Scared! Dog just got diagnosed with Cushing (Chemo has passed)

[Chemo]

Well the past 5 months have been a wild ride. My best friend chemo lab/Shepard 10yo just got diagnosed with Cushing. We went to the vet for a over dose on rymidyl he made it thru it. (he opened my nightstand for a quick snack) 2 months later we went for a tooth infection twice. Then about a month later
He was super lethargic and walking like he was dizzy. He had a prostate infection we Figured it's because he wasn't fixed so it's enlarged. The vet gave us baytril cured his prostate infection. While I was there for the check up I asked about Cushings because he was drinking a lot, house breaking, not jumping on to bed and started to loose hair around his collar. Vet said it's because his prostate causing uti's and old age. So the vet said very unlikely I was dead set on him getting tested so we did a urine cortisol test it was (urine creatine 25.7) (urine cortisol 11.4) urine cortisol/created ratio 138. Results come back she suspected it was elevated because of his stress from all these vet visits. They did a blood Panel that day and said the past 6 months of the blood work we have done something was elevating (I forgot) that points to Cushing. So we did the low dose test. Got a call said he has Cushing. We are starting him on 60mg Lysodren. He is 80ibs. I'm freaking out because everything I read says 2 to 3 years life expectancy. He is my boy so I did a lot of research about radiation shrinking the tumor so I'm wondering if I should ask about it. Also the pituitary surgery but I've looked around the only place that does it is wsu.. The life expectancy really worries me. Any advice just diagnosed yesterday.

[labblab]

Hello and welcome to you and your boy! We surely do understand how worried and upset you are feeling, and we will do our best to offer our support and suggestions. First of all, we have seen many dogs here who have proceeded to live out their normal lifespans after Cushing's treatment has successfully stabilized cortisol levels. I think one basis for the 2-3 year prediction is the fact that many dogs are older at the time they are diagnosed, as is actually the case with Chemo. So my personal thought is that we want to focus on immediate quality of life for a dog of Chemo's size and age -- controlling his symptoms and keeping him as comfortable as possible for however many more years he is graced to live.

One of the first suggestions we make to new members is to ask their vets for actual copies of all the diagnostic tests, as well as the monitoring tests going forward. These numbers are very important for us when we consider your questions. For instance, depending upon the numbers for the Low Dose test, it may be possible to conclude that Chemo has the pituitary form of Cushing's as opposed to the adrenal form. Also, once treatment has begun, the monitoring ACTH blood tests will help us all gauge how well he is responding to the medication.

I have one additional "big" question for you: are you sure it is Lysodren that is being prescribed? The 60 mg. dosage you've cited corresponds instead to Vetoryl (chemical name is trilostane). Given Chemo's weight, 60 mg. would be a very reasonable dose of Vetoryl, but it would not be a reasonable dose of Lysodren. So let's definitively double-check the medication, and then we can talk more specifically about what to expect in conjunction with his treatment regimen.

I'll go ahead and close for now. But once again, we're so glad you've joined us, and we will be hoping for very positive treatment results for Chemo.

Marianne

[Chemo]

The meds are compounded. They will be in today I will double check the brand.. Will the meds help his rear leg muscles?

[labblab]

That'll be great if you'll let us know when you find out about the medication. I'm betting it will be trilostane.

And yes, the good news is that hind leg muscle strength can indeed rebound once cortisol levels have been stabilized. That is one of the symptoms that can take some time to resolve more gradually. But patience can be rewarded! Prior to diagnosis, my own Cushpup Lab had gotten to the point where he could barely climb stairs or get into the car. But after a couple months of treatment, he regained much of that lost strength.

Marianne

[Chemo]

Meds are trilostane. one in morning one at night. Gonna start Friday so I can watch him..
Low dose dex results
Pre dex 3.8
Cort 4hr 2.7
Cort 8hr 4.8

[labblab]

Yes, I was guessing it was trilostane. ;)

However, since you say you are giving one capsule both morning and evening, does this mean you are giving two 60 mg. capsules daily? If so, this would mean that Chemo is getting a daily total of 120 mg. For a dog weighing 80 lbs., that is a bit higher starting dose than is currently recommended by most specialists. The most widely accepted starting dose now uses the formula of approx. 1 mg. per pound of a dog's weight.

I am going to give you a link to a reply on our Resources forum that discusses this dosing formula. You may even want to print it out and show it to your vet. However, the bottom line is that experience has shown that dogs tend to experience less worrisome side effects if they are started on lower doses and then later increased, if need be, rather than vice versa. So in Chemo's case, I would talk with your vet about perhaps first starting out with one 60 mg. capsule in the morning, and then waiting to see how he responds to that (both behaviorally and via monitoring bloodwork) before increasing further. Another alternative would be to additionally order some 20 or 30 mg. trilostane capsules, to be given in the evening alongside the 60 mg. morning dose. However, I think giving 60 mg. both morning and evening is too large a dose. Take a look at this link, and you'll see why.

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

Marianne

[labblab]

And I just saw that you added those Low Dose Dexamethasone results -- thanks so much. OK, so from these results, we really cannot know for certain whether Chemo suffers from a pituitary tumor vs. an adrenal tumor. A dog with either type of tumor could have these results.

Has your vet talked with you about the possibility of an abdominal ultrasound? By actually viewing the adrenal glands, you can find out whether there is a tumor there. One reason why this might be important to you is if you'd consider surgery to remove the adrenal tumor. The surgery is risky and also expensive, but it can offer a complete cure. If surgery is not an option, then trilostane is indeed approved to medically treat the symptoms of both types of tumors.

Marianne

[Chemo]

They did a ultrasound for his prostate and checked his belly said everything was fine beside inlarged prostate but we didn't suspect cushings at that time. So they probably weren't looking for it. We had x-rays also of the chest and abdomen. Looked good besides the prostate being enlarged.

[labblab]

The adrenal glands can be pretty hard to see unless special, high resolution imaging is performed. So I don't know whether your previous ultrasound would have shown the adrenals or not. You can ask your vet about that -- whether or not the adrenals were actually seen on the earlier images.

Also, just want to make sure you also saw my earlier reply about the dosing. By the way, if Chemo's trilostane comes in a tablet form, you can probably just split the tablet in order to arrive at a 30 mg. dose. However, if the trilostane is in capsule form, you cannot open and split the contents. So you'd need to order additional capsules if you want a different strength.

[Chemo]

It's a chewable that's 60mg. Half in morning half at night. Also game me prednisone incase of emergency.

[labblab]

Alrighty then!!! :) :) :)

I'll go ahead and leave my lengthy babbling in place, though, for the benefit of other newbies who may read our conversation. ;)

Sounds like you're all set to go, and please keep us updated!

[Chemo]

Thank you for the support. One more thing could his prostate being so enlarged and dropping into his abdomen to touch the adrenal glands?

[molly muffin]

Hello from me too. I don't know that a prostrate would touch the adrenals, it can certainly cause increase in urination and flow though.

Do you have a schedule to have his follow up ACTH done at the 12 - 14 day mark? That will tell you how he is doing on the medication.

High cortisol can cause ligaments and tendons to weaken, along with muscle wasting, which hopefully will improve as the cortisol comes down but it can take some time to rebuild that strength up.

[Chemo]

Thank you for a warm welcome in my time of need I really appreciate it.
My vet asked me to call her every day they are open and give updates on his symptoms tracking. Said in about 10 to 14 days we will do the acth.

he was also diagnosed with prostatitis and orchitis. About 30 days ago forgot to say that. The recheck with the ultrasound showed his prostate was looking better and his testical swelling is all gone.

[Chemo]

What symptoms would I look for to give my boy prednisone to correct it?

[labblab]

Hi again! Symptoms that cortisol level may have dropped too low include things like vomiting, diarrhea, lethargy, stumbling, trembling. Prior to advancing that far, you may see things like lack of appetite and just a general dullness. Untreated Cushpups typically exhibit excessive thirst and hunger, so you are wanting to see a decrease in those symptoms after starting the trilostane. But while seeing a decrease back to a more normal level is good, not wanting to eat or drink at all is very worrisome.

Sometimes dogs can feel yucky when their cortisol levels first start to drop, even though the cortisol level has not dropped to a level that is actually physically unsafe. This is one reason why so many clinicians now recommend starting off at a lower dose of trilostane and working upward if need be -- this approach lessens the likelihood that your dog will feel unwell from a sudden, large decrease in the circulating cortisol.

So coming back to your question about prednisone, if Chemo were to exhibit severe symptoms like acute vomiting or diarrhea during a time that your vet's office is closed, you'd probably want to go ahead and give him some emergency pred. However, if the issue arises while your vet is available, I'd contact the vet and try to take him in directly to be seen prior to giving the prednisone. This is because prednisone skews the results of the monitoring ACTH blood test, which is likely the first test your vet will want to perform if low cortisol is suspected. If possible, it's better to run the test first, and then prednisone (or an injectable steroid) can be given immediately afterwards while you await the test results.

So, bottom line, the prednisone is good to have on hand as a safety net if Chemo becomes acutely ill at a time when you cannot get him in to the vet. But if your vet is available, it's usually best to quickly take him in to be evaluated beforehand. Also, if you are ever concerned that Chemo is acting "off" even though he's not actively ill, you can always just temporarily withhold giving any more trilostane until you've had the chance to consult with your vet about your concerns.

Marianne

[Chemo]

Thank you so much. Will keep you updated.

[Chemo]

Quick question. Since his prostate is enlarged still would that cause a false low dose dex. Same with testicular cancer he might have it the vet pointed out that his ball has a hard spot on it?...

Also forgot to say he has head tilt and his eyes are draining clear liquid. Tilts his head to the side that drains more. Both eyes has styes. The eye that drains more looks like he has trouble closing.

[labblab]

The drawback to either of the two diagnosistic Cushing's blood tests is that they are not 100% specific to measuring Cushing's. What they do measure is elevated adrenal activity that is characteristic of Cushing's, but can also be caused by other stresses to the body including other disease processes. Whether or not Chemo's prostate/testicular issues are severe enough to falsely skew the LDDS, I do not know (nor probably does anybody else). But that's why the existence of other overt and laboratory abnormalities that are consistent with Cushing's play such an important role in determining whether treatment seems to be appropriate.

In Chemo's case, he does exhibit some of these other symptoms, and I assume that's why your vet thinks it's worth it to try the trilostane. Ultimately, the proof will be in the pudding -- if Chemo improves while taking the trilostane, it's fair to assume that Cushing's is truly the culprit. If he instead worsens or reacts poorly to the trilostane, you'd have better reason to believe that perhaps the Cushing's diagnosis is inaccurate after all. So, bottom line, we'll all be very anxious to see how he does!

Marianne

[Chemo]

Talked to the vet this morning. His poop was a really soft hit the floor like a cow patty in a circle. She advised me to stop giving him the meds while she seeks advice from a internal medicine specialist.

[molly muffin]

Oh dear, poor Chemo doesn't seem to be feeling quite himself and now a possible upset tummy on top of everything else.

Let us know what the IMS says and your vet recommends.

[Chemo]

Talked with IMS we have a game plan. Gonna start with a ultrasound with Chemo under sedation on monday.. Question if it's a adrenal tumor is the sergery dangerous? What are the chances of it being cancer that spreads.. Will be sleeping very little till Monday I guess. I hate having questions and no answers it so frustrating. I just want my boy better.

Also the ultrasound is 600$ is that high?

[WinstonTheWestie]

I'm fairly new here, but my dog just had surgery last week for an adrenal tumor. It is a risky surgery, and statistics say 1 in 5 dogs do not survive it. But if they do survive, they could be 'cured' from Cushing's or whatever signs they have, so sometimes it's worth the risk. Some are malignant (capable of spreading), and others (like my dog's) are benign. They will sometimes grow out of the adrenal and invade veins around the area, which makes them harder but usually not impossible to remove.

An ultrasound is about $350-400 in my area, but in larger metropolitan areas I have heard of them being more. So maybe $600 is on the higher side, but I'm not sure if its crazy for wherever you are.

[Squirt's Mom]

FYI, here is a list of questions that you may find beneficial -


This was put together by one of our members Trish whose dog Flynn under went an adrenalectomy for a pheo successfully.

Part I is for owners in the initial stages, when an adrenal tumour has been identified and they are considering if surgery is even an option for their dog.

Part II is for when surgery has been decided upon and what questions might help when they are discussing it with their surgeon.


Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.

[Squirt's Mom]

Flynn's story is rather remarkable and worth the read when you have the time ;) - https://www.k9cushings.com/forum/showthread.php?t=4242

[molly muffin]

I know it is hard when you are waiting on something that can tell you if you are going to have to make further decisions, and especially surgery, but I do hope you can also find time to relax this weekend and just find joy in the small things. Deep breaths!

[Chemo]

Thank you for the support everyone!! Some people will never understand the bond that a dog and a owner have but everyone here does! It really helps me get thru the day reading all the love in this forum thanks so much!

[Chemo]

Right adrenal tumor. Most likely benign because the size. Testical has a 2 cm growth he also thinks it's benign! The IMS said surgery is a good option because he is strong.

[WinstonTheWestie]

I'm not happy that Chemo has tumors, but I am glad that overall the news sounds like it was as good as it could be. Are you planning to meet with a board certified surgeon to discuss possible surgery? Squirt's mom posted a good list of questions to consider now that you have a better idea of what is going on.

[molly muffin]

Okay that is great that they think surgery is an option and the tumors benign.
Still any surgery is serious with risks, so make sure to go over everything carefully with a board certified surgeon. Take the list of questions with you!!! (I always forget what I wanted to ask when I'm in the heat of the moment)

We'll be waiting on further news!

[Chemo]

left adrenal not the right sry . So he said left adrenal was enlarged but alot smaller than he would have expected it to be. The right adrenal gland is smaller than normal. So he came to the conclusion of adrenal dependent cushings.. IMS said if it was his dog he would do the surgery. Also said the left adrenal gland was easier to remove. Is that true? He is contacting the surgeon he recommended so we could get prices and talk about the procedure....

His upset stomach was from parasites! We have him on a dewormer now also.

As for the testical he said the surgeon could just do it all at once.

I'm still debating if I should have the surgery done. I would hate my self if anything happened in surgery or post op.

[WinstonTheWestie]

I was told that the left adrenal gland is usually a little easier to remove because it isn't located quite as close to the vena cava, which is the largest vein that takes blood from the organs back up to the liver and heart. The right adrenal gland is usually stuck to the vena cava which makes things harder.

Did they say whether they thought the tumor was invading the veins? That can make surgery trickier. Often a CT is recommended so they can know for sure whether the tumor is growing inside the veins or still contained within the adrenal gland. They can get a pretty good idea about that on ultrasound, but CT is best. Not every surgeon requires a CT...it is definitely best, but the surgeon I ended up choosing felt comfortable enough with our ultrasounds (I had two different people do them right before surgery, and he'd had five total ultrasounds within about 18 months) and her ability to go ahead and deal with anything in the veins during surgery. But, a different surgeon may have a vastly different idea and push really hard for the CT scan. The CT will also help look for metastasis (spread) of the cancer too.

I talked to two different places/surgeons about costs and risks. You want to make sure the surgeon has done this type of surgery several times before and feels comfortable with it and has had good outcomes. It is a risky surgery even for a perfectly healthy dog. It is scary having to make those decisions, believe me, I know. It's easy to dwell on the 1 in 5 dogs that do not survive the recovery period with adrenalectomy, but the reverse of that means that 4 out of 5 dogs do make it. If you go forward with surgery, you're going to have to come to some type of terms with the unfortunate but real risk that he could die, but know you were making the decision you thought was in his best interest at the time.

I'd encourage you to meet with the surgeon and see what they have to say. Ask them the questions posted here, and really be sure everyone is comfortable with whatever decision you make. We're here to support whatever you decide. If you haven't already, reading some of the stories of dogs like Flynn on here is enlightening. Many of the pets undergoing adrenalectomy have good outcomes, but others do not, but I felt like it gave me a good idea of what to expect and ask Winston's doctors.

[Chemo]

Thanks. He should get back to me here in a couple days. Then me and the surgeon will discuss everything.

[Chemo]

Chemo had his acth stem . Game back at good levels at a really low dose. He is only on 30mg for a 85 pounds dog. Talked to the specailest he dosnt want the surgery anymore because of these results.

[Harley PoMMom]

Could you post those stim numbers for us, please? Thanks!

[Chemo]

I believe it was 1.6 or something like that I'll check when I get home.

[Chemo]

I cant seem to find the paper.

[sammisam]

We always call the vet and have them email all the notes, test results, and her chart. It actually helped us (with the help of this amazing forum) with comparing test results to previous test results to help with questions to ask the vet or suggestions to take when we needed help with Sammi.

One of the amazing people on this forum suggested that and it has been so helpful to us when we had to rush Sammi to another vet closer to our house in an emergency. We have her entire history in one file at moment's notice.

[molly muffin]

1.6 if that is the post result would be right on border line of how low he could go safely. So he is definitely being controlled. You'll want to keep an eye that he doesn't go too low though

[Chemo]

Molly muffin. She did say he was right on the line. Have you ever heard of a 85 pound dog only needing 30mg. We have his nueter in 10 days so that will fix his prostate.

[molly muffin]

yes it isn't uncommon for a larger dog to need smaller amounts and a small dog to need larger amounts. It's all in how they react to the medications.

Oh good, will be nice to have that prostrate issue taken care of I'm sure.

[Chemo]

Chemo got his nueter. Everything went good besides the testical thats in his abdomen was on the other side. They IMS did the ultra sound himself no idea how that happend. He is recoverying good. Its been 6 days.. im guesing we should do another acth test after his prostate shrink back to normal?

[Chemo]

My best buddy Chemo passed away fed 9th. Lost his battle to pneumonia. Rip chemo you will always be with me buddy.

[Budsters Mom]

I am so sorry for your loss. Thank you for returning to let us know. Chemo will always be honored and remembered here. As for you, you are family and always welcome.

Fly free Chemo, Fly free!

[Joan2517]

So sorry for you loss.

[Squirt's Mom]

I am so sorry to hear this. Fly free, sweet Chemo, fly free.

[DoxieMama]

I am so sorry for your loss.

RIP Chemo. Run free, sweet boy.

[molly muffin]

My sincerest condolences on the loss of your precious Chemo. :(