Totally lost...

[Michelle.W]

Hi our Brindle Boston Terrier Maximus is approximately 9 yrs old (Rescue Dog). He is my husband's best friend, and my little man! Our Cushings journey has been a jumble of confusion and I dont feel like I understand nearly enough of what's going on....

Over the past two years Maximus started staring off into nothingness, and we had an increasingly hard time snapping him out of it. He became increasingly lethargic and spent more time sleeping then not, and there was weight gain. His vet suggested a change in food. I thought maybe a new pup was in order to help keep him more active, and so he got a new sister. His symptoms progressed never the less, heavey drinking, swollen abdomen, panting, endless hunger, patchy hair...ect. Upon his regular vet visit last November it was strongly suggested that we have him tested, and we did so. They suggested that we skip his regular shots while investigating.
Now here is where I see all of you guys talking about result values, testing and more, but quite frankly I dont know any of that....our vet seems knowledgeable and has taken over Maxi's care at the clinic, but she talks fast and rattles off test results in abreviations and numbers and I'm lost...none of it means much to me, and I want to change that.
After Maxi's diagnosis, we were sent out of town for an ultrasound (we live in a small center). That showed a growth on each pituitary gland, an enlarged liver, and inflamed bowel. After all testing was complete he was perscribed trilostane 30 mg once daily, this was in January. In March we followed up with blood work, were I was told that his levels seemed to be ok and we would continue with the treatment. We were still very concerned with Maxi's episodes of spacing out, and were asked to switch his food to a RX Hills Science Diet Brain Development blend which we ofcourse did. During that visit we were told there was no real way to tell how Maxi would progress, but that we should be prepared to lose him. Our vet warned that with his immune system being affected and him not being immunized, that we should limit his interaction with other dogs. Regular testing was recommended every 3-6 months.
Our decision was to make Maxi's remaining time the best it could be! That means we ARE taking him camping and giving him lots of interaction with his furry buddies (all who are regularly immunized), he gets walks as long as he is up for, and lots of off leash exploration time! This is Maxi's Summer!
The treatment was making him more lucid, but doesn't seem to be as beneficial lately...he is suffering from chronic diarrhea now, his back has sunken, and his skin is awful. We brought him back last week with these concerns, and he was given extensive blood work. The vet called me Friday and he is now on a course of 2 antibiotics, Metronidazole and Amoxicillin. Also he has had FortiFlora powder and Omega 3 added to his diet. She said that his cortisol levels were stable, but his liver enzymes were elevated, and we would know more in the coming week when further results come in....
What should I be doing to help my little man?

[Squirt's Mom]

Hi! Welcome to you and Maximus!

I only have a minute right now but wanted to tell you that you are in the right place for help for your sweet boy. The first thing you can do is help us help you by getting copies of all the tests results done to diagnose him with Cushing's as well as any tests done since he was diagnosed. These could include the wellness exam which shows the liver enzymes along with other values for organ functions, the LDDS, HDDS, ACTH, and ultrasound. We need to see only the abnormal values, too high or too low, from the wellness exam but will need to see all the numbers and comments from the other tests. This will help us a great deal in giving you more meaningful feedback.

Since you can't get copies today, spend today reading the threads on the forum and the links found in our Helpful Resource section found here - http://www.k9cushings.com/forum/forumdisplay.php?10-Helpful-Resources-for-Owners-of-Cushing-s-Dogs. And of course spend as much time loving on and playing with Maxi as he wishes.

I'm glad you found and am sure others will along soon to chat with you. I look forward to learning more about you and your sweet boy as time passes.
Hugs,
Leslie

[Squirt's Mom]

Oh! and could you tell us how much Maxi weighs and what dose of Trilostane he is taking how often...ie. 50mg once or twice a day.

[Michelle.W]

Maxi weighs 11.2kgs and has been on 30mgs of Vetoryl once every am.
Thank you for your response, and I will be seeing our vet Wednesday for results and consultation, so I can get his numbers for you then!

[Harley PoMMom]

Hi and welcome to you and Maxi from me as well!

So sorry your sweet boy is having some difficulty right now :( Please do get those test results and post them here as this will help us greatly in providing you with more meaningful feedback, we are especially interested in those monitoring ACTH stimulation test results. Did the vet tell you to discontinue the Vetoryl since Maxi is presenting signs of feeling unwell (chronic diarrhea)? Stopping the Vetoryl for the time being may even make him feel better since this will allow his cortisol to rise a bit higher.

Can you describe what is going on with his skin? Or take a picture of the area and upload it to Maxi's album and we'll take a look.

You and Maxi are not alone on this journey we are here for you both, and please know we will help in any way we can.

Lori

[Michelle.W]

Hello all & thank you for your warm welcome!

We finally got the results this morning by phone so I will run down that conversation for you...( I hope I'm spelling & presenting everything right)
Maxi's ACTH Stem was 184, elevated from 83 / 94
White Cell count was 19.6 x 10/9
Neutrophyl 17.3 x 10/9
Lymph 1 x 10/9
Mono 1 x 10/9
Eosinophyl 0.4 x 10/9
Alk Phos 464 u/L
GGT 22 u/L

She did not say to discontinue the Vetoryl.
She did consult with an internist and felt that we should be
repeating the ultrasound to look for possible intestinal cancer, and to have another look at his liver. They would like to change his diet to a hyper sensitivity blend, and suggested the addition of tylosen to his meds, along with an increased dosage of the Vetoryl.
She said that we have 3 major issues occurring here, his bowels, the liver, and the cushings. She warned that all of this testing and treatment would be expensive and could be very stressful on our boy.
I asked her to give us a few days to wrap our heads around this all and decide on our next steps....

Any thoughts?

[Harley PoMMom]

Hello all & thank you for your warm welcome!

We finally got the results this morning by phone so I will run down that conversation for you...( I hope I'm spelling & presenting everything right)
Maxi's ACTH Stem was 184, elevated from 83 / 94

Thanks for this additional information! Could you do me a favor and check what the units of measurement are for his ACTH test? I'm thinking they are "nmol/L" but I want to be sure...it probably looks like this...184 nmol/L


White Cell count was 19.6 x 10/9
Neutrophyl 17.3 x 10/9
Lymph 1 x 10/9
Mono 1 x 10/9
Eosinophyl 0.4 x 10/9
Alk Phos 464 u/L
GGT 22 u/L

Can you also get the reference ranges for these values? As an example: Alk Phos 150 U/L (5-50) the numbers in the parenthesis are what I'm looking for.



She did consult with an internist and felt that we should be
repeating the ultrasound to look for possible intestinal cancer, and to have another look at his liver. They would like to change his diet to a hyper sensitivity blend, and suggested the addition of tylosen to his meds, along with an increased dosage of the Vetoryl.
She said that we have 3 major issues occurring here, his bowels, the liver, and the cushings. She warned that all of this testing and treatment would be expensive and could be very stressful on our boy.
I asked her to give us a few days to wrap our heads around this all and decide on our next steps....

Any thoughts?

Why are they leaning towards intestinal cancer? Maxi's Alk Phos, which is the abbreviation for alkaline phosphatase, is pretty low for a dog with Cushing's. On the forum we have seen some really elevated alkaline phosphatase levels, like in the 1000's. Another question I have, what is going on with his skin?

Please remember I'm not a veterinarian, but if this were me, I wouldn't raise his Vetoryl dose, at least not until his chronic diarrhea gets under control. What I would do is let the antibiotics run their course and probably change his dog food to the one they suggested if they feel this will help with the diarrhea. After Maxi's stool in consistently normal than I would run another chemistry/CBC blood panel and an ACTH stimulation test to see where those levels are.

A couple more questions :eek: is Maxi getting his Vetoryl with a meal and are those ACTH stimulation tests being performed 4-6 hours after his Vetoryl is given?

Lori

[Michelle.W]

Will call our vet tomorrow and get answers to your questions. Thank you ��

[Michelle.W]

My apologies for the delayed response as my vet was away. I received a response via email just now that read:

Nov. 21, 2017 - Baseline Cortisol 33 nmol/L
Post ACTH Stimulation 130 nmol/L

Dec. 14, 2017 - Baseline Cortisol 36 nmol/L
Post ACTH Stimulation 94 nmol/L

Feb. 12, 2018 - Baseline Cortisol 38 nmol/L
Post ACTH Stimulation 83 nmol/L

July 12, 2018 - Baseline Cortisol 110 nmol/L
Post ACTH Stimulation 184 nmol/L

To answer your other questions, Yes he is given his Vetoryl with his morning meal, and yes his tests are being preformed 4 hours after.

I hope this gives you some more insight. Thank you in advance for any advise you may have.

[Harley PoMMom]

Is he still getting 30 mg of Trilostane, and has he been weighed lately? Is he still experiencing chronic diarrhea? How's his appetite and drinking?

The one thing that does jump out to me with his ACTH stimulation tests is that his post cortisol level has risen a bit between February and July ~ Feb. 12, 2018 Post ACTH Stimulation 83 nmol/L --- July 12, 2018 Post ACTH Stimulation 184 nmol/L, and converted to ug/dl (which are the units we are used to seeing in the U.S.) comes out to 3.00 ug/dl - 6.66 ug/dl so they doubled. It just may be that Maxi feels better when his cortisol is in the lower range but how is he feeling now?

[Michelle.W]

Yes he is still on the 30 mgs each morning, and he was last weighed July 12th. Maxi still has diarrhea, and is drinking alot, but his appetite has slowed a bit (unless it's people food). Not so much that I'm concerned, but enough that I definitely noticed. His demeanor has been great, he even seems to have spurts of energy. He certainly doesn't seem to be in any pain or discomfort.
His vet had recommended that we increase the Vetoryl and consider Zentinol for his liver, and Tylosen as a long term antibiotic. I have not yet decided if that's the way we want to go or not, and have told them we would come in to discuss his treatment plan soon.

[Harley PoMMom]

The chronic diarrhea concerns me, did this begin after he started eating the Hills Science Diet Brain Development? The increased drinking could be due to the diarrhea as diarrhea can cause dehydration. Canned plain pumpkin may help make his stools firmer.

[Michelle.W]

Yes he is still on 30mg of trilostane, he was weighed at his blood work appt. in July. He had lost just about 2 lbs. He is still suffering from diarrhea ranging anywhere from moderate to extreme. His appetite seems to be good, and he still drinks alot.
Yes that is correct, his levels have doubled. The vet wants to up his dosage of trilostane, but I'm not sure.
Max has short periods where he is excited and almost puppy like, but more often is tired and even nods off while standing. He also experiences alot of episodes of 'zoning out', and we are usually able to snap him out of it by calling his name and clapping our hands, but he doesn't seem to be showing any discomfort or distress.
What are your thoughts on an increase of the Vetoryl at this point? We obviously want only what's best for him, and to keep him comfortable and happy for whatever time he has left.

[Michelle.W]

I have switched him back to a sensitive stomach formula, and have continued the use of the Fortiflora powder supplement, but it doesn't seem to have helped. I will definitely try the canned pumpkin! Thank you!

[Harley PoMMom]

I'd want to figure out what's causing the diarrhea before increasing the Trilostane dose because one of the symptoms of too low cortisol is diarrhea. When you switched his food, was it done gradually? If not, it may be a contributor to the diarrhea and his system would need some time to get used to the new food.