Lolita is New to Cushings

[Vickie20]

Hi,
I am updating my original post with a more consise history on Lolita.
We originally were monitoring her because she has kidneys that are severely impacted with stones. She was on a special diet for that. C/D Diet.
What we noticed first were the skin infections that she kept getting that just wouldn't go away. For Lolita it was around her lady parts and on her stomach. And then she started getting ear infections too. And a bladder infection. But really it was a bout with vomiting when it all came to a head. Lolita would refuse to eat anything but the boiled chicken. We even tried the special vet canned food that easier on her tummy but she wouldn't eat that either. She is now very picky.
Lolita takes Tramadol every night for the kidney pain. Other than that she is not on any other meds.
According to her vet, Lolita isn't a candidate for Vetoryl because of her levels in her kidneys and liver.
I've included Lolita's testing for the past year or so. Sorry for the info blast. :-)
And THANK YOU!!

***
We are new to Cushings and are really impressed with this website.
Lolita is an 11 year old 13 lb Long Haired Chihuahua and was recently diagnosed.
We've attempted Lysodren treatment three times, each time reducing the dosage of the Lysodren. Each time I've had to administer Prednisone because Lolita didn't respond well. The last attempt was 1/8 of a tablet. We've decided Lysodren isn't for Lolita.


x---------------TEST------------------------- x--REF RANGE----- 1/13/2015--- 11/19/2014--- 11/15/2014--- 11/7/2014--- 9/21/2014--- 9/3/2014--- 2/26/2014--- 3/30/2013
ALP------------------------------------------ 5-160 U/L---------- 386--------- x------------- 1875--------- 1809--------- 1044------- 1461-------- 213--------- 111-----
ALT------------------------------------------ 18-121 U/L--------- 423--------- x------------- 2640--------- 2079--------- 518-------- 1028-------- 62---------- 67------
AST------------------------------------------ 16-55 U/L---------- 73---------- x------------- 161---------- 243---------- 33---------- 276-------- 24---------- 26------
GGT------------------------------------------ x------------------ x------------ x------------- 57----------- x------------ x----------- x----------- x------------- x-----
TOTAL PROTEIN------------------------------ 5.5-7.5 G/DL------- 7.8---------- x------------- 7.6----------- 7.4--------- 7.1---------- 7.7--------- 7.7--------- 7.4-----
GLOBULIN------------------------------------ 2.4-4.0 G/DL------- 4.0---------- x------------- 4.1----------- 4.0--------- 3.9---------- 4.5--------- 4.3--------- 3.9-----
BUN------------------------------------------ 9-31 MG/DL-------- 52---------- x------------- 36------------ 17---------- 20---------- 13---------- 12---------- 13------
CHOLESTEROL-------------------------------- 131-345 MG/DL----- 311--------- x------------- 690/672------ 817--------- 524--------- 762-------- 439---------- 365-----
BUN/CREATININE RATIO----------------------- x------------------- 40.0-------- x------------- x------------- 17.0-------- 18.2-------- 14.4-------- 13.3--------- 14.4----
BILIRUBIN-UNCONJUGATED--------------------- 0.0-0.2 MG/DL------ 0.1--------- x------------- 0.2----------- 0.5--------- 0.1--------- 0.4--------- 0.1----------- 0--------
WBC----------------------------------------- 4.9-17.6 K/UL------- 15.3-------- x------------- x------------- 17.1-------- 16.4-------- 16.4-------- 18.0--------- 10.8----
MCV----------------------------------------- 59-76 FL------------ 72---------- x------------- x------------- 76---------- 74---------- 74--------- 76----------- 78------
MCHC---------------------------------------- 32.6-39.2 G/DL----- 34.1-------- x-------------- x------------- 32.9-------- 32.0-------- 33.4------- 31.9---------- 31.7----
NEUTROPHIL---------------------------------- 2940-12670 /UL---- 12087------ x-------------- x------------- 14672------- 12759------ 11972------ 13176-------- 7819---
BILE ACIDS----------------------------------- 0.0-6.9 UMOL/L---- x------------ x------------- 83.7---------- x------------- x----------- x---------- x------------ x------
BILE ACIDS POST PRANDIAL------------------- 0.0-14.9 UMOL/L---- x---------- x-------------- 86.5---------- x------------- x----------- x---------- x------------ x------
x-------------------------------------------- x----------------- x------------ x-------------- x-------------- x------------- x---------- x---------- x------------ x------
PRE-ACTH CORTISOL-------------------------- UG/DL-------------- x----------- 18.0--------- x------------- x------------- x------------ x----------- x------------- x------
POST-ACTH CORTISOL------------------------ UG/DL-------------- x----------- 31.6--------- x------------- x------------- x------------ x----------- x------------- x------
PRE-DEXAMETHASONE SUPPRESSION----------- 1.0-6.0 UG/DL----- x------------ x------------ 25.2---------- x------------- x------------ x----------- x------------- x------
POST 4 HR DEX------------------------------- UG/DL-------------- x------------ x----------- 2.7----------- x----------- x------------- x----------- x------------- x------
POST 8 HR DEX------------------------------- UG/DL-------------- x------------ x----------- 3.5----------- x----------- x------------- x----------- x------------- x------
x--------------------------------------------- x------------------- x------------ x---------- x------------- x----------- x------------- x----------- x------------- x------
URINE CORTISOL----------------------------- UG/DL-------------- x------------ x----------- x------------- 35.2-------- x------------- x----------- x------------- x------
URINE CREATININE--------------------------- MG/DL-------------- x------------ x----------- x------------- 125.9------- x------------- x----------- x------------- x------
URINE CORTISON/CREAT RATIO--------------- x-------------------- x------------ x---------- x------------- 87---------- x------------- x----------- x------------- x------
x-------------------------------------------- x-------------------- x------------ x---------- x------------- x------------- x------------- x----------- x------------- x------
FREE TRIIODOTHYRONINE (FT3)--------------- 1.2-8.2 PMOL/L----- x------------ x----------- 14.1 H-------- x------------- x------------- x----------- x------------- x------
x-------------------------------------------- x------------------- x------------ x----------- x------------- x------------- x------------- x----------- x------------- x------
ULTRASOUND RESULTS----------------------- x------------------ x------------ x----------- x------------- x-------------- x------------- x----------- x------------- x------
URINARY BLADDER--------------------------- ABNORMAL--------- x------------ x---------- x------------- x------------- x------------- x----------- x------------- x------
LEFT KIDNEY-------------------------------- ABNORMAL--------- x------------ x---------- x------------- x------------- x------------- x----------- x------------- x------
LEFT ADRENAL GLAND------------------------ ABNORMAL--------- x------------ x---------- x------------- x------------- x------------- x----------- x------------- x------
RIGHT KIDNEY------------------------------- ABNORMAL--------- x------------ x---------- x------------- x------------- x------------- x----------- x------------- x------
RIGHT ADRENAL GLAND----------------------- ABNORMAL--------- x------------ x---------- x------------- x------------- x------------- x----------- x------------- x------





[/B]
I am also looking for help in what to provide as a diet to Lolita. I've stopped providing packaged dog food. Right now she eats boiled chicken with spinach and carrots. She likes that but I would like to ensure I am providing all of her nutrient needs. Any advice is welcome.

[Harley PoMMom]

Hi and welcome to you and Lolita!

I only have a moment to post but wanted to share some of my thoughts.

In dogs with Cushing's usually high elevations are see in the ALP and the ALT is only moderately elevated. With the high levels from the bile acid test and along with those ALT values I am wondering if something is going on with her liver, has an ultrasound been performed?

Also, could you tell us what symptoms Lolita was displaying that led you or your vet to test for Cushing's in the first place? Is she taking any other herbs/supplements/medications?

Some dogs do well on Lysodren and some do not. The other drug that is used to treat Cushing's is Vetoryl/Trilostane, however a washout period of 30 days is needed when switching from one drug to the other.

With Vetoryl/Trilostane the starting dose can be initiated at a low dose, so for Lolita's weight of 13 lbs, a dose of 5 mg and no more than 10 mg would be appropriate to begin with. Has the vet mentioned using Vetoryl/Trilostane?

Is there a health reason as to why Lolita can not eat commercial dog food? There are some high quality canned/dry/raw dog foods which are much better than any grocery store brand.

Please know we are here for you both and we will help in any way we can.

Hugs, Lori

[Squirt's Mom]

Hi and welcome to you and Lolita!

In your shoes I would forget about Cushing's right now and have her liver and gall bladder checked very well. It is possible that she does not and never did have Cushing's but rather something going on with one or both of these organs instead.

[labblab]

I totally agree with Lori and Leslie -- it does look as though something other than Cushing's may be involved here with her liver or gallbladder. Has your vet commented on those values that are so seriously out of range?

I am thinking the issue with the Lysodren may be a moot point, depending on the status of Lolita's liver. However, can you be more specific as to exactly how you were dosing and monitoring Lolita's Lysodren? Usually, in order to "load" a dog on Lysodren, a weight-adjusted dose is given daily until certain signs emerge. The dog is then given a monitoring ACTH test, and depending on the outcome, the loading continues for a bit longer or else the regimen shifts entirely to a "maintenance" dosing protocol whereby a lesser amount is given 2-3 times weekly. Is that how you dosed Lolita? How often were you giving her the 1/8 tablet, and how did her monitoring ACTH tests turn out? What problems was she having that necessitated the prednisone?

As I say, the Lysodren dosing and Cushing's treatment may all be put on the back burner for now. But I am just curious as to how her treatment was handled originally. Thanks in advance for the info!

Marianne

[Vickie20]

I think that originally posting only the last test was a bit misleading. So I've included all of the tests.

We tried to load the Lysodrene but only got past the second dose before Lolita was shaking, her tongue was hanging out, she was disoriented, shellshocked, and she literally fell on her face. I gave her Predisone and took her right to the ER. We kept her on Predisone for a couple of days.
We waited a week and tried it again at a reduced dose. Same thing happened.
Then we tried to just give her an 1/8 tablet once a day and still Lolita had a similar reaction after two doses. She took a few days to recover from the third attempt.

I did find it interesting how different the last test results were from the previous ones.
Thanks!

[Tiger666]

Hi and welcome to you and Lolita!

I only have a moment to post but wanted to share some of my thoughts.

In dogs with Cushing's usually high elevations are see in the ALP and the ALT is only moderately elevated. With the high levels from the bile acid test and along with those ALT values I am wondering if something is going on with her liver, has an ultrasound been performed?

Also, could you tell us what symptoms Lolita was displaying that led you or your vet to test for Cushing's in the first place? Is she taking any other herbs/supplements/medications?

Some dogs do well on Lysodren and some do not. The other drug that is used to treat Cushing's is Vetoryl/Trilostane, however a washout period of 30 days is needed when switching from one drug to the other.

With Vetoryl/Trilostane the starting dose can be initiated at a low dose, so for Lolita's weight of 13 lbs, a dose of 5 mg and no more than 10 mg would be appropriate to begin with. Has the vet mentioned using Vetoryl/Trilostane?

Is there a health reason as to why Lolita can not eat commercial dog food? There are some high quality canned/dry/raw dog foods which are much better than any grocery store brand.

Please know we are here for you both and we will help in any way we can.

Hugs, Lori


I don't understand when you say a low dose and not to go higher than that because on Dechra it does say a higher dose than you say!

Edited to add: I have copied this post and mine into your boy's original thread. This way, it will be easier for our members to reply to you directly. Tiger 666 and his boy's thread can be found here: http://www.k9cushings.com/forum/showthread.php?t=6783

[Harley PoMMom]

I don't understand when you say a low dose and not to go higher than that because on Dechra it does say a higher dose than you say!

Dechra has recently revised their initial dosing protocol and they now recommend a starting dose of 2 mg/kg, which when converted to pounds is 1mg per pound of a dog's weight. Information regarding this can be found here: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

[Squirt's Mom]

Would you mind editing your post once again that lists the lab results and delete the values that are normal or bold the ones that are abnormal? Usually we only need to see those that are too high or too low. Save your fingers some work. ;)

[Dixie'sMom]

Hi and welcome from me also.

If Lolita has other issues such as liver, kidney, gallbladder, etc. she could easily have a false positive on her Cushing's test. That would explain the reason she never did well on the Lysodren... and she never will do well on Vetoryl or Lysodren because she doesn't have Cushing's. She can have high cortisol levels because of the stress the other problems are putting on her system.

What does the vet plan for her next?

You are in very good hands here with the experts above advising you and looking over her labs. In your shoes, I would listen to them closely and follow their suggestions and answer their questions completely. They care and they can help you with Lolita.

Hugs and again welcome to our family.

[Vickie20]

Thank you for some insight here. Sorry to not respond quickly. I became a grandmother for the first time two days ago. :)
How interesting that Lolita could have been misdiagnosed. I posted the condensed version of her lab reports. If you all could review and comment, I would appreciate it. I've included all of her test results for the past year or so. You can see that the ACHT test came back positive.
Lolita for sure has kidneys that are very impacted with stones. And so she was on the C/D diet for the past year. The changes in her life between the last result and the one before that include being put on a new diet and the attempt at the Lysodren.
I fully plan on taking your recommendations to the vet for a discussion. As it stands now, there is no treatment recommendation for Lolita.
Thanks again!

[Renee]

Might not be the case for Lolita -- but an ultrasound on my pug showed kidney stones. However, when we did a CT it was confirmed that those were actually calcifications not stones. She has had these calcifications for a few years now. Did the diet eliminate Lolita's kidney stones?

[Vickie20]

There have been several x-rays and the ultra sound that showed 'things' in her kidneys. The C/D diet had no impact.

[Renee]

There have been several x-rays and the ultra sound that showed 'things' in her kidneys. The C/D diet had no impact.

Yes, I would suspect it's possible that she may have internal calcifications. It's my own unscientific opinion that a cushings dog with internal caclifications is one that would be more likely to have caclinosis cutis. My pug had numerous x-rays and an ultrasound. Only the CT was able to tell what they were.

How is Lolita's skin? Any lesions or sores? Any hard, flaky bumps under the skin? Especially along the back, spine, between the shoulder blades?

[Vickie20]

How is Lolita's skin? Any lesions or sores? Any hard, flaky bumps under the skin? Especially along the back, spine, between the shoulder blades?

Lolita continually fights a skin infection on her belly and girl parts. It looks black. I wash this with medicated wipes. This has gotten a lot better lately. She had something that the vet called a benign tumor removed from her back last year. It got rather large pretty quick. It wasn't really hard though it did flake a bit. It was on her back slightly lower than her shoulder blades a little to the right.

[molly muffin]

How are things with you and Lolita?

congratulations on the new grandbaby. :)

[Vickie20]

How are things with you and Lolita?

congratulations on the new grandbaby. :)

Thanks! Lolita is doing well other than passing a kidney stone. That was not fun. We've been letting her settle down after that and the Lysodren trauma. Thanks so much for asking!

I will be taking her to the vet to discuss the possibility of a misdiagnosis of Cushing's. That suggestion surprised me but it sure makes sense based on Lolita's reaction to the Lysodren. It's just that she has so many of the symptoms...bloated belly, black skin infections, ear infections, etc. But she is not losing hair and her hair is still very pretty.
Her bloodwork is really surprising too. To have her levels go down sooo much was unexpected. The only thing that happened between the high levels and the low levels were the failed attempts at Lysodren and taking her off the C/D diet and giving her specially cooked meals.
Wondering if her diet could have facilitated the high levels??
So confusing!