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anitafrnhamer
12-27-2015, 02:26 PM
Thor is my 10.5 year old Husky who was just diagnosed with Cushing's. I don't really know where to start but this will be a long intro.

I have had Thor since he was 10 weeks old. He has always had issues with diarrhea. I had controlled it fairly well with food as no vet I took him to could explain to me why he had frequent diarrhea.

Six years ago, he began having bloody/mucousy stool. I took him to the vet on a Monday and he was put on Flagyl. The following Monday I took him for a follow up; at that time I was told he had inflammatory colitis. Friday of that same week he began vomiting so back to the vet we go. He was given Reglan and the diagnosis was changed to IBD (there was no testing to confirm this). So I was given Rx food and brought him home; 8 hours later when the Reglan had run through his system he began vomiting again. Saturday morning I received a call from the first vet who had seen him (it was a multi-vet practice) and she told me he didn't have IBD but he did have Addison's. I took him back in for the third time in a week and he was put on Pred and told he would need the ACTH test in two weeks. Needless to say, the Pred stopped the diarrhea and vomiting. He had a slight reaction to the test, so the vet insisted he had Addison's. The problem about this diagnosis that bother me was that Thor had become anorexic. He wouldn't eat much. After a month on Pred, despite eating a little every 36 hours, he went from 47 lbs to 69. I finally took him to an IM and to make a long story short, he didn't have Addison's, instead he had a stomach full of pillow stuffing. Surgery was done and all issues except the frequent loose stool, mucus covered stool, and periodic diarrhea disappeared. The only obvious left over issue other than stool problems was the weight gain from the 6 weeks on Pred. Trying for 4 years I could only get him down to 64 pounds.

In 2013 I found a mass on his abdomen. I took him back to the IM who had done the surgery after being mis-diagnosed with Addison's (2009). Luckily it was just a Lipoma and not cancer.

2014, right about time for his annual exam, I noticed his eye was very red and he would rub it on my hand. During the exam, it was discovered he had a stye on the inside of his eyelid. He was given Neo Poly Dex drops. After a couple of months when the stye had not healed it was removed surgically (11 Mar 2014). By August 2014 the redness and irritation was still present so I took Thor to an Opthomologist. He was diagnosed with Episcleritis. Prescriptions were: Pred Acetate and Tacrilimous drops. By late Dec 2014 his liver enzymes had begun to creep up. When I took him for his opthomology recheck in Jan 2015, I asked if the Pred Acetate drops could be the cause and was told it was most likely the cause and the Pred drops were discontinued. By late Jan 2015, the gen vet had decided to begin supplements to bring the liver enzymes down. They were: Standard Process Hepatrophin PMG and Cataplex G, two tablets twice a day. Recheck in June 2015, Standard Process A-F Betafood supplements were added to the routine, 2 tablets twice a day. Recheck July 2015, the ALK Phos was 1030 so Betacol capsules were added to the other supplements, 2 capsules twice a day. The dosage on the other supplements was increased to 3 tablets of each, twice a day. A semi-home cooked diets was also implemented consisting of: 1 oz of kale, 2 oz carrots, 4 oz of an alternate protein source (tuna, eggs, salmon, beef---rotating every week) and 1 cup of kibble. Recheck in Aug, ALK Phos had dropped to 420 and Thor had lost 10 pounds, from 65 down to 55; the protein in his diet was increased to 6 oz. His las check up and the ALK Phos was going up again. He had also dropped another 3 pounds. The only change made was to increase the protein in his diet from 6 oz to 9 oz. The topic of Cushing's was introduced and an LDDST was scheduled.

18 Dec, the LDDST was done. The results were “inconclusive”. Baseline was 5.9, @4 hrs 4.3, @8 hrs 1.5. When those results came in, the vet advised an ACTH.

22 Dec ACTH results: Baseline 4.2, @ 1 hr 32. No that isn't a typo it went to 32 in an hour. So-------we have Cushing's.

Thor will be starting Lysodren either 4 Jan or 5 Jan.

Now, before I say anything more, I need to say that I am already dealing with a critically ill cat. My cat was nearly killed by our previous vet who overused steroids, and then was dishonest with me about what was becoming a major health crisis. So, my cat ended up with, diabetes, heart damage, pancreatitis and ultimately kidney failure. The extreme level of care and cost of prescriptions are very high just for my cat.

What am I looking at for treating Thor's Cushings? What do I expect? What do I watch for?

I just wanted to add, Thor was not showing any of the sypmptoms of Cushing's. The only clue was the rising ALK Phos. He did seem to be urinating more heavily than normal at night but his water consumption did not increase appreciably. He was losing weight due to the diet not gaining. He is a Husky so they do pant quite a bit and he does normally shed year round.

I am looking forward to all the input and advice I can get.

Anita and Thor

labblab
12-28-2015, 09:18 AM
Hello Anita, and welcome to you and Thor! I'm sorry we have been so slow in replying to you, but we are a bit short-handed here in the midst of the holidays :o. Since you have asked several questions, I will need to wait until a bit later today before I can return and reply more thoroughly myself. But in the meantime, we do want you to know that we're very glad you've found us! :)

Marianne

labblab
12-29-2015, 10:23 AM
Hi again, Anita. I am finally back, but luck is not with me! I was nearly finished with a very lengthy reply when my desktop computer suddenly crashed on me and I lost all function. :( :(

So I am back pecking away on my iPad and need to keep this short. But the bottom line is that I am very worried about you starting Lysodren treatment when Thor does not exhibit any symptoms of Cushing's other than elevated ALKP. Lysodren can be life-threatening if overdosed, and a primary way in which appropriate dosing is monitored is by evaluating changes in observable symptoms such as excessive thirst and hunger -- which Thor doesn't have.

Plus, in the absence of other symptoms, the Cushing's diagnosis remains suspect to me. Inflammatory issues or illnesses other than Cushing's can result in "false positives" on both of the diagnostic Cushing's blood tests. I will certainly grant you that 32 ug/dL is an elevated response on the ACTH, but it is far from the highest we have seen here. And most specialists with whom we are familiar here decline to start treatment based solely upon elevated ALKP unless significant urinary protein loss or high blood pressure is also present as a corollary indicator that Cushing's may really be at play.

If Thor were mine, I would not yet be rushing into treatment. At his age, I would be less concerned about staving off slow, chronic damage that can be associated with Cushing's, but instead would be evaluating current quality of life. In the absence of any symptoms that are causing observable discomfort, I would be very reluctant to begin Lysodren treatment at this time since I think you will have a very hard time assessing appropriate treatment and dosage.

Marianne

labblab
12-29-2015, 12:34 PM
Also wanted to add this link to Lysodren loading instructions that we maintain on our Resouces forum. If you do proceed with the Lysodren treatment, I think they will be very helpful to you. As you will see, though, a key signal in assessing whether or not the load is complete is a pause or change, even slight, in thirst and/or appetite.

http://www.k9cushings.com/forum/showthread.php?t=181

molly muffin
12-30-2015, 08:27 PM
My dog never tested positive on the LDDS test, but had high ACTH. We didn't start treatment for years and only when other things became a factor that meant that the high cortisol needed to be addressed.
Since my dog too didn't have the high appetite, water increase, or urinating, my specialist wouldn't even consider lysodren, and we went with trilostane. I'm happy with that avenue as the lysodren if it was wrong would have been worse, than the trilostane. It is a great drug if you have the symptoms and can monitor but almost impossible if those symptoms aren't there, which Thor doesn't have.

I'm so sorry about your cat. What a horrible experience. Having had a dog on long term prednison, it can be awful to see the damage it can cause when used inappropriately.

If it where me, and based on quality of life I'd probably look at trilostane as an option rather than the lysodren in this instance.

Welcome to the forum