Emma diagonised with Cushings disease!!!!

[babyblackbear]

Hi, My name is Julie, My beautiful cross Poodle Maltese has cushings disease. She was diagnosed about 8 weeks ago.She has a tumor on her adrenal gland and also on her pituitary gland. apparently this is fairly rare but does happen. she weighs about 5 kilos and is taking Trilostane 0.02ml morning and night. The medication bottle has 30 mg typed on the label. she has had 2 ACTH blood tests, the first was 207 the 2nd test was 138. we are Australian, so these figures may be a little different to the american version. Our Vet was very happy with these results. Emma is 14 years old. she has all the symptoms for cushings desease, For about 3 days now we have our little girl back, the light is back in her eyes, she is being more active, eating better, drinking water again, .behaving in a more normal manner, any help or suggestion anyone can make, for us to help her would be very much appreciated, do you think her meds are ok, hs anyone had experience with their dog having tumors on both pituitary and adrenal glands?

[doxiesrock912]

That is rare!
You will see her symptoms return quickly if she's not controlled properly. If she's over controlled, she'll become listless and will become picky about her food or not eat at all. Might even vomit. If this happens stop the meds immediately and let your vet know asap. This is of the utmost importance. Do NOT give her another dose until this is resolved.

Please familiarize yourself with the helpful links section of this forum. You'll find a lot of information.

You know your dog better than anyone so if she's not acting right, stop the meds and call the vet. Every dog is different and Cushings affects each one uniquely. Is it a combination of reading the tests and learning how the dog responds to treatment. Cushings also makes them prone to infections of the skin, UTIs etc so don't be afraid to ask questions and call your vet if you think something isn't right.

Most don't get the dosage right at first, so know that changes are going to happen and it doesn't mean that's bad news.

It sounds like you're off to a good start!

Others on the forum will be along to discuss the numbers. That is not my expertise. :-)

[babyblackbear]

Thank you so much.....

[My sweet Ginger]

Hi Julie, welcome to you and Emma to the forum and yep, the experts will come by later.
I just have two questions. Do you mean Emma's eating less now since trilostane when you said she's eating better and was Emma not drinking water before trilostane when you said she's drinking again? Thank you. Song.

[LauraA]

Hi Julie. Poor Emma having two tumors! I am guessing that she isn't a candidate for having the tumor on her adrenal gland removed at 14 years of age. I am a fellow Aussie and the Vetoryl has made such a huge difference to my grumpy old girl. Cushings dogs are prone to pancreatitis so it is important to keep them on a low fat diet. I am sure your vet has told you that she needs another Stim test at around 10-14 days to check how she is responding to the dose and if it needs tweaking. It is important to make sure the test is 4-6 hours after she has had her Vetoryl (with food of course).

You will find everyone here really helpful and supportive :)

[jas77450]

Hi and welcome Julie, poor Emma has a lot going on but you are in the right place, lots of caring folks with lots of experience here. I am too new to offer advice but am here to hold your hand.
Jenny

[babyblackbear]

Hi My Sweet Ginger, Emma had a really good appetite, and she always drank plenty of water, but she was not ravenous or begging for water all the time. She has the very bony backbone, black spots and black skin all over her torso and neck. She was vomiting white bile and had diarrhea, on the 3rd day of vomiting, she started to dry retch and brought up some very bright yellow fluid. So we were off to the vet at that stage,she did not want to eat or drink at that stage.Also she was very dehydrated, so she spent a few days at the vet. They suspected Cushings disease.when she came back for some more tests, the tests showed high liver enzymes.Hope that make some sense to you, I am at sixes and sevens with this horrible disease. and yes she was very picky with food and water also very lethargic,for a while since starting the trilostane. The last five days she has been more like her old self, also the vet suggested to split her medication am & Pm so far so good.....

[babyblackbear]

.Hi Laura A,Thank you for your very good advice, and caring!!! My vet feels as Emma is 14 her chances of surviving an operation at her age are very slim.At this stage the Trilostane seems to be working.Emma has been on the medication for about 7 weeks now...

[babyblackbear]

jas77450.thank you so much for caring and holding my hand!!!

[molly muffin]

Hello and welcome to the forum.

Oh my goodness how very scary that must have been. Yes low dose am and pm often works better for some dogs.
How did they diagnose both pituitary and adrenal tumors?

What dose of trilostane is she on now?

[babyblackbear]

Hi Molly Muffin, Apparently from some of the blood tests, they are able to diagnose which gland is producing the cortisol. My vet had not seen this happen before with both glands producing cortisol. He is in touch with the university vet who had some experience where both glands were involved..

[molly muffin]

I think you are talking about the LDDS, which can sometimes tell you which gland is producing, something though it doesn't tell you that. Do you have a copy of that test result? and if so can you post it for us to see?

hugs

[babyblackbear]

Hi Molly muffin, sorry I dont have copies of any blood tests. I just know that somehow both glands are involved, I think you did ask what dosage of Trilostone Emma was on now. She is having 0.2 ml of the Trilostane twice a day. I think from what I have been reading on this forum this dosage could be a little high?

[molly muffin]

ugh, I'm terrible with the liquid measurements. Marianne though and Leslie I think are pretty good at figuring out if that is to high or not. I think you said the bottle as 30mg typed onto it? and she weights 5kg, which is about 11lbs.

1mg/1lb is where you want to start on capsules.

Just keep a close eye and make sure she doesn't vomit, get diarrhea, stop eating or become lethargic. Those are your main signs to watch for.

hugs

[babyblackbear]

Thank you Molly Muffin, hard to tell how she is going, she is fairly happy on a walk or when going out and about. she can be a little lethargic around the house..sleeping ...then again this could be age? does not play with toys, then again she has not played with toys for years..quite happy to watch us play with her toys, rolling balls etc; to keep her interested?

[molly muffin]

Well, that can be a sign of cushings too, just not being overly interested in anything on it's own, like toys.

No, when I say lethargic, think more like wobbly, won't get up, not interested in walks, or interested but unable to do it.

So far sounds okay though. Just keep a sharp eye on her for anything that seems "off".

hugs

[labblab]

She is having 0.2 ml of the Trilostane twice a day. I think from what I have been reading on this forum this dosage could be a little high?
In Sharlene's reply, she noted that your bottle has 30 mg. written on it, and also that Emma weighs around 11 pounds? If that is correct, then I think the dose she is getting fits right into the 1 mg. per pound formula. If 1 ml of the liquid holds 30 mg. of trilostane, then .2 ml would equal 6 mg. If Emma gets 6 mg. twice daily, that would total 12 mg. total -- perfect for a dog weighing 11 pounds. :)

Marianne

[Dixie'sMom]

Hi! I also wanted to pop in and welcome you to the forum. I am new, like you are, to being a Cushing's Mom. My dachshund, Dixie, was diagnosed the end of July and has been on Trilostane since September and is doing very well. I'm glad to hear that Emma is feeling better now and seems to be doing well on the Trilostane. I, like Sharlene, am also curious as to how they determined she had both types of tumors. I suspect they saw the adrenal tumor on Ultrasound but how did they find out she also had a pituitary tumor? I'm still trying to learn as much as I can and it sounds as if Emma is quite unique. Again, welcome and I look forward to getting to know you and your baby girl.

[babyblackbear]

In Sharlene's reply, she noted that your bottle has 30 mg. written on it, and also that Emma weighs around 11 pounds? If that is correct, then I think the dose she is getting fits right into the 1 mg. per pound formula. If 1 ml of the liquid holds 30 mg. of trilostane, then .2 ml would equal 6 mg. If Emma gets 6 mg. twice daily, that would total 12 mg. total -- perfect for a dog weighing 11 pounds. :)

Marianne
Thank you Marrianne..

[babyblackbear]

Hi! I also wanted to pop in and welcome you to the forum. I am new, like you are, to being a Cushing's Mom. My dachshund, Dixie, was diagnosed the end of July and has been on Trilostane since September and is doing very well. I'm glad to hear that Emma is feeling better now and seems to be doing well on the Trilostane. I, like Sharlene, am also curious as to how they determined she had both types of tumors. I suspect they saw the adrenal tumor on Ultrasound but how did they find out she also had a pituitary tumor? I'm still trying to learn as much as I can and it sounds as if Emma is quite unique. Again, welcome and I look forward to getting to know you and your baby girl.
Hi, Dixies Mum, I am not sure how they know,he mentioned, the two glands were involved after some of her tests were done, the vet was suprised about the two glands being involved but mentioned the result to the vet at the university,who had experienced this before, so I think the trilostane is supposed to work with both?

[babyblackbear]

Hi, Emma is having some trouble with diarrhea this morning, quite messy almost liquid, vet not available till to-morrow, she had eaten breakfast with her trilostane,we went to the local farmers market, for veges etc,weather quite hot here to-day, wondering if the heat was too much,she is sleeping , peacefully at the moment.She has been drinking water.Wondering if I should stop the trilostane till we see the vet to-morrow?

[My sweet Ginger]

I'd def. stop trilostane until she gets cleared of diarrhea and by the vet. You can always restart later. Does she appear lethargic or sleeps more? Do you have prednisone on hand just in case?

[babyblackbear]

I'd def. stop trilostane until she gets cleared of diarrhea and by the vet. You can always restart later. Does she appear lethargic or sleeps more? Do you have prednisone on hand just in case?
thanks for replying My Sweet Ginger, Emma appears much better now, looking for food (Frank making quick sandwich for lunch), she did have about a teaspoon of salmon with her dinner last night,believe salmon is quite fatty?No unfortunately we do not have any prednisone. We do have some medication for diarrhea (hers) so we will give her some of that...Probably best to not feed her till to-morrow.

[babyblackbear]

Emma has seen the vet, stopping the trilstone and not feeding was the correct thing to do for Emma's diarrhea.We are not to give the trilostone till to-morrow and we should not feed her till to-morrow. Just to give her steamed chicken and rice for about 5 days, slowly adding her dog food, vegtables, and the caned liver food. The vet feels the canned liver food could possibly be causing the problem. she has had a problem with high liver enzymes! I am also wondering about exercise for cushings dogs, we walk her most days, occasionally where we can take her off the lead and let her run free, she loves to run free and can run quite fast. The vet has advised that the running could possibly cause higher levels of cortisol.We felt we were all benefiting from this exercise as we have to move faster to keep up with her, just saying?

[flynnandian]

i walk my cush dogs 4 times a day, every day and everywhere;
park, river, sea, forest, always off leash and they love it!
they are still in good shape because of this, and so am i............
there are lots of members walking their cush dogs and let them run and play ball etc.
they [cush dogs] can't stand the heat anymore, so beware of that, but otherwise enjoy your walks with emma!

[babyblackbear]

i walk my cush dogs 4 times a day, every day and everywhere;
park, river, sea, forest, always off leash and they love it!
they are still in good shape because of this, and so am i............
there are lots of members walking their cush dogs and let them run and play ball etc.
they [cush dogs] can't stand the heat anymore, so beware of that, but otherwise enjoy your walks with emma!
Thank you flynnandian, for your reply, We will continue to allow her off the lead as I feel that it is important to her, thank you for your advice about the heat!!!

[molly muffin]

I would try to keep some of the higher fat content down, as cushing dogs can have issues with the pancrease. So more moderate to lower fat content in the diet. Canned liver, probably not a good option.
I agree, exercise is good for them, although as flynnandian said, heat is not. As long as she can enjoy exercise, I think it is good. It's hard to keep their muscles strong as it is.
Any adrenal increase from exercise would not be sustained, but a natural ebb and flow, I'd think.

hugs
Sharlene and molly muffin

[babyblackbear]

I would try to keep some of the higher fat content down, as cushing dogs can have issues with the pancrease. So more moderate to lower fat content in the diet. Canned liver, probably not a good option.
I agree, exercise is good for them, although as flynnandian said, heat is not. As long as she can enjoy exercise, I think it is good. It's hard to keep their muscles strong as it is.
Any adrenal increase from exercise would not be sustained, but a natural ebb and flow, I'd think.

hugs
Sharlene and molly muffin
Thank you Molly Muffin. I think I have misled you.The canned food was prescribed for Emma when the tests showed she had high enzymes in her liver,We are out of the canned food at the moment so I am not sure exactly what is in the tin......But will definitely check before giving her any more. I definitely appreciate any input from all the caring people on this site, thank you so much!!!

[molly muffin]

Oh okay I see not liver pate food but liver prescription food. Got it :).

Hugs

[babyblackbear]

Emma has been on a diet of steamed chicken and boiled white rice, to-day we are to introduce some vegetables, grated carrot and smashed peas or broccoli. she will not eat the white boiled rice, does anyone have any suggestions about what she could eat, she is inclined to diarrhea.

[LauraA]

You could try boiling up the chicken and then using that broth left over to cook the rice in. It will give the rice some flavour that way.

[judymaggie]

Julie--you might try adding a teaspoon of canned pumpkin in with the chicken and rice. It needs to be plain pumpkin, not pumpkin pie blend. It is very binding. My Abbie is prone to diarrhea and I have finally found a protocol that works for her: Pepcid 15 minutes before both meals, Fortiflora probiotics mixed in with her dinner and Flagyl after both meals. If Emma is not eating enough to get essential nutrients, I would suggest giving her Nutrical--it is a paste. When I was giving it to my Maggie, my vet suggested I get some ice cream sticks, put the Nutrical on the end of the stick and scrape it off behind Maggie's teeth. She liked it but it was like watching a dog eating peanut butter.

[Dixie'sMom]

A friend of mine has a yorkie that is prone to pancreatitis. She feeds her small but frequent meals of chicken and grits. I don't know how healthy the corn meal vs rice is, but that maybe one option.

[babyblackbear]

I have been steaming the chicken, and cooking the rice with the chicken stock left also added some low salt stock powder, just a pinch. also poured over a little stock over the mix of rice chicken and a little grated carrot. still only eating some of the chicken now.

[babyblackbear]

Thank you everyone for all your help, I have called the vet , we are to discontinue the Trilostane till Monday (Friday here in Aussie-7.00 pm) hoping to restore some of Emma's appetite. I do have copies of some of Emma's tests now,however my scanner is not working,will have to find some way of taking a copy or photo.

[LauraA]

I hope that helps her get her appetite back. So stressful when they aren't eating.

[My sweet Ginger]

Is she still on prednisone?

[Squirt's Mom]

What is in that "low salt stock powder"? I ask because so often things that are seasoned for human taste buds are not at all good for our dogs because they contain onion, which dogs should not eat as they can cause some serious problems. Also be sure to cook the rice to a paste, very over cooked, so it is easy for them to absorb and utilize rather than pass on through.

You're doing good, Mom. Hang in there!
Hugs,
Leslie and the gang

[babyblackbear]

What is in that "low salt stock powder"? I ask because so often things that are seasoned for human taste buds are not at all good for our dogs because they contain onion, which dogs should not eat as they can cause some serious problems. Also be sure to cook the rice to a paste, very over cooked, so it is easy for them to absorb and utilize rather than pass on through.

You're doing good, Mom. Hang in there!
Hugs,
Leslie and the gang
Thank you Squirts Mum, The stock powder that I used did have dehydrated onion,Thank God I only used a tiny pinch, I am so angry with myself for not checking the label......also thanks for the tip on cooking the rice till it is very overcooked, I was cooking till normal soft..

[babyblackbear]

Is she still on prednisone?
Emma was not on predisone, I will discuss that issue with the vet!!

[babyblackbear]

Julie--you might try adding a teaspoon of canned pumpkin in with the chicken and rice. It needs to be plain pumpkin, not pumpkin pie blend. It is very binding. My Abbie is prone to diarrhea and I have finally found a protocol that works for her: Pepcid 15 minutes before both meals, Fortiflora probiotics mixed in with her dinner and Flagyl after both meals. If Emma is not eating enough to get essential nutrients, I would suggest giving her Nutrical--it is a paste. When I was giving it to my Maggie, my vet suggested I get some ice cream sticks, put the Nutrical on the end of the stick and scrape it off behind Maggie's teeth. She liked it but it was like watching a dog eating peanut butter.
Hi Judy Maggie, thanks for the advice re the pumpkin, I don't think we have canned pumpkin here in Australia, but will check to-day at the supermarket.also have started her on a probotic....

[babyblackbear]

Help, Emma has been off Trilstane now since friday, she had her usual dose .2 friday am and none since,she has been eating reasonably well Sat pm and Sunday.boiled white rice steamed chicken and grated carrot.Through the night Sunday night she has been vomiting the white bile again, seems OK this morning although a little lethargic. We will be taking her to the vet this morning to see if we should be giving her the Trilostane again. Wondering if we could ask to give her half her previous dose. that would make her dose .1 am and pm, also wondering if perhaps her cortisol levels would now be too low.

[molly muffin]

I personally wouldn't give any trilostane until she has been fine and not throwing up for awhile. You just don't give trilostane if there is anything else going on with them. If she is still just on white rice and chicken and barely tolerating that (you definitely want some time with no throwing up) then you don't give the cushings meds. You can always start when things are better, but not before.

[babyblackbear]

the vet has now prescribed prednisone for Emma for 3 days, if she is OK start again with the Trilostane after 3 days as long as Emma is eating, and to change her dose to .2 ml once a day.Also noticed Emma is seeking the warmth of the sun sometimes, which is quite unusual for her, she has never liked to lay in the sun!!!

[Dixie'sMom]

I'm glad you took her to the vet. I'm assuming since she was prescribed Prednisone that he tested her cortisol and determined that she had gone too low? I'm not sure that 3 days would be enough time for her cortisol to rise enough that she would be safe to restart trilostane. I have no first hand experience, but have heard the others on the forum advise to wait until symptoms return to restart cushing's treatment. Hopefully someone will chime in soon with their thoughts. I hope Emma is feeling better.

[molly muffin]

That is what we have always said. Don't start treating again until symptoms reappear. We've had dogs go for weeks, months, Princess might have been a year before symptoms came back, actually I don't think Princess's symptoms ever did come back for cushings.

So, don't rush anything. It doesn't hurt one bit for them to regain their strength and have their adrenal glands producing again.

hugs

[babyblackbear]

I'm glad you took her to the vet. I'm assuming since she was prescribed Prednisone that he tested her cortisol and determined that she had gone too low? I'm not sure that 3 days would be enough time for her cortisol to rise enough that she would be safe to restart trilostane. I have no first hand experience, but have heard the others on the forum advise to wait until symptoms return to restart cushing's treatment. Hopefully someone will chime in soon with their thoughts. I hope Emma is feeling better.
Hi, Dixie's Mum, no Emma was not checked for cortisol levels at this time, I think the decision was based on the fact that for a few days before we stopped the Trilostane Emma was not eating and was very lethargic and wobbly on her feet. while being off the Trilostane and on the Prednisone she has had a very good appetite...A much happier little dog!!

[babyblackbear]

That is what we have always said. Don't start treating again until symptoms reappear. We've had dogs go for weeks, months, Princess might have been a year before symptoms came back, actually I don't think Princess's symptoms ever did come back for cushings.

So, don't rush anything. It doesn't hurt one bit for them to regain their strength and have their adrenal glands producing again.

hugs
Hi Molly Muffin, thank you for your very wise advice, Emma is supposed to have another prednisone tablet to-morrow....Emma did not have a lot of Cushings symptoms, she was not ravenous, did not drink huge amounts of water, she does have the protruding backbone and lots of black spots on her back and torso(whitch we had attributed to age (she is 14) We raced her to the vet when she started to bring up white and yellow bile. So I guess that I would have to watch her carefully for any signs of lethargy etc. what do you think?

[Squirt's Mom]

Would you do us a HUGE favor and get copies of all the tests done to diagnose your baby with Cushing's then post all the info here? Include the ultrasound report, too. We are sort of floundering here trying to help with minimal info. So it would help us a great deal if you would get that info and share it here. :)

I CANNOT believe your vet didn't do an ACTH to see how low Emma is or if his electrolytes are ok. :mad: Why was this not done, did they explain that to you? I would have demanded the vet do an ACTH. ;)

[babyblackbear]

Hi Squirt,s Mom, I have some copies of Emma's results, I am having trouble trying to post them into this page, wondering how to do that?I have managed to post a photo of the initial test into my profile, but not into this area.

[Squirt's Mom]

The easiest way for me to do it is simply type out the abnormal values, too high or too low. They look something like this -

ALP 350 150-500 ug/dl

For the ACTH and LDDS we want to see all the numbers and notations. For the ultrasound all comments made about each organ. Lots of typing, sorry, but that's the way I do it since I can't scan things in.

[babyblackbear]

http://www.k9cushings.com/forum/picture.php?pictureid=7246&albumid=945&dl=1416374405&thumb=1

[Squirt's Mom]

I can't read that with my old eyes! :p Maybe someone else can.

[lulusmom]

I can't read it either.

[labblab]

The image is also posted in the photo album, and is viewable there. I am copying Emma's 10-17 ACTH results from the image there:

Baseline: 134 nmol/L (15-170). [ this converts to 4.8 ug/dl for our U.S. members]
1-hour: 138 nmol/L. [this converts to 5.0 ug/dl]

Marianne

[Squirt's Mom]

To repeat what Marianne said on the other post about attachments just in case you missed it there -


Honestly, though, it is easier for us to review the results and give feedback if you will type only the abnormal results that have been flagged as being too high or too low (and the reference ranges) directly into the body of your post. In that way, we are not stuck plowing through a bunch of numbers that are not significant to us. You can do the same with written interpretations of ultrasound or x-ray reports: type out the interpretation in your reply.

No need to type it ALLLL out - just those values that are too high or too low. ;)

[labblab]

In this case, the interpretation for the ACTH took up an entire printed page so I understand why it may have seemed daunting to type that all in here. But that is rather unusual -- most times the info we need will be much shorter. And with an ACTH, all we ever really need is what I have typed in above. We already know how to interpret those numbers once we see them.

The reason there is so much written interpretation with an ACTH is because it can be used both as a diagnostic test for Cushing's and also a monitoring test after treatment has begun. From the looks of the results, it seems as though this test must have been run after Emma had started on the trilostane instead of before. Is that true?

[babyblackbear]

In this case, the interpretation for the ACTH took up an entire printed page so I understand why it may have seemed daunting to type that all in here. But that is rather unusual -- most times the info we need will be much shorter. And with an ACTH, all we ever really need is what I have typed in above. We already know how to interpret those numbers once we see them.

The reason there is so much written interpretation with an ACTH is because it can be used both as a diagnostic test for Cushing's and also a monitoring test after treatment has begun. From the looks of the results, it seems as though this test must have been run after Emma had started on the trilostane instead of before. Is that true?
Hi Labblab, So glad you found Emma's test results, scanned them into my computer as a jpeg to bring into that section, there was another button that did actually make the print a little clearer in that area. I could scan in at a higher resolution, not sure if that would make any difference?. Yes Emma was started on Trilostane 10 th Sep 2014...The test posted was her most recent test. Hope that will help. She has had two tests done previously to that one. These two tests have about 3 pages . of information none of which mean anything to me. I will try to sort out the information that you have indicated would help. Thanks so much for all your help.

[babyblackbear]

Results for Emma; 3rd September 2014.

Cortisol resting 315 High nmol/L 15-170
Cortisol.l 1st post 51 nmol/L
Cortisol 2nd post 42 nmol/
1st post dose time 4
2nd post dose time 8

Normal dog
baseline cortisol 15-170


Emma Test; 19th September 2014
Cortisol resting 56 nmol/L 15-170
Cortisol 1st post 207 nmol/L
1st post dose time 1

Hoping these results will help...

[Squirt's Mom]

You done good! :cool: And do you have any labs with things like ALP, BUN, CHOL showing on them? If so, would you mind posting the results that are either too high or too low along with the normal ranges for each? It would look something like this -

ALP 350 150-500 ug/dl

Did Emma have an LDDS? or just the ACTH to diagnose?

[labblab]

Results for Emma; 3rd September 2014.

Cortisol resting 315 High nmol/L 15-170 [11.4 ug/dl]
Cortisol.l 1st post 51 nmol/L [1.8 ug/dl]
Cortisol 2nd post 42 nmol/ [1.5 ug/dl]
1st post dose time 4
2nd post dose time 8

Normal dog
baseline cortisol 15-170


Emma Test; 19th September 2014
Cortisol resting 56 nmol/L 15-170 [2.0 ug/dl]
Cortisol 1st post 207 nmol/L [7.5 ug/dl]
1st post dose time 1

Hoping these results will help...
They do help, thank you very much! So now if I have the timeline straight, the diagnostic LDDS result given above was performed on Sept. 3. Then Emma started on the trilostane Sept. 10. Then the first monitoring ACTH (above) was given on Sept. 19. And the next monitoring ACTH was on Oct. 17 with a "pre" of 4.8 ug/dl (134 nmol/L) and a "post" of 5.0 ug/dl (138 nmol/L).

As you will see, once again I've plugged in the conversions for our U.S. members. The way to convert to ug/dl is to divide the nmol/L number by 27.59.

So this is what I see. We don't have the normal range for the 4 and 8 hour readings on the LDDS (we've just seen another lab report that didn't list it either). But in terms of U.S. units, the 8-hour cut-off is usually 1.4 ug/dl. This means that a dog without Cushing's will test below 1.4. In Emma's case, the 8-hour result was 1.5. So that means she was likely just borderline high or "positive." Taking the test one step further, both the 4-hour and 8-hour results were less than 50% of the baseline. So assuming Emma does indeed have Cushing's, this would be consistent with the pituitary form of the disease.

Switching to the two monitoring ACTH tests, the results were good at those times. The second one has the "post" number lowered to 5.0, which is right at the top of the ideal therapeutic range. There is not much difference between her pre and her post number on that test, but they were both high enough that I wouldn't have thought that would be an issue. But the problems she has had lately may be related in some way. Or perhaps her cortisol production overall dropped even further during this intervening month.

What I don't remember off-hand is what Emma's dosing history has been, so I'll come back later and take a look at that. But for right now, I want to go ahead and post this test info.

Marianne

[babyblackbear]

They do help, thank you very much! So now if I have the timeline straight, the diagnostic LDDS result given above was performed on Sept. 3. Then Emma started on the trilostane Sept. 10. Then the first monitoring ACTH (above) was given on Sept. 19. And the next monitoring ACTH was on Oct. 17 with a "pre" of 4.8 ug/dl (134 nmol/L) and a "post" of 5.0 ug/dl (138 nmol/L).

As you will see, once again I've plugged in the conversions for our U.S. members. The way to convert to ug/dl is to divide the nmol/L number by 27.59.

So this is what I see. We don't have the normal range for the 4 and 8 hour readings on the LDDS (we've just seen another lab report that didn't list it either). But in terms of U.S. units, the 8-hour cut-off is usually 1.4 ug/dl. This means that a dog without Cushing's will test below 1.4. In Emma's case, the 8-hour result was 1.5. So that means she was likely just borderline high or "positive." Taking the test one step further, both the 4-hour and 8-hour results were less than 50% of the baseline. So assuming Emma does indeed have Cushing's, this would be consistent with the pituitary form of the disease.

Switching to the two monitoring ACTH tests, the results were good at those times. The second one has the "post" number lowered to 5.0, which is right at the top of the ideal therapeutic range. There is not much difference between her pre and her post number on that test, but they were both high enough that I wouldn't have thought that would be an issue. But the problems she has had lately may be related in some way. Or perhaps her cortisol production overall dropped even further during this intervening month.

What I don't remember off-hand is what Emma's dosing history has been, so I'll come back later and take a look at that. But for right now, I want to go ahead and post this test info.

Marianne
Thank you Labblab...

[labblab]

You are so welcome, Julie! :)

OK, just checked back through the dosing and it looks as though Emma (who weighs 11 pounds) had remained on the .2 ml (6 mg.) twice daily up until her recent episode of feeling unwell. The vet has now lowered her to the single dose of 6 mg. in the morning. I think this is a reasonable decision in view of her recent behavior. If she acts "off" again, it would be cause to totally discontinue the trilostane again and this time I agree that I would unquestionably want another ACTH test immediately. But I am hoping this may turn out to be a better dosing level for her. As long as her symptoms are controlled, it is OK for her cortisol to run somewhat higher than on the previous monitoring tests. Even if she outwardly appears well on this new dose, however, I would wait no longer than a month before rechecking the cortisol again.

Just wanted to add, now that we have the results of the diagnostic LDDS test that are consistent with a pituitary tumor, I am guessing that it is the only tumor that Emma has. In the absence of an ultrasound image showing a growth on an adrenal gland, there is no reason to think she has an adrenal tumor as well. My thought is that the vets are simply telling you that the pituitary gland and the adrenal glands are all jointly involved -- due to the pituitary tumor, the adrenal glands are overproducing hormones including cortisol.

Marianne

[babyblackbear]

Hi Marianne, thank you for that information, just a little information about the adrenal gland, Emma has had an ultrasound on her adrenal gland, and there is a tumor on her adrenal gland, it is apparently quite large, as far as they could tell the tumor is benign. Unfortunately I don't have any results for that ultrasound.

[babyblackbear]

You done good! :cool: And do you have any labs with things like ALP, BUN, CHOL showing on them? If so, would you mind posting the results that are either too high or too low along with the normal ranges for each? It would look something like this -

ALP 350 150-500 ug/dl

Did Emma have an LDDS? or just the ACTH to diagnose?
Hi Squirts Mum, Not Sure if Emma had a LDD I do remember that she had high cholesterol reading at one stage, but I think that did come down to an acceptable level. Unfortunately I do not have any paperwork on that issue eithor.. Will definitely ask for copies of everything and all furture tests etc from now on!!!

[babyblackbear]

:confused:Emma's appetite seems to have increased somewhat, looking in the pantry for food now, has never done that before. Also noticed some white frothy bile on the floor. Wondering if we should restart her on the Trilostone now. Decided to restart on the .2 dosage and watch her carefully over the next few days. Any input here is really appreciated......

[babyblackbear]

Hi everyone, I often call in to this forum (everyday just about) to see how everyone else is going, the help and knowledge available on the forum never ceases to amaze me! Myself I would have been totally lost and will continue to be totally lost as this dreadful disease progresses. So many of us depend on our canine companions so much, the love they give is beyond question....My little Emma has coped fairly well with her medication over the last six days she has been having .2ml a day and seems to be tolerating the dosage. She is eating quite well but would like more to eat. drinking ok but not desperate for more water, noticed she is a little itchy on her back we have looked but cannot find anything that looks like a sore. She will be bathed tomorrow, as she seems to be quite smelly at times, wondering if that would be caused by the Trilostane?

[addy]

Sometimes their skin can get greasy from the disease. They can get dry and flaky skin in patches too as well as bacteria on the skin. A medicated shampoo can help with that. It does not have to be prescription. Sometimes they get yeast and yeast can give off an odor. With skin issues we need to be proactive as they can get out of control quickly.

You can always ask your vet to do a skin scraping. It could be yeast.

[babyblackbear]

Sometimes their skin can get greasy from the disease. They can get dry and flaky skin in patches too as well as bacteria on the skin. A medicated shampoo can help with that. It does not have to be prescription. Sometimes they get yeast and yeast can give off an odor. With skin issues we need to be proactive as they can get out of control quickly.

You can always ask your vet to do a skin scraping. It could be yeast.

Thank you Addy

[babyblackbear]

We have noticed that Emma is becoming weaker with her back legs, she seems to be able to walk and run ok, but no longer seems to want to jump up on her favourite spot on top of the lounge where she can look out the window to watch the passing traffic etc., Does the Trilostone help with this issue, she is only on a small dose .2 ml once a day.

[labblab]

This behavioral change with Emma may indicate that cutting her trilostane dose in half is allowing her cortisol level to rise higher than is optimal for her. It will be interesting to see where her levels are on the next monitoring ACTH test. How is she otherwise doing in terms of appetite, water consumption, energy level, etc.?

Marianne

[babyblackbear]

Hi Marianne, Emma has a good appetite she could always eat more but she is not ravenous, drinking normal amount of water, her energy levels are not too bad, she enjoys her walks, doesn't have any diarrhea at the moment. She does feel the heat, we have been having some very hot days which will get worse (coming into an Australian summer started to-day . She is not due for another test till 21st January 2015, but-if she needs one before that date & I think she will we will make the necessary arrangements. Do you think I should increase her dosage of the Trilostone at this stage. Thank you for caring!!! Julie...

[molly muffin]

We all do that. You know the date that you should have the tests and if anything comes up that makes you the least bit uncomfortable, then schedule it sooner. I am not suppose to test for another month and not sure if I'll make it that long or not. :)

you aren't alone
hugs

[Squirt's Mom]

Don't increase the dose on your own. She needs the ACTH first. ;)

[labblab]

Hi Marianne, Emma has a good appetite she could always eat more but she is not ravenous, drinking normal amount of water, her energy levels are not too bad, she enjoys her walks, doesn't have any diarrhea at the moment. She does feel the heat, we have been having some very hot days which will get worse (coming into an Australian summer started to-day . She is not due for another test till 21st January 2015, but-if she needs one before that date & I think she will we will make the necessary arrangements. Do you think I should increase her dosage of the Trilostone at this stage. Thank you for caring!!! Julie...
Since all of Emma's other symptoms seem to be well controlled on the current dose, no, I would not increase the trilostane at this point. If you start seeing a rebound in them, as well, I'd move up the ACTH as Leslie says, and go from there.

Given the fact that Emma is almost 14, it is possible that lowering her cortisol level may be unmasking some arthritic issues that are now affecting her mobility. If so, there are supplements and meds that may be helpful to her. I think her overall behavior plus the next ACTH test results will help distinguish whether the rear-end issues are due to cortisol levels vs. orthopedic/arthritic deterioration.

Marianne

[babyblackbear]

Since all of Emma's other symptoms seem to be well controlled on the current dose, no, I would not increase the trilostane at this point. If you start seeing a rebound in them, as well, I'd move up the ACTH as Leslie says, and go from there.

Given the fact that Emma is almost 14, it is possible that lowering her cortisol level may be unmasking some arthritic issues that are now affecting her mobility. If so, there are supplements and meds that may be helpful to her. I think her overall behavior plus the next ACTH test results will help distinguish whether the rear-end issues are due to cortisol levels vs. orthopedic/arthritic deterioration.

Marianne

Thank you Marianne

[babyblackbear]

Wondering if I could add a little more variety to Emma's food, she currently has white rice very very soft, chicken, mild flavoured fish (flathead) very small amount of salmon,dog food, (light) carrot beans asparagus brocoli. wondering if she should have some red meat sometimes? we do feed her twice a day. she also will eat small amounts of tomato and cucumber. occasionally some apple or banana.

[Squirt's Mom]

Is there a reason she is on such a diet? Did someone design that for her or did you just put it together yourself? If it is not balanced, meaning the nutrients, minerals, and vitamins meet her needs, then you are asking for trouble feeding this long-term. I would first make sure this diet is balance and if it's not, do what has to be done to make it so. If you can't do that yourself or hire someone to help you, I would use a commercial feed myself. You can add a little of these things to commercial feeds, canned or kibble - I do and call them "freshies". :D But I know my babies are getting a well balanced meal each and every time. That is the important factor - balanced for Emma. ;)

[babyblackbear]

Hi everyone, Emma has taken a step backwards, she appears to be quite stressed at the moment, she has some diarrhea, not eating very well, and wanting to go outside to the toilet quite frequently. I noticed a slight change about three nights ago, she wanted to be in a different room from us? slower on her walks. .she did have a morning at the groomers yesterday,she was really stressed to be going to the groomer who works out of the same surgery as the vet we are seeing.She was shaking and quite fearful. We did have a really bad night with her last night. kept wanting to go outside for the toilet etc. Her cortisal levels could be high because of the grooming? she did leave most of her breakfast.Emma appeared to be doing quite well for the last few weeks!

[molly muffin]

Do not give her any trilostane in that condition. It is not that the cortisol becomes higher but that either it has dropped very low, her electrolyte same off or something else going on. I would take her to the vet pronto if it were me.

Take no chances. Let us know how she continues to be.

[molly muffin]

You didn't increase her trilostane dosage did you?

[Harley PoMMom]

I agree with Sharlene, no Trilostane should be given when a dog is acting ill. Has an ACTH stimulation test been done recently, and if so, could you post those results for us? What is the dose of Trilostane she is getting?

[babyblackbear]

Thank you everyone for your advice and your concern. We have seen the vet she has advised to come off the Trilostane for 2-3 days Emma...also has some diarrhea, We have done all this before, last time we had to reduce her medication from 0.4 ml to 0.2 ml, she has been doing quite well on the lower dosage till the last few days. Wondering how much lower we can go to reduce the medication. No HARLEY Pommom we haven't had another ACTH done I guess that will be the next thing to be done She is due to have another ACTH 21st January 2015 that will be her 90 days test. I think we will have to bring that test forward. I find myself becoming quite confused with the signs for high cortisal and low cortisol as Emma's age is 14 years, her birthday 14 years 10th November 2014. She is looking quite old now I believe that also is a sign of low cortisol.. Thank you all for being there ...

[Squirt's Mom]

Your vet is making dose adjustments WITHOUT an ACTH?! :eek::eek::eek: If so, no wonder she has had problems!

[babyblackbear]

Hi Squirts Mum, I realize that Emma should be having more tests done at this stage, but this is a very expensive disease, so far the tests, and the ultrasound have cost us about 3000 dollars plus all the vet visits which are about seventy dollars each time. unfortunately money is tight for us, we are both in our late seventies, I will be 76 next month and my partner is now 78, we are both on age pensions. We are trying to the best we can for our little girl and we do love her dearly. At the moment she is doing well, she has not had any trilostane for two days, she is much brighter, sleeping well, and tolerating her food, eating well. I don't know where we should go at this stage, and I don't know if the vet knows either, Thank you for caring and I really do appreciate your input.

[Harley PoMMom]

She is due to have another ACTH 21st January 2015 that will be her 90 days test. I think we will have to bring that test forward. I find myself becoming quite confused with the signs for high cortisal and low cortisol as Emma's age is 14 years, her birthday 14 years 10th November 2014. She is looking quite old now I believe that also is a sign of low cortisol.. Thank you all for being there ...

When a dog's cortisol drops too low symptoms can include: vomiting diarrhea, lethargy/weakness, loss of appetite, increasing in drinking/urinating...

Too high cortisol may also cause increases in drinking/urination in a dog and usually their appetite becomes greater, they may act restless, and they may start panting a lot.

Another thing that can cause a dog to drink more water/urinate along with a loss of appetite is an urinary tract infection (UTI), an UTI test requires only a clean urine sample which needs to be taken to the vet's office ASAP and if one can not make it to the vet's office right away the urine can be stored in the refrigerator, I believe, for up to twelve hours.

We sure do understand how costly this disease is to treat, especially those ACTH stim test. How is Emma now? Is she drinking/eating normally?

Hugs, Lori

[babyblackbear]

Hi Lori, thank you so much for your information re the cortisol levels.Each time we see the vet we take an early morning urine sample along with us so the urine can be tested,Frank is becoming very adept by managing to slip the container under to catch the flow.So far there has been no indication of urine infections. Emma has been well, .bright and very social for two days now eating normally and drinking normally, enjoying her walk. She has not had any trilostane since Friday 11th.december. She was taking 0.2ml each day. I believe that to be a fairly low dose.

[molly muffin]

You could also do a baseline cortisol check. That is cheaper and would give you some clue if she is going too low. That she is better without the trilostane makes me think that she might have gone lower than you want her to. I'd wait till symptoms of Cushing's return before starting her on the meds though. Then when they come back. Get the ACTH and I'd start at a lower dose than what you were on when she got sick this time.

That's my preliminary thoughts

Hugs

[babyblackbear]

You could also do a baseline cortisol check. That is cheaper and would give you some clue if she is going too low. That she is better without the trilostane makes me think that she might have gone lower than you want her to. I'd wait till symptoms of Cushing's return before starting her on the meds though. Then when they come back. Get the ACTH and I'd start at a lower dose than what you were on when she got sick this time.

That's my preliminary thoughts

Hugs

Thank you Sharlene, I feel that she was going too low, now thinking back, we are inclined to take some of the signs as aging, but she is now so much better all round after only two days of the trilostane. Her dosage was only 0.2 ml. A lower dose would then be 0.1ml. witch seems to be very low indeed.

[molly muffin]

So, two more days now. How is Emma doing?

hugs

[babyblackbear]

So, two more days now. How is Emma doing?

hugs

HI, Molly Muffin, Emma has been off the trilostane now for 5 days, she is doing well, no diarrhea, more energy, really enjoying her walks, able to walk for about 30 minutes ,early mornings walking. Appetite is good.Almost too good to be true!!!,Keeping an eye on her though and watching for signs of the cortisol rising. She is also sleeping well, waking us once each night to go outside. Thank you again for caring. How far should we let her go before contacting the vet re more testing, I imagine she would have to be medicated again, perhaps just 0.1ml of the trilostane?

[babyblackbear]

Emma showing some signs of cortisol rising, slight stumblng yesterday, more stumbling to-day and very slow on her walk to-day, also diarrhea this morning. So we will be seeing the vet later to-day.

[labblab]

I'm afraid that stumbling and diarrhea are not usually signs of cortisol rising, but instead the opposite or something else altogether. I am glad you will be seeing the vet to try to sort things out. Please let us know what you find out.

Marianne

[babyblackbear]

So, two more days now. How is Emma doing?

hugs


I'm afraid that stumbling and diarrhea are not usually signs of cortisol rising, but instead the opposite or something else altogether. I am glad you will be seeing the vet to try to sort things out. Please let us know what you find out.

Marianne

Hi Marianne, you were of course right about the cortisol level, probably is low!!!the vet has taken a blood sample to be tested for cortisol levels, should have the results later to-day. .Thank God that I did not put her back on the trilostane!!!!

[doxiesrock912]

General rule of thumb. Whenever a dog is not feeling well, skip the Trilostane altogether so you did the right thing.

[babyblackbear]

Hi everyone, We have the results of Emma's cortisol test. This was a baseline cortisol test. Apparently normal is from 15-170, Emma's reading was 99. the vet was happy with that reading at this stage we are not to give Trilostane. we will be looking at doing the ACTH at a later time. waiting to see how she goes now??? She has had some very watery diarrhea this afternoon,eating and drinking OK. although leaving small amount of food in the bowl(has been eating the lot)...Thanks so much for reading. Vet did check for pain etc. she did find the back legs a little stiff. Thank you so much for your patience, I do realize that you have a great many dogs on this forum with a huge amount of illness's happening.

[labblab]

Yes, with a baseline cortisol of around 3.6 ug/dl (for our U.S. readers), it seems very unlikely that low cortisol is the problem. I am so very sorry that Emma is feeling poorly, and surely hoping that this is just a temporary bug of some sort and that she is soon back to feeling better. I would continue to hold off on adding trilostane, too, until such time that a full ACTH can be performed and Emma has recovered from this episode and her behavior heralds a return of active Cushing's symptoms.

Marianne

[Dixie'sMom]

I hope Emma gets to feeling better soon. I'll be checking in when I can to keep up with whats going on with her. Hugs to you both!

[babyblackbear]

I am wondering if the diarrhea and lethargy could be due to her being too hot, Yesterday was quite a warm day, we went for a walk in the afternoon, let her off the lead and she did have quite a run for a few minutes at a time, diarrhea was like water, and she did feel quite hot. The very watery diarrhea happened another time when we were at a farmers market, the weather was very hot that particular day a well.She always likes to lie on the cool tiles when we come in after being out. We have always taken her with us when we go out if at all possible!!

[molly muffin]

Could be a tad of colitis or IBD. When Molly has been like that I have had to give antibiotic. Flora fora probiotic and use food with a bit more fiber till cleared up.

[molly muffin]

Hoping that Emma is doing okay.

Wishing you happy healthy holiday season

hugs

[babyblackbear]

Hoping that Emma is doing okay.

Wishing you happy healthy holiday season

hugs
Hi Sharlene, Emma is doing okay, eating and drinking normally, not giving the trilostane at this point. She is sleeping well, having a few walks, no diarrhea at this stage. Hope that you had a wonderful Christmas day with famiy and friends. Again thank you for caring...

[molly muffin]

Oh very glad to hear that she is doing better. Excellent news indeed.

We had a very relaxing Xmas. Just what we needed.

Hugs

[molly muffin]

I'm not sure if I mentioned or not but you can use steps goes Emma to be able to get up and down to her favourite lounge area. We had to do domething like that for our Molly.
Here is a picture to give you a bit of an idea f what we tried.
http://www.k9cushings.com/forum/album.php?albumid=518&pictureid=7186

It took her a bit to get use to it and she wasn't thrilled at first but now she loves it and she goes iPad and down at will

Hugs

[babyblackbear]

Hi everyone, hope that each and everyone had a wonderful Christmas. My little Emma appears to be doing o.k. Still eating and drinking normally walking well. She does seem to be sleeping a lot. She is a senior dog afterall, so I would think that the sleeping would be fairly normal? She has been off her cushing medication for 17 days at this point. All the very best for the new year!!!

[Dixie'sMom]

I'm glad to hear that Emma is doing good. Sleeping a lot - well I do that too. haha!

I hope the New Year will bring good health to all of us and our furbabies. Hugs to you and Emma!

[babyblackbear]

Happy New Year to everyone and all the best for the New Year... Just wondering?? Emma has now been off the trilostane 20 days and she does not appear to be having any high levels of cortisol, well none that I can see !, she is eating well, not ravenous though,drinking O.K. she still has the cushings backbone and the black spots on back and tummy. she is sleeping well may have to go to toilet once through the night. Some days she has a little diarrhea and she may be a little unsteady on her feet at times. We seem to playing a waiting game here!!!what do you think?? Any input would be appreciated...

[Squirt's Mom]

Happy New Year to you and yours!

If I were you, I'd simply enjoy this 'vacation' from meds. ;) Keep a close eye on her for any increase in signs OR signs something else may be going on like you usually do but otherwise, enjoy! :)

[labblab]

I agree with Leslie. I would just leave things alone for now and continue to watch Emma for any changes. When the time comes that you do perform the full ACTH, you can also use that information upon which to base decisions re: any necessary changes. But for the time being, I would continue to give Emma a break from her treatment.

Marianne

[babyblackbear]

Thank you everyone, for all your advice, Emma still not showing signs of Cushings, she is sleeping a lot, and feeling the heat. Summer here in Australia at the moment most days 34 degrees. She did pant a little yesterday out walking, but was O.K. after a little rest,also very slow on her walk this morning...I think perhaps we should leave her at home when the weather is so warm. Thank you for all your help!!!

[flynnandian]

cush dogs can not tolerate the heat very well, so 34C is too much for a cush dog.
so, i would walk in the early morning and late evening in the shade.
or maybe she wants to swim?

[addy]

The heat can tire them out. Give Emma some belly rubs from me and I hope some cooler weather will help.

[LauraA]

A pleasant 43C currently. Yuck, doesn't take much to break out in a sweat at the moment :) babyblackbear I have been taking them out at 5.30am and around 7-7.30pm. Too hot on there feet otherwise. Holding out till Thursday and a hopefully a few days of a more bearable heat. I also have a pool for them to jump into before and after there walks, helps them both cool down - just have to make sure the doors are shut into the house or they do crazy runs around the house and Maggie likes to jump all over the bed and lounge while she is still soaking wet.

[babyblackbear]

Hi everyone, Just checking in , Emma is now 35 days off Trilostane, she has had a few days of not eating really well, and not wanting to drink out of any of her water bowls, and trying to dig up the bathroom tiles. this behavour is interspersed with days of eating normally drinking normally and not digging up the bathroom tiles. I feel that she is having some anxiety probably due to her illness? She is quite happy to drink water out of the duck ponds, lakes, and off the brick patio when rainwater is available.all in all though she seems to be doing quite well at the moment. thank you all for your caring!!!

[babyblackbear]

Hi everyone, checking in for February 2015, Emma has now been off her medication (Trilostane)for about 2 months now, She seems to be reasonably o.k at the moment. She does have the odd bout of diarrhea now and then, so we feed her chicken rice and pumpkin for a few days and the diarrhea clears. She does dig feverishly sometimes at nights. Eats fairly well, sometimes a little stumbley first thing in the morning .Enjoys her walks, she turned 14 on the 10th of November 2014. Sleeps well at night, wakes us about once each night to go potty outside. Wondering if her cortisol levels go up and down through the day. Thanks for reading any thoughts about my rambling on would be appreciated. Happy new year to each and everyone. Thank God for all the knowledgeable people on this site!!!!!!

[Harley PoMMom]

Happy belated Birthday, dear Emma!!!!

Cortisol does fluctuate throughout the day. As for the diarrhea have you noticed if this happens after she eats something in particular or when she is stressed? Is it at the same time almost every day?

Hugs, Lori

[babyblackbear]

Hi Harley PoMMom, Emma's diarrhea just seems to happen at different times. We are trying to rule out foods that may be causing the diarrhea. We think fish, and tomato? Mostly she has a fairly bland diet, dog food steamed chicken, pumpkin, carrot and rice. Often happens early morning.

[Squirt's Mom]

Happy Belated 14th Birthday, Emma!

[molly muffin]

Sorry, missed it, but Happy Belated Birthday from me too!!!!!