Lola - Recommendations for diet

[jill927]

Hi all. Lola is a 7-8 yr old pittie mix that was just diagnosed with cushing's last week. The vet did blood work and an ultrasound to confirm. No tumors. I noticed a lot of people post the blood work results but I do not have that information. Lola's hair loss started about 2 years ago. Her ears, neck, down the sides of her body and on her belly are pretty much bald. The rest of her hair is very thin. I thought this was related to allergies and was trying to find a good diet for her that was rich in omega 3s. Within the last 6 months she got a pot belly and within the past few months I can see her whole spine sticking out and she lost about 5 pounds. She does not have all of the other signs - drinking alot, frequent urination, or panting - but every time she eats its like she's never seen food before. The vet started her on 20 mg of Vetoryl 2x/day. I've been trying to read as much as I can about this disease. I read that diet should be more chicken based rather than fish based and that a raw diet is best. She is currently on Zignature Trout and Salmon formula. Unfortunately I'm having a very hard time affording the blood tests and the Vetoryl. Within the past week I've debated if I should even treat her for this. I'm trying my best to keep with it and see if the medication is helping her. In the mean time I want to make sure I'm not aggravating the disease with her diet. I'm all around frustrated, sad, and very confused. Any advice is greatly appreciated! :(

[molly muffin]

Hello and welcome to the forum.

For a dog with cushings, it maters more that it is a good quality protein and moderate to low in fat. Whether it is dry food or raw food is a personal preference, as we have seen dogs do well on both.

As far as vetroly goes, 1mg/1lb is a good starting dose. yes it can be expensive, but you can get your vet to do a prescription for trilostane (the compounded medication instead of name brand vetroyl) and it will be cheaper.
Many of our members use Diamondback Drugs (look up online) your vet calls in the prescription and they will send to you.

Do you remember if they tested thyroid at all? As that can have many of the same symptoms. Is it possible to ask your vet about getting copies of the test results so you have them for your home file?
Diabetes was ruled out?

Not all dogs have all the symptoms with cushings, some just have some.
It is hard to know exactly without seeing the diagnostic test results for cushings.

[judymaggie]

Hello to you and your pup! I just wanted to add on to Sharlene's post regarding sources of less expensive Vetoryl/trilostane. I buy brand name Vetoryl through the California Pet Pharmacy. I also use Diamondback Pharmacy for compounded trilostane. FYI, compounded trilostane has to be a quantity that is not manufactured by Dechra (the manufacturer of Vetoryl). For example, I get 4.5 mg. trilostane since Dechra offers 5 mg. Both pharmacies are drastically less expensive than anything I can find locally. My vet totally gets how expensive this disease can be and is willing to call both pharmacies.

[jill927]

Wow I just got a quote from Diamondback Drugs and I can't believe how cheap it is! Thank you SO much for letting me know about it. I'm not sure if they tested for diabetes or thyroid. They started with a CBC. Not sure if that's included in it. When I bring her for her next blood test I am going to get copies of her previous bloodwork. I should have it for my files anyway. I'll be in touch when I get them. Thanks again !!

[molly muffin]

The cbc would have shown a result for glucose. So if that isn't high or low, then that rules out diatebes, blood sugar issues. They might have run a T4 which in cushing dogs can be a tad bit low and then later clear up when cortisol is regulated, but if more than a tad low, then a thyroid panel would then show a better picture of the thyroid.

Yes the pharmacies you can order from are usually much better than the vet prices.

[Harley PoMMom]

It is sometimes confusing keeping all these tests straight :confused::) It is a chemistry blood panel that will show the levels in glucose, liver enzymes, and electrolytes.

The CBC is a complete blood count with results from the white, red blood cells, platelets... ;)

Hugs, Lori

[jill927]

I got copies of her blood work. Can anyone help interpret ? Glucose came back normal so that rules out diabetes right? T4 was 0.9. Reference is 1-4. So right on the border of being low. Does that mean it could be a thyroid issue too? Also Lola got a hematoma on her ear yesterday. The vet said not related to Cushings but from what I've read Cushings makes the skin thin and therefore dogs are more susceptible to getting them. Has anyone else experienced this ? Thanks in advance for an input !

[lulusmom]

Yes, we can help you interpret the labs. Please post just the high and low blood chemistry and cbc values, to include the reference ranges. Your vet should have also done an acth stimulation test or a low dose dexamethasone suppression test (LDDS). The acth stim test is a one to two hour test and the LDDS is an 8 hour test. Please include the reference range when you post the results. Lastly, can you please share the abdominal ultrasound interpretation? This imaging should have allowed your vet to determine whether Lola has pituitary or adrenal dependent cushing's. Do you recall what the vet told you? Lola's first acth stimulation test should be coming up very soon so please remember to get a copy and share those results with us too.

To answer your question, if blood glucose is normal, then yes, you can rule out diabetes. The T-4 is low but that is very common in dogs with cushing's and it does not necessarily mean that Lola has primary hypothyroidism. This is usually a transient decrease in T-4 caused by high levels of cortisol. T-4 will return to normal once treatment effectively reduces cortisol. If a recheck once Lola is stabilized on trilostane still shows T-4 as being low, then the vet should request a full adrenal panel before confirming hypothyroidism.

Dogs with cushing's do have thin, crepey skin which is easily bruised but if a dog with cushing's has a hematoma in the ear, it's unlikely that thin skin is the problem. Dogs with uncontrolled cushing's have a compromised immune system which leaves them open to infections, including ear infections, which are the underlying cause of ear hematomas. I have seen this being connected to cushing's which would make sense but it is rarely mentioned here, if ever. I have a horrible memory so I will have to rely on others whose brains are still firing on all cylinders to share their experience. :D

I'm really glad you called Diamondback Drugs for a quote on compounded trilostane. I've had tiny dogs most of my life so most of their medication had to be compounded to smaller doses, including trilostane. Vetoryl comes in 5mg capsules now but back when my dogs were diagnosed, 30 mg was the smallest dose available and even then, your vet had to do a lot of paperwork to get it from the UK. I was getting my dogs' trilostane from a local compounding pharmacy in So California and when I heard about Diamondback, I decided to call them to see if I was paying a fair price. I was shocked that I was paying a lot more than Diamondback quoted so they were not just less expensive than name brand Vetoryl, their compounded trilostane was very competitively priced.

Glynda

[kanga]

Hello welcome to the forum.

[randomguy]

Very interesting about hypothyroidism! I googled the symptoms and can see how they would get confused. If my dog has had an acth stim test, would that definitively rule out his symptoms as being cushings? Just curious! Will call my vet about it tomorrow!

[lulusmom]

Randomguy, I copied your post here to Chucks thread and posted a response there which I have copied below:


Clinical symptoms, as well as lab abnormalities, commonly associated with cushing's overlap with those of dogs with primary hypothyroidism. A very large number of cushingoid dogs will have a low T4 at the time of the cushing's diagnosis but this is most often sick euthyroid instead of primary hypothyroidism. Non-thyroidal illness, and most certainly cushing's, can cause a transient decrease in T4 which corrects itself once the underlying cause is treated. That is why most cushing's savvy vets will treat the cushing's first and once the dog has been stabilized, recheck the T4 to see if it has returned to normal. I am not really sure what question you are asking but if Chuck symptoms are commonly associated with cushing's, his lab abnormalities are consistent with cushing's and a diagnostic test, such as the acth stim test is consistent with cushing's, I would say his symptoms are probably caused by cushing's. However, if Chuck's T4 is also low, you can't rule out primary low thyroid until a recheck of the T4 after he's stable on an appropriate dose of Vetoryl. I hope that makes sense.

Glynda

[jill927]

ALP: 687 (high) Reference range: 5-160
Amylase: 314 (low) Reference range: 337-1469
Lymphocyte: 578 (low) Reference range: 1060-4950
Eosinophil: 58 (low) Reference range: 70-1490
T4: 0.9 (low) Reference range: 1.0-4.0

From dexamethasone suppression test:
Pre dex: 3.8, Reference range: 1.0-6.0
Post 4 hour dex: 2.2, Refernce range: less than 1.5
Post 8 hour dex: 2.3, Refernce range: less than 1.5

As far as the ultrasound goes they said she did not have a tumor which is what they were looking for. I did not get any paper results and they really didn't say anything else about it. I noticed after 3 weeks on the vetoryl her hair is already starting to grow and her spine is no longer sticking out. She goes for her first follow up blood test tomorrow.

Thanks for all your help! I am so happy I found this forum.

[lulusmom]

Thank you for posting those abnormal lab results which are what we usually see in dogs with cushing's. The results of the LDDS are certainly consistent with cushing's but because suppression at 4 and 8 hours were not more than 50% of baseline, results cannot distinguish between pituitary or adrenal cushing's. Since the ultrasound did not detect any adrenal tumors, I think it is fair to say that Lola has pituitary dependent disease (PDH).

I am happy to hear that Lola's symptoms have improved and I will look forward to hearing about the results of her upcoming acth stimulation test. Don't forget to get copies. In preparation for that test, I've included a link below to Dechra's Diagnosis, Treatment and Monitoring brochure which will help you understand the treatment monitoring protocol. It will also help you learn how to assess the results for yourself. If you see something that doesn't make sense, ask and we'll do our best to help clarify things for you. If you scroll down to the third page, you will see a treatment monitoring flow chart that is fairly easy to follow. You will note that protocol dictates that the first test be done 10 to 14 days after starting treatment; however, it appears your vet decided to wait until the 30 day mark. With more and more experience with Vetoryl, it has become well known that cortisol will continue to drop after the two week mark so unless the results are too low, any adjustments in dosing should be delayed until the 30 day test. Some vets are therefore choosing to wait for 30 days before testing. That's fine but I'm old school and know that cortisol drops like a rock in the first two weeks and I'd want to know if cortisol was scary low. That happened with one of my dogs whose first pre and post stimulated cortisol were less the 1 ug/dL and he never acted ill. Had I continued to dose him, he most certainly would have crashed. I'm an anal worry wart. :D

http://www.dechrace.com/pdfs/vetoryl/VETORYLTreatmentMonitoringBrochure.pdf

[jill927]

Thanks for the quick response. Although I do trust my vet and I know she got two other opinions on whether to treat Lola, I always worry that they are quick to treat to boost their business. It's comforting to hear from an unbiased (and very knowledgable!) third party that these results are consistent with Cushing's. My vet had told me to test her at 2 weeks but I didn't have the money to so I had to wait an extra week. I will post the results once I get them. Thanks for the info on Vectoryl. The chart definitely makes it easier to understand all of this :)

[westcoastflea1]

first let me say im not a vet
just sharing my experience with a cushings dog

cushings is hard on all the organs, it is organ failure that kills cushings dogs because the endocrine imbalance is hard on kidneys liver pancreas and gallbladder

high fat is bad for the pancreas so low fat diet is good

raw meat has pathogens and in a dog with a compromised immune system not a good idea

i feed declan wellness core low fat dry food combined with merrick beef and vegetable 3% fat canned food, a little yoghurt as well to help digestion and uti's

again im not a vet but i think the best way to keep your dog living as long as possible is to support all the vital organs that are being damaged by cushings

i also use a little neosporine on his tummy since skin is thin and gets damaged easily, with small scabs i dont want infection getting even the slightest chance to start, i also put it on any raw looking spots that are really dry, like his elbows

just my 2 cents :) hope it helps

good luck

[jill927]

Thanks for your input ! :)

[westcoastflea1]

t4 alone is not a good indicator for thyroid issues

dr dodds (basenji thyroid expert) says you need T3 T4 free T3 free T4 and TgAA to get any real answers on thyroid issues
and
for any sight hound owners out there sight hounds have higher then normal hematocrit and cholesterol values and thyroid numbers for an adult sighthound are as follows
T4 1.40 - 3.50
Ft4 0.85 - 2.30
T3 35-70 ng
Ft3 1.6 - 3.5
quite a difference from the idexx etc values and important for any sight hound owner to know as many vets arent aware of the different values for sight hounds
just saying :)

[jill927]

Hi all. My dog Lola is being treated for Cushings. She’s been on trilostane for almost a year and a half now. I’ve noticed a few times a small black scab on her belly that the vet was never really worried about. It never grew in size and would come and go. I noticed tonight that the scab is about three times its normal size and a little bloody. I know Cushings can affect the skin but can this be related ? It’s worrying me a bit. I should also add that she had a dental procedure about two weeks ago and was put under anesthesia. Would this in any way affect her skin?

[labblab]

Hello, Jill, and welcome to you and Lola! I’m sorry she’s having this skin problem, and unfortunately I am not certain as to what it might be. I don’t know of a way in which the anesthesia would be involved, so I suspect it’s something else that is the cause, especially since it’s been an ongoing presence. It’s true that Cushpups can be vulnerable to a range of skin infections and irritations, so I think the best thing would be to let the vet take another look since the spot is worsening. If need be, you might even want to request a referral to a doggy dermatologist if there’s one in your area.

Aside from the spot, how has Lola been doing? Have her Cushing’s symptoms resolved since beginning the trilostane? Have you had any recent monitoring testing done which indicates where her cortisol level is right now? In that vein, it’ll help us a lot if you care to share more info about her overall health history and also the symptoms and testing that led to the Cushing’s diagnosis in the first place.

Thanks in advance, and once again, welcome!
Marianne

[Squirt's Mom]

Hi Jill

I have merged your new post about the black scab into Lola's original thread. We like to keep all info about each dog in their own thread. That way it is easier to look back through the history for members and for you. This thread can also serve as a sort of diary of Lola's journey that can come in very handy for you.

I have also taken the liberty of adding Lola's name to her thread so it will be easier for you to find in the future,
Hugs,
Leslie