Hello, Newly diagnosed with questions?

[makettle29]

Hello all, My Maltese, Hercules, is 11 years old and just diagnosed. I have two initial questions. How do I determine how advanced the disease is and should I go to a specialist for management of his health? I have all the test results. Let me know what numbers you need. Thanks so much I've been a member of Spoiled Maltese since he was a baby and they referred me here. Gratefully, mary anna:)

[DoxieMama]

Hi Mary Anna, welcome to you and Hercules.

I apologize as I only have a moment to post but I'm sure others will be along with more questions as the day goes on. If you can share the symptoms that led to your/your vet suspecting Cushing's, the diagnostic test results (ACTH, LDDS - all numbers from either) as well as if you've had an ultrasound done and what they found from that, it would be helpful. Additionally, post any bloodwork that was abnormal - the value of the result along with the normal range indicated by the lab. How much does Hercules weigh and have you started any treatment for his Cushing's yet?

Looking forward to learning more about him!

[makettle29]

Thanks Doxie, 11 year oldHercules is 13lbs. just started 20mg of Vetoryl 1xdaily.

He started having accidents last Spring, gained weight and belly hardened over the summer, developed crusty skin and started panting just recently. He has gradually become more tired, not interested in walking. Always drank lots of water. Adrenal Cushings diagnosis.

Pre-ACTH Cortisol 4.7 Post ACT Cortisol 23.2

Ultrasound: Liver mildly enlarged, Gallbladder moderate isoechoic sediment, Kidney's normal sized with moderately decreased corto-medullary definition. Bilateral renal pelvis mineralizations keft kidney has small cyst. Adrenal glands mildly increased size.

ALP 168, high
Chloride 107 , low
Potassium 5.5, high
NA/K ratio 27, low

Thanks to anyone who can tell me how progressed he is and if I should use a specialist for his ongoing treatment. :)

[Squirt's Mom]

Hi Mary Anna! Welcome to you and Hercules!

What a great name for such a tiny baby! :D

You say this is Adrenal based yet both adrenal glands show enlarged on the ultrasound. In the adrenal based form of Cushing's, ADH, we usually see a tumor on one of the glands which is very large while the other gland is very small, or even atrophied. Was an LDDS performed? That test is capable of determining if it is pituitary, PDH, or adrenal, ADH. Based on the comments from the US you shared, this appears to be PDH, not ADH but an LDDS would help. ;)

And if you would edit your post to include the little letters and normal ranges for each of those values you posted that are too high or too low that would be wonderful!

The new starting dose for Vetoryl is 1mg per lb so 20mg may be a tad bit much for a 13lb baby. Keep a very close eye on him for any of the signs that the cortisol is going too low, which is a life-threatening situation. Those signs are loss of appetite, nausea/vomiting, loose stools/diarrhea, lethargy. If you see ANY of those things, stop the Vetoryl immediately and call his vet asap.

As for the progression in his case, that is about impossible to say. His cortisol on the initial ACTH is not as high as we have seen in many, including my own little 5lb'er who's post is off the charts at >50. :eek: So I wouldn't worry to much about that. When the cortisol is back in more normal range your little boy will feel better and he can live a nice long life barring any complications.

I am very glad you found us and want you to know that you and Hercules are now part of our little family here at K9C. If you have any questions never hesitate to ask and we will do our best to help you.

Hugs,
Leslie and the gang

[makettle29]

Hi Squirt's mom, I got it backwards, It's Pituitary. I'm so confused:eek:

Ok, His highs and lows are all just out of normal range. Don't know what LDDS is? Can't see anything on my paperwork with those initials? I have T4 results, CBC results, CHEM 27 with SDMA results, Sonogram results and ACTH results.

I will watch for reactions to the meds. I think the Dr took a middle range option based on the guide inside the pill package. Also made an appointment for him to see an internist, I'll feel better about his care with a second opinion.

THANK YOU!

[labblab]

Hello, Mary Anna, and welcome from a fellow Marianne! :D :)

I'm so glad you've already gotten such great info from other folks. I just want to elaborate a bit more on the dosing issue. As odd as it seems, the printed dosing chart inside the Vetoryl package is now outdated -- in other more recently revised publications, Dechra is advocating for the lower, 1 mg. per pound, starting dose. I will give you a link that will explain all of this in greater detail. But in honesty, if Hercules was my dog, I would talk to your vet about dropping back to either only 10 mg. daily, or else I would purchase some 5 mg. capsules so as to drop back to a daily total of 15 mg. The good thing is that, either way, you won't be wasting any 10 mg. capsules since I assume you're giving him two 10 mg. capsules each morning. Your 10 mgs. will last longer, even if you add in the 5mgs. as well. Anyway, here's the link. Please read through it and let us know of questions. You may even want to print it off for your vet.

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

Marianne

[makettle29]

Hi Marianne, thanks. Hercules did throw up this morning, so he could be having a reaction already on day three. His stool was a little soft this morning also. Going to read your link right now. THANK YOU

Update: I called Vet and reduced dosage to 10mg until next testing.!

[Squirt's Mom]

Do NOT reduce - STOP now! This is not the correct protocol according to the drug manufacturer so STOP giving the Vetoryl and have an ACTH done asap. If this were my baby, no way I would follow the vet's directions on this. ;)

[Squirt's Mom]

From the drug insert -

"Serious adverse reactions associated with this drug can occur without warning and in some cases result in death (see ADVERSE
REACTIONS and POST-APPROVAL EXPERIENCE). Owners should be advised to discontinue VETORYL Capsules and contact their veterinarian immediately if signs of intolerance such as vomiting, diarrhea, lethargy, poor/reduced appetite, weakness, or collapse are observed."

Note the word "discontinue" not reduce. ;)

[labblab]

Can you tell us how many doses of Vetoryl you've given to Hercules? If it's only been a day or two, I myself wouldn't go to the length of running a repeat ACTH right now unless he were to worsen or remain unwell. Since he did vomit and had a loose stool, though, I do agree with Leslie that I would hold off on giving any more Vetoryl until all GI symptoms are gone and his behavior is back to the pretreatment norm. At that point, I'd restart dosing with the 10 mg. and go from there. And of course, if he remains ill, then I agree I'd take him back for testing. Most likely he is having a reaction to the sudden lowering of his cortisol, though, and a break from the medication will allow his system to recover as his cortisol level rebounds once again.

Marianne

[Joan2517]

Hello and welcome from me, too. Yes, please stop until Hercules tummy feels better....

[makettle29]

wow.......I'm a little stunned right now. I will watch his symptoms and behavior closely tonight. I will NOT give him a dose tomorrow and re-start on Friday(or later) with a low dose. If he is not better soon, I'll take him in to the vet.

This whole diagnosis has caught me off guard as his symptoms just creeped up so slowly I didn't see them. I also had given the task of bathing him to someone else and I regret not having my hands on him more completely. Thank all of you for your incredible responses. I was so anxious to get the meds in my little guy that I think your warnings are valid. I will take him to a specialist next week. When I asked my vet about side effects he did NOT tell me to discontinue if they appear.

Peace.

[molly muffin]

Hello and welcome from me too.

I would do as Marianne suggested and stop the vetroyl for now. Wait for him to be back to normal, no vomiting and stool more formed then restart at 10 mg.
it's not uncommon for them to feel icky when cortisol drops but the key is to doing it slowly so you can gauge how they are doing.

I know this is all overwhelming when first getting the diagnosis. We have all been exactly where you are now but I am sure that you and Hercules will do just fine. The more you learn about the disease, the meds, testing, etc the more comfortable you will feel. deep breathes.

[Squirt's Mom]

Hang in there...I know this is almost more than we can bear at first but as you learn more it will become easier, both to deal with and to understand. You are doing a great job of watching him, Mom. ;) I think we all blame ourselves in some manner for our babies getting sick but this disease just happens, unfortunately. And it creeps up on most of us - it's only when we start to learn about the signs and look back that we can see changes, changes that are so easily attributed to other things. But treatment can and usually does bring our babies back to themselves so have faith.

Hugs,
Leslie and the gang

[makettle29]

I am grateful for all the support here. Hercules is feeling better today so I'll try again tomorrow with a single 10mg dose. As a precaution I had been getting his blood work done every six months for the past 18 months thinking that if there were anything abnormal I would be told. My vet didn't tell me anything was off. :(

I brought him in because of a skin condition that wasn't going away. I know someone who just went through this with her pup, who later developed diabetes. It's discouraging to see the symptoms in hind sight.

How soon after starting medication should I expect hi to fee better?

[molly muffin]

Checking to see how Hercules is doing. Did you start him back in on the lower dose? How is he handling it?

[makettle29]

Hi, I just got the result from his stim test and his numbers are back in normal range after 10 days of 10mg 1x a day. His energy is better and he walks further. His belly is still a little swollen but I'm so glad to have him on the mend. My vet wants me to come back for another test in 30 days. I hope he'll continue to improve. Wondering if there are any supplements that you ladies would recommend to support his health in dealing with the medication?

thanks again, mary anna

[molly muffin]

I always gave my dog a good joint support, with msm and some sort of liver support, like Hepato support, sam-e, etc

Glad to hear that he is feeling so much better, do you know what his numbers were?

[cyncyn]

So Many things here I never thought of...I feel so unprepared :eek::eek:

[Harley PoMMom]

Glad to hear that your boy is improving! Could you please get those ACTH stimulation results and post them here, please?

Hugs, Lori

[judymaggie]

Mary Anna -- please don't feel like you are the only Cushing's parent who has felt overwhelmed. We have all been there and, whenever anything new comes up, we are still there! That is one of the huge benefits of belonging to a forum like ours -- just post your thoughts/questions and someone will come along to help you out. Give yourself a huge bundle of credit for joining the forum and being willing to learn!

[makettle29]

Hi everyone,

Hercules is a 14 lb Maltese. His original test results was 4.7 pre stim and 23.2 post stim. After 10 days of 10 mg 1x a day his pre stim was 1 and the post stim was 3.7. Thanks for the help.

mary anna

[Harley PoMMom]

Thanks so much for posting those stim numbers for us. I'm a bit concerned, you see even though Hercules` post stim number is great, it bothers me that it decreased so fast. So if you see signs of his cortisol dropping too low, stopping the Trilostane is required, the adverse effects you want to watch out for are vomiting, diarrhea, loss of appetite, lethargy, or Hercules is just not acting like his normal self, if you notice any one of these symptoms in Hercules stop the Trilostane.

Hugs, Lori

[makettle29]

Thanks Lori, I thought it was a fast drop too. I'll continue to watch him closely. So far his poop has been good and his energy is up. His belly is still a little swollen but my vet said that takes a while.

I really appreciate your words of caution! Bless all of you. mary anna:)

[Harley PoMMom]

So happy to hear that Hercules is doing so well!!! You're doing a great job, Mary Anna!!!!

[molly muffin]

Whoo hooo wonderful to hear Hercules is doing well. Good news is always great to hear. :)

[makettle29]

Thanks to all who replied. Hercules seems to have a little trouble walking, his hind legs seem unsteady. I'm taking him in for evaluation for arthritis. Otherwise he has more energy but still has a swollen belly. He's also on antibiotic for a crusty type skin ailment. They did a scraping sample so at least I know he's on the right antibiotics. He second stim test is in 10 days. I'll update as it unfolds.

[molly muffin]

Hi, just checking in to see if you had the ACTH follow up test done yet and how your boy is doing.

[makettle29]

My Hercules woke up panting and shaking this morning. He is unsteady on his legs also. I had a third stim test done three weeks ago and he was right in the normal range. He's been on 10mg of veterol since about February and has been doing great, until this morning. He won't touch his water , breakfast or medication which I give in a pill pocket. Right now I'm watching him and waiting for the Vet to open.

Any thoughts? thanks, mary anna:(

[labblab]

Hi Mary Anna, I'm really sorry Hercules is doing poorly this morning! Under these circumstances, I would not try to give him any more Vetoryl for the time being, regardless of the recent ACTH results. Also, can you tell us exactly what those numbers were?

I am guessing your vet will want to see him in person, and perhaps draw blood to check his general blood chemistries. There may be something going on that is unrelated to his Vetoryl. Or, it's also possible that even though his cortisol level is OK, some of his other blood chemistries (most notably potassium and sodium) may be unbalanced by the medication.

Please keep us updated, OK?
Marianne

[makettle29]

Thanks Marianne, The Vet is not in until 9 and I got an emergency appt at 10. I'll ask about the potassium and sodium. He also feels a little warm to me. I guess it could be anything related, or not, to Cushings.

He did just drink a little water, but won't eat. Will post results later.

[makettle29]

My Vet has no idea what's wrong???? The blood work came back in normal range except the liver which was just out of normal and x-ray showed nothing in the stomach. I'm not near my primary vet but I have seen this one before. Hercules stayed at the vet all day and when he got home he drank a large quantity of water and then peed. He won't eat anything at all and still panting. He is still unsteady on his legs. I'll keep an eye on him overnight and hope for the best I guess.

[molly muffin]

I wouldn't put him back on any vetroyl until he is well again.

What about pancreatis? I know everything came back normal, but I'm just throwing some ideas out there.

Back pain? My molly from out of nowhere it seemed couldn't get up and walk very well, wobbly, would walk a bit, lay down. I had the vet do an xray of her back and they found an injury (we think she slipped and twisted or something and didn't affect her until hours or day later maybe) You can do a sort of check by running 2 fingers own the sides of the spine firm but not overly so and see if you get a skin ripple affect. (indicative of pain when the skin ripples like that)

Just throwing some ideas out to eliminate I guess.

[makettle29]

Molly, thanks. I forced a vetroly on him before I read your post. I didn't know they could go without. He would not keep one down yesterday. How long can they go without?

He is very unsteady on his legs and basically collapses on my wood floor but seems to be able to do better on my brick flooring. He wouldn't eat anything this morning so I made him scrambled eggs and he had a few hand fed bites before he quit. Still drinking water eagerly. Last nite he panted quite a bit and would not lay down so I gave him the sedative I use for plane flights which seemed to work until he woke me up with unusual crying/breathing noises and when I went to comfort hiim he walked right off the edge of my bed! I held him for the rest of the nite.

Please tell me how you treated your doggies spine problem. It's possible that this is what's happening. I ran my fingers down his back but didn't get the rippling effect. His sway back seems more pronounced than normal and his hips look prominent.

Thanks Molly, I'm baffled and I guess so is this vet. I question her competency and may try another if she can't resolve this.

[labblab]

It is really not a problem to discontinue the Vetoryl for as long as it takes until Hercules is eating and behaving normally again. When a dog is not eating, the medication really does not get metabolized properly, anyway. Plus right now when he is so stressed, he might actually benefit from allowing his cortisol to increase somewhat.

Like Sharlene, I wonder somewhat about the possibility of pancreatitis. That can be very painful and can result in a loss of appetite, in addition to vomiting and/or diarrhea. There is a specific blood test that can help diagnose pancreatitis. If that is the issue, offering small, bland meals (mushy white rice and boiled chicken, for instance) is often recommended. But some professional intervention might also be needed (antibiotics or IV treatment). That may not be at all what is wrong, but it might be a possibility. I agree with you totally -- if he doesn't start to rebound quickly, I'd seek a second opinion without delay.

Marianne

[makettle29]

Hi Marianne,

He is feeling better! I think he was having back problems and back pain. I carried him everywhere for about 3-4 days, keeping him off his feet and on pain meds. He slowly started eating again (hand fed). I am continuing to keep him from any activity and bought him an orthopedic bed.

I do appreciate your responses and having a place to turn when I'm unsure is a big relief. So glad you are there!

best, mary anna

[makettle29]

Hi, my little Herk is swollen up again with a hard tummy. I give him 10 mg of Veterol daily and watch his calories but his belly feels like it did when first diagnose. He's not panting or drinking too much, just pumped up like a basketball. Any ideas? Is this normal?

thanks, mary anna:confused:

[DoxieMama]

Hi Mary Anna,

I don't know what might be going on with his tummy. Did that occur quickly or has it been gradual? Have you seen your vet? When was the last monitoring ACTH test done and what were the numbers from it?

Shana

[makettle29]

Hi Shana,

He was tested about 6 weeks ago (third test since February) and his numbers are all good. It seems to have come on gradually. His original swollen belly reduced and became more pliable after being on the veterol for a few months. Now it seems nearly back to pre diagnosis swelling. I haven't brought him to the vet.

[molly muffin]

I'd have him checked out by the vet. Hard tummies aren't good to have and you never know if it is going to mean something serious or something simple unfortunately, so best to have it looked at.

Do you know what the numbers were on that last monitoring test? if so can you post them for us?