Emmy, 11 year old lab mix/ Emmy has passed

[Windhammer]

Hello everyone, posting to help keep track of my dogs status as you all have. Our ~65lb Emmy was recently diagnosed via all of the same tests as everyone else, but I have not yet asked the vet for the numbers to post up here

The vet prescribed 120mg of Vetoryl (in the form of 2x60mg due to them being out of 120mg's I guess), once a day, but having already read up on my dosage here I pushed back and the vet didn't have any problem starting at 1x60mg.

Our doctor was up front that while others in her practice have treated lots of cushings dogs, she had not treated as many patients on her own, and she's open to feedback on the treatment plan. Armed with the information and people on this forum I'm confident that this will work out fine to hopefully get Emmy's symptoms under control quickly and safely.

We're currently on day 8 and other than very minor changes (sleeping better I think?) she is still drinking lots of water and frequently using the floor instead of going outside, which is why we brought her in in the first place. Looking forward to paying for the first ACTH stim text next week and seeing how she's doing.

[Iraklis]

Hello & welcome!

Have you done any tests (MRI, ultrasound, etc.) to determine the cause of it (ADH or PDH)?

I post very rarely here since i lost my Husko due to Cushings, but rest assured the wonderfull people here will stand by you!!!

[Windhammer]

No imaging has been done, we did the full blood workup followed by UCCR, then LDDS, and moved directly to treatment following LDDS.

[Harley PoMMom]

Hi and welcome to you and Emmy!

If you would get those tests results and post them here along with the reference ranges and units of measurement that would be a great help to us...e.g...ALT 150 U/L (5-50)....thanks! We are especially interested in the results of the diagnostic and momitoring tests that were performed to diagnose Emmy's Cushing's.

I am so relieved to read that you had Emmy start at a lower dose of Vetoryl instead of that 120, kudos to you!!! For Emmy's weight of 65 lbs the 60mg is very reasonable, also recent publication from Dechra now recommends a starting dose of 1mg per pound of a dog's weight.

With Vetoryl treatment there are certain protocols that have to be followed such as, a monitoring ACTH stimulation test needs to be performed 10-14 days after treatment has started, was this scheduled? Is she getting her Vetoryl with food so that it is properly absorbed? Another thing, those ACTH monitoring tests have to be done 4-6 hours after the Vetoryl is given, has the vet mentioned this?

Could you tell us what symptoms Emmy displayed that led you or your vet to test for Cushing's in the first place? Is Emmy taking any other herbs/supplements/medications?

I am so glad you found us and we will help in any way we can. I am also including a link where you will find information regarding Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) If you have any questions please do not hesitate to ask them ;)

Hugs, Lori

[Windhammer]

I'm going to get her prior test results when I bring her in for the ACTH stim on day 16 for ACTH test due to ours/vets schedule, so next week.

We've been giving her the pill in a pill-pocket and making sure it touches a bunch of her bowl of dog food in the process so she eats most of it with the pill each day.

Initial symptoms were the massively increased water drinking which as we all know leads to more pee on the floor than most people can deal with. In hindsight, her weight has definitely increased recently as well as her panting and restlessness/insomnia(prior to treatment), but luckily no hair loss that we've seen or any of the other symptoms.

No other medications or supplements - other than having some lumps removed in her history she's always been a healthy, energetic dog. If anything the only real improvement I think I've been seeing since we started treatment is that I think she's sleeping a little better, and able to relax more/nap during the day which is more typical for her.

[Squirt's Mom]

While drinking does contribute to peeing, in a cush pup the action is actually backward. They don't pee a lot because they drink a lot - they drink a lot because they pee a lot. They are gonna pee regardless so they *must* drink a lot to stay hydrated. ;) This is why you never ever withhold water from a cush pup.

[molly muffin]

Hello and welcome. Sounds like you went in with a game plan and the vet got on board with it. Kudos! That is the best way to start out.

[Windhammer]

Just dropped her off for her first ACTH stim test, and got the results from her previous tests. Only abnormal/out of range results shown below

Superchem/CBC:
ALT (SGPT) 172 (HIGH) [12-118 U/L]
Alk Phosphatase 811 (HIGH) [4-131 U/L]
Cholesterol 425 (HIGH) [92-324 mg/dL]
Triglycerides 293 (HIGH) [29-291 mg/dL]


UCCR:
Cortisol(Urine) 8.4 [5-55 ug/dL (not out of range but included)]
Creatinine(Urine) 31.2 (LOW) [100-500 mg/dL]
Cortisol/Creatinine(Urine) Ratio 84 (HIGH) [<13 probably not cushings, >13 maybe cushings)

LDDS:
Sample 1 (0): 8.0 ug/dL
Sample 2 (4): 7.3 ug/dL
Sample 3 (8): 10.8 ug/dL

[labblab]

Thanks very much for these results; they are pretty classic for a Cushpup, as you undoubtedly already know. You are probably also aware that even though the LDDS is strongly positive for Cushing's, these numbers do not allow us to distinguish between the pituitary vs. adrenal form of the disease. At her age, I don't know whether or not you would consider the possibility of curative surgery if the tumor is on an adrenal gland (it is risky and costly surgery). But just wanted to mention that option if you wanted to pursue additional diagnostics.

We'll surely be interested in today's ACTH results. Just remember, the general recommendation is to leave the trilo dose unchanged for the first 30 days unless cortisol has dropped too much. Especially since we don't have a pretreatment ACTH baseline to compare to, I think you will want to hold off on a dosing increase unless the result today is really high and you have not seen any symptom improvement at all.

Marianne

[molly muffin]

yes, it does appear to be a rather textbook case where the numbers are concerned, so will be interested in seeing what the ACTH results are.

Molly's cortisol does drop for 30 days with every increase we've done, so I never change till after 30 days or even 45 days have passed.

[Windhammer]

Doctor called with the ACTH Stim test and blood results - I don't have units of measure since I got the results verbally

Baseline - 5.6
Post - 7.2

ALT came back at 423 [12-118] and ALK Phos at 1766 [4-131] which are both about double the test from last month (pre-treatment)

She's still peeing/drinking a lot, but since the cortisol numbers are below the 9.1 number we're going to hope for the 30 day improvement to happen

[molly muffin]

hmm, don't like those liver values doubling like that, did you get her started on Denamarin supplement for her liver? You want something with milk thistle and sam-e in it.

Other question is have they done an ultrasound? If not, then it might be worth your consideration to take a look at the liver, kidneys, adrenals, gall bladder, pancrease, etc and see whats what in there.

Thats my initial thought. Every time my dog has been increased on the trilsotane (vetroyl) she drops for 30 days. So I think sticking to the dose you are on is a good idea.

[Bonnie0420]

While drinking does contribute to peeing, in a cush pup the action is actually backward. They don't pee a lot because they drink a lot - they drink a lot because they pee a lot. They are gonna pee regardless so they *must* drink a lot to stay hydrated. ;) This is why you never ever withhold water from a cush pup.
Thank you, I have been searching for an answer about the water, I'm giving her as much as she wants and yes while it gets old to have to take her out constantly I want her to be getting what she needs

[Windhammer]

So after the 30 days there was no decrease in her urination/drinking, panting, or increased appetite, so we moved her dosage up to 60mg morning/30mg night from just 60mg morning with the vet's blessing, with a plan to do another ACTH stim test in two weeks.

Four days into the new dosage and she's just not herself - eating less, a little diarrhea (could be from too much ham yesterday with Easter dinner), but the peeing has finally subsided to what I would consider her "pre-cushings" levels. She also was doing some minor shivering in her crate which is abnormal for her
**Edit: Back to regular stool this morning so far

Obviously I will be calling the vet first thing in the morning as I'm wondering if she's getting close to addisions type of symptoms but what's the boards recommendation as to just dropping back down to 60mg or halting vetoryl completely?

I hate this stupid disease.

[molly muffin]

What was the results of the 30 days ACTH test? I think that with a result the previous ACTH
Baseline - 5.6
Post - 7.2

that an increase of 30mg, from 60 mg to 90mg is a too much. Anything post 5.0 is in range and some symptoms just take a longer time to go away. This kind of an increase is not normally recommended unless the post is still a long way out of range, which yours was not at 2 weeks.

Let us know what the vet says, but I would have the cortisol and electrolytes checked and not give any more medication till you know what is going on with the cortisol.

[Windhammer]

We didn't do the 30 day due to symptoms not stopping, most likely my fault for suggesting it

emmy was crashing hard today, she's currently at the vet getting monitored and fluids administered

[molly muffin]

Oh dear. Let us know how she is. The cortisol would have dropped even more at the 30 day mark. So yes very possible she is having. Crisis. Make sure they check everything and give you the numbers and no going back to 90 mg. in fact don't start again until symptoms come back.

[molly muffin]

How is Emmy???
Haven't heard since she was in getting fluids. :(

[Windhammer]

Sorry for lack of update, Emmy came home with us the next day after being looked after in the ICU at our vet over night and being given IV fluids. She's on a replacement prednisone dose of 5mg in the morning and 2.5mg at night which seems to align with the recommendation of .25mg*kg at her last measured weight. She was not completely (addisonian?) but was headed there quickly. They did give her an ACTH stim that next morning and all of the results came in at "less than 1". Obviously we have discontinued vetoryl completely.

Her eating has not rebounded completely but she is eating at least a little food each day. Our vet has us giving her frequent status updates over the phone and has adjusted the prednisone dosage slightly depending on her symptoms. We have noticed a little less strength in her back legs and that she's slipped a few times when trying to jump on the couch or something, but she at least seems happy and herself at the moment.

She's still drinking and peeing more than we'd like but with everything else going on that's pretty low on the priority list until she's completely better otherwise.

[Windhammer]

After a series of infections Emmy never recovered back to her normal self, and it saddens me to say we ended up putting her to sleep earlier today to end her pain.

We miss her already, and hope for much better outcomes for everyone else

[LauraA]

It is heartbreaking to have to say that goodbye. She was obviously loved very much and I bet she would never regret any part of her life with her loving, caring parents. Life feels so empty at first when they leave us, I saw a saying once that said something along the lines of how your heart is shattered into a thousand pieces and then when you try to pick up and fit those tiny shards back together you inevitably miss a few. So while your heart continues on it is never quite the same as before.

[Harley PoMMom]

Oh, I am so sorry for your loss and my heart goes out to you at this most difficult time. Please know we are here for you and do understand the pain you are feeling.

With Heartfelt Sympathy,
Lori

[Robert]

Praying for Emmy and those left behind. So very sorry for your loss.

[molly muffin]

So sorry to hear that Emmy has passed. Sometimes their bodies just can't recover enough. My sincerest condolences to you and your family.

[judymaggie]

My condolences to you during this difficult time -- hopefully, as time passes, you will be able to focus on all the wonderful times you had with Emma.

[pansywags]

My sincere condolences on your loss. You and everyone who love Emmy are in my thoughts.