Ginger, 8-1/2 year old Lab/Coonhound Mix Rescue, Cushings Diagnosis

[tryan8]

Hello my name is Terry & I have an 8-1/2 year old Lab/Redbone Coonhound Mix Rescue (Ginger) who was recently diagnosed with Cushings Disease on 12/23/14. I never heard of Cushings disease and when the vet told me - I did some research and cried like a baby. She is my baby girl and I can not bear the thought of losing her. Let my give you some background on my journey here - last spring 2013 Ginger tore her ACL running around on our lawn and playing frisbee with my sons. We had tried various things to let her heal, but eventually we had surgery in November 2013 as it was getting worse and she was limping. During Surgery I get a phone call that they found a suspicious lump and wanted to do a biopsy - they did and she was diagnosed with Cancer. So in December 2013 she had surgery - the vet removed the mass, and we did followups and she was cancer free. Then in April 2014 we go back just for some tests and the vet notices her liver enzymes are slightly elevated. We go back in December 2014 for her check up and he wants to do more tests as her morning urine was quite diluted and Doc thought that she might be drinking too much. We did the cortisol test and her levels were high, then followed up with more blood tests, which gave more results towards Cushings (PDH). Finally we did the low dex test and it came back positive for Cushings. Oh and I forgot to mention we did a sonogram and her liver was slightly enlarged and her adrenal glands were both slightly enlarged. The only signs she has is she drinks excessively and urinating a lot - never any accidents in the house so far. Doc said we caught it early and wants to start her on either Lysodren or Trilostane - after reading up on both we are leaning towards the Trilostane. I wanted to know if anyone out there has ever tried going the homeopathic route? My vet only knows the regular drug route to treat Cushings - but has no problem with me trying another approach if I choose to. Sorry this post was so long - just wanted to give some background first. Any advise would greatly be appreciated - I am still trying to accept this myself.

[Dixie'sMom]

Hi Terry and welcome to you and Ginger! I'm sorry Ginger is having health problems but am glad you found us. I'm fairly new to being a Cushpup Mom myself so I won't try to advise you. There are many experts on this forum with real life experience who will be along shortly to help you. In the meantime, you are doing the right thing by trying to educate yourself about Cushings, however, don't believe all the doom and gloom things you read. Cushing's is treatable and doesn't necessarily mean a death sentence for your beloved Ginger. There are many, many pups who are successfully treated and live out their normal lifespan.

Please gather together any medical information you have about Ginger because the experts will want you to post any abnormal test results with their reference ranges. If you don't have copies of tests or labs, please request a copy from your vet. That will provide the guru's on this site to get a clearer picture of Ginger's health and history and they can help you to make sure Ginger gets the best medical care and treatment possible.

Hang in there! Help is on the way and you don't have to do this alone. We're here for you!

[tryan8]

Hi Dixie's Mom,
Thank you for the advice and inspiration. I will call my vet's office tomorrow and try to pick up copies of her test results and will post them as soon as I get them. My vet at first told me that normally with Cushings dogs they only live about 2 years or so on medication, but when my husband questioned him further he did say she could live her normal lifespan on medication since he felt that it is early in the disease. I will keep you posted.

[Harley PoMMom]

Hi Terry,

Welcome to you and Ginger from me as well! Suzie has gotten you off to a good start, getting copies of all those tests and posting the results here would definitely help us to get a clearer picture of what may be going on with your sweet girl. Since there isn't one test that is 100% accurate at diagnosing Cushing's a vet needs to perform multiple tests to validate a diagnosis for Cushing's, another reason we like to see test results ;)

Cushing's is one the most difficult diseases to get a confirmed diagnosis for, and unfortunately it is often misdiagnosed. Other non-adrenal illnesses, such as diabetes and/or any thyroid issue, share some of the same symptoms and should be ruled out.

How much does your girl weigh? Does she have any other health issues? Is she taking any herbs/supplements/medications?

And as Suzie mentioned Cushing's is a treatable disease but success in treatment does depend on a few things; keen owner observation, a pet parent willing to educate themselves about Cushing's, and a vet/IMS that has experience treating Cushing's and is knowledgeable about the protocols for Cushing's.

Unfortunately there are no homeopathic remedies available, that I know of, to treat Cushing's disease. The homeopathic medicines may aid in lessening the symptoms of Cushing's but do nothing for the root cause of Cushing's which is the elevated cortisol that the dog's system is producing.

I am providing a link to our Helpful Resource Thread where you will find a wealth of information regarding Cushing's: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

If you have any questions please do not hesitate to ask them, and remember we are here to help in any way we can.

Hugs, Lori

[LauraA]

Just want to say that the thing about them only lasting 2 years is very outdated and not true. They can live out their normal lifespans quite happily.

I still remember when Cushings was first mentioned to me and every time I looked at her I would burst out crying thinking this is it, it is a downhill slope from here. However I was so wrong!! We have all been where you are right now and experienced the turmoil you are going through. But you and Ginger are in very good hands here :)

[tryan8]

Hello Dixie'sMom, Harley PoMMom & LauraA,
I am sorry for the delay in response -
Ginger weighs 56 lbs and she is a mix (Lab/Redbone Coonhound mix or so we were told)- makes no difference to me - she is my baby girl.
She went in for her annual exam in December and the vet had called to say that it appeared her urine was diluted and could be consistent with a dog that is drinking too much. I really didn't notice it - as she usually drinks in the morning - at least 1 bowl of water - then I refill it (16 oz. bowls) and when i get home she finishes the second bowl and asks for more. Since I am not the only one at home refilling her water - she is everyone's baby girl - the vet asked I keep track of her water intake for 1 week. I was amazed to see that she was actually drinking 80 - 96 oz. of water a day. She has recently also been hanging around the table when we have dinner - which is something she has never done before. She does not beg, but she just stares as if she is trying to mind meld with you. She looks at you and then she stares at her treat bin. She eats 2x a day - which is what she has done since she was a puppy.
The vet requested that i redo the first morning urine and bring in another sample - which i did and he tested her cortisol 9.4ug/dL urine Creatinine 46.0mg/dL Urine/Creatinine Ratio 64 on 12/23/14.
I finally got copies of Ginger's blood work and her numbers are as follows:
ALT 136U/L in April 2014, 251 U/L in Dec. 2014
GGT 10 U/L in Dec 2014
CHOL 332 mg/dL in Dec. 2014
Additionally she had a sonagram which showed a modest enlargement (8-9mm) of both adrenal glands.
We also did the low dose dex test and her baseline cort was >10.0 ug/dl, her 4 hour post was 3.1 ug/dL and same for her 8 hour post result - consistent with PDH.
I have been reading the wealth of information on this website and it has been extremely helpful and everyone has been very supportive.
My husband and I have decided to start her on Trilostane. I have a call into the vet and expect to hear from him this weekend or Monday as he is returning from vacation and we decided not to start her on any medication until I did further research. We also wanted our vet who has taken care of her since she was 7 weeks old to be here in case we need him in an emergency.
If you need any other numbers or information - I now have a folder with all her numbers.
Thanks again for the support - looking forward to your responses.

[tryan8]

Our vet has returned and after speaking to him- I will bring Ginger into his office for the ACTH test on Thursday AM and then after 1 hour I can take her home - he will give me the Trilostane and i guess I start it on Friday AM - I am thinking I should take the day off work to be home with her and make sure she is OK. He said she is to take 60mg once a day in the morning with food. Additionally he said he will give me Prednisone so I have it on hand just in case I need it. He said if she has stress, vomits, or is lethargic to give her prednisone (I think - I will get more details on Thursday). I realized I had posted
her test results but did not put the acceptable ranges so here they are again with the acceptable ranges:
October 2013
HGB 19.2 High (12.0 - 18.0g/dl)
ALT 136 High (10-100 U/L)
April 2014
ALT 132 High (10-100 U/L)
Dec 2014
ALT 251 High (10-100 U/L)
GGT 10 UL High (0 - 7)
CHOL 332 High (110-320)

i am so so nervous about giving her Trilostane, but I know it is the only way for her to get Cushings under control. Wish me luck

[molly muffin]

Usually it isn't the first day you worry so much as it is about a week or so into it. Evey dog metabolizes medicine differently though, so never say never, but in general we tend to notice changes in symptoms about day 10.
Dose starting should be 1mg/1lb.

We'll be right here with you.

[Harley PoMMom]

Ginger weighs 56 lbs and she is a mix (Lab/Redbone Coonhound mix or so we were told)- makes no difference to me - she is my baby girl.

With her weight of 56 lbs the 60 mg starting dose of Trilostane sounds reasonable to me.


...I was amazed to see that she was actually drinking 80 - 96 oz. of water a day. She has recently also been hanging around the table when we have dinner - which is something she has never done before.

The increased in drinking/urinating, appetite along with the diluted urine are symptoms of Cushing's, and from the test results you posted I'm guessing diabetes was ruled out, right?



The vet requested that i redo the first morning urine and bring in another sample - which i did and he tested her cortisol 9.4ug/dL urine Creatinine 46.0mg/dL Urine/Creatinine Ratio 64 on 12/23/14.
I finally got copies of Ginger's blood work and her numbers are as follows:
ALT 136U/L in April 2014, 251 U/L in Dec. 2014
GGT 10 U/L in Dec 2014
CHOL 332 mg/dL in Dec. 2014
Additionally she had a sonagram which showed a modest enlargement (8-9mm) of both adrenal glands.
We also did the low dose dex test and her baseline cort was >10.0 ug/dl, her 4 hour post was 3.1 ug/dL and same for her 8 hour post result - consistent with PDH.


With the bilateral adrenal enlargement, and those LDDS test results it sure does seem that Ginger does have the pituitary type of Cushing's. My one question is, was the ALP elevated too?


Our vet has returned and after speaking to him- I will bring Ginger into his office for the ACTH test on Thursday AM and then after 1 hour I can take her home - he will give me the Trilostane and i guess I start it on Friday AM - I am thinking I should take the day off work to be home with her and make sure she is OK. He said she is to take 60mg once a day in the morning with food. Additionally he said he will give me Prednisone so I have it on hand just in case I need it. He said if she has stress, vomits, or is lethargic to give her prednisone (I think - I will get more details on Thursday). I realized I had posted
her test results but did not put the acceptable ranges so here they are again with the acceptable ranges:
October 2013
HGB 19.2 High (12.0 - 18.0g/dl)
ALT 136 High (10-100 U/L)
April 2014
ALT 132 High (10-100 U/L)
Dec 2014
ALT 251 High (10-100 U/L)
GGT 10 UL High (0 - 7)
CHOL 332 High (110-320)

i am so so nervous about giving her Trilostane, but I know it is the only way for her to get Cushings under control. Wish me luck

Is the vet performing the ACTH stimulation test for the purpose of using the results as sorta like a guide?

All those elevations in her chemistry panel can be attributed to Cushing's, however, like I mentioned before we usually see significant elevations in the ALP when a dog has Cushing's. I don't want you to think that all dogs with Cushing's must have high ALP numbers and it surely does not mean that since Ginger does not have increased ALP levels that she may not have Cushing's, it's just unusual for those ALP numbers to be normal in a dog with Cushing's. Hope I'm not confusing you :eek:

You will do fine on your Cushing's journey with Ginger, and remember we are here for you both. Just watch Ginger and if she seems to be acting off than just stop the Trilostane, the good thing with Trilostane is that it has a short half-life and will leave a dog's system rather quickly.

Don't know if we provided any links with info regarding Vetoryl/Trilostane so here is one: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Hugs, Lori

[tryan8]

Hello everyone,
Thanks again for the information and responses to my post. I really appreciate all the support!
I did not realize that it would take about 10 days for her symptoms to be effected - I will keep a close eye on everything as she is my baby girl. Diabetes was ruled out, as well as any thyroid problem - her levels are all good.
One thing I did forget to mention is that she has a spot (bald patch) on her back that was shaven when she had surgery (it is by her tail and it is part of the hair on her back that STANDS UP when she is excited or nervous) that has NEVER GROWN BACK. The surgery was for her Cancer and they shaved the whole hind quarter of her right side in Dec. 2013. The rest of her hair grew back, which is what made the vet check her thyroid levels the first time.
I will check the ALP levels once I get home tonight- I do not have the test results with me at work. I check my email on lunch.
Yes I do believe the Vet is performing the ACTH stim test for the purpose of using the results as a guide. He said it will be repeated after 2 weeks, then if her levels are good, in 3 - 4 months. If not - then her medication would be adjusted and another test in 2 weeks, then if OK 3 - 4 months.
I will post her ALP levels tonight.

[tryan8]

Hello again,
I was looking at Ginger's bloodwork this morning and could not find the ALP - but I did find the ALKP (which apparently is the same, I think)
Her ALKP in 10/13 prior to surgery was 81 (23-212), on 4/14 113, now on 12/18/14 it was 159 so it is on the rise - but it is not out of acceptable range. I hope this helps.
I just dropped Ginger off at the vets office for her ACTH stim test - she always starts to shake when I get off the parkway and go down the street to the vets office - she seems to recognize the area - poor thing - she was trembling when I left - but I will pick her up this morning as soon as the test is over. She just looked at me with her sad eyes and I kissed her and told her I would be back soon - they truely are our babies!

[tryan8]

Well I just got back from picking up Ginger from her baseline ACTH Stim test and her post Cort was 29.7 ug/dL (>22 ug/dL - in the presence of supporting clinical signs, results are consistent with Cushings Syndrome). So we also picked up the Vetoryl and she will start 60mg tomorrow AM. Our vet also gave us some prednisone and we were told to give her it to her in case of adverse reactions - stress, vomiting, lack of appetite, diarrhea, and to call him immediately. So our journey begins.......and we go back in 2 weeks on 1/29/14 for her retest ACTH - we will keep you posted- I am a nervous wreck and now know I am not alone and will get through this thanks to this website and the wealth of information that you all have supplied.

[Harley PoMMom]

Sure sounds like you have a terrific vet that is knowledgeable about Cushing's and Vetoryl.

Just to make sure, Vetoryl has to be given with food to be properly absorbed, and the monitoring ACTH stim tests have to be done 4-6 hours after the Vetoryl is given.

You will do great, and remember we are here for you both, if you have any questions just ask them...one more thing, if Ginger would seem off while on treatment do not give the Vetoryl. One nice thing with Vetoryl is it has a short half-life so it leaves a dog's system rather quickly.

Hugs, Lori

[tryan8]

Yes my vet does have experience with treating dogs with Cushings. I was told that they have to do the followup ACTH test at least 4 hours after she takes the Vetoryl. I laughed and said - no problem -she gets up at 5:30 AM with me and wants to be fed before I do anything else (start cooking breakfast, making lunches, etc). So I will bring her in for her test after 9:30 AM. My vet also did tell me to give it to her with food and she is not to CHEW the pill - he suggested putting it in some meat or cheese and giving it to her. I laughed and said no problem - she loves cheese and just swallows it - so he said perfect - wrap it in a little cheese and she will be good. So that is the plan. He also said it was too late to give her any doses today - so to start tomorrow AM. Thanks for your input - it is greatly appreciated. I will be watching the message boards and keeping you posted. What a wonderful website - I have been telling everyone about it - needless to say they all have dogs.

[rebecca]

Hi just wanted to know how Ginger is doing as my dog has just been diagnosed with cushings and is starting trilostane and I would love some positive feedback to give me hope

[molly muffin]

Definitely sounds like you have a knowledgeable vet and are starting off on the right track.

[tryan8]

Hello,
Just wanted to let everyone know that Ginger is doing well & we are on Day 2 of Vetoryl. No change in her drinking or eating, but we do not expect any changes until around 10 days. Will keep you posted.
Hugs,
Terry

[Harley PoMMom]

Thanks so much for letting us know how things are going and please do keep us updated!

Hugs, Lori

[tryan8]

Day 5 of Vetoryl - Ginger had a loose poop this morning - so when i fed her breakfast I gave her some pumpkin with her kibble (I have given it to her before for upset stomach and diarrhea). I called the vets office to find out if it could be the Vetoryl and if I should stop giving it to her. Well I just heard from the vet and he said to give her 1/2 a prednisone pill (which they gave me pre-cut when I received the Vetoryl) today and tomorrow and to followup with him on Thursday. I did mention also that there has been a decrease in her water consumption - she has gone from 6 bowls (90 oz.) to 3-1/2 bowls (56 oz.) and did not even finish her first bowl of water today. She was sleeping and I woke her up to give her the prednisone and she just looked at me - swallowed it and went back to sleep - which is normally what she does when I work from home. Has anyone seen similar effects on their dogs when starting Vetoryl? I am sure i am just being a worried mom - but that is what we do.

[Harley PoMMom]

We have seen many dogs have some kind of adverse effect when starting the Vetroyl, loose stool being one of them. How is Ginger's appetite? Is the Vetoryl being withheld too?

Keen observation is most definitely needed when a dog is on treatment, kudos to you!! You are doing an excellent job ;)

Keep us updated, ok.

Hugs, Lori

[tryan8]

Hello Lori,
No the Vetoryl is not being withheld also. The vet said to give it (Prednisone) to her and still give her the Vetoryl tomorrow ( I will confirm with the vet just in case I misunderstood) . Her appetite is not being effected -she still gobbled her breakfast- it could be that I put the pumpkin in it (she does love pumpkin). I will keep a close watch on her today and tomorrow - probably work from home again or have my son stay home and watch her all day. Starting meds that she is be taking for the rest of her life is petrifying to say the least. I will keep you posted. Thanks for the response.
Hugs,
Terry

[tryan8]

Just a quick update on Ginger - her lose poop is gone - she is back to normal again. She is off the prednisone and still taking the Vetoryl (day 7) with her breakfast. I will keep you posted. Thanks again for the support. We go back to the vet next Thursday for tests.
Hugs,
Terry

[Squirt's Mom]

So glad to know she is feeling better!

[tryan8]

Just dropped Ginger off at the vet for her 2 week ACTH Stim test. I know the Vetoryl is working as for the first time last night she actually walked away from her food bowl with a little kibble left in it and her water consumption is way down - it went from 6 bowls of water (16oz.each) to between 2 -3 bowls per day. She is always a nervous wreck when we go to the vet, but I am hoping she gets use to it. She knows when we get off the parkway - she starts to shake and I do believe she recognizes the area. Oh well I will pick her up as soon as the testing is over and I will post her results later.
Hugs,
Terry

[Harley PoMMom]

Hoping for good ACTH stim numbers, keeping all fingers and toes crossed. ;)

[tryan8]

Well just returned from the vet with Ginger - she had her ACTH Stim test this morning and if I am reading this correctly her post level is 7.3 ug/dl with significant improvement. She is drinking less and feeling better. Our vet was quite pleased, but he would like to do the ACTH Stim test again in 1 month again, then every 3 - 4 months after that. Now I have started researching about changing her food. I have read a lot about The Healthy Kitchen dog food and actually I am getting samples this week to try some slowly with her to see if she likes it. I have read lots of info on diet making a big difference and I am definitely going to change her food, now that I think she is settling down. Probably will wait for another week or so to start to try, but I am convinced it will help her feel better also. She is my baby girl and needs to be taken special care of. Thanks for the support. I will keep you posted on her progress.

[tryan8]

Correction - I meant The Honest Kitchen dog food is what I will be trying.

[Harley PoMMom]

Well just returned from the vet with Ginger - she had her ACTH Stim test this morning and if I am reading this correctly her post level is 7.3 ug/dl with significant improvement. She is drinking less and feeling better. Our vet was quite pleased, but he would like to do the ACTH Stim test again in 1 month again, then every 3 - 4 months after that.

I see from your previous post that Ginger had an ACTH stimulation test done before treatment started and her post was 29.7 ug/dL. If that recent post number is correct, that is a significant drop in cortisol, I am assuming that Ginger's Vetoryl dose of 60 mg is not being changed, right?

If Ginger continues feeling/doing well with her Vetoryl treatment than having another monitoring ACTH stim test done in one month is fine but her electrolytes should be checked at that time as well.


Now I have started researching about changing her food. I have read a lot about The Healthy Kitchen dog food and actually I am getting samples this week to try some slowly with her to see if she likes it. I have read lots of info on diet making a big difference and I am definitely going to change her food, now that I think she is settling down. Probably will wait for another week or so to start to try, but I am convinced it will help her feel better also. She is my baby girl and needs to be taken special care of. Thanks for the support. I will keep you posted on her progress.

There is really no set diet that a dog with Cushing's should eat, a diet needs to be tailored to that individual dog. A dog's health issues, age, and personal preference should be taken in consideration when deciding on their diet. As an example, if a dog has pancreatitis than a very low fat diet is required.

You're doing a fantastic job taking care of Ginger. Ginger is really lucky having a mom that is so devoted to her and that loves her deeply.

Hugs, Lori

[tryan8]

Ginger's Vetoryl dose of 60 mg is not being changed. She is doing fine. As far as changing her diet - I will be changing from a kibble (Purina OM) to The Honest Kitchen base mix dog food (you add the protein/meat yourself) - I am getting samples to see if she likes it and will make sure it does not upset her stomach - it will be a slow transition and I will make sure I switch to something she does like and has all her health requirements considered. I will ask the vet about testing her electrolytes in 1 month also. Thanks for the constant support and recommendations - it is truly appreciated.
Hugs,
Terry

[Dixie'sMom]

You're doing a great job and Ginger is too! YAY!
That post can continue to drop so hopefully you will continue to see improvement in her symptoms. The pumpkin seemed to do the trick too.

Happy Hugs for you both!

[tryan8]

Went to the vet for Ginger's followup 1 month ACTH Stim test Thursday 2/26/15 and her post level is 7.2 ug/dl with significant improvement. She always gets so nervous when she goes to the vet, I am sure she even knows the exit we get off from the parkway and she starts to get quite vocal and shakes, but she also knows I will be picking her up as soon as the testing is done. Ginger is drinking the normal amount for her weight and feeling better. My husband has noticed she is not hanging around the table when we eat and she waits to see if there are any leftovers for her when we are done. Our vet was quite pleased and he will do the ACTH Stim test at the end of June and keep monitoring her every 3 - 4 months. She is back to herself - going for long walks and playing with her toys. Life is good. I am still transitioning her to the Honest Kitchen food - she seems to like it, but it is quite a change to what she was use to. Thanks again for the support! I will keep you posted on her progress.

[Harley PoMMom]

Looks like her post result (7.2 ug/dl) is almost identical to the post (7.3 ug/dl) of her last ACTH stim test that was done 1/29, which is great especially since her symptoms have continued to significantly improve...Atta girl, Ginger!!! And good job, Mom!!

Hugs, Lori

[molly muffin]

That is wonderful that her symptoms are improving and she is remaining stable. Yay!!

[Dixie'sMom]

Great news! Go Ginger!