is almost always smaller or even atrophied due to lack of use. Your vet would also be looking at the liver for the usual enlargement caused by cushing's. He would also have a good look at other internal organs to check for any non adrenal issues that Casper may have going on.

Has your vet identified what the skin sores are? Boxers and other brachycephalic breeds with cushing's seem to be predisposed to a rare and nasty symptom of cushing's, calcinosis cutis. Make sure that your vet does the necessary tests to rule cc out. Did he do any skin scrapings or punch biopsies to determine what you are dealing with?

Lori already mentioned this but if thyroid hormone supplementation is too high, a dog will pee lakes and drink tons of water, just like most dogs with cushing's. They basically go from hypothyroidism to hyperthyrodism. I bring this up again because most dogs with uncontrolled cushing's have low T4. This is a transient condition that corrects itself with effective treatment of the underlying condition. Unless your vet did a complete thyroid panel to confirm a hypothyroid diagnosis, there is a very real possibility that Jed does not need thyroid meds.

Glynda

[Edward]

Thanks again for everything.

I will ask the vet about doing an ultrasound, i think part of his reasoning has been to keep costs as low as he can since that is always an issue.

He hasn't done any scrapings or tests of the skin sores, but i just did a google image search for calcinosis cutis and from what i find, the descriptions and pictures match what Casper has very closely. Is there a separate treatment for this? They seem to be healing fairly well since he's been on the antibiotic.

I'm not sure if a full Thyroid panel has been done yet. I feel so uneducated now after all your replies to me! I'm going to have a long list of questions for my vet next time I see him.

Casper is scheduled for an more blood work in two weeks after being on the Vetroyl. (ACHT I think)