Nickie has weight loss

[LAL]

I need your help!! My Nickie was diagnosed with Cushings coming up on two years ago. She did relatively well on her Trilostane for a year, and then started losing weight. Her ideal weight is 8.5 pounds and she is now under 5 pounds. She will not live much longer with her continuous weight loss. Her primary veterinarian and her Internist are stumped. Her ACTH test results are a bit high, but nothing significant. Nickie's intestinal panel came back with 1 or 2 elevated pancreas enzymes, but the results were inconclusive for pancreatitis. Her abdominal ultrasound came back normal, aside from enlarged liver. Her liver enzymes are through the roof after being close to normal for many months. Her Internist does not believe her weight loss is contributed to liver failure. We are all so puzzled and don't know what to do. The only alternative is to switch her medication to Lysodren which I hate to do (it is such a harsh drug). I am thinking it is the Trilostane causing weight loss??? Any suggestions? LA

[Harley PoMMom]

You definitely don't want to switch her to Lysodren with her loss of appetite. Did the IMS tell you to stop the Trilostane? If not, I would withhold the Trilostane and see if Nickie's appetite perks up.

The 2 pancreas enzymes that you mentioned that were high are they the amylase and lipase? These enzymes are not reliable markers for pancreatitis, one test that has a very high percentage rate for diagnosing pancreatitis is the spec cPL test. My Harley had pancreatitis which was first seen on an ultrasound and then was confirmed with the spec cPL test. On his blood panel the amylase and lipase levels were normal, however his spec PL results were over 300, reference range for this test is 0-200. Here's a link about the spec cPL test: http://www.idexx.com.au/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.html

If this were me I would have the spec cPL test done, pancreatitis will make a dog inappetent and it can be very painful, which in turn will make a dog not want to eat. If you have a copy of her ACTH stimulation tests could you post those results for us? And what dose of Trilostane is she taking? Is she on any medication besides the Trilostane? Are her stools normal looking and color? Has an urinalysis been done to rule out an UTI?

Carbs can help with weight loss if she will eat them, sometimes dogs will go for chicken breasts (low fat) mixed in with some mushy rice. Baby food (no onions or powder) is another thing she may eat, oh and tuna.

Keeping you both in my thoughts and prayers.

Hugs, Lori

[LAL]

Hi Lori-

Don't have her gi test results at home. Nickie does not appear to be in any pain at home or at medical exam. She has no diarrhea or vomiting. Her stools are normal/hard and normal to dark in color. She was on Prednisone and appetite stimulant and off Trilostane for about two weeks. Her appetite improved. She now has skin bacterial and fungal infections (taking Clavamox and special shampoo for fungal infection), so we are taking her off prednisone. She is eating, but continues to lose weight. Had her on organic diet including chicken, rice, and veggies...no weight gain. Her medications and supplements are Trilostane, Theophylline, FortiFlora, fish oil, colostrum, and starting IP6. Her ACTH results: pre-7.0 and post-3.7. Thank you for your response!!

LA

[Harley PoMMom]

Have parasites been ruled out? Is the vet having you taper the presdnisone down because an abrupt stop is not recommended.

[Harley PoMMom]

Hi Lori-

Her medications and supplements are Theophylline, FortiFlora, fish oil, colostrum, and starting IP6.
LA

These 3 supplements I am not familiar with, what health issue do these help treat?

[LAL]

Test for parasites was negative. Yes, we are tapering her prednisone. I started her on these supplements after online searching for canine cushings treatment. Doc has no problem with this. Just don't know what to do. She is skin and bones, and it is so upsetting to see. It's hard for me to let her go because she seems to be in no pain, she eats, barks a little, is aware and interested in her surroundings, etc. I know her organs will start shutting down soon from the weight loss. Her Internist has treated many cushinoid dogs and has never seen this. Saw an old post on here with same symptoms, but with no informative answers.

[Harley PoMMom]

Could you post the results from her chemistry/CBC blood panel, all we need to see are the levels marked abnormal and please include the normal ranges...thanks

Is Nickie eating the same amount of food that she always did? Has her diet changed in any way? What breed of dog is she?

[Haleth]

Throwing out some things:

Have they checked her heart? I've heard heart failure can cause weight loss, but I don't know how severe. Have the heart/lungs been checked for tumors?

Perhaps it's time to see another IM specialist. Not that yours is bad, but sometimes another mind will see things differently. It sounds like the current one has gone as far as they can go, so a fresh perspective might help.

[LAL]

Her CBC results have a lot of highs and lows(unusual for her) except her liver enzymes, but nothing significant. She is not eating her normal amount, but eating a good bit of food. It all is very puzzling. . .

[LAL]

Hi Haleth -

No heart problems or tumors (other than pituitary). Her pituitary tumor may have become enlarged?? Don't know for sure without MRI, but if it has grown, she is too sick to undergo any treatment.

Thank you for your reply.

LA

[labblab]

Even though Nickie's stools are normal, I believe I would administer the blood test for canine pancreatic enzyme insufficiency syndrome ("EPI"). Here's a link that explains this severe wasting disorder in greater detail:

http://www.epi4dogs.com/

At this point, I would not leave any stone unturned even though she does not seem to exhibit classic symptoms other than the malnutrition. If she had lost her appetite and was not eating, I'd be more apt to suspect an enlarging pituitary tumor. But as long as she is eating normally, a digestive abnormality seems more likely to me.

By any chance, do you live near a veterinary school? I kind of agree that enlisting a fresh set of eyes might be helpful, and the beauty of a vet school is that every specialty is available for joint consultation on difficult cases.

I'm surely sorry you two are suffering through this. It has to be very hard on you both!

Marianne

[mytil]

Hi,

I was posting the same information as Marianne as EPI stuck out for me as well. It can be treated and the dog can make a full recovery, but must stay on the treatment for life. The treatment is an enzyme supplement that is added to the food 30 minutes prior to feeding.


Exocrine Pancreatic Insufficiency, or EPI, also referred to as Pancreatic Hypoplasia or Pancreatic Acinar Atrophy (PAA), is a disease of maldigestion and malabsorption, which when left untreated eventually leads to starvation. One of the major difficulties with this disease is in the prompt and accurate diagnosis. Astonishingly, visible symptoms may not appear until 80 to 95 percent of the pancreas has atrophied.
There are two primary functions of the pancreas:
1. Endocrine cells produce and secrete hormones, insulin, and glucagon.
2. Exocrine cells produce and secrete digestive enzymes.
EPI is the inability of the pancreas to secrete digestive enzymes: amylase to digest starches, lipases to digest fats, and proteases to digest protein. Without a steady supply of these enzymes to help break down and absorb nutrients, the body starves.

Terry

[molly muffin]

Hello and welcome to the forum

The gang has already gone through a lot of good information with you.

How are her kidneys? Bun and Creatinine, protein loss in urine? Those things can also cause weight loss with no other symptoms specifically involved.

It can also cause a loss of appetite.