Quincy - 9yr Old Cocker Mix - Newly Diagnosed

[del1rium]

Hi Everyone, I found this board after doing some online research after Quincy was diagnosed with Cushings. I'd like to get your feedback as we're still trying to find a dose that works for him!

A little history - he went in for his physical in March and they found liver/kidney failure and some heart and thyroid problems. He's been on Thyroxin and some other stuff since then to get those things under control. At this point they said it "might" be Cushings and re-tested his blood twice after that. Finally we asked to do the ACTH test.

So he started at 21 - Doc recommended Lysodren so we did 7 loading days, 1 500mg pill a day (half in morning, half at night)

After a week his test was 5.4 - no meds for a week

Tested a week later and was at 12.2 - they wanted to re-load at this point so we gave him a whole pill for two days and he threw up, call to the vet said no more loading, start maintenance.

One week later, re-tested at 17.9 (this was yesterday), doc recommends today's maintenance dose (whole pill), then 7 days of 1/2 pill a day.

Could you guys give me your thoughts on this progress and if there's anything we should be concerned about. It's gotten frustrating giving all these meds, doing all this bloodwork, and not really looking like we're getting anywhere :(.

Thanks in advance!
Emily & Quincy

[AlisonandMia]

Hi and welcome to you and Quincy.

Just one question - how much does Quincy weigh?

Alison

[del1rium]

Thanks for the welcome!

He weighs 42 lbs now... he started at 35 in March. The vet put him on a restricted diet in March (l/d I believe it's called), so the weight is a mystery cause he gets NO treats now and this very specific food.

[ventilate]

HI;
welcome from me and mine;
What symptoms did your dog have? What were the blood tests they did twice? How did they diag the liver failure? was it just from some of the liver enzymes being elevated? I am concerened with your vets experience with treating Cushings. It seems that he/she is not following the tried and proven protocol for lysodren loading and treating. We have seen here, to many times when vets wonder away from the protocol, it is when dogs tend to get into trouble. the protocol is here under important information With just an ACTH test and with your dog being 21 with normal being up to 20 I would want another test to confirm cushings before treating. If your dog does indeed have cushings waiting a week when your dogs level was 5.4 allowed time for the cortisol to go back up, normally we want our dogs between 1 and 5 ug/dl you were almost there and probably should have started mainten right away
IMO I would ask for a referal to a internal med specialist, with all that is going on with your dog, the internal med specialist are the experts and have more experience with this kind of stuff. A lot of times it can be cheaper in the long run, less stims tests, less visits to the vet.
Did your vet give you prednisone? It is very important for a dog on lysodren for you to have pred on hand in case of overdose of lysodren, it acts like an antidote, lysodren lowers the cortisol and if it gets to low, the dog can get very sick, giving pred will increase the steroid in the dogs system and keep the dog from getting worse until you can get to the vets.
Please let us know the tests that were done, your dogs symptoms, how liver failure was diagnosed
Sharon

[jrepac]

I too, noticed that 21 on the ACTH is barely past what is "normal"...not sure I would rush to conclude Cushings....as others noted, what leads the vet to believe liver failure? That is pretty extreme and it is not brought on merely by high enzyme scores...

Jeff

[frijole]

Emily,

Hi from me also! My dog has used lysodren for 3 yrs now and I would love to know more about your dog, the diagnostics etc. It really helps us help you.

Alison asked about the weight - that is because normal dosing ranges from 25 to 50 mgs of lysodren per kg of weight. You are dosing at slightly over 25 so that is inline.

I agree that starting lysodren after an acth of 21 seems unusual but you mentioned other tests. That is why we are asking - we want to help make sure we are talking cushings and understand the background of treatment so far. The more info the better. :D

I am putting a link here for you to read regarding lysodren as it really helps understand dosing, how it works and things to look for when giving it. Please read it. You might also (if you haven't yet) take some time to read up on cushings as you are Quincy's voice in this. Cushings can be complicated and alot of vets just don't see enough cases to know everything. We are not vets but we read about it each and every day for years now and often see misdiagnosed cases and vets over their heads.

This might not be the case here but we just want to make sure. Lysodren is a wonderful drug when used properly and like any drug, if not given in accordance with protocols... can lead to serious problems.

So here's that link! http://www.k9cushings.com/forum/showthread.php?t=181

Glad you found us.
Kim

[Squirt's Mom]

Hi Emily,

Welcome to you and Quincy! :)

I am quite concerned about Quincy based on his reaction to the Lyso and the unconventional treatment approach your vet is taking.

It would help us a great deal if you could get copies of the tests he has had and post the results here along with the units of measurements (ug/dl, mnol/L, etc) and the normal or reference ranges the lab used. Cushing's testing and the lab tests that caused your vet to think liver/kidney failure. One of our members reads human labs as her career and is a big help to us here interpreting labs for our babies.

My Squirt is a good point in case for you concerning the need for extensive testing and a confirmed diagnosis before starting any meds as strong as Lyso or Trilo. All of Squirt's Cushing's testing came back positive for PDH - pituitary dependent hyperadrenocorticisim. The LDDS, the HDDS, and the ultrasound all supported this diagnosis. However, I wanted to cover all my bases first, so I had the UTK panel done and sure enough she was diagnosed as Atypical, too. On the results sheet from UTK, Dr Oliver suggested another ultrasound. So we had it done again and a splenic tumor was found. (It had been there four months earlier but the IMS at that time didn't mention it. :mad: ) Squirt had the tumor and part of her spleen removed last Sept and her cortisol has returned to normal since then. Her docs now say the diagnosis of PDH is "highly questionable".

It was suggested over and over that I get her started on Lyso or Trilo asap when she was first diagnosed but I wasn't ready for that until she had been tested as thoroughly as possible. Thank god I didn't give in and start her on treatment then! She may easily have suffered some serious consequences if I had. :(

Cushing's is a slowly progressing condition which gives you plenty of time to make sure what the problem is with Quincy. Since your vet feels his liver and kidneys are compromised, the Cushing's diagnosis is suspect since liver and kidney problems can cause some of the same signs and test results that Cushing's can.

Cortisol is one of the stress hormones - a "fight or flight" hormone. Any stress causes this hormone to become elevated in the body as a natural response. Physiological stress, such as liver/kidney disease or a tumor on the spleen ;) , will cause the body to release excess cortisol which is what Cushing's tests look for. So it is entirely possible that Quincy does not have Cushing's after all, but that his body is reacting to some other stressor, like the liver or kidneys.

A reading of 21 ug/dl as a post result on an ACTH is barely over the normal range of up to 20 ug/dl. This number is indicative of a problem somewhere but not necessarily indicative of Cushing's. We have seen post ACTH numbers in the 50's! :eek: With a post number as high as 50, Cushing's is good bet, but still not proof of Cushing's. Because so many other factors can cause elevated cortisol plus the same signs as Cushing's, this is a very complex and often difficult disease to accurately diagnose. To start treatment with Lysodren because it "might" be Cushing's is dangerous and IMHO says your vet has little experience or knowledge of Cushing's.

Just based on Squirt's history alone you can understand my concern for Quincy; then, when you add Quincy's reactions and the vets apparent lack of experience with the condition and treatment protocols, my concern is multiplied.

Personally, I would like to see you stop the Lyso for now and pursue further testing concerning the liver and kidneys as well as other organs and systems. If Quincy hasn't had an ultrasound recently, I strongly recommend he have one done with a high resolution machine asap. The U/S will not only give them a good look the liver and kidneys, they will be able to see other organs including the adrenals, which can help with diagnosing Cushing's, IF that's what it turns out Quincy actually has.

As Kim said, you are Quincy's voice. You are his advocate, his first and last line of defense. So the more you know, the better you can speak and act on his behalf. Check out our Resources section at:

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

You will find some great links on Cushing's in general, treatment options, studies that have been done, as well as other conditions closely related to Cushing's, like diabetes and thyroid problems. ;) I have several other good links in my personal file if you are interested. Read the threads here, see what others have done and how they are handling their pups case. And, most importantly, ask questions! :) We will do our best to help you understand. If we don't know the answer, we will research and learn together.

Would you mind giving us some more detail concerning Quincy? What other conditions does he have? What meds, supplements, herbs, etc is he on now, what dose and how often? What led you to take him to the vet in the first place when these conditions were diagnosed? Have there been any changes in his behavior and/or physical condition? If so, what? The more we know about Quincy, the better input we can offer plus we just love details! :D

Hang in there! You're gut is telling you something's not quite right and you are doing a great job of listening to it! :cool: You no longer have to take this journey alone, we will be with you every step of the way.

I am so glad you found us and hope to learn more about you and your baby soon.

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Emily,
I also wanted to welcome you and Quincy. You have been given some good information and advice so I have nothing else to add except .... We know this is alot to take in. Just take a deep breath, read and educate yourself as we all had to do.

As has been said, we are here to help in anyway we can, experiences, advice, opinions and handholding. Feel free to ask any questions or just express your thoughts, sometimes it helps knowing there are others of us in the same situation and sharing the same feelings of being totally lost.

Ok, one last question... Has Quincy shown any of the classic symptoms of cushings? Excessive water intake, huge appetite, excessive urination, loss of hair or a pot belly?

[del1rium]

Hi again everyone! Thank you SO much for taking the time to respond to this. I'm going to pick up a copy of Quincy's file from the vet on Monday and will post test results then.

Question for the board - our vet said the high level is 17, not 20 - can you guys fill me in on why that might be?

And to answer some of the questions that have been posed:

"Has Quincy shown any of the classic symptoms of cushings? Excessive water intake, huge appetite, excessive urination, loss of hair or a pot belly?"

He's got all of these except the loss of hair, but he's kinda dandruffy which the vet said might be related.

"Would you mind giving us some more detail concerning Quincy? What other conditions does he have? What meds, supplements, herbs, etc is he on now, what dose and how often? What led you to take him to the vet in the first place when these conditions were diagnosed? Have there been any changes in his behavior and/or physical condition? If so, what?"

Up until now he's been pretty healthy, this is the first major issue we've encountered with ANY pet (probably why it's stressful!). We took him to the vet in March for his vaccinations and a checkup, hence the general bloodwork that was done that revealed the problems (will get details on those Monday). Since then he's been on Thyroxin, Hepato Support and Ursodiol (sp?) daily.

Hope this info helps a bit! Will get you more details shortly.

[Squirt's Mom]

Question for the board - our vet said the high level is 17, not 20 - can you guys fill me in on why that might be?

From 17-20 ug/dl is considered the "border-line" range to most vets, I believe, and some go up as high as 22 ug/dl as the upper limit. Here is a chart from the Idexx Lab that tells their values for interpretation:

http://www.idexx.com/animalhealth/analyzers/snapreader/testmenu/cortisol/acth.pdf

You can find this and other info about test results at:

http://www.k9cushings.com/forum/showthread.php?t=217

According to Idexx, a post of 21 would indicate possible Cushing's.

I hope this helps,
Hugs,
Leslie and the girls