Constant urination-Looking for support and thoughts for my 9 year old husky/lab

[SeattleDex]

Hi everyone,

I'm really happy that I found this forum today when researching Cushings. Our 9 year old husky/lab mix, Dexter was diagnosed about 6 months ago. He is a beautiful 80 pound dog but we knew something was wrong when he started drinking entire bowls of water every hour or so and panting constantly. We took him to a specialist who started him on Trilostane a few months ago. We started at 30 mg twice a day and are now up to 80 mg twice a day.

It's been a real struggle, recently taking a toll on my boyfriends and my relationship. We do not sleep through the night as Dex keeps us up panting and drinking water. He also sometimes throws up from the water. We also have to put a fan directly on his face to keep him cool. Recently the biggest frustration has been accidents in the house. We take him out every 2 hours when he isn't crated but a few times a week he will have accidents even only after an hour of being taken out. You can imagine the volume of urine for an 80 lb dog is nothing small to deal with. I feel so bad for him and just don't know what to do. Can we limit his water?

If we get the Trilostane to the right dose, will this issue subside? Thanks in advance for any support, help or direction you can provide.

[mytil]

Hi and welcome to our site. I am sorry you are having to deal with this.

Firstly, do not withhold water. In layman's terms they drink because their bodies are trying to keep up with their output. You do not want him to become dehydrated of which can cause some additional problems.

160 mgs daily is a big dose of Trilostane for his weight --- how long has he been on this dosage?

Were his only symptoms excessive drinking/peeing and at times heat intolerance? If so, I would suspect the possibility of other conditions i.e. Atypical Cushing's or Diabetes Insipidus. I say these two because I am assuming your specialist has ruled out Diabetes Mellitus etc.

Sorry for all the questions but the more we know the better we can offer help.

Let us know all the test results for the diagnosis of his Cushing's.

Terry

[labblab]

Hello and welcome to you and Dex. I am so sorry you are continuing to struggle right now because, yes, once the trilostane has lowered Dex's cortisol level into the therapeutic range, you would expect to see reductions in thirst and urination. That is, if high cortisol is indeed the cause. Can you tell us more about the original diagnostic test results? Also, did Dex exhibit any other abnormalities besides the thirst/urination -- external symptoms and/or lab values that were "off?"

Additionally, can you give us the actual numerical results for any monitoring ACTH tests that have corresponded with the dosing increases? Those numbers are key when it comes to deciding whether Dex's cortisol has yet been lowered into the range where you'd expect to see good results. There can be a great deal of individual variability in the size of the dose that is needed to lower cortisol effectively, so that's why the monitoring tests are so important. One dog may need only a small dose in relation to weight; another dog may need a much higher dose.

I am assuming your specialist has ruled out the presence of a chronic urinary tract infection? Such infections are common in Cushpups and can be difficult to detect because their urine is so dilute and therefore difficult to analyze.

I am sorry but it is not safe to limit the amount of water he is given to drink. Doing so can be physically harmful to him. But I can imagine how rough things are for you right now. I have an 80 pound Lab myself, and I know how much urine she produces! As soon as we hear back from you with this additional info, we can all brainstorm re: the next step and further options.

Marianne

[SeattleDex]

Hi everyone,

Really appreciate the quick response. Understand not restricting water so will make sure that he has what he needs to stay hydrated and cool.

As far as his ACTH tests, I need to call and ask the vet for some more specifics but here is what I have. His primary care vet felt that his blood tests last spring showed Atypical Cushings.

He was first put on Trilostane in July. Here were his test results:
Blood Pressure: Normal (142mmHg systolic) on medications
Urine concentration: Dilute (1.021)
Urine protein level: Mildly elevated (1.05)

At this point he was put on 35mg 2x day of Trilostane. The vet then told us to increase his dose to 50 mg 2x day in September.

His most recent check up 2 weeks ago did not provide new blood test results but the doctor did provide the following as feedback:
Special Instructions: The plan is to increase the trilostane dose to see if this improves panting and thirst. A recheck ACTH stim test is recommended 1-2 weeks after the dose increase to assess his levels. We may further increase the dose based upon those results.

We also discussed the possibility of a pituitary tumor (in the brain) as a contributor to his behavior and persistent increased thirst. He does have some changes to the left eye that may or may not be related to brain disease. An MRI of the brain should be considered, especially if behavioral changes worsen to screen for a growth in the pituitary gland or elsewhere.

[mytil]

I have just a sec but wanted to pass this on to you regarding Atypical Cushing's - http://www.k9cushings.com/forum/showthread.php?t=198

Terry

[labblab]

I know it may take a bit of time to gather up all the previous test results, but they will really be helpful to us. Now that you've mentioned Atypical Cushing's, I am especially interested in the diagnostic blood test results from last spring. As you will see in that link that Terry gave you, "Atypical" is a specific diagnosis that is associated with elevated adrenal hormones other than cortisol. For dogs with that diagnosis, cortisol levels remain within a normal range.

Aside from the blood pressure reading, the other two diagnostic values you've given us relate to urine. And while both dilute urine and the presence of protein occur with Cushing's, you cannot base a diagnosis on those features alone. Since you are now planning to increase Dex's trilostane even above the 160 mg. daily total due to a lack of symptom resolution, I'm even more anxious now to see those initial blood results and monitoring ACTH tests. If Dex's cortisol was not even elevated to begin with, he is on a whopping big dose of trilostane with a lack of response that makes me wonder whether there is something else at play here. But in the absence of the test results, it is impossible to unravel the diagnosis and treatment. So I will be watching for them as soon as you can get ahold of them.

Marianne