Katie and Jo Jo, the Cushing Beagle - looking for advice, please!

[kelarsonhart33]

Hi everybody!

I signed up to be a member of this group a couple of months ago, and I must say that I am so happy and grateful to have stumbled across this site. It seems like such a supportive and informative group – one I most definitely appreciate when trying to learn and deal with Cushing’s Disease.

Murphy Jo (“Jo Jo”) is a 10-year-old, female Beagle. I have had her since she was a puppy, and she means the world to me, which is something to which I am sure you can all relate! Murphy was actually “accidentally” diagnosed two years ago. Looking back on it now, I am not sure why I waited so long to get her spayed, but I didn’t have it done until she was 7 years old. Unfortunately, her incision just refused to heal and kept herniating. She had surgery three different times to get it sewed back up – the final time the vet used permanent stitches. It was really an awful deal. I felt like because she was older, she wasn’t healing as quickly as she should, and I felt terrible. The vet, on the other hand, suspected something more and ran a low dose dexamethasone suppression test:

Pre Dex Cortisol level was 6.0
4 Hour Post Dex Cortisol level was 0.5
8 Hour Post Dex Cortisol level was 1.6

The vet said that this was consistent with pituitary-dependent Cushing’s Disease. We discussed a few different options, but she seemed to lean towards not treating her until she was a little more symptomatic of having the disease. At this point in time, she had no signs or symptoms (aside from her stomach incision refusing to heal).

In 2015, I took her to a new vet that had more experience with Cushing’s disease, and he ran just a general blood work test on her. Most things were within the normal range aside from her liver enzymes, which he said was consistent with Cushing’s disease. I don’t have that test, but can certainly get a hold of it if it helps. This vet also seemed to lean towards holding off on treatment because again, she was relatively asymptomatic at the time. She had started the notable panting by this time frame though.

This year in June, I took her in for her standard blood work, and most things were again normal, but her liver enzyme levels scared me.

ALT – 246
AST – 26 (normal)
ALP – 1,841
GGT – 91

The ALP in particular is terribly alarming since the test says that the normal range is 5-160 U/L. This prompted me to stop thinking that I should just wait until she has more symptoms. Right now she just does the excessive panting (occasionally) and has the pot belly. Due to my concern and insistence, the vet suggested that we go forward with the ACTH stimulation test. So we did that too, and the vet said that results were inconclusive.

Cortisol Pre-ACTH – 9.3
Cortisol Post-ACTH – 15.3

So! That brings me to the present. I am now considering the possibility of an ultrasound, but am unsure if that is even necessary. At the same time, I feel like we need to be 100% sure without a shadow of a doubt that Jo Jo has Cushing’s Disease before we start down the road of treatment. What are all of your thoughts on doing the ultrasound to further diagnose the disease?

I am also getting very conflicting information regarding treatment options. I have read that one medication is better for pituitary based Cushing’s, but then I have also read that it doesn’t matter. I have read that trilostane (Vetoryl) is the way to go regardless of whether the tumor is adrenal or pituitary based. I have read so much about both of these drugs since Jo Jo was first diagnosed that my head is spinning because there seems to be SO much contradictory information out there. I welcome any thoughts or opinions on the efficacy of the two main drugs out there (mitotane and trilostane – I think).

Jo Jo is a relatively happy dog and by no means seems miserable. But I am very concerned that without treatment at this juncture, she is going to wind up with liver disease or some other serious condition as a direct result of not treating her Cushing’s Disease. If anyone has any thoughts or recommendations on whether or not the ultrasound is necessary as well as advice on which drug is the best for treatment, please let me know. I would be extremely grateful and appreciative of any advice.

P.S. She has never been on any medication aside from a pain pill after surgery for about 3 days after each surgery. She has no other known medical issues at this time.

Thank you!

-Katie and Murphy Jo

[judymaggie]

Hi and welcome to you and Jo Jo! I am also a beagle Mom and live with my second beagle Cush pup. Your story of Jo Jo's spaying has similarities to Abbie's as she was also spayed when she was 7 after I adopted her. She developed an infection from the suture material and had to have a subsequent surgery to clear out the infected tissue.

Okay, enough reminiscing ... on to your concerns. I believe that both vets' recommendation to hold off treatment is appropriate in light of the lack of symptoms. That said, Dr. Mark Peterson, an endocrinology expert, agrees except when a dog has hypertension or proteinuria. Has Jo Jo had a urinalysis done recently? If, so, please advise if the protein is high (noted by a plus sign and a number, i.e., +3). Also of interest would be if the urine specific gravity is low which is another marker for Cushing's. It might be worthwhile for Jo Jo to get her BP tested.

Can you post the ranges for all the liver enzymes? Were all other labs normal? With regard to a high alkaline phosphatase, Dr. Peterson has written that "in general most dogs with Cushing's syndrome develop a high alkaline phosphatase which is "induced" to rise because of the cortisol excess. In other words, the fact that the liver enzyme is high only means that it is a marker for Cushing's and does not reflect liver damage." He adds that this is not a reason to treat because this rarely normalizes even after successful treatment.

If the other liver enzymes you listed are all high, then it might be worthwhile to have an ultrasound done so a thorough look at the liver can be done as well as take a look at adrenal glands and gallbladder.

As you have probably read on other posts, Cushing's progresses at a snail's pace and, in the absence of hypertension and proteinuria, treatment is usually initiated to curb the more common symptoms of ravenous hunger, excessive thirst and/or urination. For Jo Jo, if treatment were started now, the only option would be trilostane as there would be no way to judge loading of mitotane without presence of increased hunger or thirst.

Others will be along with their thoughts--looking forward to learning more about Jo Jo!

[kelarsonhart33]

Hi Judy!

Thank you SO much for your response and sharing with me about your beagles! I have to say that I am actually REALLY relieved to hear that you agree that holding off on treatment was a reasonable choice. That has been one of my biggest concerns, and I have gone around and around with myself wondering if the vets were right not to treat it until we had some symptoms.

Jo Jo has not had a urinalysis done, but after reading your response, I think that is definitely something I will have done to see if she has proteinuria. As far as hypertension goes, do you have any suggestions as to how I might be able to do this myself? The reason I ask is that she hates the vet, and going there throws her into full panic mode. I suspect having her BP taken there will result in some high numbers no matter what.

Onto those test ranges!

Overall – most things were in the normal range, but here is what was not so normal:
ALT – range should be 18 to 121 U/L – Jo Jo is 246 (was at 243 last year)
AST – range should be 15 to 55 U/L – Jo Jo is 26 (normal result – results not captured last year)
ALP – range should be 5 to 160 U/L – Jo Jo is 1,841 - (was at 975 last year - yikes)
GGT – range should be 0 to 13 U/L – Jo Jo is 91 (results not captured last year)
Lipase – range should be 138 to 755 U/L – Jo Jo is 797 (results not captured last year)
Cholesterol – range should be 131-345 mg/dL – Jo Jo 544 (results not captured last year)

The ALT and GGT are a bit high, with the ALT being consistent with last year. The ALP, however, was already high last year and has double this year. That said, I am thinking the ultrasound is something we should probably do, just in case (?)

I think/hope the cholesterol has gone down since this test also. As a beagle, Jo LOVES TO EAT! I know that can sometimes be a symptom of Cushing’s, but she has always been that way. So we have been working on our portions and have switched foods. She is now down about 10 pounds. Still a ways to go (currently at around 50 lbs), but we are diligently working on this.

The interesting thing is that she did have increased thirst until we switched foods. She now gets canned food (Wellness and Castor & Pollux) and has gone completely back to drinking normal amounts of water with regular bathroom trips (3 maybe 4 times total for the day). I wanted to switch her because of her weight, but also because I read that Cush dogs should eat higher amounts of protein, lesser fat, and very few carbohydrates.

Let me know if you think those liver enzymes are as scary as I feel like they are! Also curious as to your thoughts on the canned food switch alleviating Jo’s Cushing’s “thirst” (and excessive bathroom trips) almost completely. I suspect the increased water content in the canned food plays a big role here, but I was quite surprised she just went back to normal with the thirst/excessive urination symptom (panting has since decreased as well).

Sorry I have written a book here, but very much appreciative of the thoughts and insights you have provided so far, and I am definitely looking forward to any more that you might have!

Thank you, Judy!!! I hope you are having a fantastic evening!

-Katie and Jo Jo

[molly muffin]

Hello and welcome from me too. I would think that the water content in can food might have something to do with alleviating thirst. In cushings, the dogs kidneys work over time, they go to the bathroom more, therefore they need more water. So if she is back to a normal urination schedule, then her need for water is also less.
Yes the liver AST and GGT going up would be of more concern. The ALKP being high is quite often seen in dogs with cushings or even pre cushings and the AST can go up at bit too, but the AST and the GGT are liver specific.
If it is feasible to have an ultrasound (they can be expensive) then it might be worthwhile to take a look at the liver, kidney and adrenal glands.
I'd start though with a urinalysis as Judy mentioned to see if there is any protein loss. They can do a UPC on the urinalysis. You actually need to have 3 consistent high UPCs, taken several weeks apart to make a ruling that there is a problem. I try to do first morning urine catches to check it.
I wouldn't say definitely that cushings is in play yet based on these results.
Welcome to the forum.

[judymaggie]

Katie -- You asked if you could take Jo Jo's BP at home. There are some you tube videos showing how this can be done; however, I think the trick will be finding a cuff that is small enough for Jo Jo's forearm. Your vet might have a suggestion. I totally understand about trying to limit vet visits due to stress. My vet has Abbie go into a darkened room with a vet tech and the tech does at least five readings over an hour's time. The readings are then averaged. I realize that this might not relax a lot of dogs and, interestingly, after Abbie's last vet visit, she was extremely agitated for several hours. Abbie has also had her pressure measured at an animal hospital and they used a doppler machine and it only took a few minutes to get a reading. My vet's machine was broken and set up the appointment. What was good was Abbie had no idea where we were going and seemed excited about checking out a new place!

[kelarsonhart33]

Hi ladies!
Thank you for your responses! I am going to see if I can get a urinalysis done in short order, but I also went ahead and scheduled the ultrasound. I am really hoping that there aren’t any additional issues that are found when the ultrasound is performed, but I guess we will cross that bridge when we get there!

I am also going to check with the vet to see what kind of options there are to get her BP taken (and see if I can find some YouTube videos on it too!). Jo Jo often experiences anxiety at the vet’s office, but also at new places in general and with people she doesn’t know well, so this might get tricky.

I know that Jo Jo is going to be extremely stressed out and uncomfortable with the ultrasound though. Do either of you have any suggestions/ideas to help calm a dog down when an ultrasound is being done? The vet threw out mild sedatives as an option, but I am really nervous about having her sedated. I don’t know if that is a good option for a dog that likely has Cushing’s disease? Curious as to both of your thoughts on that!

Hope you are both having a nice weekend!

-Katie and Jo Jo

[molly muffin]

I never had to have mine sedated for the ultrasound, they just did it and she was okay. She would calm down when she couldn't see me.
Light sedation, not anesthesia could be an option if she is too stressed for them to do the ultrasound.

[DoxieMama]

Hi Katie, and welcome to you and Jo Jo! I don't have anything more to add right now, but will be following along. When is the ultrasound?

Shana

[judymaggie]

Hi, Katie! Just checking to see if you were able to get Jo Jo's ultrasound scheduled -- did you have a urinalysis run? If so, you know we would want to see those results, particularly what the specific gravity is as well as whether there is any protein in her urine.