English cocker just diagnosed with cushings

[MilliesGrandma]

Hi all. *sigh*. Another scary Journey. Our newfoundland is currently undergoing chemo for lymphoma, and now our English cocker spaniel, Millie has been dx with cushings. I've long suspected she had it but we've been so focused on our boys chemo that we put the cushings test on the back burner.

A little about Millie. She came to us as such a blessing 2 years ago. Grossly overweight, 24 kgs instead of a healthy 15. We got her healthy. She had two hip surgeries due to the damage caused by excessive weight. She is now 12 years old. The rescue dog that saved my daughters life.

So today. We got results back from LOw dose dex suppression test. Results were:
Resting cortisol 124nmol/L (20-165)
Post dex 3-4 hrs 77 nmol/L (<40)
Post dex 8 hrs 173 nmol/L (<40)

Pathologist reports pattern of escape at 8 hours strongly supports cushings disease secondary to pituitary tumour.

Even were it adrenal we would not put her through surgery.

Symptoms: excessive drinking and eating, excessive peeing inside a lot, panting, rear end weakness, hair not growing back after surgery, hair loss along her back evenly, UTIs. The usual.

Our vet has to order in the medication. We are looking at starting her on low dose trilostane in a couple of days.

Thanks for listening/reading. :)

[LauraA]

I am so sorry to hear about your Newfoundland having chemo. Sounds like you have a lot going on with your boy.

With Cushings a dog can live out there natural life once you get that cortisol back into range. You will find the trilostane will probably need tweaking in the beginning to find the sweet spot :) It is now recommended to start at 1mg to 1 pound of doggy weight as their is less chance of any side effects or going into an addisons crisis. The meds have helped my girl amazingly with her panting, and night time roaming activities (which she made sure I was woken to walk around and around the house with her hehe), she also had absolutely no bladder control at all till we started the Vetoryl (which is trilostane). I hope your Millie responds just as positively as my girl did (been 19 months now).

[labblab]

Welcome to you and Millie! :)

It sounds as though it was so lucky that you all found one another! And we are so glad you are now joining our family, as well. Your description of Millie's symptoms is certainly typical of the disease, and the LDDS test results are consistent, as well. For what it is worth, though, I do question the conclusion that the results point toward the pituitary form of the disease. I believe they are inconclusive. For the benefit of the majority of our American readers, I am converting the test units (dividing them by 27.59):

Resting cortisol: 4.5 ug/dL
4-hour cortisol: 2.8 ug/dL
8-hour cortisol: 6.3 ug/dL

Since the 4-hour result is greater than 1.5 (or actually 1.45 according to your lab's norms) and neither the 4-hour nor 8-hour results are less than 50% of the resting cortisol, there is insufficient suppression to conclude that the cause is a pituitary tumor. It can still be the case, but we don't yet have evidence. Look at the third page of this print-out for interpretation guidelines:

https://www.idexx.com/resource-library/smallanimal/snap-cortisol-testing-guide-en.pdf

Since you would not pursue adrenal surgery, regardless, then the issue may be moot. But I did want to point out this inconsistency in the pathologist's report.

I am so glad to hear that you are planning to start out with a low dose of trilostane. I am not sure about Millie's current weight now that you have gotten some of the excess off, but the safest formula is to not exceed approx. 2 mg./kg. (1 mg./lb.). So I hope that is the dose your vet is recommending.

Once again, I'm so glad you've found us, and we look forward to reading much more about your girl.

Marianne

[MilliesGrandma]

Thank you for being so welcoming. I've spent the last hour or so reading threads. I had to stick with the thread about Jenny...what a little trooper!

Marianne, Millie is currently about 15kgs. Probably the weight she needs to be although she's thin in the back end, and heavier around the torso.

I haven't sat with the vet to discuss her dosage as he had to order it in. I've read enough on here now to know that we are better starting low,than starting too high. I will stick to my guns about that!

LauraA, I'm really hoping the meds will help with the huge pee lakes that Millie leaves around the place. I'm forever mopping up her puddles lol.

I was wondering whether the treatment could reduce the back end weakness, or whether it will just stop it from deteriorating further? Has anyone had much experience with that?

Thanks for the support and advice! :)

[doxiesrock912]

It might help with the weakness but if she's got arthritis that will bother her and many use tramadol for this. The only plus to Cushings is that pain is masked by the high levels of Cortisol. Hidden health issues will become more obvious as Cushings is controlled.

You mentioned your vet ordering Trilostane, myself and others use Diamondback Pet pharmacy. Their prices are great and they mail the meds quickly. Your vet can call in or FAX the script.

[LauraA]

MilliesGrandma, my girl has that classic Cushings back leg weakness. Since being on the drugs it has helped her immensely and she can now jump up and down of things again (though I am unsure if this is a good thing :D ). She still has some muscle wasting around her back area, and a luxating patella to make thinks more interesting!! It really does depend on the dog though as each dog responds differently, and athritis can complicate matters. Lucky most of the year is fairly warm here in Australia so she isn't having to much trouble in that department yet.

[MilliesGrandma]

LauraA, we are also in Australia but it gets a bit cold living in the hills. Fortunately Miss Millie lives the life of Riley indoors and even has her own onesie!

[LauraA]

umm doesn't every pup have their own onesies lol!! I am in Perth, so enjoying some much needed rain. Luckily I have many rain coats for my two furbies to choose from hehe. They want there two walks a day no matter what the weather, and yes they allow us to sleep in 'their' bed at night - though somewhat reluctantly on occasions :P

[MilliesGrandma]

Ok we have started Millie on the trilostane. But I am concerned about the dosage the vet has prescribed. We are using an oral suspension so that it's easier to play with the dosage as required. The vet assured me we were starting very low so that if necessary we could go up.

So it's 60mg/ml, and she is on .8mls per day. She is 15 kgs. Is this too much?
Thank you!

[Harley PoMMom]

If my calculations are right, Millie weighs 33 pounds (converting kg into pounds; 15 kg * 2.2) Her liquid suspension is 60 mg/ml, her dose is .8ml which = 48 mg. Dechra, the makers of Vetoryl, now recommend a starting dose of 1 mg per pound of a dog's weight, so Millie will be getting a bit more than that (1.45mg/lb)

If this were me, I would feel more comfortable starting out at .5ml, which would be 30 mg...but that's just me. ;)

Is her first monitoring ACTH stimulation test scheduled? Has the vet mentioned that the Trilostane needs to be given with food to be properly absorbed, and those monitoring ACTH stimulation tests have to be performed 4-6 hours after her Trilostane dose?

Hugs, Lori

[labblab]

Yes, I agree totally with Lori. I would feel better starting at 30 mg., too. Take a look at this post. Your vet may not be aware that Dechra has recently revised their initial dosing recommendations downward:

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

Marianne

[MilliesGrandma]

Thanks folks. I know ideally we should be on a still lower dose. I will raise it with the vet when we are in there this week. Unfortunately our newf (not the chushpup) has come out of remission for his lymphoma/leukemia. We are all a bit emotionally rung out as further chemo is unlikely to give us more than a few months (best case scenario). I just want to fix them both...:(

[Harley PoMMom]

Unfortunately our newf (not the chushpup) has come out of remission for his lymphoma/leukemia. We are all a bit emotionally rung out as further chemo is unlikely to give us more than a few months (best case scenario). I just want to fix them both...:(

Oh my goodness, I am so sorry to this about your boy, and certainly understand how emotionally challenging this is. Many comforting hugs and positive energy being sent your way, you and your boy are in my thoughts and prayers. Please know that we are here for you and your dear boy.

Hugs, Lori

[LauraA]

I am so sorry about your Newf :( I really hope he is one of those dogs that defies all odds and stays around much longer than anticipated. So much going on for you at the moment, makes me hug my furbabies just a little bit more than usual :(