my 2 dogs have cushings disease

[vicky593]

Hi, my name is Vicky and I have two dogs, an 8 year old maltese and a 10 year old pom. Both dogs have been diagnosed with cushings disease. I'll start off with Bella, my maltese. I got her when she was about 4 months old. She always seemed to have high anxiety. She started having numerous urinary infections and eventually had bladder stones which had to be surgically removed. She was put on a prescription diet to help prevent that from happening again. She continued to have urinary infections with low specific gravity and was treated with antibiotics. Eventually my vet said that because of her thinning hair, increased water consumption, pot bellied appearance, increased liver enzymes, and the reoccurring urinary infections that she suspected that Bella had cushings disease. An adrenal panel was done and sent off to the University of TN and the results came back positive for cushings disease. A holistic method of treatment was tried first and she was given 6 mg of melatonin and 15 mg of SDG lignans with flaxseed. Vet retested her after about 6 months and her levels were still too high. The vet has now put her on mitotane. My vet doesn't load in the typical way I've read about. Vet started her out at 0.2 ml once a day for 5 days and then 0.2 ml once a week for six weeks and then she was retested. I thought she was doing fine because she wasn't urinating in the house anymore. Her cortisol levels were still too high so the vet has now changed her to 0.2 ml twice a week and she will be retested on 28 May. I noticed today that food is getting stuck on the side of her mouth and she doesn't make any attempt to get it out and just drools. I have to get the food out for her. Also, she stumbled and staggered on three occasions that I saw today. Is this a side effect of mitotane? She still eats and drinks and isn't showing any of the side effects the vet mentioned to watch out for. I am concerned about this and know my vet is currently out of town. There are other vets in the clinic, but they aren't as familiar with my dog. Any thoughts or advice would be appreciated.

My other dog, Zoe was diagnosed with cushings disease last January. I took her in because she was running into things and I found out she had totally gone blind. She was also diagnosed as being hypothyroid, having high blood pressure, start of trachea collapse (she was coughing), keratosis on her nose and she also had a urinary infection which has never happened before. The vet decided to test her for cushings because of her hair, high liver enzymes and the urinary infection. Blood work was done and sent off to the University of TN and came back positive for cushings disease. She was started on 6 mg of melatonin and 10 mg of SDG lignans with flaxseed in addition to the thyroid and blood pressure medication. I also give her herbal cough syrup and probiotics when needed. When this first happened Zoe would urinate while she was sleeping and have numerous accidents in the house. She is doing much better and very rarely has any accidents in the house. She goes back to the vet in June and I'm sure that she'll be retested for her cortisol levels. If they are still high, the vet will probably want to put her on mitotane as well. I would appreciate any advice anyone has on this.

Needless to say this is all a bit overwhelming for me. Isn't is bizarre that both my dogs have cushings disease plus all the other issues. I would really appreciate any advice anyone has. Thank you so much.

[lulusmom]

Hi Vicky and welcome to the forum.

I only have a moment but wanted to tell you that neurotoxicity is a recorded side effect of mitotane and the symptoms you mention definitely fit. Please, please discontinue dosing and contact your vet. We would love to hear more about your precious pups; however, let's concentrate on Bella first because she seems to be in distress. If Bella continues to decline, I highly recommend that you get her to an ER. Did your vet give you prednisone in the event of an emergency? If so, you should give her a rescue dose now just in case her cortisol has dropped to low.

It would be very helpful if you could please obtain copies of the full adrenal panel that was done by the University of Tennessee Knoxville (UTK) and post the results here. I would be most interested in the pre and post stimulated cortisol levels. Since your vet has prescribed a most unorthodox mitotane dosing regimen, I am wondering if the diagnosis is atypical cushing's in which case cortisol would not be elevated above 22 ug/dl which would be consistent with typical cushing's.

How much does Bella weigh. 0.2 ml is the syringe measurement not the mg prescribed. If you look on the bottle of mitotane, it should state the mg. Can you please let us know what that is?

Glynda

[vicky593]

Thank you Glynda for replying so quickly. Bella weighs 14 lbs and the dosage on the mitotane is 0.2 ml and the syringe is marked in ml as well. I was given predisone too in case it was needed.

I do have the test results from the University of TN and the cortisol levels are 7.3 baseline, normal range baseline <1.0 - 5.9 and result post ACTH was 34.8 with normal range post ACTH 6.5 - 17.5. It said results indicate presence of increased adrenal activity.

I know my vet is treating this disease differently than normal and I did question her about this as I had done a lot of reading so I would know what to expect. From what my vet said I believe she is trying to make it more affordable for clients to treat their pets because it is such an expensive disease to treat.

Bella does seem to be fine now and only had those three episodes of stumbling and staggering. She ate and drank, but did refuse to go outside since it was thundering. She is scared to death of that. I won't hesitate to call the vet tonight if she has any more episodes. She isn't due for mitotane again until Thursday so I will call the vet tomorrow and let them know what happened and I guess I'll go from there.

Thank you again and please let me know your thoughts.

[DoxieMama]

Hi Vicky,

Welcome to all 3 of you! It sounds like you've got your hands full with two Cushpups. Bless you for taking care of them.

Thank you for posting the test results for Bella.

I'm glad she is doing okay at the moment (aside from being scared of the thunder - poor girl!). Please do call the vet to see what he recommends and let us know.

Hugs!
Shana

[lulusmom]

Hi Vicky and thank you for providing additional information. A post acth stimulated cortisol of 34.8 ug/dL is definitely consistent with cushing's but your vet should have done additional testing to differentiate between pituitary and dependent disease. Do you know which form of the disease Bella has?

My first cushdog was a tiny Pom who was not diagnosed for a very long time, thanks to our ignorant gp vet. As a result, she had two bouts of calcium oxalate bladder stones requiring surgical removal only 11 months apart. This type of stone cannot be managed with diet so I am wondering which type of stones Bella had? If they were calcium oxalate stones, I suspect once you get her stabilized on an effective dose, you won't see any more occurrences. I never put my pup on special diet and she never had another recurrence for the rest of her life. Thank goodness, I found an amazing internal medicine specialist to get both of my cushdogs on the right track.

Since the results of the acth stimulation test is positive for cushing's, I am not sure why your vet has chosen not to follow protocol and prescribe the recommended loading dose of mitotane. I am highly doubtful that the treatment regimen your vet is going to be effective in reducing pre and post cortisol levels to within 1 ug/dL - 5 ug/dL which is the theraupeutic range for dogs being treated with mitotane.

I am also not sure why your bottle of mitotane does not show the dosage in milligrams so please ask your vet what the 1 ml compounded dose is. As I mentioned earlier, 0.2 ml is a syringe measurement which means you are giving Bella 20% of the full compounded dose. If the full dose (1 ml) is 500 mg, 0.2 ml would be 100 mg. A full loading dose based on Bella's weight would be 300 mg split in half and given with food in am and pm for 5 to 8 days so I am very curious to know more details of your vet's odd treatment recommendations. You mentioned that you were instructed to give 0.2 ml once a day for five days then give 0.2 ml once a week for six weeks and then be tested again. I know mitotane like the back of my hand and I firmly believe this treatment recommendation is not going to be effective. I believe with cortisol as high as Bella's, nothing short of the normal mitotane loading phase will be effective. If your vet is that uncomfortable with the possible side effects of mitotane, perhaps he should have considered Vetoryl. I would just hate for you to go through seven weeks of treatment only to find out you are back at square one. Another concern with this weird treatment is that if Bella were to have an adrenal tumor, your vet's dosing regimen would do absolutely nothing as adrenal tumors are resistant to even the large loading doses that are necessary for dogs with pituitary dependent disease. If you vet failed to determine which form of the disease Bella has, I have serious concerns as to whether your vet possesses the knowledge and experience necessary to effectively diagnose and treat cushing's. The red flags went up for me when you stated that your dog was diagnosed with cushing's and you tried holistic treatment first. There is no credible science based evidence that any natural or holistic remedy effectively reduces cortisol which is supported by the many members who have joined here after holistic treatment failed. While it may help with very mild symptoms, the progression of the disease will eventually overcome the positive effect of any Chinese herbs and symptoms will become worse, requiring conventional treatment.

Glynda

P.S. I forgot to mention that your vet should do an acth stimulation test on the seventh day after starting the five day daily dosing to make certain that pre and post cortisol levels are within 1 - 5 ug/dL. If not, a weekly maintenance should not be started and daily dosing should continue until levels are brought down within that range. It will be very helpful to know what the exact dose Bella is getting. without knowing that, it is difficult to know if the daily dose is high enough to achieve even a negligible amount of erosion to the adrenal gland. You really have to pummel the adrenal glands with large daily doses of mitotane to kill enough of the adrenal tissue to stem the over secretion of cortisol.