Max

[Caz28]

My lovely beardie x boy was constantly hungry and gaining a lot of weight and became disinterested in exercise, he sleeps a lot he is 11.5 years old. He had degenerative retinal disease and has been blind since he was 6 but I retrained him, learnt new commands and up to now has coped brilliantly. The vet did blood tests and said a liver enzyme that should be around 212 was reading 4000 and to take him in for more tests. He had to stay there for one and a half hours and they said he was distressed in the cage just circling and trying to get out, which is why I hate leaving him in that environment, he doesn't understand, he can't see what's going on! They suspect Cushings and said he should start treatment and then be tested again in 9 days but because its Christmas treatment couldn't be started till New Year. They explained he would have to have scans and x rays to determine what kind of cushings, said he could also have liver disease or tumour. They also said the medication could make him sick and upset stomach and could even cause addisons which can be fatal and go away and think about it. I'm thinking I don't want to put him through the stress and risk with him being blind too. I would like your opinion of the right course of action and if you agree I should just look after him and keep him at home and comfortable what will happen with progression of the illness?

[Harley PoMMom]

Hi and welcome to you and your boy!!

Im sorry but I have only a moment to post, I'm at work :( But I wanted to greet you and your sweet boy. On thing that is very important with Cushing's is that you don't start treatment unless you have a confirmed diagnosis. And since this disease moves at a snail's pace there is a sufficient amount of time to get that confirmed diagnosis.

I'll try to get back later on, and in the meantime if you could round up copies of all tests that were done on your boy and post any values that are abnormal with their normal ranges that would be great. If you have any questions please feel free to ask them ;)

Hugs, Lori

[Caz28]

Hi, thanks for your reply. The vet did a general blood profile first and said all appeared ok except a liver enzyme, ALP which should be around 212 but was 4000! They then did a biochemistry ACTH stim test. They went through the results which I didn't really take in, but said it pointed to Cushings although 'there are a lot of grey areas in diagnosing this'. Max takes a 50mg carprieve daily to help with soreness in his eyes and 2 x seraquin daily. He now weighs 34kg having gained 5/6 kg since his booster jabs in August. He has 2 large lumps, 1 underneath and 1 on his leg which he's had for a long time and the vet says are fatty lumps.

[Caz28]

Any advice would be greatly appreciated thanks. Reading a lot of posts on here, Max hasn't got the excessive weeing associated with Cushings.

[Harley PoMMom]

Cushing's is typically a slow progressing disease, and the decision whether to treat or not depends on a number of factors: age of the dog, apparent discomfort, and severity of symptoms (both external and internal).

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. Another reason that makes it difficult in deciding to treat is that it's not pleasant for any dog to go through the trauma of multiple vet visits and the many monitoring tests that are required for treatment and for a senior dog it can be worse. Also, if a dog is already suffering from arthritis, Cushing's treatment may cause more discomfort as that elevated cortisol does have anti-inflammatory properties.

With this disease 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. And even though this disease has its own complications in treating we do have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success.

Another very important factor, treatment should not start until a confirmed diagnosis of Cushing's is made. And since this disease moves at a snail's pace there is time to make sure that it is Cushing's.

The tests performed to identify Cushing's are the ACTH stimulation and LDDS (low-dose dexamethasone suppression). Has the vet performed one or both of these tests on your boy? And if so, could you post the results? Was a urine sample taken for an urinalysis? Does your boy have diluted urine?

Please know we will help in any way we can, and know we will walk this journey with you.

Hugs, Lori

[Caz28]

Thank you so much, your reply is very helpful. The vet has done the ACTH stimulation test, I don't have the exact results the vet just said they are consistent with cushings. The other tests you mention haven't been done. Max's main symptoms are excessive hunger, to deal with this I am giving him 6 very small meals a day instead of 2, he has gained weight and isn't very interested in walks, I take him 2 short walks a day. He does pant when asking for food, but doesn't pant when at rest, he sleeps quite a bit. He doesn't seem uncomfortable or in any pain. If his requests for food are ignored and I tell him 'not yet, not time' he will settle. He isn't weeing excessively and hasn't had any accidents in the house. His coat is ok, perhaps going a bit thinner on his head.

[judymaggie]

Hi and welcome to you and Max! Many of us were not in the habit of obtaining written test results from our vets but this is a good practice to start. You are entitled to the specific results -- some vets will choose to e-mail results rather than provide hard copies. To follow up on Lori's request for test results, in order for us to guide you more effectively, it is important for you to get the specific results from the ACTH test. There will be two numbers, a "pre" and a "post". These numbers will help us determine if Cushing's is indicated. An ultrasound is not a required diagnostic tool to for Cushing's but the results can offer important information about the adrenal glands (in order to determine if Max has pituitary or adrenal gland based Cushing's) as well as the state of other organs. With Max' high enzymes, more information about his liver would be useful.

The "Helpful Resources" forum offers many articles to read about diagnosis and treatment. Here is a link to a pamphlet provided by Dechra, the manufacturer of Vetoryl:

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

[molly muffin]

Hello and welcome from me too.

Hmmm, if only the ALKP is up, I wonder if they can do an ultrasound if that is feasible since I'm wondering about sludge in the gallbladder which can also cause the ALKP to go up. Many things can, just as if there Is something else going on, then the cortisol can be elevated. (bodys natural reaction to stress is to produce cortisol) Also a bile acid test for the liver. I would investigate further before starting the treatment for cushings just so you know for sure what you are dealing with.