Always hungry

[MacDuff]

Hi,

I am new to this site and would like any input.

My boy MacDuff (a Dandie Dinmont Terrier) has just had his tests today. The vet is certain he has Cushing's and now we are waiting to find out which kind.

My poor boy is hungry all the time, will lay by his bowl licking and licking and begging all the time. I don't think I should be feeding him anymore but it is so sad to see him like this.

Any ideas what I can do?

Rebecca

[mytil]

Hi Rebecca,

Welcome to our site.

I know it is hard to watch them at this stage when it comes to hunger, and it is hard not to feed them more and more. This will subside when treatment starts. But for now you can try some things like (low fat and high in fiber) frozen green beans, carrots etc.

When you get the chance, post the results of all test performed to come to the diagnosis of Cushing's. Also what symptoms prompted your vet to come to this conclusion?

Also, has your vet indicated other conditions have been ruled out - such as diabetes, thyroid imbalances for example? These conditions mimic Cushing's symptoms as well.

Keep us posted
Terry

[labblab]

Hello Rebecca, and welcome to you and MacDuff! Most of us with Cushing's dogs have experienced that ravenous appetite, and it truly is pitiful. However, once cortisol levels are reduced and stabilized, improvements in appetite are generally seen. So there is definitely hope! In the meantime, you can try giving MacDuff some healthy snacks to help fill his tummy -- things like frozen or canned (salt-free!) green beans or pieces of baby carrots. Carrots do have a relatively high level of natural sugar, but they are high in fiber and given in the amounts you would be feeding as treats, they can be a healthy snack.

Can you tell us a bit more about MacDuff's overall health history? Does he have other Cushing's symptoms, and what other testing has been done thus far? If you could give us actual test numbers, that would be great (we only need to see abnormal numbers on regular blood or urine panels, and also any Cushing's specific test results).

By the way, you'll see that I've moved your thread here to our main "Questions" forum so that more members are likely to see it and have the chance to meet you. Once again, welcome, and we'll be anxious to read more about your little boy.

Marianne

P.S. I see that Terry and I were posting at the same time, so please forgive my duplication of stuff! ;)

[judymaggie]

Hi Terry and MacDuff! As Marianne and Terry have said, a ravenous appetite will typically decline with treatment if Cushing's is the diagnosis. As an example, my beagle, Abbie's, favorite "treat" was dead worms, the crispier the better. We have had cortisol control for the last few months and she actually walks right by those worms now! :D Looking forward to learning more about MacDuff--the good folks here will be right by your side to help you navigate this road.

[MacDuff]

Hi,

Thank you for your replies. We will get some frozen green beans and see if it helps.

Our Cushing's journey:

We took MacDuff for his annual check-up, our vet said since he was 10 years old we should do a seniors blood work.

July 27
ALP 445 - high
RDW 18.2 - high
RDW 143 - low
CPK 542 - high
Amylase - high
Lipase - high
Tetraiodothyronine 7.7 low

Retested September 2 - he had an abscess on his foot.

RBC 5.88 - low
HGB 137.0 low
HCT 0.401 - low
Platelet count 132 - low
ALP 884 - high
ALT 200 - high
Tetraiodothyroine - 11.3 low

At this point our vet said he had liver disease and wanted to do a biopsy. I went home and did some research, found an article called "diagnosing Liver Disease a round table discussion.

The vets agreed that the first thing to do with high liver enzymes is to clean the dogs teeth. I told vet that before we go any further we would clean his teeth. We did and had four extracted.

I advised the vet that if it was liver disease we would go not further, we wanted quality of life not quantity. We would let him enjoy what time he had left

Retested October 23

RDW 18.7 - high
Platelet count - 154 low
Lymphocytes - 0.88 low
ALP 780 - high

Vet phone and told me his ALP was still high, I said I would go no further. She didn't listen to me and went on to say I should do a liver biopsy. I told her no but I would retest in a couple of months. She then said well,if you are going to do that we could do a liver detox which we did.

I sent my breeder an email to let her know what was happening. She answered me briefly from China where she was judging and said she would phone me when she got home. We had a long talk and she asked me what I would do if I did the biopsy and it was bad I said I would not treat, she agreed. She then said perhaps I should try a different vet and got me a recommendation from a breeder/judge who lives close by.

At this point we decided to just let things go and let him enjoy what time he had left.

About this time I started to notice he was peeing a lot but thought nothing of it. He was hungry all time but I thought he was being greedy. We went down to a neighbours before Christmas and took MacDuff. He peed in their house, something he has never done before. He has never peed inside since he was house broken. I was concerned so called the new vet and made an appointment we took the blood results. He read them over then spent about 30 minutes talking to us. He then said he was almost certain it was Cushing's.

He took another blood sample and called me Christmas Eve to say with MacDuffs urine results and his ALP now at 1200 he was certain in was Cushing's. Best Christmas present I ever received!

We took him yesterday and he was there all day taking two different tests. We will get results late today or tomorrow.

Rebecca

[molly muffin]

Liver enzymes can certainly go up with cushings, as the high cortisol affects the liver. So that is a possibility.

If it shows that cushings is diagnosed, remember if using trilostane, start at around 1mg/1lb of body weight. This is the new recommendation from the manufacturer and not all vets seem to be aware of this. It is the safer starting dose.

As Terry and Marrianne said, the hunger gets better as they are treated. The high cortisol makes them ravenous.

[MacDuff]

Thank you for your response and the information on dosage.

Should hear results today, want to get him on medication ASAP.

He's not having a good day today.

Rebecca

[MacDuff]

Hi,

Just spoke with the vet, his test results are low positive. With the clinical signs and the results he said there is not need for further tests.

We will start him on Trilostane on Tuesday at the lowest range and then retest in two weeks. He said that some dogs take to the drug with no problem but with others they have to tweet the dose. It is a wait and see.

Today he is pretty miserable has been shivering again, just wonder if it is a result of the tests they gave him.

Rebecca

[labblab]

You mentioned that he was having two different tests performed. Can you find out exactly what was done, and also the numerical results?

One of the two diagnostic blood tests (the LDDS) can sometimes indicate whether pituitary vs. adrenal Cushing's is the culprit. That conclusion would depend upon the actual numbers, and the information might be important to you if you would consider surgery in the event an adrenal tumor is involved. No matter which test was done, the actual results will be of interest to us.

Marianne

[MacDuff]

I will be seeing the vet on Tuesday and will get the information.

Rebecca

[molly muffin]

The ACTH dumps cortisol in the body from the adrenal gland and that I'd think could cause some shivering. It also sometimes make them very active, restless and more ravenous. Normally the increased symptoms due to the test lessen after about 48 hours though.

[MacDuff]

From what I can make out they did a DEXL3C

Comment:

It was borderline at 8 hours, to call Cushing's would need classic clinical signs, if these are present this support Cushing's.

Today he started on 30mg Vetoryl - he weights 34 lbs.

Rebecca

[MacDuff]

Hi,

Do you know how long it takes to see an improvement in MacDuff's symptoms now he is on meds?

Rebecca

[Harley PoMMom]

Could you post those LDDS test results, there will be 3 numbers for that test; one for the baseline, the second number is the 4 hour mark, and the third is for the 8 hour mark...thanks!

Improvements in drinking/urinating and appetite are usually seen in about 2 weeks. Has the follow-up ACTH monitoring test, which is recommended to be done 10-14 days after the start of treatment, been scheduled?

Hugs, Lori

[MacDuff]

0 hr - 165

4 hr - <27.6

8 hr - 49

Is the above what you mean?

He is scheduled for his test on January 25th.

[Harley PoMMom]

0 hr - 165

4 hr - <27.6

8 hr - 49

Is the above what you mean?

He is scheduled for his test on January 25th.

Yep, these are the numbers, however, I know I'm being a pain :o but can you edit your post and add the reference range and the units of measurement, which it looks like they are in nmol/L.....thanks!

[MacDuff]

Will give it a try.

Low dose Dexamethasone Diagnostic Intervals

8 hours. 4 hours. Interpretation

<28nmol/L. Not appl. Normal

28-41 nmol/L. Not appl. Inconclusive

>41 nmol/L. <50% baseline. Consistent with pituitary-dependant and/or <41 nmol/L hyperadrenocorticism

>41 nmol/L. >50% baseline. Consistent with hyperadrenocorticism

Rebecca

[Harley PoMMom]

Thanks so much for adding those values. Ok, lets see if I got this right:
0 hr - 165 nmol/L

4 hr - <27.6 nmol/L

8 hr - 49 nmol/L

reference range - 28-41 nmol/L


Since in the States we are used to seeing ug/dl as reporting units for the LDDS test I'm going to convert those nmol/L to ug/dl, so.... 0 hr = 5.9 ug/dl

4 hr = 1.0 ug/dl

8 hr = 1.77 ug/dl

reference range = 1.0 ug/dl - 1.48 ug/dl


I'm going to use an excerpt from an article that is written by a renown Cushing's expert, Dr. Bruyette's, which he explains how the LDDS test is interpreted:
Test interpretation. When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

If the eight-hour post-dexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

So it seems that MacDuff's LDDS test results show that he does have Cushing's and it is the pituitary type.

[MacDuff]

Thank you so much for explaining it to me.

I will look up Cushing's in the pituitary gland.

Is there anything other than giving MacDuff the meds that I should be doing?

He has had two so far and doesn't seem to be having any reaction to them.

Rebecca

[Harley PoMMom]

Hi Rebecca,

I forgot to add a link to that excerpt I posted to you :o so here it is: http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

In case we haven't mentioned the Vetoryl/Trilostane has to be given with food to be properly absorbed and those ACTH stim test have to be performed 4-6 hours after the Vetoryl/Trilostane is given.

I think this article explains Cushing's pretty well: http://www.lbah.com/word/canine/cushings-hyperadrenocorticism/

If you have any questions please do not hesitate to ask them. ;)

Hugs, Lori

[MacDuff]

Thank you so much for your responses. This is a wonderful site.

MacDuff has already cut back on the amount of water he was drinking after just 2 doses. We are relieved to finally know what was wrong with him.

We are thankful for any quality time we can give him.

All the best.

Rebecca

[molly muffin]

How is he doing on his treatement? It's been a few more days now. Just want to check in on your

[MacDuff]

Hi,

Sorry to take so long to get back to you.

MacDuff has had his second blood test, he will go back in a month for another one. So far so good, he has more energy and is drinking a normal amount of water. He is on 30mg Vetoryl.

He still is bugging us for food and has started this funny snorting sound and snores. Are these part of the Cushing's?

Rebecca

[Harley PoMMom]

Could you get a copy of those ACTH stim results and post them here? We have seen that some cushdogs do tend to snore and/or breathe differently than before.

[MacDuff]

Will have to ask for them. Will post when I get them.

Rebecca

[molly muffin]

I don't know if it is cushings related or not, but my dog snorts and snores all the time. She also will sneeze to get my attention if she thinks I need a reminder she is there. :)

Glad he is doing good and yep, would like to see what the ACTH results where too.