Arnie the Bullmastiff

[Arnie's mum]

Hi

My 11 1/2 year old bullmastiff has just been diagnosed with Cushings disease and started Vetroyl (120mg) on Friday. He is due back at the vets next week to check the dosage.
I was wondering when I would notice any changes in him. He has been more tired and lethargic today but put it down to the weather. He is constantly sleeping and little interest in food (unless we rattle the biscuit tin). Is this normal?
As I'm new to this disease I would appreciate any advice from other owners.
Thanks in advance. x

[labblab]

Hello and welcome to you and Arnie! I'm guessing Arnie is a big boy and this is why he was prescribed a starting dose of 120 mg. However, the behavior you are describing (lethargy, loss of appetite) suggests that he may be overdosing on the medication. I believe you should notify your vet of these changes as soon as possible. If you cannot reach your vet before the next dose is due, it is probably safest to go ahead and withhold the dose on your own until you are able to consult with him/her. Dogs metabolize the drug on an individual basis, and we have found that dogs may require doses that are either much larger or much smaller than their weight may suggest. If Arnie's cortisol level is being lowered too greatly too quickly, this can make him feel ill and even become a serious safety issue.

Can you tell us more about the symptoms that led you to suspect Cushing's, and also more about the testing that led to the diagnosis?

Thanks so much,
Marianne

[judymaggie]

Hi and welcome to you and Arnie! Arnie's reactions to the Vetoryl are a bit concerning -- my first thought is that his dose might be a bit high for him. We ask lots of questions in order to help guide you -- my first one would be "what does Arnie" weigh? Current recommendations for a starting dose is 1 mg./lb. That said, we have seen that large dogs often need less, not more, Vetoryl to maintain a healthy cortisol level.

In order for us to provide you with the best feedback, it is helpful if you would get copies of all tests that were done on Arnie and post those abnormal values along with their normal ranges. With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows. Does Arnie have any underlying illness that he is taking medication for? And if so, what is it and what is the medication? Is he taking any supplements, medications or herbs? Was an urinalysis done and, if so, could you post those findings too?

Please also advise what specific Cushing's tests were done to diagnose Arnie along with the results. These could include the LDDS, ACTH, ultrasound, etc. The LDDS would have three numbers (baseline, 4 hr. and 8 hr.). The ACTH would have two numbers, a pre and a post.

We have a wealth of information regarding Cushing's in our Resource forum -- the medications used, and treatment protocols as well as articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman. So please utilize it to educate yourself and if you have any questions do not hesitate to ask them. We all eventually figured out that safe and effective treatment is much easier facilitated if the vet is experienced and the pet owner is educated. Here's a link to our Resource thread:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

Others will be along to add their thoughts -- we are looking forward to learning more about Arnie!

[Arnie's mum]

Hi Marianne
Sorry a bit long winded...
Arnie went to the vets a little over a month ago for having two nose bleeds... I knew this wasn't normal and the vet said he had worms and prescribed panacur. No worms and a hefty vet bill later she prescribed him antibiotics as he had a minor skin irritation and she suggested that this could be a number of things. These lumps grew all over his body and then ulcerated. Skin scrappings were done and showed nothing.
She did say she thought he had Cushings then but wanted to try the less aggressive option first. Two weeks later and a high dosage of antibiotics for the skin condition along with a shampoo with no change his head started changing shape and more skin blisters he went back to a different vet (same practice) who couldn't hear any heart sounds from him, ultra sound and more blood test I asked for him to be tested for Cushings and confirmed the next day after a short stay in hospital.

I just put his pot belly down to old age, less active and his bald tail to banging so hard the hair follicles were damaged causing the hair not to grow again. He wasn't drinking or eating more and previous vets visits nothing was picked up.

I will withhold the medication tomorrow morning and speak to the vets, I'm just trying to do what's right for him at his age.
Thanks. x

[Arnie's mum]

Arnie currently weighs 53kg and not on any other medications and no other illnesses that I am aware of.
I think a urinalysis was done and can get them results also. I'm not sure of the test that were done, just that they were blood tests. I can get the vet to email them over to me and post them then to get some idea what he levels are. Sorry for the little information I have said for them to do what was needed (Barclaycard in hand)! x

[labblab]

Thank you so much for this additional info, but to be honest, it worries me about the accuracy of the Cushing's diagnosis :o. Nosebleeds are not at all typical of the disease -- in fact, Cushing's is more often associated with the opposite issue: formation of blood clots due to hyercoagulation. Also, the absence of classic symptoms of excessive thirst and hunger are to be noted. It sounds as though skin problems and perhaps a pot belly are the decisive symptoms here, and there can be many other causes for skin issues other than Cushing's.

This is part of the rub: the two diagnostic blood tests for Cushing's can both return "false positives" in the presence of other nonadrenal illness and even stress. If Arnie was given one of these tests in the midst of a stressful hospital stay, that could have affected the test results. This is why the symptom profile is also so important when a diagnosis is made. And it does not sound to me, at least as of yet, that he has many symptoms that we would expect to see with the disease.

It is true that infections of all sorts are found with Cushing's, and there is a particular skin condition, Calcinosis cutis, that is directly associated with the disease. This condition can only be definitively diagnosed through actual skin biopsy, however. There are also certain lab abnormalities that Cushpups typically exhibit, such as elevated liver markers and elevated cholesterol. Urine is usually very dilute due to excessive thirst and urination. And finally, abdominal ultrasounds will typically reveal enlargement of the adrenal glands and liver changes that are consistent with Cushing's. The more corroborating evidence is present, the greater confidence we have in the accuracy of the diagnosis. So once you actually have all his test results in hand, that will be a big help to us.

I am surely sorry that Arnie is doing poorly and I can easily imagine how worried you are about him. We will do our very best to help you sort things out, though!

Marianne

[Harley PoMMom]

Hi and a belated welcome to you and Arnie from me as well!

The nose bleeds are a bit of concern to me and can be caused by high blood pressure. Has Arnie's blood pressure been checked recently?

Hugs, Lori

[labblab]

That's a really good thought, Lori, and I'm really glad you posted it. High blood pressure can indeed be associated with Cushing's, so it would be good to have it checked out.

Marianne

[Arnie's mum]

Hi all
Arnie was back at the vets this morning. He was unable to bare any weight this morning and could not stand up. He is still there and attached to a IV drip.
He also would not eat and when he went to the toilet he had diarrhoea and a small amount of blood.
His blood pressure has been done each time and normal.
The vet has diagnosed him with pituitary cushings and redone his bloods today and the count was down from 5000 to 4000 so as I understand it's a improvement. The think that the lethargic/tiredness was due to the steroids being reduced and arthritis now being painful.
He is now on paracetamol and fluids for pain and 120mg of vetoryl for cushings.
Thanks for all of your concerns, reading them has helped me understand a lot more about cushings and how grateful I am to hear your advice. x

[DoxieMama]

He has diarrhea with blood in it? What do they think is the cause of that? I would not give him Vetoryl until he feels better and no longer has those symptoms...

[Arnie's mum]

Hi Doxie man
Yes, it happened at the vets, they saw and said it was fresh blood and was a very small amount. He has been to the toilet again whilst being in their care and had diarrhoea again but no signs of blood. They are monitoring him and we are possibly going to reduce the dosage of vetoryl. x

[Arnie's mum]

Apologies... Doxie mama... Silly predictive text. X

[Arnie's mum]

Quick update on Arnie

He collapsed at home mid week and was hospitalised for a few days. He was on a drip of fluids and pain relief.
He could not bare any weight on his legs and had to be carried everywhere! Not easy at 53kg!
He had bad diarrhoea with blood in at the vets. The blood was fresh and the vets said this was due to vetoryl. His body could not cope with the drop in steroids. We think that he has other underlying issues with arthritis (possibly cancer or liver disease) and the drop in steroids had caused more problems than solved.
I have taken him of vetoryl and he is now able to stand and support himself.
He is going to be monitored at home and assess whether he will start treatment again. I think that due to the length of time untreated for Cushings his body could not cope with such a change.
Thanks.

[Squirt's Mom]

I am glad he is doing better! I hope the hospital did an ACTH so you know what the cortisol was at the time of his collapse...and that they checked his electrolytes at the same time? If so, would you mind posting those results here? Is Arnie still on pred at home? I so hope he continues to improve and you can get to the bottom of what is causing his issues.

Hugs,
Leslie and the gang