This is Winnie

[WinnieFolk]

So happy to have found this forum. This is Winnie, a rescued Weimaraner who was diagnosed with Cushings just this fall. So far all of her symptom have been well controlled with Trilostane at a 60mg dosage. She has her next test next week to see if this is an appropriate level.

[lulusmom]

Hi and welcome to the forum.

Congratulation on successfully getting your Winnie's cortisol under control. That isn't always an easy thing to do. Did you start with 60 mg or did you have to do some adjustments? Can you tell us which symptoms she had that lead you and your vet to test for cushing's? Sorry for the questions but we don't see many Weimaraners with cushing's so I'm nosier than usual. :D I'll be looking forward to hearing about the upcoming acth stimulation test.

Glynda

[WinnieFolk]

Winnie's symptoms began as you might see with a UTI. A little incontinence, thirsty,. After about two weeks we took a urine sample to the vet who ran it and determined no UTI but bun creatinine ratio out of whack. Sorry I don't have the numbers.

He put her on a low protein diet and Enalapril. After a couple of weeks, retested and showed improvement in BC but physical symptoms still present. Upped the Enalapril and after two more weeks no improvement in numbers and physical symptoms worse.

Went to the Low Dose dexamethasone suppression test and it indicated Cushings. Again, can't quote the numbers but according to the prescribing info, they indicated 1mg per pound. As my vet is conservative, we went for the lower dose 60mg as indicated by her 80 pound weight vs. 90mg.

Physical symptoms improved almost immediately. BC numbers also improved but are still high. We checked her blood pressure and it is high as well so she is now taking the Trilostane and the Enalapril which requires monitoring her potassium levels as well.

Our family has seen this disease before. We just lost my daughters beagle about a month ago to Cushings

[Harley PoMMom]

Hi and a belated welcome to you and Winnie from me as well!


Winnie's symptoms began as you might see with a UTI. A little incontinence, thirsty,. After about two weeks we took a urine sample to the vet who ran it and determined no UTI but bun creatinine ratio out of whack. Sorry I don't have the numbers....

Physical symptoms improved almost immediately. BC numbers also improved but are still high. We checked her blood pressure and it is high as well so she is now taking the Trilostane and the Enalapril which requires monitoring her potassium levels as well.


The bun creatinine ratio test you referred to, which I bolded, is not something I am familiar with. There is a screening test for Cushing's called the urine cortisol-to-creatinine ratio (UC:CR) test. Could the UC:CR ratio test be the one you are referring to? If it is, the UC:CR is not used as a monitoring test for Cushing's, the test that is performed to monitor treatment for Cushing's is the ACTH stimulation test. Is Winnie being monitored with the ACTH stimulation test, and is the test performed 4-6 hours after her Trilostane is given with food? Also could you get copies of those ACTH stim tests and post those results for us?


He put her on a low protein diet and Enalapril. After a couple of weeks, retested and showed improvement in BC but physical symptoms still present. Upped the Enalapril and after two more weeks no improvement in numbers and physical symptoms worse.

Initially why was Winne put on a low protein diet and Enalapril, was protein loss discovered at that time? And could you tell us what symptoms got worse for which the Enalapril dosage was increased?


Went to the Low Dose dexamethasone suppression test and it indicated Cushings. Again, can't quote the numbers but according to the prescribing info, they indicated 1mg per pound. As my vet is conservative, we went for the lower dose 60mg as indicated by her 80 pound weight vs. 90mg.

We are really interested in seeing those LDDS test results so if you could get those numbers and post them here that would be great. And yep, starting Trilostane at 1 mg per pound of a dog's weight is recommended so I am glad that Winnie was initially started at 60 mg for her weight of 80 lbs.



Our family has seen this disease before. We just lost my daughters beagle about a month ago to Cushings

I am so sorry for the loss of your daughter's beagle, my heart goes out to you and your daughter at this painful time.

Hugs, Lori

[WinnieFolk]

Let me try as best as I can to answer your questions.

Bun creatinine is a urine test when kidney disease is suspected and is not a test for Cushings. As I understand it, defective kidneys leak protein. The higher the blood pressure and the more protein leakage, the harder the kidneys need to work. Before the Cushings diagnosis, the low protein diet and Enalipril were prescribed to reduce the stress on the kidneys and while it has given some improvement, the BC numbers are still high.

In September the BC Ratio was 3.0 In November 3.9 Normal is less than .5 so it is going the wrong way. Last week it was 3.2 which suggests the Enalapril is having some impact but not enough and she is maxed out it.

I believe the test on Monday is the ACTH which is a test she had before, I think about 3 months ago. Again, as I understand it (there is so much I don't understand so I use that phrase a lot), it is used in part to measure the progression of the disease and the effectiveness of the Trilostane dose.

[judymaggie]

Hi and welcome to you and Winnie! First, I am so sorry to learn about the passing of your daughter's beagle. My Abbie is my second beagle with Cushing's and it is, unfortunately, very prevalent among beagles.

I believe that the "bun creatinine test" that you are referring to is known more commonly to us here as the "UPC" or "urine protein creatinine" test. My Abbie and Sharlene's Molly ("Molly's Mom") are two Cushing pups here who are currently having difficulty controlling the proteinuria (measured by the UPC) and high blood pressure. My Abbie is currently being treated with amlodipine and telmisartan. The last UPC level was 5.4. My vet and I would be thrilled with a 3.2 level but it is all relative. Abbie's blood pressure is still fluctuating -- we are on an every six week check and will next get it checked Tuesday. All of Abbie's other Cushing's symptoms are under control so it is frustrating not to be able to do the same with the kidney issues.

There are quite a few studies available to your vet with regard to adding a second medication if the enalapril does not continue to bring down the UPC level. We have recently added omega-3 fish oil which has shown good results with stabilizing kidney issues so that is something that you may want to consider. FYI, my vet consults with Abbie's internal medicine specialist with regard to the proteinuria and high blood pressure.

Looking forward to learning more about Winnie!

[labblab]

Hi Guys, perhaps Winnie's parent is referring to the BUN/Creatinine Ratio, but this refers to a value on a blood chemistry panel rather than a urine test. It is simply a ratio of the individual BUN and Creatinine results, and if is unbalanced it can signal kidney dysfunction. Here's an explanation from Wikipedia:

https://en.m.wikipedia.org/wiki/BUN-to-creatinine_ratio

However, this value is not a direct test of protein loss. So if protein loss is Winnie's issue, then I'm betting Judy is right re: the test being the UPC (and Winnie's stated values do indeed correspond with a UPC as opposed to a BUN/Creatinine Ratio).

Either way, I am assuming that Winnie's vets are assuming that Cushing's, as an underlying disease, may be causing some kidney damage.

Marianne

[WinnieFolk]

Thanks to all for your interest in Winnie and her situation.

This article regarding the canine test is what we are doing definitely relative to protein loss.

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/urine-protein-creatinine-ratios/442

I think we are referring to the same test, just perhaps a different name here. The vet referred to it as BUN Creatinine, hence my usage of the term.

[labblab]

OK, so Judy is correct and it is indeed the UPC (Urine Protein:Creatinine Ratio). Unfortunately, your vet is going to confuse folks by labelling it as a BUN Creatinine Ratio, because truly, that is an altogether different measurement. But now we're all on the same page here, so thanks very much for clarifying!

Marianne

[mytil]

Hi and welcome from me too. Well, it looks like the others have started things off for you.

I just have a few thing to mention.....

Are you still administering enalapril in conjunction with the Trilostane? It is an ACE inhibitor and should be given with loads of caution. Both meds can be pretty hard on the kidneys.

Keep us posted
Terry

[labblab]

Yes, I believe the biggest worry about combining trilostane and ace inhibitors is that they both have the potential to lower aldosterone and thereby increase potassium levels. But I believe you mentioned above that your vet is indeed keeping a sharp eye on potassium for this reason, and I assume Winnie's level is OK thus far?

Marianne

[WinnieFolk]

Yes...and thank you for the concern. We are aware of the precaution regarding the ACE inhibitor but her internist believes the benefits outweigh the risk and assesses that risk as low due to her low dose of Trilostane relative to her weight

[mytil]

Thanks so much for the update. I just wanted to cover the bases :)

Continue to keep us posted
Terry

[WinnieFolk]

Thanks for all the interest in Winnie.

I have Winnie's ACHT results Her pre value is 2.9 and her post value is 2.1. The consensus is to reduce her Trilostane from 60 to 30, monitor for symptoms and retest in 30 days.

Regarding Enalapril, we are reducing her dosage of that in that her potassium levels are creeping up and adding Amlodipine in an effort to lower her blood pressure and reduce her protein leakage.

[molly muffin]

My dog too is on trilostane, benazepril (same as enalapril) and amoldipine and so far doing okay on that combination. We've been on it for just over a year now.

[WinnieFolk]

Thanks for the note. I'm pretty confident in the team that is working on her but thanks for the validation.

[molly muffin]

Just checking in to see how Winnie is doing.

[WinnieFolk]

Thanks so much for checking. Winnie's physiologic systems continue to be normal. Her blood pressure today was within 10 pts of the mean average. We increased the Amlodipine by 1.75 mg and believe that will have her pressure under control.

[molly muffin]

That is great news. We have had to adjust my Molly's amoldipine too T times and think we have her bp stable. Crossed fingers. Really good to hear she is doing better. We have also had to increase the benazepril a couple times. Both due to UPC and potassium levels creeping up.

I think regular monitoring is the key to dogs with all of the issues like our two. I usually test now every few months those 3 items and do CBC every 6 months. Just to keep on top of any potential areas of concern.

[WinnieFolk]

Seems like testing is key to being aggressive with the management of this. Rechecking blood pressure in two weeks and UPC end of February.

Thanks for the note.

[Harley PoMMom]

Yep, monitoring that BP is important. I found with my boy Harley that his BP would fluctuate depending on which leg was used, I think that his right front leg was the one that he felt most comfortable with when taking his BP.

Hugs, Lori