New to Cushings - Maggie has passed

[MaggieLassel]

We just found out our dog Maggie has Cushings. She had been living with it for a few years before be diagnosed. the side effect of the medications scared me. I have been researching and found that a no grain and raw diets are best for this condition. Any feedback would be great appreciated or recommend books to read. We haven't started any treatment yet but are introducing raw food in her diet slowly.
Question are 'to treat or not to treat' and 'quality of life'. Her symptoms are overweight (pot belly), blackheads, begging, liver levels slightly up and occasional panting. We had put her on an en-gastro dry food this summer. We also mix wet food with the dry.
thanks for reading. Any advice?

[labblab]

YAY! You found us and have started Maggie's thread for us. :)

I apologize that I haven't time to post more right now, but I just wanted to tell you that I've moved your thread here to our main "Questions and Discussion" forum where the most folks will see you.

I will definitely come back, myself, later on in order to add some thoughts and suggestions.

Welcome!
Marianne

[MaggieLassel]

thanks. still not sure how to find my way around the site.

[Harley PoMMom]

Hi and welcome to you and Maggie!

I'm so glad you found your way here although I'm sorry for the circumstances that brought you to us.

It would help us greatly if you could tell us more about Maggie and her medical history, in this way we can provide you with our best possible feedback, and the way we get this information is with a lot of questions, so here goes some of mine :eek::)

Could you round up all copies of the testing that was done to diagnose Maggie and post the results here. With respect to the blood chemistry and CBC, you need only post the highs and lows and please include the normal reference ranges. Was an urinalysis done, and if so, could you post those findings too? Were other non-adrenal diseases ruled out? Was Maggie diagnosed with the adrenal or pituitary type of Cushing's? Does Maggie have a ravenous appetite, and/or has her drinking/urinating increased? Is she taking any other herbs/supplements/medications?

The two medications that are usually prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane. These are strong drugs and both have some pretty scary side effects, however, adverse effects are usually not seen unless the proper treatment protocols are not followed. We have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success. The key to facilitating safe and effective treatment is an experienced vet and an educated pet owner, so the best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. With treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span.

Concerning the diet, there really isn't a "set" diet for a cushdog, it should be tailored to that individual dog's needs. However, because of the effects of excess steroid on protein and fat metabolism, a good quality, moderate to high protein, low fat diet is recommended.

I'm including some links to info regarding Cushing's: http://www.k9cushings.com/forum/showthread.php?t=180

http://www.k9cushings.com/forum/forumdisplay.php?f=10

We understand that you are fearful but we will help you and your dear furbaby in any way we can, we will walk this journey with you, ok? ;)

Hugs, Lori

[mytil]

Just wanted to shout out a welcome to you as well.

I agree, when you get the chance post the results of any tests performed here. You mentioned the liver values are slightly up --- let us know the numbers too.

Other symptoms that is prevalent in a cushpup is excessive drinking and peeing. Is your Maggie exhibiting these as well?

Cushing's can be a difficult condition to diagnose as a lot of the symptoms mimic other conditions such as thyroid imbalances and diabetes.

Keep us posted
Terry

[labblab]

OK, I've finally made it back here again, and am pleased to see that Lori and Terry have already gotten you off to a great start! I only have a couple of additional thoughts to add right now.

As far as diet, I agree with Lori that we have not discovered that any particular category of food -- raw, homecooked, commercial, grainfree, grain-containing -- carries any special advantage in terms of being beneficial for Cushpups, per se. We have many dogs here who do well, regardless of the type of food they are being fed. So as Lori said, I would tailor Maggie's food choices to whatever seems to work best for her, individually.

I am not a raw feeder myself, so I cannot give you specific brand suggestions for commercially prepared raw foods. If I fed raw, though, I would definitely select a commercial product rather than feeding meat/poultry straight out of a human grocery store. This is because raw commercial dogfoods usually are treated in some manner so as to minimize the risk of microbial contamination.

Also, if you are shifting to a high-protein option, the only other caution I would offer is to first make sure, through urinalysis, that Maggie is not losing significant protein through her kidneys. Cushing's can affect the kidneys in a manner that allows this abnormal protein loss to take place. Not every Cushpup is affected, but if it is taking place for Maggie, the recommendation is to not exceed a moderate level of protein in the diet. If severe enough, low protein is even recommended. So this is one diagnostic I would want to check on before moving to a high protein alternative.

Another reason why it would be good is because the test outcome might help you to decide whether or not to actively begin medicating Molly. Even clinicians who endorse waiting to start treatment if symptoms are otherwise mild will opt to prescribe medication if either high blood pressure or significant urinary protein loss is found. This is because these two Cushing's-related problems can cause major internal damage to the body over time if they remain out of control.

OK, I've blabbed enough and like the others, will be anxious to read more about Molly's testing.

Marianne

[MaggieLassel]

these are her test results. Haven't figured out how to attached a pdf to the messages. I do not have her cushings test results but will get them.

Her symptoms are begging lots, overweight pot belly, blackheads, not feeling well this summer when blood work was done...in pain but couldn't narrow it down. That's when we changed her food to en-gastro prescription dry food. She is drinking more but no sign of more urination or loss of control. No house accidents.


Test Results Reference Interval LOW NORMAL HIGH
RBC 7.58 x10^12/L 5.65 - 8.87
HCT 47.8 % 37.3 - 61.7
HGB 16.6 g/dL 13.1 - 20.5
MCV 63.1 fL 61.6 - 73.5
MCH 21.9 pg 21.2 - 25.9
MCHC 34.7 g/dL 32.0 - 37.9
RDW 19.7 % 13.6 - 21.7
%RETIC 1.4 %
RETIC 109.2 K/μL 10.0 - 110.0
WBC 12.38 x10^9/L 5.05 - 16.76
%NEU 69.5 %
%LYM 22.6 %
%MONO 4.1 %
%EOS 3.1 %
%BASO 0.7 %
NEU 8.60 x10^9/L 2.95 - 11.64
LYM 2.80 x10^9/L 1.05 - 5.10
MONO 0.51 x10^9/L 0.16 - 1.12
EOS 0.38 x10^9/L 0.06 - 1.23
BASO 0.09 x10^9/L 0.00 - 0.10
PLT 367 K/μL 148 - 484
MPV 12.3 fL 8.7 - 13.2
PDW 16.9 fL 9.1 - 19.4
PCT 0.45 % 0.14 - 0.46
ProCyte Dx (July 10, 2015 9:57 AM)
GLU 6.81 mmol/L 3.89 - 7.95
UREA 5.6 mmol/L 2.5 - 9.6
CREA 63 μmol/L 44 - 159
BUN/CREA 23
PHOS 1.50 mmol/L 0.81 - 2.20
CA 2.76 mmol/L 1.98 - 3.00
TP 76 g/L 52 - 82
ALB 39 g/L 22 - 39
GLOB 37 g/L 25 - 45
ALB/GLOB 1.1
ALT 140 U/L 10 - 125 HIGH
ALKP 155 U/L 23 - 212
GGT 3 U/L 0 - 7
TBIL 7 μmol/L 0 - 15
CHOL 7.45 mmol/L 2.84 - 8.26
AMYL 639 U/L 500 - 1500
LIPA 1370 U/L 200 - 1800
Na 156 mmol/L 144 - 160
K 3.9 mmol/L 3.5 - 5.8
Na/K 40
Cl 113 mmol/L 109 - 122
Osm Calc 310 mmol/kg
Catalyst Dx (July 10, 2015 9:53 AM)

[molly muffin]

Hi and welcome from me too.
Looks like the only abnormal results is:
ALT 140 U/L 10 - 125 HIGH

That is actually a good thing, that other things aren't high or low, but it does mean that there is a possibility that the liver is being affected by the higher cortisol levels, which is often what happens.

The medication while it is scary to read about, can be a real life saver for many dogs, so would discuss options with your vet. You could even try a low dose vetroyl (recommended to start at 1mg/1lb as safe starting spot) and see how she does.

[Harley PoMMom]

Her symptoms are begging lots, overweight pot belly, blackheads, not feeling well this summer when blood work was done...in pain but couldn't narrow it down. That's when we changed her food to en-gastro prescription dry food. She is drinking more but no sign of more urination or loss of control. No house accidents.


Test Results Reference Interval LOW NORMAL HIGH
RBC 7.58 x10^12/L 5.65 - 8.87
HCT 47.8 % 37.3 - 61.7
HGB 16.6 g/dL 13.1 - 20.5
MCV 63.1 fL 61.6 - 73.5
MCH 21.9 pg 21.2 - 25.9
MCHC 34.7 g/dL 32.0 - 37.9
RDW 19.7 % 13.6 - 21.7
%RETIC 1.4 %
RETIC 109.2 K/μL 10.0 - 110.0
WBC 12.38 x10^9/L 5.05 - 16.76
%NEU 69.5 %
%LYM 22.6 %
%MONO 4.1 %
%EOS 3.1 %
%BASO 0.7 %
NEU 8.60 x10^9/L 2.95 - 11.64
LYM 2.80 x10^9/L 1.05 - 5.10
MONO 0.51 x10^9/L 0.16 - 1.12
EOS 0.38 x10^9/L 0.06 - 1.23
BASO 0.09 x10^9/L 0.00 - 0.10
PLT 367 K/μL 148 - 484
MPV 12.3 fL 8.7 - 13.2
PDW 16.9 fL 9.1 - 19.4
PCT 0.45 % 0.14 - 0.46
ProCyte Dx (July 10, 2015 9:57 AM)

Dogs with Cushing's syndrome have what is called a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS).

Since I'm not seeing these specific blood anomalies in Maggie's CBC panel I am inclined to think that Cushing's isn't the correct diagnosis for her especially since it is believed that she has had Cushing's for a few years.


GLU 6.81 mmol/L 3.89 - 7.95
UREA 5.6 mmol/L 2.5 - 9.6
CREA 63 μmol/L 44 - 159
BUN/CREA 23
PHOS 1.50 mmol/L 0.81 - 2.20
CA 2.76 mmol/L 1.98 - 3.00
TP 76 g/L 52 - 82
ALB 39 g/L 22 - 39
GLOB 37 g/L 25 - 45
ALB/GLOB 1.1
ALT 140 U/L 10 - 125 HIGH
ALKP 155 U/L 23 - 212
GGT 3 U/L 0 - 7
TBIL 7 μmol/L 0 - 15
CHOL 7.45 mmol/L 2.84 - 8.26
AMYL 639 U/L 500 - 1500
LIPA 1370 U/L 200 - 1800
Na 156 mmol/L 144 - 160
K 3.9 mmol/L 3.5 - 5.8
Na/K 40
Cl 113 mmol/L 109 - 122
Osm Calc 310 mmol/kg
Catalyst Dx (July 10, 2015 9:53 AM)

Abnormalities generally seen on a chemistry panel in a dog with Cushing's are increased levels in cholesterol, triglycerides, a low BUN, a mild to severe increase in ALKP and usually there are only mild elevations in the ALT.

Again, I don't see these abnormal levels in Maggie's chemistry blood panel, which makes me question a diagnosis of Cushing's. With her ALT being the only liver enzyme that is high I really do think that there is something else going on, if this were me I would be more inclined in focusing on a liver issue, now, I'm no vet so this is strictly my layperson's opinion.

Hugs, Lori

[MaggieLassel]

Maggie's results = acth stim (cush selected) 815 nmol/L

ACTH Stim (Cushing's selected)
< 55 nmol/L - In the presence of supporting clinical signs, results are consistent with Addison's Disease
55 - 170 nmol/L - Inconclusive
170 - 470 nmol/L - Normal
470 - 600 nmol/L - Cushing's Syndrome possible
> 600 nmol/L - In the presence of supporting clinical signs, results are consistent with Cushing's Syndrome

Off to the vet tomorrow to discuss treatment. I also wanted to start on a lower dose and not the 60mg of Vetoryl. Thanks for everyone's input.

[molly muffin]

How much does Maggie weigh?

The starting dosage recommendation has recently been changed to 1mg/1lb for a starting point. I would stick to that for a good place to start and monitor the cortisol levels closely.

[MaggieLassel]

Maggie weighs 26 lbs and we have her started on 30mg Vetoryl the first of January. The vet and I decided to start with a lower dose for a longer period of time and retesting after 3 months instead of 1 month. I am trying to be the responsible owner and not break the bank at the same time. Still not sure if it is the right course of treatment. we'll see if there are any changes in the next month or two, then reassess the situation.

[labblab]

Hmmmmm...it seems as though you are thinking that because you are starting at an appropriate starting dose of medication, you don't have to perform initial monitoring testing? For safety's sake, that is absolutely not true and it worries me that your vet does not realize this. Starting a 26 pound dog on 30 mg. is not an unusually low dose. In fact, it exceeds the currently recommended starting formula of 1 mg. per pound by a little bit.

More importantly, the early monitoring testing is essential no matter what the starting dose is because every dog metabolizes the drug differently and adjustments early on are commonly required. The formal recommendation, regardless of dose, is to test first at the 10-14 day mark. As long as dogs are apparently doing well, I'm aware that some clinicians will defer the testing until the 30-day mark. But I'm truly unaware of any researcher or clinician who approves waiting any longer than that, regardless of starting dose. It simply is not safe, because monitoring blood testing may reveal excessive cortisol suppression prior to seeing the outward signs of an Addisonian crash. You do not want to wait until a crisis develops to find out that overdosing is occurring. I know the monitoring testing is expensive, but as we have sadly learned from experience here, hospitalization for overdosing costs a whole lot more.

For confirmation of these recommendations, please take a look at the links on our Trilostane FAQs thread:

http://www.k9cushings.com/forum/showthread.php?t=185

Especially since you are unsure whether this is the right course of treatment, you will want to make sure early on that Maggie is taking a therapeutic dose of the medication, both for the sake of safety and effectiveness.

Marianne

[MaggieLassel]

We lost Maggie this week. :(
She was a very sick dog. She had developed pancreatitis and diabetes. Her sugar levels were at 28 and the high range of normal was 8. I am not sure if it was the vetoryl or the cushings that made her. sick. Either way she is no longer in pain. She was diagnosed in December and on 60mg for almost two months.

[Joan2517]

Oh, I am so sorry...Lena was also diagnosed in December and on 30mg of Vetoryl and I am wondering too if it was the Vetoryl. My condolences to you and your family.

Joan

[budindian]

Welcome, I'm not an expert but the lower dose is the way to go. My vet started my baby at twice the dose for his weight and he had a very bad reaction, I didn't think he would make it thru the night.
The good news is I found this forum and they armed me with all the information I needed to talk with my vet. I always trusted the info here more so sometimes than the vet. Good luck to you and your baby.

[Harley PoMMom]

I am so terribly sorry for your loss of dear Maggie and my heart goes out to you at this most difficult time. Please know that we understand the pain you are feeling and are here for you always.

With Heartfelt Sympathy, Lori

[budindian]

I am so sorry, I lost my baby February 23, My thoughts and prayers are with you and your family.

[DoxieMama]

I am so sorry to hear of the loss of your sweet girl. There are no words to ease the pain, but we are here to support you as best we can during this time.

Run free, dear Maggie.

Hugs,
Shana

[Joan2517]

Afterlife & A Loss For Words
A sweet little poem and picture I saw on Facebook. For those who may have lost a pet.

Afterlife & A Loss For Words

I stood by your bed last night, I came to have a peep.
I could see that you were crying...you found it hard to sleep.

I whined to you softly as you brushed away a tear.
"It's me, I haven't left you...I'm well, I'm fine, I'm here."

I was close to you at breakfast, I watched you pour the tea.
You were thinking of the many times, your hands reached down to me.

I was with you at the shops today, your arms were getting sore.
I longed to take your parcels, I wish I could do more.

I was with you at my grave today, you tend it with such care.
I want to reassure you that I am not lying there.

I walked with you toward the house, as you fumbled for your key,
I gently put my paw on you. I smiled and said, "It's me."

You looked so very tired, and sank into a chair.
I tried so hard to let you know that I was standing there.

It's possible for me to be so near you every day.
To say to you with certainty, "I never went away."

You sat there very quietly, then smiled, I think you knew...
In the stillness of that evening, I was very close to you.

The day is over...I smile and watch you yawning
And say, "Goodnight, God bless, I'll see you in the morning."

And when the time is right for you to cross the brief divide,
I'll rush across to greet you and we will stand, side-by-side.

I have so many things to show you, there is so much for you to see.
Be patient, live your journey out...then come home to be with me.

-Author Unknown


This is beautiful to me and what I hope will be.....

[Tammysmom]

So very sorry for the loss of your Maggie. She will live forever in your heart. Thoughts and prayers. Brianna

[Allison]

Belated condolences to you on your loss of Maggie. Our adopted senior dog died last year. He had Cushings but other ailments too and we believed he died battling pancreatisis. These are not easy diseases to handle. Hugs to you!