Remington, German Shorthair Pointer diagnosed with Cushing's Disease

[Lili0127]

Hi there. My dog Remington, a 14 year old Pointer had symptoms just like this last summer before we knew he had Cushings!

He had a day where he started stumbling and falling as if he was drunk or dizzy. And, he would stare out and look around at things when I called his name. We took him to the Vet and by the time we got there, he was walking a bit better and not stumbling as much and was focused. By the next day, he was fine!

Vet wasn't sure what was wrong, and since he was better by the next day, I wrote it off and maybe an ear issue. I've heard that when does get older, the hairs inside their ear, break off and they feel dizzy at times.

A year later, he started loosing lots of hair on his back by his tail, eating like crazy and his hind legs were starting to give out and became really weak like within a three-month period. He also had elevated liver enzymes in his April Vet annual exam. I did my research and Cushing's Disease fit his symptoms. The vet disagreed with me at first until I had a hair analysis test which came back with his cortisol level being high. The Vet then had us do a LDDS and the results confirmed what I thought from the start that he has Cushing's Disease.

He was diagnosed a couple weeks ago with the pituitary Cushing's Disease and I am starting him tomorrow on Trilostane 30mg twice daily. I am terrified to start the meds!!!! I have heard dogs suddenly can die while on this medication.

I've had him on Cushaway which is a lignin and melatonin supplement, Thistle Milk, half an aspirin and Standard Process Adrenal Support supplements and he seems to been walking a lot better with less hind leg weakness. Still hungry all the time! Just torn between wanting to put him on Trilostane.

Any advice for this fearful mommy?

[Lili0127]

Hi there everyone.

I am thankful for finding this forum and I have been educating myself with all of the forum posts and medical research information!
Remington is a very active 14-year old dog! Up until 3 months ago, we were jogging on his daily walks, not my choice but his natural way of walking!

In May, he started loosing clumps of hair and scaly skin on his lower back by his tail, started eating like crazy and his hind legs were starting to give out and became really weak all within a three-month period.

The Vet gave him an anti-fungal and an antibiotic for his hair loss, and it cleared up very quickly and the hair grew back.
He also had elevated liver enzymes in his April Vet annual exam. I did my research and Cushing's Disease fit his symptoms. The vet disagreed with me at first until I had a Viaguard hair analysis test, which came back with his cortisol level being high (43.72pg/mg). The Vet then had us do the high low dex test and the results confirmed what I already knew intuitively from the start.

He was diagnosed a couple weeks ago with the pituitary version of the Cushing's Disease and I am starting him tomorrow on Trilostane 30mg twice daily. I am terrified to start the meds!!!! I have heard dogs suddenly can die while on this medication.

The past few months, I've had him on Cushaway, which is a lignin and melatonin supplement, Thistle Milk, half an aspirin and Standard Process Adrenal Support supplements. He seems to been walking a lot better with less hind leg weakness. Still hungry all the time! Just torn between wanting to put him on Trilostane.

Any advice for this fearful mommy?

[Harley PoMMom]

Hi and welcome to you and Remington!

You will see that I have taken the liberty of shifting your reply from another member's thread where you originally posted, and I instead shifted it here to create a new thread that is your very own. This way, it will be much easier for our members to reply to you directly.

I was wondering if you would tell us more about your boy's medical history, this will enable us to provide you with our best possible feedback.

I wasn't aware that the hair cortisol concentration test was now being used, the last peer reviewed study I read was in 2013 and it still needed to be further investigated. So, could you tell me more about this test, please? Also could you get copies of all tests that were done on Remington and post those values that are marked abnormal with the reference ranges? And we are very interested in seeing those LDDS test results too. How much does your boy weigh? Is he taking any other supplements/herbs/medications? Is his urine diluted? Was an urinalysis done recently, and if so, could you post those findings?

Vetoryl/Trilostane is a strong drug, and yes, it does have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. Dechra, the manufacturers of Vetoryl, recommend a starting dose of 1 mg per pound of a dog's weight. If 30 mg twice a day is what is prescribed than Remington must weigh at least 60 pounds, does he weigh that much?

Safe and effective treatment requires an experienced vet and an educated pet owner and it is when one or both is missing that dogs get into trouble. We have many members that are treating their cushdog with Vetoryl/Trilostane and are experiencing success.

We certainly understand that you may have some apprehensions in starting your sweet boy on treatment but you are not alone and we will walk this journey with you. If you have any questions please do not hesitate to ask them.

Hugs, Lori

PS: I now see that you were faster than me and created a thread for Remington, Good Job!!!

[Allison]

Welcome to the forum!

I'm sorry I can't answer your questions. Our own Gizmo struggled with Cushings for only a few years before he developed pancreatisis. It's the latter that caused him his life.

However, there are many experts on this site who will be able to help. They'll give the guidance you need so that Remington will have many more years.

In the meantime, we're all here to encourage and support you. Hang in there!

[Lili0127]

To answer your question about the Viaguard hair analysis test for Cushing's Disease. No, it is not approved by Vets as a way to diagnose Cushing's. My Vet didn't think he had it initially, and my intuition said he did. At first, I didn't want to pay for all the Vet tests to know if he had it.

So, I ordered the hair analysis test. The results came back with a level of cortisol at 43.72 pg/mg. So, I went ahead and had the Vet do the LDDS test to officially tell me that he had Cushing's Disease. She has not given me the actual results of the blood tests. I will ask for them to see how they compared to the hair analyses results.

He had the hair analysis test done in May and the low high dex test in July, so there could be a little bit of a difference in the level of cortisol.

You asked about Remington's weight: he ways 68 pounds, so his dosage of Trilostane at 30mg every 12 hours is good.

You asked about supplements that I currently have been using that appear to help him with his hind leg lameness and mood: ve had him

1) Cushaway, which is a lignin and melatonin supplement.
2) Thistle Milk
3) half an aspirin
4) Standard Process Adrenal Support supplements.

Cushaway is awesome! When I ran out for a week, his hind leg weakness came back instantly and he could barely finish his daily walks on the way home. We walk on average about 6-12 blocks and his legs give out about a block or two before we're home.

When his legs give out during walks or swimming, which I do to help keep his muscles strong, I find that having him sit and rest for 1-2 minutes when they give out helps a lot, and he regains hind leg strength to be able to walk normally, but at a slow pace to make it home.

It's sad to see your dog trying to catch a frog in the water and have his legs suddenly give out, so he ends up laying in the water to try to catch the frog! The whole hind leg issue really just started in the early Spring. Before that, he was so active and nothing would stop him from running, hunting, etc.

Lisa

[Lili0127]

I've heard that the latest lab studies are having great results with Dopamine receptor treatment! Since, stress is the trigger for the release of cortisol even in humans who don't suffer from Cushing's Disease, it makes sense to study the effects of our brains release of dopamine in a flight or fight stressful situation.

Our Hypothalamus is responsible for sending the signal to the Pituitary glands when we are stressed. The same is true for dogs. My dog is always stressing over simple things like when I leave the house without him, or if I raise me voice in an argument, he goes and tries to hide! No wonder why his body is releasing cortisol in huge amounts!

Anyway, I've heard that FDA approved, Anipryl is an Oxidose inhibitor that increase dopamine in the brain, which is key to controlling Cushing's Disease in many of the latest studies. It's available by prescription for dogs who have Cushing's or other depression or memory issues, etc.

Here is the link to the FDA article on Anipryl for dogs with Cushing's Disease and other issues:
Link to FDA story on Anipryl: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm151209.htm
(http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm151209.htm)

I've heard it is mainly used in dogs with very low symptoms of Cushing's and it must be the pituitary-dependent version.

Why not start the dogs out on this rather than the heavy duty drugs like Trilostane and the other??

I would like to know if anyone has tried it on their dog and have had any good or bad results.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about Anipryl into Remington’s original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members, and parents, to refer back to the pup's history when needed. Thanks!


Yes, my Squirt started out on Anipryl (Selegiline) and she was among the few this drug actually helped. Anipryl will work ONLY on dogs with the pituitary form and ONLY if the pituitary tumor is in the pars intermedia portion of that gland. 85% of cush pups have the pituitary form and of that 85%, only about 20-25% have the tumor in the pars intermedia so it is a very small portion of the cush population Anipryl has the ability to help - we were very lucky.

I see no problem with trying it if the pup is in the early stage and has mild signs or there are concerns about using one of the more effective treatments - Lysodren (Mitotane) or Vetoryl (Trilostane). Talk to your vet and see what they think.

Hugs,
Leslie and the gang

[Lili0127]

Thanks, Leslie!

I don't know if Remington has a tumor and where it actually is. He does have the Pituitary-dependent form of Cushing's Disease.

Remi is supposed to start his Trilostane today and my gut is stopping me! He is 14-years old and I am afraid something bad is going to happen! Have a lot of dogs diagnosed at his age, who started Trilostane had good results where the dog actually lived another 2 years feeling healthy for the most part?

I am just afraid that it will cause organ failure even though he doesn't have any major issues that we are aware of. Just old age and slightly elevated liver enzymes. He also has a heart murmur level 3.

Sorry, I am just really stressed about starting his Trilostane and cannot foresee giving him the pill twice a day for at least 30 days or longer. I have to think about this longer. Any advice from people out there good or bad would be wonderful!

Lisa:)

[Squirt's Mom]

Just FYI - all forms of Cushing's with the exception of Iatrogenic which is caused by the use of or exposure to steroids, involves a tumor. I know how scary it is to hear that but in most of our pups with the pituitary form, PDH, that tumor remains microscopic and causes no more problems than the elevated cortisol and subsequent signs of Cushing's. In rare cases, that tumor becomes what we refer to as a macro, growing until it causes neurological issues - but that is NOT the norm. ;)

Do you mind telling me what you mean by a "high low dex test"? There are two different tests, HDDS and LDDS, but not a combination that I know of. And, would you mind getting the actual results of that test/those tests and posting them here?

For cush pups properly diagnosed, treatment is for life, not til the signs go away and the cortisol is normal again. It is a life-long treatment.

You should also know that the ingredients in CushAway are not capable of addressing the levels of cortisol seen in a true cush pup. Lignans and melatonin, the combination in specific amounts based on weight, are used to treat a form of Cushing's called Atypical which involves NORMAL cortisol and elevated intermediate, or sex, hormones. They are not used to treat true Cushing's with elevated cortisol. Phosphatidylserine is used to address mental acuity in aging dogs and has no real value in treating Cushing's. I gave PS100 to my cush pup in addition to other supplements and herbs along with Lysodren - I knew the PS100, herbs, and supplements could not address her cortisol....and they did not alone. They were great supports along with the Lysodren but not alone. (I chose to use Lyso VS Vetoryl.) The melatonin and the PS do have the capability to lower cortisol but only levels found in things like jet lag - not the massive amounts found in a cush pup's body. Here is a link from 2009 where PS was discussed on K9C - http://www.k9cushings.com/forum/showthread.php?t=878

Something to consider - if any of the "natural" methods worked not one person here would use either Lysodren or Vetoryl - those two drugs would have no use. None of us wanted to put our babies on such powerful meds but we all wanted to offer our babies the best life possible - and those two drugs do just that for a true cush pup.

[Lili0127]

Thanks for all the info. I will get the LDDS test results from my Vet and share with you. The test he had is called IDEXX Dexamethasone Suppression then it says high amount and low amount. Hence, what I call high low dex test:0


Lisa

[Lili0127]

Leslie,


How did you find out where the tumor was in the pituitary gland? MRI or x-ray? I haven't gone that far yet with testing Remington for whether it is a cancerous tumor or most likely a non cancerous tumor like most dogs have with the pituitary dependent Cushing's.


For me personally, it's one step at a time and due to his age of 14 years old I am not sure if I want to put him too much more additional testing like MRI's. I am asking because I am still interested in Anipryl as an alternative from the Trilostane and his starting point. Though, I have already paid for the Trilostane and met with my Vet to cover everything I need to do and watch for.

[Squirt's Mom]

I didn't test Squirt to locate the tumor...I just knew from the abdominal ultrasound that she didn't have adrenal tumor(s) so that meant a pituitary tumor. Her vet at the time said she felt Anipryl was worth a try - the fact that it worked told us her tumor was where it needed to be for the Anipryl to reach it. ;)

[flynnandian]

you can start with 30 mg of vetoryl once a day in the morning with food. there is nothing wrong with starting low and slow. you can perform an acth test after 2-3 weeks to see how he is doing. maybe you are lucky and your dog has good results on only 30 mg, or maybe you need to up his dose after a month. at age 14 and with his back leg issues/arthritis he will feel better when his cortisol levels are a bit higher.

[Lili0127]

Thank you for that advice of starting him on just 30mg once per day until I see that he doesn't have any of the side effects. That makes me feel a little bit better at getting him started on his Trilostane.

He is already scheduled for his 10-14 day follow up appointment with the vet for a stim test within 4-6 hours of taking his med. I figured he will have his appointment at the 5th hour of the 4-6 hours of taking the pill with food. Does that sound like a good plan for the follow-up?

Lisa and Remington

[Harley PoMMom]

Quality of life is most important and that is especially true with our senior dogs. There are pros and cons in treating Cushing's. One of Administrators, Marianne, posted a reply to a member with a senior dog who was contemplating treatment and I want to share that with you:
Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

I'm a firm believer in trusting one's own instincts so if your gut is saying no I completely understand your apprehensions. Only you know Remington best.

Hugs, Lori

[Lili0127]

Thank you, Harley. Did she ever treat her dog with Trilostane or the other dog do you know?

Just curious as to how it went for Pepper.

[Harley PoMMom]

Pepper's Cushing's diagnosis was questionable and in her last post, dated 2/3/2013, Lisa (Pepper's Mom) stated that she was not going to pursue any more testing because Pepper was doing well.

The goal of treatment is to control the troublesome symptoms (things like excessive thirst, urination, hunger, panting) and since the damage of untreated Cushing's usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly and my primary concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I probably wouldn't. Also, in the absence of strong, obvious symptoms it certainly makes it harder to judge if treatment is working

You mentioned Anipryl and I see that Leslie (Squirt's Mom) had posted about her positive experience using it with her furbaby. Also, if clinical symptoms are not that bothersome to the dog or owner, some members have told us that Cushex and Adrenal Harmony Gold worked very well in controlling symptoms but only for a short time period. Now, Cushex and Adrenal Harmony Gold have no controlled clinical testing whatsoever to back up their claims (we know this because we have contacted the manufacturers and we have been told that no testing has been done).

The decision to treat or not is a very personal one and we are here to support you with the treatment plan you feel is best for Remington. ;)

Hugs, Lori

[Lili0127]

Thanks, Laurie:) Your advice makes sense.

After careful consideration of all the wonderful comments to help me determine what is the best route to go with Remington's medication, I have decided today to get him going on the Trilostane despite my fears due to his age.

I started him on his Trilostane today, 30 mg twice daily. So far, so good. I've realized this weekend that his hind legs are his biggest issue as a Cushing's Disease problem and I have to try to see if the Trilostane will bring down his Cortisol enough to have his back legs regain their strength, which the disease is ravaging for at least the past 4 months that they have deteriorated.

Remington's Cortisol level increasing is definitely tied directly to his stress levels, because he is very sensitive to when I leave him alone for periods of times. He barks and barks because I've put a video camera in the house. I work from home and we are together almost 24/7. When I leave to go somewhere, he flips out. I know this stress increases his Cortisol levels! I had to leave him alone Thursday night and by Saturday, his hind leg weakness kicked in big time. A little better today, but still not very good after two weeks of hardly any weakness, or falling down the steps, or needing to rest on walks.

Lisa

[judymaggie]

Lisa -- just a thought re Remington's stress levels. High cortisol can increase stress and often is reflected in a higher "fight or flight" reaction. My beagle's reaction to other dogs and people was much more reactive when her cortisol was high. You may, indeed, find that Remington is a bit calmer after cortisol levels have lowered for a while.

[Lili0127]

Ha ha, Judy, that is funny! He has always been a spaz his entire life and always over reactive to many situations. He went through obedience training class twice in his younger days and we tried everything until we finally excepted that's just the way he is.....cortisol or not....




Lisa

[Lili0127]

Leslie and Lori,

One of you asked for the results of Remington's LDDS/IDEXX test which the Vet used to determine that he has Cushing's Disease. I have the results:

Pre-Dex: 2.5 ug/dl
4 Post Dex: 0.7 ug/dl
8 Post Dex: 2.9 ug/dl

Reference Range: 1.0 - 6.0

Is there a way to understand these results? Am I supposed to multiple the numbers by something?

Lisa Saliture

[Harley PoMMom]

Leslie and Lori,

One of you asked for the results of Remington's LDEXX test which the Vet used to determine that he has Cushing's Disease. I have the results:

Pre-Dex: 2.5 ug/dl
4 Post Dex: 0.7 ug/dl
8 Post Dex: 2.9 ug/dl

Reference Range: 1.0 - 6.0

Is there a way to understand these results? Am I supposed to multiple the numbers by something?

Lisa Saliture

The LDDS (low-dose dexamethasone suppression) is one diagnostic test, which takes 8 hours to perform, that is used to identify Cushing's and has the potential to differentiate between the adrenal or pituitary type of Cushing's.

When performing this test 3 blood draws are taken; the first one is to get a baseline number, next the dexamethasone is injected and blood is drawn 4 and 8 hours later.

The 8 hour number is looked at first and if it is higher than the cut-off range, which is usually 1.4 ug/dl or 1.5 ug/dl, the dog probably has Cushing's. If the base number is above the cut-off range than the next step is to determine if the Cushing's is pituitary or the adrenal form and this is based on that 4 and 8 hour level.

I'm including a quote from one of the top veterinary endocrinologist, Dr. Bruyette, on interpreting LDDS test results:
Test procedure.

The LDDS test is typically performed in dogs that have fasted for eight hours (check whether your laboratory requires fasted samples). To perform this test, obtain a baseline (0 hour) blood sample, administer dexamethasone sodium phosphate (0.015 mg/kg) or aqueous dexamethasone (0.01 mg/kg) intravenously, and obtain two additional blood samples four and eight hours later. Contact your laboratory before testing to determine its specific LDDS test protocol. The serum cortisol concentrations are measured in the three blood samples.

Test interpretation. When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

If the eight-hour post-dexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

I am pretty sure that the reference ranges listed for Remington's LDDS test, Reference Range: 1.0 - 6.0, are not the ones that are used for this type of test, the cut- off (reference) range is usually 1.4 or 1.5 ug/dl, so taking in account that Remington's 8 hour level was over the cut-off range this is indicative for Cushing's but his results do not differentiate between the adrenal or pituitary form.

Hugs, Lori

[labblab]

Hi Lisa, just wanted to pop in to say that I'm betting the listed normal reference range of 1.0 - 6.0 relates to the baseline (pre-dex) cortisol level. That would be a typical range for resting, baseline cortisol levels. If you look elsewhere on the page, I'm betting a second reference range is also given.

As Lori has written, the normal range for the 8-hour value is different: typically 1.4 or 1.5 ug/dL. So just as she's said, Remington's 8-hour result is positive for Cushing's since it is higher than the typical 1.4/1.5 cut-off.

One last thing I'll add is that Remington's result is actually consistent with the pituitary form of Cushing's since his 4-hour value was less than 50% of his baseline level (in other words, more than 50% suppression occurred at the 4-hour level). Hope this adds a bit more clarification.

Marianne

[Lili0127]

Yes, Marriane, the Vet said it was Pituitary kind based on the results of the test.


I'm concerned and need advice!!! Today, is the second day Remi is on Trilostane and he cannot walk at all today!!

This has never happened thus far to this extent since he's has had hind leg weakness in the past few months!!

Today, since around 1 PM, he has not been able to get his back legs to work. I have to hold his back end up so he can get up and try to walk.

Normally, it takes him a couple minutes to recover if say we are on a walk and his hind legs give out and then he can get up and walk fairly good.

Does anyone think it could be caused by the Trilostane I started yesterday????? I find it very coincidental that he suddenly cannot walk at all today! Like I said, his hind legs have never been this bad in a day where he cannot walk at all.

I'm worried. I called the vet but she had her baby on Friday and a fill in Vet is there, who probably isn't familiar with Remington at all, except that I was told that she has used Trilostane to treat dogs with Cushing's disease.


Please advise.


Lisa

[flynnandian]

hi lisa, which dosage of vetoryl did you chose to give remi? the 30 or 60 mg? when his reaction is this bad, i would stop the vetoryl immediately and watch remi very carefully. is he ok otherwise? no vomiting, diarrhea etc.? those can be signs of an over dose.
the high levels of cortisol do mask arthritis and inflammation of the joints and ligaments. my border collie showed the same symptoms after his firts dose. he was a retired working dog so his joints were not 100% anymore. your dog is a big dog and 14 years old, so there must be some damage to the joints too.
i stopped giving vetoryl to my dog because of this.
i hope remi will feel better soon.

[labblab]

Lisa, you'll see that I've redirected your new thread about Remi's inability to walk back here to your original thread. This is because it's important for folks to be able to read his whole history as they make suggestions as to what may be going on.

I do agree with Iris -- I would not give Remi any more trilostane for the time being. As she says, as long as there are no other signs of drug overdose, I would not expect that his cortisol has dropped to a level that is dangerously low in terms of overall bodily function. But it may be the case that the drop in cortisol is "unmasking" arthritic pain or other orthopedic issues, resulting in worsening mobility. It is true that Cushing's often causes hind-end muscle wasting, but at Remi's age, he may suffer from orthopedic degeneration that is unrelated to Cushing's, as well. Very sadly, I just lost my 12-year-old nonCushpup Lab due to hind end collapse resulting from severe hip dysplasia.

So returning to full circle, I would not give any more trilostane for now. The drug should exit Remi's body within about 12 hours, and if it is indeed the culprit, hopefully you'll start seeing improvement again by tomorrow.

Marianne

[Harley PoMMom]

One last thing I'll add is that Remington's result is actually consistent with the pituitary form of Cushing's since his 4-hour value was less than 50% of his baseline level (in other words, more than 50% suppression occurred at the 4-hour level). Hope this adds a bit more clarification.

Marianne

Thanks for catching my error, :o you are right those LDDS test results are indicative to the pituitary form.

Even after all this time of researching Cushing's I sometimes get those LDDS test results goofed up. :o:o

Hugs, Lori

[Lili0127]

Thanks ladies! I am stopping his 30 mg of Trilostane as of tonight per the Vet and your advice.
Still not able to use his hind legs this evening.

He started with diarrhea last night and again today by the way as another possible side effect.

Will keep you posted.

Liss

[lulusmom]

Leslie and Lori,

One of you asked for the results of Remington's LDEXX test which the Vet used to determine that he has Cushing's Disease. I have the results:

Pre-Dex: 2.5 ug/dl
4 Post Dex: 0.7 ug/dl
8 Post Dex: 2.9 ug/dl

Reference Range: 1.0 - 6.0

Is there a way to understand these results? Am I supposed to multiple the numbers by something?

Lisa Saliture

Hi and a belated welcome to you and Remington. I am a bit confused because you said that the diagnosis was based on a follicle cortisol evaluation and that your vet did a high dose dexamethasone suppression test (HDDS) to differentiate between between pituitary and adrenal disease. Your comment above makes it sound like he also did a low dose dexamethasone suppression test (LDDS). Can you please confirm that the above results are in fact the LDDS? If the test result is unclear, please double check with your vet. If this is a HDDS, results can only be used to differentiate between pituitary and adrenal disease and cannot be used to confirm or validate a diagnosis. To confuse things even more, the results you posted would be consistent with pituitary dependent disease on both a LDDS and an HDDS. If these are not LDDS results, Remington will be the only dog I've ever known to be diagnosed with cushing's using a hair cortisol test. There was a study done a few years ago that suggested this may be an effective diagnostic test but that more studies would need to be done. I'm unaware of any additional studies. The only facility I was able to find that does this type of analysis is Accu-Metrics in Canada. Did you buy the cortisol hair analysis kit directly from them? If not, how did you get this test done?

Your vet should have done a complete senior panel before any diagnostics. These include the blood chemistry, complete blood count (CBC) and a urinalysis, preferably with a urine culture. Can you please share the results of those tests with us? You need only post the high and low values on the blood chemistry and CBC and please include the reference ranges. I will be looking forward to learning a lot more about your precious Remington.

Glynda

[labblab]

Hi Glynda! Thanks for asking Lisa for more clarification about the dexamethasone testing. From what she had written, I assumed that the hair test exhibited high cortisol (kind of like an elevated UC:CR), but then a LDDS was subsequently performed in order to confirm the specificity of the overall Cushing's diagnosis. But that is indeed merely an assumption on my part, so it is an excellent idea to confirm the exact nature of the dexamathasone testing.

I surely hope that Remi is feeling better today. After my own recent experience, I know how heart-breaking and difficult it is to deal with leg collapse in a larger dog. And adding in the diarrhea is even more worrisome and awkward. The diarrhea does have me feeling more concerned that Remi's cortisol did indeed dip too low for comfort, even after only a couple of doses. If he is still acting so poorly today, you may want to ask the vet's permission to give him some supplemental prednisone. That could help in two ways: if his natural cortisol fell too low, it can help bridge the gap; and even if not, the anti-inflammatory effect of the prednisone may help ease an acute orthopedic issue.

Do let us know how you both are doing!

Marianne

[molly muffin]

How is Remington now?

Did they do a senior panel of bloodwork on him at all recently?

My dog, is currently having problems getting up and down and when she lays too long needs help getting up on her feet and then getting them to work right. There are several reasons, one of which is a spine issues, which a vet could determine, and xrays could confirm, (mine tweaked hers somehow and is likely causing a nerve pinch), another is a laxating patella and on the other side, hip dyslplasia. So there could be definite reasons that lowering the cortisol would unmask as was mentioned by Marianne. The diarrhea, in conjunction though is concerning, although mine too is currently having a bit of diarrhea, and they think it is due to the pain causing stomach upset, etc. But unless Remington is checked thoroughly for anything other than lower cortisol to be causing the problem you won't know for sure. Which means it is well worth a vet visit to get this straightened out so you know how to proceed.

[Lili0127]

Glynda and Marriane,

Yes, Marrianne is correct in saying that I chose to have the hair analysis test done on my own on a hunch, not wanting to pay for the expensive vet tests.

By the way, the results are spot on!

The vet then did the LDDS test that I posted above that you asked me to confim.

Remi is walkng a little better today but not back to doing it without my help. We stopped the Trilostane and will have a stim test next week and back xrays to see what else might be going on with his hind legs.

marriane, what are the names of some of the supplement predisones?

Lisa

[labblab]

Hi again, Lisa. I'm glad Remi is doing at least a little better. How about the diarrhea -- has that cleared up? If so, he may not need any prednisone since the effects of the trilostane are probably already out of his system and his natural cortisol will be rebounding. Prednisone, itself, is a generic synthetic form of glucocorticoid (steroid). At least in the U.S., it is readily available and very inexpensive in generic form. It is also available here as a brandname drug (like Deltasone), but through the years, I've only been given generic prednisone by our vet. Dexamethasone, just like was used for Remi's test, is also a steroid that can be given to supplement natural cortisol production.

One warning: if you do give prednisone, Remi should not have it during the 24-36 hours prior to an ACTH stimulation test because it will falsely elevate the results. Dexamethasone, by the way, does not create this same problem.

Marianne

[Lili0127]

Thanks, Marriane. He does actually still have diarhea as of 6pm this evening. He had one regular earlier this morning and then back to the runs.

hopefully, tomorrow will be a better day for him!

[Lili0127]

Sharlene,

yes, remi had a senior panel in April where everything looked good except elevated liver enzymes. Next week, he will have xrays done on his back to see msybe if he has a pinched nerve in addition to the Cushings causing the hind leg weakness along with a stim test to make sure the Trilostane didn't damage his adrenal system even though he was on it for only 2 days, I think is what the Vet said.

Lisa

[lulusmom]

Lisa, thank you for your response. To be perfectly honest, I'm still not completely clear as to which test you had done because you've called it a high low dex test and a LDEXX test neither of which are correct titles. However, since Remington is already on treatment, it's water under the bridge at this point, but I am still very much interested in knowing where you had the hair cortisol analysis done. FYI, I reviewed the study, Evaluation of Hair Cortisol in the Diagnosis of Hypercortisolism in Dogs, and you are absolutely right, Remington's results were definitely in the median range of cortisol concentration in dogs with cushing's.

Glynda

[Lili0127]

Glynda,

The correct name of the test the vet did to officially confirm Remington has Cushing's Disease is a LDDS test according to her. When I got the actual document, it says, IDEXX as the Lab ID. Sorry, may have mistyped it previously, since I have had a lot on my mind with Remi not being able to walk after the 3 Trilostane pills!

As for the hair analysis test that I had done on my own accord prior to the vet doing the LDDS test, I ordered it from Viaguard Accu-Metrics from Canada. They perform DNA and many other human and animal tests using hair samples. The cortisol accumulates in hair for 6 months and is very reliable, You will see it becoming a mainstream test in the future. The Vets aren't ready to make it their choice based on a report from a few years ago, probably paid off by another dominating company to do so.

Here is the site for ordering the hair analysis test: http://www.accu-metrics.com/cushings.php (http://www.accu-metrics.com/cushings.php)

For $90, it gave me some piece of mind when I wasn't ready to pay for the expensive tests initially by the Vet, but wanted to start giving Remi natural Supplements for Cushing's which have been working well with some of the symptoms despite what some say on this forum! This may be temporary but Remi is 14-years old and I am buying him time anyway:)

The hair analysis results showed his level of cortisol at 43.72 pg/mg as of June 21st of this year. Then, had the LDDS test done by the vet done in August of this year confirming Cushing's Disease. Those results are listed in a previous thread I posted.

Lisa


Lisa

[Lili0127]

Yes, High low dex and IDEXX is the LDDS Test, ladies! This is what I mean when I refer to the test. It's all the same. I apologize for any confusion.


Lisa

[Lili0127]

Here is what I would like to determine if possible:

The hair analysis test shows a Cortisol level of 43.72 pg/mg which is elevated levels of cortisol in Remington's body. Pg is pictograms and mg are millograms of hair.

20-30 pg/mg is average level of cortisol.

How does this interpret to the LDDS test results from the Vet if we look at the following:

Pretest: 2.5 ug/dl
4 Post Dex: 0.7 ug/dl
8 Post Dex: 2.9 ug/dl

Reference Range: 1.0 - 6.0 Normal

Lisa

[Lili0127]

Does anyone know if there is an canine Cushing's disease organization where I can donate the 30mg Vetoryl box of medication to? I only used three of the pills? I suppose I cannot ship it anywhere legally even if it is for a medical donation.


Lisa

[Lili0127]

Two days after taking Remi off the Trilostane and he is walking a lot better. We went for a walk around the block just now and he only land on his butt once, which is a big improvement since yesterday. He can make it down the stairs today, but I still have to help him up them since taking the Trilostane.

When he does sit or fall, his left leg is straight out and does not bend now. Seems stiff. This is new.

Lisa

[flynnandian]

this was the case with my bordercollie too. the high levels of cortisol have masked the arthritis for a long time so we didn't know how bad it really was. it happened overnight too with my dog. after his first dose he became lame, weak and his right wrist was 2x as big as before.
your dog is a 14 year old working dog too, so his joints are not 100% anymore. no vetoryl anymore for remi i guess. my dog got a nsaid painkiller and omega 3 capsules, but he never recovered from that one day of vetoryl. it is your decision of course, but i wanted to tell you our story, because it is very similar to remi's story.

[Lili0127]

Flynnandian,

Seriously, your border collie never was the same after that one does of Vetoryl? I wish I could have talked to you before deciding to give Remi this medication. Maybe, older dogs just shouldn't risk taking it if it is going to make their lives worst than prior to starting the meds. My goal was to make his hind leg weakness better with the Trilostane by treating the Cushing's Disease not making it worse.


This is quite depressing to hear.

[Lili0127]

Remi still has diarrhea as of today. Still having problems going up stairs and with walking. He now keeps his left left straight out rather than bending it since his 3 Trilostane doses over the weekend which lead to him not being able to walk at all. This is really a mess. His walking is better but still hasn't gone back to pre-Trilostane and it's been 4 days as of today.
http://www.k9cushings.com/forum/picture.php?albumid=1126&pictureid=8509
Next week, he goes back to the Vet for a stim test. Not sure what the next step should be to treat Cushing's disease at this point. But, need to address the hind leg issue quickly.

I've included a picture that I took today of that hind leg which now sticks straight out when he lays down. This indicates to me stiffness and possibly arthritis uncovered after three Trilostane pills at 30mg every 12 hours. That is the only logical explanation. Prior to Trilostane, he did straighten his leg out like this but not constantly!


Lisa

[labblab]

Lisa, I'm so sorry Remi is having these problems. Is he able to bear weight on that hind leg when he walks, or does he favor it? I am just wondering whether he may have damaged a cruciate ligament in his knee while slipping or falling, as that might account for the unwillingness to flex that joint while at rest, too.

I am concerned about the ongoing diarrhea, as well. Since his cortisol level won't be checked until next week, is the vet aware that the diarrhea is continuing? Has there been any discussion of giving him a low dose of prednisone in order to see whether that helps?

Marianne

[Lili0127]

Marianne,


Yes does walk on the leg but is still unsteady as of today. The Vet doesn't know about the ongoing diarrhea because I don't get paid until next Wednesday and he is going in on Thursday. Hoping the diarrhea stops soon.

No, Vet didn't mention prednisone yet but we are going to do xrays of his lower back because about 8 years ago he had an xray done and a different vet said he had fused vertebrae at the time. He used to cry out in pain in 2008 but then it stopped. So, the Vet now thinks the hind legs could be connected but I still feel the Cushing's has brought the weakness out since it all started about 3 months ago out of nowhere and came on so strong.

[Lili0127]

Update:

Today Remington is visiting the Vet to discuss Acupuncture and Chinese herbs as an alternative to treat the symptoms rather than cure the Cushing's Disease. Please note the difference.

Remington is 14 years old and as you may recall, after 3 doses of 30mg of Trilostane, his hind legs gave out, so we took him off of it immediately.

As an alternative, I am trying Chinese herbs from the Vet based on his type of Cushing's Disease which is pituitary dependent and acupuncture to help his lower spine and hind legs.

My goal is to keep his spirits up, him feeling good for now and as healthy as possible! I will keep you posted on this journey he and I are taking together.

If this doesn't work, we may try Anipryl, but right now he is on Dasuquin and Metacam for his spine and leg joint issues and don't believe he can do them both at once. He just started Dasuquin and Metacam about 5 days ago and will need to be on it at least a month to see if his hind legs will make an improvement. I will talk to the vet about this again today to verify if he can take Anipryl while on Metacam and Dasuquin.

Lisa and Remington

[Joan2517]

Good luck to you and Remi, Lisa. Hopefully, you can find a way to make him comfortable....

[labblab]

Lisa, I wish you the best of luck, as well. We will definitely be interested in hearing your updates, and I surely hope you can keep Remi as comfortable as possible. At this stage of his life, by far that is the most important consideration.

For what it's worth, I don't know why Anipryl could not be used alongside either Dasuquin or Metacam. But I am no expert about that. If you do discover there is a drug interaction, we'd be interested in knowing about that on behalf of our other members who use Anipryl. Thanks!

Marianne

[DoxieMama]

I hope that Remington does well with the supplements. Please do keep us informed.

[Lili0127]

Thanks everyone I will keep you posted. Remi had his first session of acupuncture with the Vet on Thursday, 17 pins to be exact. He did very well and only felt one when the vet took one out of his paw and injected it with Vitamin B12.

The first thing I have noticed is that he has slept soundly that night and last night only having to go out once during the night to take a quick pee. Other than that, he is sleeping like a rock on the bed with us, which is not like him. The past few months, he has been restless, and moving around a lot, waking up and his leg twitches in his sleep.

So, the acupuncture seems to help him with his sleeping. He also seems happier the past few days and maybe is even walking a little better! I will keep you posted....

Here is a pic of Remi at the Vet with his acupuncture needles in his back. https://www.dropbox.com/s/05qihok41n0c141/14224953_10210113936233262_2869285311961321029_n.j pg?dl=0

Lisa and Remi

[Squirt's Mom]

Glad to hear he is doing better and that the acupuncture is helping him sleep better. Hopefully you will see more improvements over time.

What were his ACTH results? Did you talk to the vet about the Anipryl?

Hugs,
Leslie and the gang