Patience Basset has cushings

[Bassetmum]

Hi my 8 year old Basset was diagnosed with Cushings three weeks ago.She was drinking and peeing loads so went to the Vet.Her urine sample a was clear but bloods showed some Liver problems and also that she was dehydrated.
She had ACTH test done and her Cortisol pre was 67 and post was 693.

Because she looks and acts really well they prescribed Samylin for liver support then wanted to do a low Dexamethasone Suppression test the following week and another Extended Urine screen.The urine was negative.
Her results came back as positive for Cushings and suggestive of Pituitary
She is on 60mg of Vetoryl per day and will have another ACTH next week.

[Harley PoMMom]

Hi and welcome to you and your girl!

It would help us a great deal if you could share more information about your dog, in this way we can provide you with our best possible feedback, and we get this information through a ton of questions so here goes some of mine. :eek::)

Could you get copies of all tests that were done on your girl and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Would you post the results of the diagnostic tests that were performed on your dog for Cushing's? Besides the increased drinking/urinating does your girl display any other Cushing's symptoms, such as: a ravenous appetite, skin/hair issues, pot-bellied appearance, exercise intolerance, and difficulty or unable to go up steps or jump on furniture? Does your girl have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? How much does your girl weigh? Did the vet tell you that the Vetoryl has to be given with a meal to be properly absorbed? And those monitoring ACTH stimulation tests have to be performed 4-6 hours post pill, was this mentioned? Is her urine diluted and does she have a low urine specific gravity? If so than an urine culture and sensitivity test is recommended.

I'm including a link from our Helpful Resource forum regarding Vetoryl: http://www.k9cushings.com/forum/showthread.php?t=185 If you have any questions please do not hesitate to ask them.

I sure am sorry for the reasons that brought you here but so glad you found us and we will help in any way we can.

Hugs, Lori

[Bassetmum]

Hi
Patience has no other symptoms at all and has always been healthy in fact apart from spaying and Vax has not seen the Vet since we adopted her 7 years ago.

She weighs 61 pounds and is quite a lean looking Basset.I know that she needs to have the pill with food and she gets it around 8 in the morning.I am also aware of the 4 to 6 hours post pill for the ACTH thanks.
I do not have a copy of her bloods unfortunately.

Cortisol pre ACTH 67.0 nmol/L ref.range 25.0 125.0
Cortisol post ACTH 693 nmol/L ref. range 125.0 -520.0

LDDS Cortisol basal 110.0 nmol/L low range 25.0 high range 125.0
Cortisol post low dose 4 hr 21.3
Cortisol post low dose 8hr 119.0
Notes High

Urine pale yellow and clear.
I am UK based

[Harley PoMMom]

Other non-adrenal illnesses can cause a dog to drink/urinate more, so I assume diabetes and any thyroid issue has been ruled out?

[Bassetmum]

Hi
No idea re thyroid but urine test
was specific gravity 1.014
pH 5
negative for protein
glucose
ketones
bilirubin
blood

Yvonne

[Bassetmum]

The last few nights Patience has gone back to wetting overnight again.

Yvonne

[labblab]

Hi Yvonne, and welcome to you and Patience. I'm sorry to hear that the overnight urination is starting back up again. That has to be both upsetting and frustrating. If you can hang in there until the next ACTH test next week, I'm hoping that will give you some helpful information re: moving forward. For some dogs, it ends up being better to give them 1/2 of the daily total dosage at twelve hour intervals. Trilostane can be metabolized fairly rapidly, and for some dogs, this means that the effect of the drug wears off by bedtime and the cortisol level starts rebounding to a point where symptoms re-emerge overnight. In that case, keeping the cortisol level more consistently low over an entire 24-hour time period can take care of the problem.

You'll know more after the ACTH testing, however. It may be the case that Patience's cortisol level is still too high even in the morning and an overall dosage increase may be in order. If the testing level is good, however, then you may end up giving her a 30 mg. capsule both morning and evening.

So hang in there, and let's see how things develop over the next week.

Marianne

[Bassetmum]

Hi Yvonne, and welcome to you and Patience. I'm sorry to hear that the overnight urination is starting back up again. That has to be both upsetting and frustrating. If you can hang in there until the next ACTH test next week, I'm hoping that will give you some helpful information re: moving forward. For some dogs, it ends up being better to give them 1/2 of the daily total dosage at twelve hour intervals. Trilostane can be metabolized fairly rapidly, and for some dogs, this means that the effect of the drug wears off by bedtime and the cortisol level starts rebounding to a point where symptoms re-emerge overnight. In that case, keeping the cortisol level more consistently low over an entire 24-hour time period can take care of the problem.

You'll know more after the ACTH testing, however. It may be the case that Patience's cortisol level is still too high even in the morning and an overall dosage increase may be in order. If the testing level is good, however, then you may end up giving her a 30 mg. capsule both morning and evening.

So hang in there, and let's see how things develop over the next week.

Marianne

Thankyou that makes sense :)

[Bassetmum]

We now have the results of her ACTH test.

Cortisol pre ACTH 66.2

Cortisol post ACTH 243.0

This is after about 3 weeks on 60mg Vetoryl so her levels are still a bit high.The Vet wants to leave her on this dose for another 4 weeks and retest then.
She is still doing well but is having the odd accident overnight.

[labblab]

Hi again, Yvonne, and thanks so much for this update. I'm going to convert Patience's ACTH results into the units more commonly used here in the U.S.

pre-ACTH: 2.4 ug/dL

post-ACTH: 8.8 ug/dL

So yes, your vet is entirely correct that these results are still running a bit higher than is ideal, given the fact that Patience is still having some urination issues at night. But I cannot argue with leaving the dose unchanged for a few more weeks and then retesting. Her cortisol may still drift downward a bit during that time period, and you will have a good reference point for making any dosing changes at that time.

If symptoms persist and she does need an increase, you would have the option of either just raising her morning dose by a little bit. Or as an alternative, you could divide the dosage amount and give half in the morning and half in the evening. If her only symptom remains night-time urination issues, then dividing the dose might be a good option to consider. But we can talk about that more at the time of the retesting.

Once again, thanks so much for letting us know how she is doing!
Marianne

[Bassetmum]

Thanks Marianne

I guessed the US system was a bit different to the UK one.Patience is still looking and acting very healthy.She has been dry the last three nights which is a bonus:)

Yvonne

[Bassetmum]

Hi again
I am wondering if somebody can tell me what I need to look out for behaviour wise to know if Patience is having Cushings related problems. I have had dogs many years but she is my first with this type of illness. Reading this site there seems to be lots of side effects that can happen with the Vetoryl and I want to make sure that I do not dismiss something that might be crucial.
Thanks
Yvonne

[molly muffin]

Hi, you will want to watch for things like, voimiting, diarrhea, lethargy (like wobbly not wanting, able to walk), while eating and drinking might and should decrease, you don't want it to stop. So any of those things you should watch out for.

Most side effects come from too high of a dose of vetroyl for the dog.