Newbie.. Bichon with Cushings

[Missfemale]

Hi guys, I'm Susan! I have a bichon frise recently diagnosed with Cushings and coming on here hoping to find out a bit more about it :(
The poor thing isn't himself I feel so bad for him our vet is a bit scatty she doesn't seem to know much about Cushings,

Over a year ago I suspected it Evo had all the symptoms and the vet tested him didn't find anything so I brought him back a few months later and had to demand more tests poor Evo started off drinking serious amounts of water and peeing inside then the pot belly came, the never ending hunger and his hair started to thin out and he wasn't himself so the vet finally tested him again and said worked out he had Cushings, I requested his test results off her I will post them below he's been taking vetoryl the last while started off with 30mg and up we upped it to 60mg recently after the last visit to the vet he was on it a month and it made no difference, recently he started lost weight and he's not himself poor thing seems miserable he put him back to 30mg I think 60mg was too much? So he is back in the vets for more tests Tuesday it seems to be vet visit after vet visit and no results I feel so bad for him maybe ye have some advice for me the vet wants to do a liver test and thyroid test next I just want him to be comfortable any help appreciated I feel like she's a bit lost she didn't explain any of the results it's like Chinese to me ha maybe ye can help here

Sorry for the long message guys

Thanks Susan

[judymaggie]

Hi, Susan & Evo! I am glad you found us and we will do our best to help you sort out what has been going on with Evo. In that regard, if you could tell us more about Evo's health and diagnostic history that would be a great help to us in providing you with more meaningful feedback.

I realize that sometimes it is hard for folks to get actual copies of test results from their vets but, if you can, please round up all copies of the testing that was done to diagnose Evo 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. We are especially interested in seeing the results of all diagnostic tests that were performed on Evo with regard to the Cushing's diagnosis. Was an urinalysis done, and if so, could you post those findings too? Is Evo taking any other herbs/supplements/medications? Does she have any underlying illnesses? How much does Evo weigh? Has your vet told you whether Evo has the pituitary or adrenal form of Cushing's?

[Harley PoMMom]

Hi Susan,

Welcome to you and Evo! I am sorry sweet Evo is not feeling like himself and hope soon that he is better.

We're a nosy bunch here and we would really appreciate it if you could tell us some more about your boy's treatment history, in this way we can provide you with better feedback, ok?

Yep, we would love to see all those test results; so if you could please get copies of the testing that was done to diagnose your boy and post the results here that would be great. With respect to the blood chemistry and CBC, you need only post the highs and lows and please include the normal reference ranges. We are especially interested in seeing those monitoring ACTH stimulation test results, so please post them here too. Was he diagnosed with the adrenal or pituitary type of Cushing's? Does your boy have any underlying illness that he is taking medication for, and if so, what is it and what is the medication? Is your boy getting his Trilostane with food and are those ACTH stimulation tests being performed 4-6 hours after the Trilostane is given?

Now, let me see if I can explain what Cushing's is and not confuse you more. When a dog has Cushing's their body is producing excessive amounts of cortisol. Now, a dog's (and human's) system produces cortisol and it plays a important role in the proper function of the body. However when too much cortisol is being produced it can cause systemic damage but this takes a long period of time for that kind of damage to happen.

There are two forms of spontaneous Cushing’s, pituitary dependent hyperadrenocorticism (PDH) and adrenal-dependent hyperadrenocorticism (ADH).

Cushing's is caused by a tumor that is located on the pituitary or the adrenal gland. Most dogs, 85% of them, have the pituitary type (PDH) while 15% have the adrenal form (ADH), and rarely some dogs do have both.

Now, Cushing's can also be caused by a overuse of a steroid, such as prednsione which is known as Iatrogenic Cushing's. With this type of Cushing's a dog can display the same symptoms as the naturally-occurring Cushing's while the only treatment for Iatrogenic that is needed is to slowly taper the steroid use.

Cush dogs on treatment have to be monitored with the ACTH stimulation test.

The ACTH stimulation test measures how well the adrenal glands respond to adrenocorticotropic hormone (ACTH), and there is a pre blood draw and a post blood draw. ACTH is a hormone produced in the pituitary gland that stimulates the adrenal glands to release a hormone called cortisol. The stimulating agent generally used is Cortrosyn which is a synthetic form of ACTH.

When those adrenal glands get "stimulated" they dump that cortisol into the dog's system, the ACTH stimulation test measures how much of that cortisol was dumped, which is known as the post number.

The pre number is done before the stimulating agent is injected, and is known as the resting/baseline number.

Unfortunately Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed. One of the things that makes Cushing's so challenging is that there's not one test that can 100% accurately identify it, so vets have to perform multiple diagnostic tests to validate a Cushing's diagnosis.

A lot of vets are clueless when it comes to the diagnosis and treatment protocols for Cushing, and some of us learned the hard way that placing blind faith in our vets can carry a heavy price tag for our dogs and that is why we encourage all members to educate themselves. It takes an experienced vet and an educated pet owner to facilitate safe and effective treatment. It is when one or both is missing that dogs get into trouble. On that note I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and the treatment protocols: http://www.k9cushings.com/forum/forumdisplay.php?f=10

Please know you are not alone on this journey as we are right there beside you, if you have any questions at all do not hesitate to ask them. ;)

Hugs, Lori

[Missfemale]

Thanks for the reply guys your so hopeful already sorry I meant to post the test results last night but I couldn't attach them to the thread.

Evo was 13.5kg and he's now just over 12kg never had any health probs only had a skin allergy that effected his ears but we changed food and he seems to be fine since. I'm not even 100% what tests he has had done I'll post the results here I'm sure you can understand them more. I have the tests included in drop box I am not sure how to upload them sorry. http://https://www.dropbox.com/sc/nlrxz96w2tzebcp/AAAOa4ulEu_hVngMUhKpdtbka


https://www.dropbox.com/sc/nlrxz96w2tzebcp/AAAOa4ulEu_hVngMUhKpdtbka

[Harley PoMMom]

Unfortunately I'm not able to view those test results in the drop box, it's asking for my username and PW:confused:

I know it may be a pain but you can just type out those results in a reply post...as an example:

ALP 150 U/L (5-50)
Glucose 80 mg/dl (64-120)

The ACTH stimulation results will look like this and these are random numbers:

pre - 3.0 ug/dl
post - 7.5 ug/dl

Now, your units of measurement and reference ranges may be different that those I listed so it is important that you include Evo's actual lab values.

Hugs, Lori

[Renee]

I was able to pull it up

Bloodwork dated 9/15/15 (all others normal)

GGT 42 (0-7) High
CHOL 467 (110-320) High
PHOS 7.5 (2.5-6.8) High
ALT 796 (10-125) High
ALKP 729 (23-212) High

10/5/15 LDDS
Baseline 189 nmol (<125)
Post 4hr 252 nmol
Post 8hr 109 nmol (<40)

Prescribed 30mg vetoryl based on this

Weight is 27lbs as of the bloodwork

I did not see any ACTH on any of the paperwork.

[molly muffin]

I'll add the 5 Oct abnormal to what Renee posted:

Bloodwork dated 9/15/15 (all others normal)

GGT 42 (0-7) High
CHOL 467 (110-320) High
PHOS 7.5 (2.5-6.8) High
ALT 796 (10-125) High
ALKP 729 (23-212) High

10/5/15 LDDS
Baseline 189 nmol (<125)
Post 4hr 252 nmol
Post 8hr 109 nmol (<40)

Prescribed 30mg vetoryl based on this

Weight is 27lbs as of the bloodwork

I did not see any ACTH on any of the paperwork.

5 Oct 2015

ALKP 1046 0. - 25.
ALT 1142 0.0 - 25.
AST 121 0.0 - 49.
GLDH 284 0/0 - 10.
Gamma GT 87 0./0 - 27.
Bile acids 46umol (high no range given)
dynamic bile acids 31 umol 0.1 - 10.
Cholesterol 19.40 3.8 0 7.0

WBC 15.2 6.0 - 15.0
Neutrophils 12.92 3.0 - 11.5

I didn't see any ACTH either, was this done prior to increasing dosage of vetroyl?

When exactly did the increase in medication take place? December or November?

Doubling his dosage is pretty extreme without an ACTH. I'd worry about going too low. Also have you rechecked the cbc to see what those liver values are now?

[Harley PoMMom]

I was able to pull it up
Thank you so much Renee!!



Bloodwork dated 9/15/15 (all others normal)

GGT 42 (0-7) High
CHOL 467 (110-320) High
PHOS 7.5 (2.5-6.8) High
ALT 796 (10-125) High
ALKP 729 (23-212) High

I believe with the elevated ALT and GGT, both of which are a liver enzyme, along with the high phosphorus (PHOS) warrants a need for a closer look, other than Cushing's.

If this were me, I would ask to have a bile acid test performed, this kind of test will show if the liver is functioning properly. How do Evo's teeth look? Something as simple as dental disease may be causing the increased liver enzyme activity.


10/5/15 LDDS
Baseline 189 nmol (<125)
Post 4hr 252 nmol
Post 8hr 109 nmol (<40)

Prescribed 30mg vetoryl based on this

Weight is 27lbs as of the bloodwork

I did not see any ACTH on any of the paperwork.

Those LDDS test results do point to Cushing's, however the LDDS test can yield a false positive result when a non-adrenal illness is present or even if the pet is stressed.

PS I just saw that Sharlene posted that Evo already had a bile acid test done, what has the vet said about the results being high? If this were me, I really would want the liver to be checked out more thoroughly.