Max my 9 year old Irish Setter has been diagnosed with Cushings

[Grazzzz]

I have read through the site and my question is for a 48 kg dog what dosage of vetoryl would you expect to be prescribed at first ?

[labblab]

Hello and wecome! The generally recommended initial dosing formula is an amount not to exceed 1mg. per pound. If you wish to stick with brandname Vetoryl, this might require buying a combination of capsule strengths to arrive as closely as possible to the ideal dose (i.e., combining one 30 mg. capsule and 1-2 10 mg. capsules). This may be a rather expensive proposition, though. So to save money, you could first start very conservatively with one 30 mg. capsule, and then increase the dose later on if symptom resolution and monitoring testing show a higher dose is warranted. Or, you could be less conservative and start with 60 mg. since this exceeds the formula by just a bit. In honesty, if it were me, I think I would start with the 30 mg. You can always combine those capsules down the line to achieve a higher dose, but you cannot split 60 mg. capsules if that dose turns out to be too high. (Edited to add: Oops, I misread your post and thought your dog weighs only 48 pounds instead of 48 kg. So please disregard what I wrote above and look instead to my revised reply added below).

Can you tell us some more about your dog's medical history, Cushing's symptoms, and diagnostic testing? That info can help factor into the dosing decision.

Thanks!
Marianne

[Renee]

So your pup is approx 100 lbs. I agree with Marianne; I would start with either 30 or 60mg. It seems that the larger dogs can be a bit more sensitive to the medication and don't require doses as high as the smaller dogs. I would probably go with the 60mg, since that is still 40mg under the 1mg per 1lb recommendation, but Marianne makes a good point about being able to combine the 30mg, but not break up the 60mg.

[Squirt's Mom]

Dechra recently changed their starting dose recommendations. Here are the new recommendations -


The starting dose for treatment is approximately 2 mg/kg, [or approx. 1 mg/lb] based on available combinations of capsule sizes.

[labblab]

OK, I'm back again and will revise my recommendation now that I realize your dog weighs 48 kg. rather than 48 lbs.! :o

However, the theory behind my recommendation will remain the same as in my earlier reply. You can either combine capsules to arrive at a dose closest to 100 mg., or you can pick a more conservative route. In this case, my conservative suggestion would be 60 mg. at a minimum. You could add an additional 30 mg. capsule or just stick with the 60 mg. to begin with.

I definitely would not want to commit to buying 120 mg. capsules at the start of treatment. Again, even though Max might end up taking that high a dose eventually, there is no way to split that size capsule if it turns out to be too much for him. You can always combine 60 mg. capsules, but you cannot split 120 mg. capsules.

Marianne

[Grazzzz]

Ok, i say been diagnosed, he has all the symptoms, drinking ,weeing excessive eating, panting and a full belly the vet is pretty certain but has taken a bloodtest and urine sample and on tuesday having the other test but i and he are pretty convinced its cushings .
so doing as much research so can be pro active. have been recommended dandelion and burdock also on his food.
i have read about less mg is better than over prescribing.
still getting over the shock the symptoms seem to have crept up on us!
thanks for all your advice

[molly muffin]

Cushing's does do that creep up thing. A lot of people think it is age creeping up. It is treatable though and they can do just fiepne for a long time. Crossing fingers for answers.

Welcome to the forum.

[Grazzzz]

I have posted late last week that my dog Max a 9 year old Irish(red )setter has all the symptoms of cushings ,he had a urine and a blood test of which i have the print outs however i was expecting a ACTH stimulation test tommorrow but the vets has rung today to say they cant get hold of the kit required and may have to wait till the end of the month! clearly this is not satisfactory and have now found another vet who will perform the test on thursday.
However looking at the results of the test i am very concerned
the comments at the bottom of the test say

Marked cholestasis/induction and mild hepatocellular damage,may be secondary to endocrinopathy. Further differentials include cardiac disease,intestinal disease, primary hepatopathy

very worried can anyone interpret the above please .
i was hoping that once the test was done and drugs perscribed he could return to his old self ?
regards

[Grazzzz]

Reading the tests they say:
ALT (SGPT )37 C 131.5 19B-124.0 U/L High
ALK Phosphate 3498.0 <=130.0 U/L High

Absoulute Retic count 116.4 <=110.0 10 ^9/L High

can someone give me some advice he is a very large dog the biggest setter the red setter rescue centre had ever seen he weighs 48kg
Thanks in advance

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about the stim agent for an ACTH into Max’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Harley PoMMom]

Hi and a belated welcome from me,

Sorry I am late in posting to you and Max, and I apologize for the additional questions I am going to be asking :o

Is Max taking any other herbs/supplements/medications? I'm a bit confused with the numbers for the ALT, specifically that 37 C value, is the ALT level measured 131.5 U/L? Was an urinalysis done, and if so, could you post those findings too? What tests were done to diagnose Max and can you please post the results of those tests? How many monitoring ACTH stimulation tests have been performed and could you post those results along with their timelines. Does Max have pituitary or adrenal dependent disease? Is Max taking Vetoryl, and what dose is he on?

Cushdogs commonly have elevated ALK Phosphate (ALKP) levels because 80% or 90% of dogs have a steroid induced isoenzyme of ALKP so if one of those dogs has Cushing's, you are gonna see anywhere from a mild to severe increase in ALKP. These increases are not because the excess steroids are killing liver cells, it's because the steroids are causing an abnormal accumulation of fat in the liver and it is having to work a bit harder. I do believe the cholestasis and the high ALPk can be attributed to Cushing's disease.

Looking forward in hearing more about dear Max.

Hugs, Lori

[Grazzzz]

Hi Lori No supplements as yet, i have started him on raw food and understand dandelion and burdock or milk thistle is a good supplement ?
He hasn't the stimulation test yet that is Friday as we have had difficulty acquiring the drug to do the test it is in short supply in the UK.
URINALYSIS
Glucose =neg
Bili +
Ketone =neg
Sp Gr 1.021
Blood=neg
Ph =5.0
Protein =++++
Urob=neg

not on Vetoryl yet but if needed vet has suggested 90 mg as Max is 48kg a big dog (overweight thou because of his condition)

not sure what type is causing his condition yet will the stimulation test tell this or does he need a scan ?
thanks in advance
Graham and Max

[molly muffin]

An LDDS test might tell you what kind of cushings. It is usually the test used to diagnose cushings.

Looks like protein in the urine is high too. Have they mentioned that? A UPC done on the urine, with 3 consistent high results will tell you if there is an issue with protein loss in the urine, which also can be treated and can happen in cushing dogs.

That ALKP is very high, have they done any kind of bile acid test to check the liver and the gall bladder? If it is possible to have an ultrasound done, that gives you a lot of bang for your buck.

[Harley PoMMom]

Hi Graham,

Milk thistle is a good supplement to give to aid the liver, however, I would not introduce anything new right now because if Max does start Vetoryl for Cushing's and any ill effects would arise it would be difficult to know if those effects were from the Vetoryl or new supplements. How is he adjusting to his new raw food diet?

Sharlene is correct in that the low-dose dexamethasone (LDDS) is the preferred test when trying to diagnose Cushing's. Please do post those ACTH stimulation test results when you get them.

Hugs, Lori

[Grazzzz]

Hi well max had the test done today it cost £159.00 and the results are
Cortisol Basal 161.0 nmol/l 50.0 -250.0
Cortisol post ACTH 248.0

Vets saying this is normal so another test needs to be done a Dexamethasone low dose supression test.
he has lost 4 kg on the new diet his excessive panting and drinking has stopped and he has not wanted to go out at night he has been on it 5 days .
It has been suggested a ultrasound should be done on his liver , not sure where to take this now to have the new test or ultrasound first .
Any advice would be great ?

[Harley PoMMom]

Converting those results from nmol/L to ug/dl, which are the units we are used to seeing, that comes out to: pre = 5.8ug/dl; post = 8.98ug/dl. If Max is not showing any symptoms of Cushing's, I'd be apt to not having any more testing done.

Hugs, Lori

[Grazzzz]

Converting those results from nmol/L to ug/dl, which are the units we are used to seeing, that comes out to: pre = 5.8ug/dl; post = 8.98ug/dl. If Max is not showing any symptoms of Cushing's, I'd be apt to not having any more testing done.

Hugs, Lori

Thanks Lori
However his blood and urine shows issues ? from those tests should i keep him on the milk thistle and raw diet and check them in a few weeks time as clearly something is wrong ?

[Harley PoMMom]

Marked cholestasis/induction and mild hepatocellular damage,may be secondary to endocrinopathy. Further differentials include cardiac disease,intestinal disease, primary hepatopathy



Were these findings from a previous ultrasound, and if so when was it done, also was it noted if the adrenal glands were visualized?

What symptoms does Max display at this present time? With his ALKP being so elevated it sure does seem that something is going on. Some illnesses that can cause high ALKP levels are: GI issues, impaired bile flow, diabetes, and pancreatitis.

If Max is not showing the obvious Cushing's symptoms, I believe an ultrasound would be beneficial. However not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. My gen. vet has an ultrasound machine that just doesn't have the power to capture crisp, high-resolution images. The technician, most likely, will perform their own and therefore, it should be those most experienced with capturing good windows and images. That would be a board certified radiologist or board certified IMS. Likewise the one interpreting it should be the most experienced as well, and that's generally one of the 2 above.

When my boy, Harley, has his first ultrasound it found that he had prior bouts of pancreatitis which he never showed any symptoms of. Our motto here is you get a lot of bang for your buck with an ultrasound.

Hugs, Lori

[molly muffin]

I would go with an ultrasound at this point.

If the ACTH is high, positive then often you would want to do the low dex to know what type of Cushing or if something else is causing the high cortisol. However with it being negative it is not likely to be Cushing's. No high cortisol in the body because the test is normal so that is not what is causing max problems.
Now ultrasound can give a lot of info on what the internal organs look like. So yep that would be the next step.

[labblab]

Just wanted to pop back to say that I agree with proceeding next with a high-quality ultrasound. One of the draw-backs to the ACTH is that it is more likely than the LDDS to return a "false negative" even when a dog truly has Cushing's. This is especially true when a dog suffers from a tumor on the adrenal gland (rather than the more common pituitary form of the disease). So I do understand why a vet would want to perform an LDDS on a dog that is highly symptomatic but tested negative on the ACTH. But in Max's case, you say his overt symptoms seemed to have resolved. So I think I, too, would move next to an ultrasound because not only can it give helpful information about the state of Max's liver and kidneys, it can also reveal whether there is a tumor or any adrenal abnormalities that are consistent with Cushing's.

I do want to add one cautionary note about the raw diet in the event that Max is truly losing a lot of protein in his urine. It is great that the new diet has seemed to help with several things, but unfortunately, feeding a diet that is really high in protein can worsen kidney problems for a dog who is having a lot of protein leak into the urine. So I do agree that it may be important to do some additional checking of his urine to see whether the protein loss is a genuine and consistent problem. And once again, the ultrasound can also be helpful in this regard because the kidneys will be visualized in the images.

Marianne

[Grazzzz]

Thanks
Since the change in diet he appears to be back to normal, he is on a low fat diet today he has had turkey mince egg shells (powdered) carrots broccoli green beans(milk thistle) all blended.
we have a dilemma as we are off on a trip to Indonesia in 10 days and will be leaving Max with a dog sitter. (she has had him many times before)
Do i wait to see if the diet stabilizes some of his issues.
So far we have spent over $500 and are no nearer to knowing whats wrong not that money is an issue as i dont want him suffering
The new test they need Max for 8 hours for 3 injections
ultrasound has not been suggested.
i dont want him suffering he currently seems back to normal however the previous tests show otherwise.
Before his change of diet he was on pedigree vital could this be related to some of the test results (bad diet)
Could he also have gall bladder sludge ?
I have learnt a lot over the last few weeks so thank you all that have taken the time to reply.

[labblab]

Since Max is currently doing well outwardly, if he were mine, I believe I would just leave things as they stand while you take your trip. Once you get back, you can find out whether any of the symptoms returned or whether they remain resolved. And with that info in hand, you can discuss with your vet your next diagnostic step. Just my own thoughts as to what I would do. ;)

Marianne