Rock and a hard place.....

[my_winston]

Hello everyone,
I'm new to this, I signed up last week but have been in denial I guess. My Yorkie (Winston) was diagnosed last week with Cushings. He had an ultrasound 2 days ago to check his adrenal glands.....which looked 'normal' (normal size & no mass) so; unless we have caught this disease very early it looks like it's pituitary gland dependant. From everything I've read about Cushings Disease in dogs.......it is a terrible disease....and I'm seriously heartbroken that Winston has this. I'm sure everyone on this page is feeling the same way about their fur babies.
Yesterday we picked up his prescription "'Vetoryl" 30mg. He's obese (29 pounds, due to Cushings) He's not a "small" Yorkie; he should weigh about 15+ pounds. For the past 2+ years I"ve been trying everything to keep his weight down, plenty of walks, playing, diet foods, serving fewer calories and spreading his meals out throughout the day, slow feed bowl etc. Nothing works.........it's the Cushings.
My vet told me about the vomitting and diarreah possible side effects and said I should read the manufacturers insert about the drug. Well........now I don't know what's worse......not giving him these meds; or giving him these meds. Obviously I want to do the best thing I can for Winston, but am wondering which is worse....the 'treatment' or the disease....?
Winston is VERY young, too young to get this (he just turned 4 on May 19,2015). It's rare, but obviously not impossible for a dog this young to get Cushings. Anyone have any advise for me at all on 'vetoryl'? I do understand that any reply to my post doesn't replace veterinary advice........but I'm desperate, I don't know what to do about this drug.......I seriously am between a rock & a hard place......because it seems like giving him the drug or not giving him this drug.......seems like enormous risk(s) either way. Thank you in advance for anyone who can help shed some light on this nightmare for me (& Winston)

[Squirt's Mom]

Hi and welcome to you and Winston! :)

Yes, 4 is young but not unheard of. The good news is that with proper treatment and diligent monitoring by both you and the vet, Winston can live out his normal lifespan and beyond. Cushing's is not necessarily a death sentence. Most cush babies live a fairly normal life with Cushing's and live into old age. My own baby passed at a couple of months past 16 yrs old - she lived with Cushing's for almost 7 years. During that time, she had two major surgeries and did wonderfully.

But I do know exactly how you are feeling at the moment. When Squirt was first diagnosed I thought my world was truly ending. I believed she was dying and there was nothing I could do to fix it this time. But then I found these wonderful people who took my trembling hands and gently held me until I could take a breath again. Then they began to teach me. I listened hungrily because they offered the only ray of hope I had seen. They saved not only my Sweet Bebe's life but my sanity and they became our family, the most amazing family I could ever imagine. So you just take a deep breath and relax a tad bit - you have found the very best place in the world to be for canine Cushing's.

We will ask LOTS of questions and the more details you can offer, the better. We dearly LOVE details. :D To help you get ready, have all the test results at hand. If you don't have copies of these, ask the vet to give them to you - you paid for them and have the right to them. It is a good idea to start a file at home for Winston so if he ever has to see another vet for any reason you walk in the door with his medical history in hand. Another good idea is to start a daily dairy or journal on Winston; record the things you see that are different like eating and drinking, sleep pattern, moods, odd or different behaviors, anything you see that is not his usual self, note. Then when you see those things changing, note the changes, positive and negative. You and your vet can really benefit from a journal like this.

I know others will be by to chat about the Vetoryl. We were a Lysodren house. ;) But I can tell you this - these drugs are very powerful and have the potential to be fatal if misuse. BUT so does aspirin. ;) These drugs are also life-saving. Your vet has started Winston on a dose that sounds pretty good to me. The current starting dose is 1mg per pound. Starting low and going slow is the key to Vetoryl (Trilostane) and it looks like your vet is on the right track and that is very good to see. And you now have us on your side as well. We will be with you every step of the way. Ask any questions you may have and we will do our best to help. If you need to cry, to scream, to laugh, or just not feel alone - we are here.

I'm glad you found us and look forward to learning more as time passes.
Hugs,
Leslie and the gang

[molly muffin]

Welcome to the forum. Glad you decided you to say hello. :)

I think we all where trying to find any other reason for what is happening with our furbabies once we get that diagnosis.

With treatment though it can work miracles and you and Winston can have a long life together.

What is important is getting the dosage right.. 30mg for a 29lb dog is okay to start with, the appropriate starting place is 1mg/1lb, but since he is over weight, there is a chance that once this is controlled or his numbers brought down that you will need less. Follow up testing is VERY important. You want to give the medication in the morning with breakfast and then retest in 12 - 14 days and at 30 days (ACTH) to see how he is reacting to the medicaiton.

Do you have the results of his blood work and urinalysis as Leslie mentioned? We'd really like to see just the results that our abnormal for instance

ALT - 250ug (range 50 - 150ug)

Like that. Is his urine dilute? (this is a specific gravity on the urinalysis)

What exactly are his symptoms? I'm guessing ravenous appetite as you mentioned his weight and trying to get him to eat using the slow bowl, how about drinking and urinating? Hair coat issues?

So glad you found us.

[my_winston]

Thank you "Squirts Mom"......... I was able to finally finish reading your reply to my first post......through all my tears.
I will ask my vet for a copy of all test results, and I'll do my best to get them early next week.....and post them so you can see them.
Winston was also diagnosed (2 months or so ago) with a thyroid condition; I'll get those test results as well. He takes medication for that also (one pill every 12 hours).

Winston has the 'textbook' symptoms of Cushing's; weight gain, insatiable hunger and thirst (frequent urination), recently started struggling with stairs; back legs giving him problems (I've just purchased him a ramp, for getting up on the couch and into the bed), excessive panting, sleeps a lot during the day (doesn't really move much) and very restless at night, very large 'pot belly'.

Your suggestion about starting and keeping a daily journal about Winston's conditions/health/symptoms/....the good and the bad; is an excellent idea! Thank you. I've been such a basket case for the past week that I feel like I can't think straight. You were right, sometimes I want to scream, but mostly I cry. I've got to pull it together......none of this is about me, it's all about Winston. Your idea about the journal, will absolutely help me in communication with my vet, she will get a very good picture of how he's doing daily which in turn will help her monitor his condition and help me work with her in helping him. THANK YOU SO MUCH for that suggestion!

I'll post the test results sometime early next week, and I'm going to take the weekend (if not a little longer) to do yet more research on "Vetoryl" and pituitary dependant Cushings. Almost everything I read on the subject is bad, heartbreaking and scary........which makes it almost impossible to be 'hopeful' about any of this.

I am just beginning the journey down this scary path of loving a fur baby with Cushings......my heart goes out to everyone who is part of this forum, anyone who has, or had, or will have a Cush pup.........this appears that it will be an uphill battle, with many tears, hopefully some smiles, and TONS of cuddle time with our dogs. I am very grateful for this forum, I'm going to need it! And a special thank you to the person(s) who started this forum to begin with......I hate that I am now a member (for obvious reasons), but am way beyond thankful that this forum exists. XOXO

[my_winston]

Hello everyone; 2 questions.......
I haven't started Winston on the Vetoryl yet, because he's having stomach 'issues'....... he's got diareah and vomiting. (sorry for any spelling mistakes.....) My vet wasn't in the office today, but she is aware this is going on (it has been since last week) I've been giving him 'Metronidazole' 200mg every 12 hours. As soon as I stop; because he seems to be better, the diareah and vomiting come back.
Are vomitting and diareah "typical" symptoms of Cushing's? I know they are potential side effects of Vetoryl, but we haven't started those yet. And I'm worried about starting while he's got these other problems.
My other question is this: his Vetoryl is 30mg. I read, that at the very most, dogs should start this drug at 1mg per pound of body weight. Winston is 28-29 pounds, so does 30mg sound right? I'm thinking about asking for a lower dose to start him on........maybe I'm being overly cautious.....?
I've requested copies of all his Cushing's test results, and should have them sometime tomorrow.
He's sleeping most of the time, really only gets up and moves if I put food down for him or if he needs outside to pee/poop. I can't believe how much 'life' this disease has taken out of a dog that just turned 4........I sit with him and gently pet him, he looks at me right in my eyes and does a soft 'cry/whine', I don't know if he's in pain. Or maybe he's making these soft cry/whine sounds because he's constantly hungry.....I hate this! I'm new here, I just signed up to this forum last week.....Winston and I are new to this whole thing..........sorry to sound like a 'whiner' I know everyone on this site is going through the same things. And I know none of this is about me. This is ALL about our fur babies who we love so much. It's so hard to stay positive and hopeful, I can only pray that with starting the Vetoryl things will get better.
If anyone can offer their advice or opinion to my 2 questions, I'll be very grateful :)

[labblab]

Hi again, but I'm surely sorry Winston is doing so poorly. In terms of dosing, the 30 mg. of trilostane is a reasonable dose given his weight. But I would not yet start the medication yet given the fact that Winston is acutely ill. Vomiting and diarrhea are not symptoms of Cushing's itself. Cushpups can be vulnerable to pancreatitis which can cause acute GI symptoms such as these. However, some other unrelated issue may be causing his illness. Either way, I believe it would be very unwise to start the trilostane under these circumstances, and your vet needs to be pursuing the cause of the GI problems more aggressively. I encourage you to contact your vet ASAP tomorrow and let her know that Winston remains quite ill! There is a special and specific blood test that can be given to test for pancreatitis ("Spec cPL"). Given your description of Winston's symptoms, that's one place I would want to start.

P.S. You'll see that I merged your new post into your original thread so that we have all of Winston's history together in one spot.

Marianne

[my_winston]

Thanks Marianne, sounds like great advise! I think my vet mentioned something about pancreatitis when they did the ultrasound to look at his adrenal glands. She was going to look on the ultrasound to see if anything abnormal showed up with regard to his pancreas; but then never mentioned it again. I will definitely ask her tomorrow about that, and get her to do something more about his GI issues. And thanks for merging my posts/threads........I haven't figured stuff out yet on how to use this effectively/properly.....I'll get there eventually :)

[MiamiThom]

Leslie, I benefited from your suggestion to journal and will begin that today. Thank so much. My Winston, welcome. I am a newbie here too and we just started the Vetoryl a week ago, so we will learn together too.

Our "family" here is amazing.

Thom

[my_winston]

I don't know if I'm posting this in the correct location.....? I got a copy of Winston's Cushing's test results today. Here's what they gave me...

Tube Labeled PRE
Tube Labeled 4H POST
Tube Labeled 8H POST
Cortisol 3 Samples (DEX)
Cortisol Sample 1 Dex 159 nmol/L
Cortisol Sample 2 Dex 111 nmol/L
Cortisol Sample 3 Dex 102 nmol/L


I have no idea what any of that means, but I've typed it out above exactly how it is on the paper I was given.

Winston was just diagnosed on May 14 2015 with Cushings. I have not started the Vetoryl yet.........here is why.....

He has had diarrhea for a week (with some vomitting) I don't feel at all comfortable starting him on Vetoryl (30mg) while he has this going on. He's been on boiled white rice and steamed chicken breast for the past week, along with a prescription of Metronidazole 200mg every 12 hours.

Because the most common side effects of Vetoryl are diarrhea and vomitting; I'm VERY reluctant to start that medicine. My vet is pushing for me to start the Vetoryl despite these other ongoing health issues. So, if I start giving him the Vetoryl, and the diarrhea and vomitting continue or get worse I will have no way of knowing if it's the medicine making him sick or if it's still the same problem he's having now. This is not sitting well with me at all........my 'gut'/intuition is screaming at me not to start the Vetoryl until his GI problems have been cleared up. And the vet hasn't even seen him since last week; I know they are busy people, but this isn't a minor thing happening. Cushing's is a serious disease and having diahrreah for a week can't be good. I'm angry, frustrated, scared......
Am I over reacting, over cautious? Or do I have valid points on this?? I would appreciate anyone's input/opinion.........HELP me please.
I'm seriously considering going for a second opinion on wether to start the Vetoryl while he's got this GI upset, and a second opinion on prescribing something else to try to stop the GI upset........My head is spinning, I want to do the best and right thing for Winston but I don't know what to do because I'm not a vet.
Then there's the test results.....I have no idea what any of those numbers mean.....if anyone can help me with that, I'd be super appreciative. But more importantly, I don't know what I should be doing for Winston right now.......stopping the GI upset before he starts on Vetoryl? Or should I start those meds immediately as my vet wants me to............??
Thank you for any help anyone can give me...I'm desperate.

[molly muffin]

Can you check and see what the range is for the test? It should be listed. This is the LDDS test used to diagnose Cushing's.

You are right. You don't give vetroyl ever to a sick dog and Winston is certainly sick. The question is whether it is pancreatis or a gi upset. If it is gi then often they will need an antibiotic metronidazole. Also make sure he is staying hydrated with that amount of diarrhea.

He wasn't tested while he was throwing up and diarrhea was he?

I'd go to another vet just because yours doesn't seem to understand the medication or that your dog is sick outside of Cushing's. Diarrhea and vomiting are not Cushing symptoms. The manufacturer specifically says not to give medication to a dog with either of those two things until they are no longer sick.

[my_winston]

Hi Molly Muffin,
Ok, my vet just called me.......
It was the receptionist who told me today that my vet said to start him on the Vetoryl despite the other problems. My vet, who I just spoke with on the phone said she agrees, Winston should NOT start Vetoryl until the GI upset is treated successfully.
I did ask her just now on the phone about possible pancreas problems, she said no, on the ultrasound he had his pancreas was normal; no problems there. He's currently on Metronidazole, and been eating white rice (boiled) and steamed chicken breast.
No, he wasn't tested while he was throwing up or having diarrhea, those problems appeared about a week after the test.
The 'range for the test'....LDDS test....that you mentioned;....I think this is what you're referring to......I've typed it out below (verbatim). Sorry it's so long, and I really don't know if it's even what you're asking me about.....?

"Low-dose dexamethasone suppression test:
Normal: Cortisol level less than 40 mol/L 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 40 mol/L 8hrs post-dex.

If the 8hr post dex. cortisol level is greater than 40 mol/L, the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) fro an adrenal tumor:
1. Cortisol level less than 40 nmol/L post-box is consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8 hours post-box is consistent with PDH. (Samples taken at 2 or 6hrs are interpreted the same way as a 4hr sample)

If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tutor Cushings.

High-dose dexamethasone suppression test: Use this test after hyperadrenocorticism has been diagnosed.
PDH or AT: Cortisol level suppressed by less than 50% 8hrs post-box.
PDH ONLY: Cortisol level suppressed by >50% 8hrs post-box."

[Bonnie0420]

Just to interject but listen to these ladies and gents, you have found and incredible site and trust me when I say they will be with you EVERY step of the way. I'm so sorry about Winston but trust your gut and keep posting..hugs to you and Winston

[my_winston]

Thanks Bonnie!
hugs right back to you :)

[labblab]

How is Winston doing today? Has your vet given you a gameplan for the next step if he doesn't quickly improve?

There are a couple of things that are still bothering me. I find it very disturbing that the receptionist was giving you medical instruction that was contrary to the vet's. How did your vet explain that mistake, and did she act as though it was a serious issue that she would look into? In the future, I would not accept any instructions that don't come directly from the vet. But overall, it raises some red flags re: proper office management.

Secondly, I am not at all an expert on pancreatitis, but I'm not certain that you can rely solely on an ultrasound to rule out any related issues. I also don't think you can rely on whether or not there are elevations in the pancreatic enzymes that are included in standard blood chemistry panels. That's why the development of this canine-specific blood test that I mentioned above has been such a helpful breakthrough. From my experience with my own dog, I know that a dog's general blood panel can look totally normal even in the face of pancreatitis. My dog was only able to be diagnosed through that special test.

Apparently your vet does not think the pancreas is involved, but if Winston does not normalize pretty quickly and no other cause can be identified, I believe I might lean on the vet to consider running that blood test, anyway. In reality, the treatment might be the same, regardless (multiple small meals of bland food and metronidazole). But having knowledge as to whether or not pancreatitis is involved might affect future treatment and/or dietary decisions.

Marianne

[my_winston]

Hi Marianne,
Thank you for your message :)
Winston is extremely lethargic today.....although he did have a energy spurt and wanted to play about an hour ago. It lasted about 10 minutes, then he was panting and needed to lie down. I took him for a short walk today, just around our back yard. We went at his pace; very slow. By the time we were done (about 5-7 minutes) he wanted to come back inside to recuperate. I've spent much of today just sitting with him, talking to him and petting him :)

Thankfully, he has not vomited or had diarrhea at all today (hasn't pooped at all actually). He's still on Metronidazole 1.3ml every 12 hours.....maybe it's finally starting to work/clear up......?
I find it disturbing too that I was given incorrect info yesterday by the receptionist. I was just so thankful to actually speak to the vet on the phone last night that I didn't think to tell her what had happened earlier in the day. I will talk to her about it though for sure. I'll be speaking with her again on Friday; she (the vet) said she was going to call again Friday to see how Winston's doing. He's to continue on the Metronidazole until next week. Then he'll be seen by her again early next week to try another medication if this still isn't working. I hate to speak too soon, but I'm hoping that because today there was no diarrhea that it's clearing up. I'm feeding him freshly steamed chicken breast with a small amount of boiled white rice mixed in. Today I started to introduce a small amount of canned food as well.......

The pancreas issue.......I don't know how my vet is sure that he's not having troubles with that as well. There have been so many tests lately, that might have been one of them. My head is just spinning not only with trying to accept that he has Cushing's, but there's so much information on the web and just about everyone has had different experiences with different treatments.......it's all really overwhelming.

I agree with you 100%, if Winston isn't much better 'normalized' very very soon.......by next week; I will be making sure more testing is done. This is getting ridiculous, something needs to be done, and quickly.

I've been trying to find out more info about 'Lignons' & 'flax seed hulls' and 'melatonin'. When ever I research Cushings I keep seeing these being recommended for dogs with this disease. But like I said, it's all very overwhelming and confusing right now.

I'm very happy I found this forum. My vet actually gave me the name of a website, and I followed a link........and voila! Here I am :)
Everyone is very caring, compassionate and thoughtful.......I am appreciative of that and to have this place to go to....thank you.

Winston is a Yorkie, and I have one of his brothers too. Same parents, different litter. I made an appointment today for Jaxon (Winston's brother) to be tested for Cushings. Jaxon is 5 years old and over the past 2 months or so his appetite and thirst have at least doubled if not tripped in intensity. I have since learned (the hard way) that these could be symptoms of Cushings. Jaxon is being tested next Thursday......I have my fingers crossed, toes crossed, everything crossed......that his test results will be negative.

Anyway, now that I've written you such a long message.....(sorry) I'm going to go sit with "my guys"......
to be continued :)

[labblab]

Only enough time to add a quick note to tell you I'm so relieved that Winston's diarrhea is improved! Just a caution, too, to perhaps not be too hasty about adding in the canned food. It may be best to stick solely with the chicken and rice for at least a couple more days so as to give the GI irritation some more time to thoroughly heal after such a long bout.

Marianne

[Squirt's Mom]

I'm with Marianne on the canned food, honey. Stick with the chicken and rice only until he is much, much better. If this is pancreatitis the fats in that canned food could make it much worse. ;)

[my_winston]

Thank you Marianne and 'Squirt's Mom' :)
Great advice, I have removed the canned and gone back to chicken and rice. The last thing I want to start the stomach upset again! So far so good.....no diarrhea or vommiting at all yesterday or so far today. He's not pooping at all actually.....how many days should go by before I start to wonder if he's constipated?
Again, thanks for all the terrific advice.....you guys are awesome. So glad I found this forum.

[labblab]

There's a lot less fiber/bulk to chicken and white rice than there is in regular commercial food. One of my girls has recurrent bouts of diarrhea and whenever I put her solely on chicken and rice, I notice her poops are much less frequent and smaller in volume. So I wouldn't worry yet. Winston is probably so cleaned out from the diarrhea that it may take a while before he generates much volume of poop again!

Marianne

[my_winston]

Thanks Marianne,
I took the advice and removed the canned (I gave him about 1/2 teaspoon in total before I removed it all together). He finally pooped this morning......still really really soft.
The vet is calling me again today to see how he's doing. If I haven't heard by noon I'll call her. This has gone on too long (in my opinion). Something else needs to be tried.
He's very lethargic over the past few days. He has been sleeping SO much, and even though he's still eating the chicken and rice I give him; he's not 'excited' to get his food like he was even 2 weeks ago. He eats it, but the gulping it down like he's starving has disappeared. Being new to Cushing's.......I don't know what this means......? Up until about 2 (maybe 3) weeks ago, every day I could set a watch by how at meal time he would sit by the spot where I prepare his food and cry. I could always tell that his stomach knew it was 'meal time'. That has stopped all together. He just sleeps, and when he sees me getting his food, then he gets up and waits patiently for it.......my gut feeling is that this is NOT a good sign.
He does still have very short (about 5-10 minutes) periods during the day or evening where he wants to play, but that only happens about once a day.
I'll post again later, after I've talked to the vet. I'm going to make sure she tries a different approach to this GI upset, this has gone on FAR too long.
To be continued............

[my_winston]

well.......back to the vet tomorrow morning. A week and a half of GI upset is too long for any dog. Especially a "Cush pup".......and we can't even start the Vetoryl until this other problem has been completely cleared up. He's lethargic, loosing some of his 'excitement' he always had for food. And I feel like this isn't being taken seriously enough.........starting to get angry. Time for a different vet office.......? Or am I over-reacting?

[My sweet Ginger]

Hi, I'm putting this out there as an option for you to discuss with your vet. It's only from one person's (or pup's) experience but I'd like to as it's made a profound difference in my pup GI system.

My pup had developed occasional IBD or colitis last year which I still don't know exactly which one and by early this year they kept coming back after each metronidazole treatment. I started adding plain yogurt in her mush which I make for probiotics. It sort of worked for a while tho her poops were still soft but better nonetheless. And then loose and mucousy, bloody end often times again. She was put on Proviable capsule for a few wks with no better results.

She then was put on Tylan powder about a month ago or so and by then I wasn't expecting any positive results. Soon after her poops were getting formed for the first time in the longest time and hardly no more straining. :eek: She used to strain for minutes and minutes and leaves many small very loose stools all over. She still does her business maybe more often than I'd like her to but they now have nice shapes to them and I hardly hear anymore grumbly noises from her gut which was constant before Tylan powder.
I don't really know if this powder will work for your Winston too or not but maybe worth to give it a try if none has worked so far.
My pup's dosage is 1/8 tsp (she weighs under 9 lbs) but she gets probably 1/16 tsp each morning (my choice ;)) and she will be on it indefinitely. She was getting 1/16 tsp BID in the beginning but SID has been working ok too. I hope this helps. Song.

My advice if you decide to try this powder, would be not to mix the powder in any of his food or treat as it's known to have such a bitter taste no dog will go near. I empty capsules that she no longer uses and put her does in them along with her other meds as there's still room. You can get gelatin capsules on line too.

[molly muffin]

That's a definitely possibility that the tylan powder might help. Didn't think of it even.

[my_winston]

Thank you "My Sweet Ginger" and Sharlene,
I'll look for that today......never heard of it so should I be looking in a 'health' food store? Or is this something I get online?
Again, thank you for the info!

[labblab]

I don't think you need a prescription for it and yes, you can buy it online. But I think you need to first talk it over with your vet because it is a form of antibiotic and it may or may not be compatible with other medications she wishes to give Winston.

I was anxious to try it with my Peg, but discovered that it is in a class of antiobiotic that is not recommended for use alongside phenobarbital (Peg has seizures in addition to GI issues). Tylan has worked well for many people, but you do need to let the vet know if you want to try it.

Marianne

[my_winston]

Thanks Marianne. Much appreciated:)

Sorry.....one more question.....HMR Lignans and melatonin....I'm going to try to find these today, any idea how much is a safe amount to give Winston? He's 28 pounds. Not sure if I should be starting this while he's still being treated for the GI upset, but I'd like to find these products and have them here on hand for when he's good to start the Vetoryl. The melatonin, I'm pretty sure I could find at any health food store; but don't know about the HMR Lignans.

[My sweet Ginger]

I don't really know whether you can get Tylan powder online as our neurologist prescribed it for my pup's colitis/IBDs but either way you should always consult with your vet whether a prescription is needed or not. My pup also is on Keppra for her seizures so do talk to your vet and go with the best possible option for you and Winston.

[judymaggie]

Hi! I was just on Amazon getting Abbie's probiotics and checked to see if they have Tylan powder. They do. Definitely agree that you need to discuss with your vet before you add it to Winston's regimen.

I looked back through your thread to see if Winston has had testing by UTenn to ascertain if other hormones are elevated and I don't see that he has had this testing. If they are, then they would most likely recommend treatment with lignans and melatonin. If cortisol is also elevated, then this would be in addition to Vetoryl or Lysodren. If Winston's only elevated hormone is cortisol, then the lignans and melatonin would not typically be recommended by UTenn.

I also noted in your very first post that the ultrasound showed "normal" adrenal glands. This seems inconsistent with Winston's diagnosis. Hopefully, our in-house experts could address this.

I also don't see any posting of Winston's lab tests (other than specific Cushing's tests) that have been done prior to diagnosis and since that time. It would really help everyone here to see what the results are -- you need only post the highs and lows (along with the range for each test). Hopefully, a urinalysis has been done and those results can help as well.

[labblab]

My thanks to you, Judy, for touching on these questions. As far as adrenal glands that are of normal size, there is a certain percentage of dogs with pituitary Cushing's that do not exhibit enlarged adrenals, especially early in the disease process. So it is more common for dogs with PDH to have bilaterally enlarged adrenals, but not necessarily so.

I also am wondering about the melatonin and lignans. As Judy says, typically that treatment is recommended for symptomatic dogs when cortisol levels are normal but other adrenal hormones are elevated (as she says, confirmed via specialized testing). If cortisol is elevated, typically the treatment of choice is either trilostane or Lysodren alone. The primary treatment goal in that situation is lowering the cortisol, regardless of the potential presence of other adrenal elevations. In truth, virtually all dogs with elevated cortisol will also exhibit elevations in other adrenal hormones as well.

I don't know that you have anything to lose by giving Winston melatonin and lignans, but I also don't know that you have a lot to gain. If you do decide to give those supplements, I would wait and not start giving them at the same time as beginning the trilostane. You do not want to introduce any other new variables at that same time. If Winston has an ill effect, you don't want to be wondering as to the source -- is it the trilo, or is it a supplement? That is the same reason why you want him stabilized re: his diet and GI function before starting the drug.

Marianne

[my_winston]

Wow, ok........it sounds like my vet might be missing doing some testing on Winston.......I don't know anything about him having had a urinalysis test or any test for that matter other than the actual Cushing's test and the ultra sound.

Are there specific names for these tests? I'm thinking I should tell my vet I want these tests performed.........
Of course the number 1 problem to be cleared up right now is the GI upset, because nothing else can be addressed until that's gone. This is taking too long......am I being impatient? It's been almost 2 weeks....

After reading many of the posts, I'm beginning to wonder & seriously question how thorough Winston is being looked after (medically, buy the vet) Im thinking lots of things are just not being done, that should have been looked after weeks ago (if not months).

We did have a vet appointment for this morning, but it was not with our usual vet. So, it got moved to Tuesday and I'm definitely going to ask for these tests. If anyone knows the name(s) of the test(s) so I can tell my vet what I specifically want done I would be SO appreciative. Thank you to everyone giving me advice, help, input etc. here in this forum........thank you SO much. I wouldn't know about any of these things you've all mentioned had it not been for you guys! You are wonderful people

[labblab]

I'm betting your vet actually has performed the tests we are talking about because they are standard tests, but perhaps she just hasn't discussed the results with you in detail. Cushpups typically exhibit certain abnormalities on basic lab tests, so that's what we are curious about.

The standard blood panels include "Chem" or chemistry panels and "CBC" panels. A chemistry panel includes values related to possible abnormalities in organs such as the kidneys, liver, and pancreas. It also includes readings for glucose (to rule out diabetes) and also basic thyroid function. In addition, it includes levels for important chemicals in the bloodstream such as potassium, phosphorous, etc.

A "CBC," or complete blood count, tells the levels of various types of blood cells in the body, both red and white.

Among other things, a urinalysis supplies information re: the specific gravity of the urine; we would expect it to be dilute when a dog is drinking and peeing excessively. It can also indicate whether an infection is present. This can be helpful to know since urinary tract infections, by themselves, can cause excessive thirst and urination.

As I say, I'll bet your vet performed this testing around the same time as the diagnostic Cushing's test, if not before. What we would be interested in knowing is whether any of Winston's lab values on these tests were abnormal. As I say, there are some common abnormalities displayed by dogs with Cushing's.

When you go in to see the vet on Tuesday, I'd encourage you to ask for copies of all the laboratory tests that have been run on Winston in conjunction with the Cushing's diagnostic process.

Marianne