Vet thinks my boy has Cushing's. I'm very worried.

[FoxFire]

Hey folks. Just searching for information and a supportive group to share my concerns with.

I'm the proud dad of an awesome boxer dog, Kobe (pronounced Kobay). He'll be six in September. I don't know for sure if he has Cushing's but I took him in to a vet with many of the symptoms I'm now reading are common with Cushing's and after some blood work, the vet informed me that he had an elevated marker that along with the symptoms I described could indicate Cushing's. He's now scheduled to go back in 11 days for an all day (8 hour) long test. And not a cheap test at that. :-\

Needless to say I'm super worried. Like most pet parents my boy and I are very attached to one another, and I don't want to lose him any earlier than a boxer would normally live.

The most prominent symptom that increasingly got my attention was that he was drinking a lot more. He was always a very thirsty dog, but over the last 2 or 3 months not only I but other family members noticed he was spending a lot more time at his water dish, and often drinking until it was empty and I'd have to refill it for him. That and he was sleeping a lot more and was very low on energy (normally being an energetic dog).

I chalked it up to the warm weather, his getting older, his paws seeming a bit red & swollen (which I thought might be from walking on hot pavement), and his putting on excess weight from I thought too many snacks and less activity/walks which he stopped wanting to take.

Then just over a week ago he had an accident in the house. He hadn't had one of those since he was a puppy. I thought I wasn't attentive enough to his wanting to go out. Then he had a 2nd accident, and a 3rd. He failed to inform me he needed to go out, or couldn't hold it for 5 minutes of whining it would normally take for me to notice he needed to go out. This triggered me to think something was definitely amiss. I had a vet appointment for him 2 days later (yesterday). By then he'd had a 4th accident. :-( The rug cleaner is getting a work out. 8

So other than the blood test with a super high value of something that suggests Cushing's, (oh and the doctor found he had a fungal infection on his paws and infection of his *ahem* penis, which she gave antibiotics for)

His symptoms have been:

* Significantly increased thirst.
* Increased urination. Way more stops while walking, and now accidents in the house.
* Very lethargic. Not the bouncy energetic pup he'd been even 6 months ago. Rarely will chase ball anymore.
* No longer likes long walks. Wants to come home right away, or find a shady tree to sleep under.
* Increased appetite. Used to have to mix in 1/2 a can of wet food into his dry. Now he'll gobble up the dry asap and eat treats he used to turn his nose up at and beg for more.
* Much more frequent panting, even in comfortable conditions.
* His svelte boxer physique is mostly gone. i.e. Still has his deep chest, but his belly is lower, less pulled up.
* He used to be a unstoppable lick machine, to dog and person alike. Now he turns away from human attention & just sniffs other dogs. I'm lucky to get a peck rarely now.

Otherwise he seems largely content and not particularly distressed.

So... yeah from what I've read, I'm thinking this sounds almost certainly to be Cushing's. I'm still hopeful it will turn out to be something less serious and temporary, but I expect to be told it's what he has.

If so, I will be hoping to hear other pet parents experience with this disease, and what my fur baby's prospects are for a long, happy, healthy, and bouncy life.

Thanks in advance for the support.

- Glen

[labblab]

Hello Glen, and welcome to you and Kobe! You’ve done a great job of introducing your sweet boy to us, and yup, I gotta agree that Cushing’s sounds like a definite possibility. I’m guessing that Kobe’s elevated lab value is his ALKP (alkaline phosphatase). This is a marker that results from liver changes associated with high levels of circulating steroids, and it commonly accompanies Cushing’s. If this is the case, it does not mean that Kobe’s liver is damaged such that it is not functioning properly, but it does signal steroidal effects on the composition of the liver. Along with dilute urine from the excessive thirst and urination, it is often the first lab abnormality to be noted with the disease.

When there is no other known illness present, the 8-hour LDDS is the “gold standard” for detecting Cushing’s, so I think your vet is on exactly the right track with Kobe. In the meantime, I know the temptation might be to start limiting his water intake in the hope that might lessen his accidents, but unfortunately it would be dangerous to do so. He has to be able to drink freely to avoid dehydration. But the good news is that excessive thirst/urination is one of the Cushing’s symptoms that typically resolves the most quickly once effective treatment begins. So if you can hold out a little bit longer, I’m really hoping you’ll soon get an answer and see some improvement.

Once diagnosed, the two most effective Cushing’s medications are Vetoryl (trilostane) and Lysodren (mitotane). Please do start glancing through our “Resources” forum in order to find helpful info about treatment and monitoring protocols for both of these meds. And also please feel free to continue asking any questions that come to mind! We’re really glad you’ve found us, and we’ll do our very best to assist both you and Kobe in the days ahead.

Marianne

[Joan2517]

Hi Glen and welcome from me too. It does sound like Cushing's is a possibility. Both of my Cushpups had all of those symptoms. I had forgotten about the change in preference for other dogs over humans. When my Lena started hanging out with our other dogs instead of me, I just figured it was because she was with them all day while I was at work. And now with my Gable, he is constantly sniffing the little girls which he never used to do. Gable has had many fungal and bacterial infections. We are fighting some now, possibly from flea bites.

But he has been on Vetoryl now for almost three months and he looks and acts much better. He has hips, which we haven't seen in a long time and his belly has gone back to a normal shape. He's playing again and doesn't seem so uncomfortable and restless. His drinking has slowed down, he still drinks a lot, but not as frequently. I was filling the water dishes four or five times a day, now only a couple.

I had my doubts about treating him, but am now happy that I did. I couldn't have done it without the wonderful people on this forum. They know more than my last vet did. I am using one of his associates with Gable who is willing to apply what I have learned here and things are going much better this time around.

So you have come to the right place if Kobe does indeed have Cushing's. If he doesn't, they can steer you in the right direction for help.

[FoxFire]

Thanks Marianne and Joan. I'm really glad I found this forum. It helps to know there are others in the same boat (not that anyone wants to be) and I'm not alone with this. It does ease my worries to know that other pet parents are successfully treating their pups that have this condition.

Marianne, thanks for that advice on water. You must have read my mind, because I was actually wondering if I should cut back on Kobe's water availability so he would be less likely to have accidents. I haven't yet, because I didn't know if that would be okay to do, so it's good to know that I shouldn't do that. I have started putting him outside more often, even if he's not asking to go out, and he's not had an accident in the house since. When he does give me indication he needs to go out, unlike how he used to just walk down the deck stairs to the yard, he'll now bolt to get down to the grass, like he's about to burst, and then pee for a long time.

Yes, ALKP, that sounds like the blood test I was told was high (unfortunately the paper work they gave me doesn't have his blood test information). The vet said his last blood work several months ago was well within normal on that, and now it's well above normal.

Joan, I'm happy to hear that Gable is doing better with his medication. That gives me hope that this is indeed manageable if Kobe does in fact have this. I'm sure everyone hopes they will have a health problem free pup, but nevertheless it's good to find out that if they do have something there are treatments available, and they can still live a relatively normal life.

I'm glad to hear that the excessive drinking / urination does start to subside after treatment. I'm wondering if his bubbly personality will return, where he couldn't get enough of greeting people and playing with other dogs. And of course chasing his ball. I'm sure to some degree it's just his getting older and more mature, but the decline in his perkiness was pretty rapid (over just a few months) so I suspect much of it is due to the illness.

Thanks again for welcoming me here. I'll keep everyone posted on what Kobe's prognosis is.

[Harley PoMMom]

Hi Glen,

Welcome to you and Kobe from me as well! Marianne and Joan have done a superb job of covering all the bases but I do have a few questions to ask. How much does Kobe weigh? Could you get copies of all test/s that were done on your boy and post those values that are abnormal with the reference ranges and units of measurement..for example ALP 200 U/L (5-50). Besides the antibiotics for the fungal infection, is Kobe taking any other herbs/supplements/medications?

While the LDDS is the hallmark test used to diagnose Cushing’s, it is also the most likely to yield a false positive result in the face of a non adrenal illness or even severe stress. Since Kobe has a fungal infection you'll want to make sure that it is completely gone before having the LDDS test performed, I do see that this test is not scheduled for another 11 days so hopefully his paw/penis will be healed in that time-frame. Did the vet mention to fast Kobe for the LDDS test? Although fasting is not mandatory it is preferred, unless this would cause undue stress for Kobe.

Please know we are here for you both and we will help in any way we can.

Lori

[FoxFire]

Hi Lori,

Thank you for your welcoming, and helpful input. Kobe is 94 pounds. He is taller and more solid than your average boxer, yet is still a bit overweight. At an earlier vet visit the doctor said he should probably lose 5-6 lbs, which would put him at the upper end of his ideal weight. As I recall, the doctor said that his previous blood work nearly a year ago had his (ALP?) at 68 I believe, and she said it ought to be no higher than 200. This time it was above 600. I'll look in to getting the blood work results so I can post them.

Other than the antibiotics which he just started, he's not taking any other medication. I do give him Vitabone treats which have vitamins in them. I had him into the vet about two months ago, because at the time he was already showing signs of slowing down, not wanting to walk or play as much, but I hadn't yet noticed any other symptoms (although he probably was showing some that I just didn't catch on to). At the time the vet thought he was suffering from some hip pain (or something don't remember) and might have injured himself or was starting to get arthritis. He was arching his back, tightening his back muscles. She prescribed some pain medication and a course of muscle relaxers to see if there was any improvement. During and after that course of medication he didn't seem to improve much. I didn't get back to the vet about these results, and figured that maybe he's just disliking this really warm summer. But then, he was getting even more lethargic, and I began noticing his other symptoms like the excessive thirst, urination, hunger, panting, etc. When he started having accidents I figured it was time to get him back to the vet.

Yes the vet did say Kobe needed to fast for 12 hours prior to his test later this month. I think you may be right that she wanted to clear up his infections before the test.

- Glen

[FoxFire]

I dropped Kobe off for his appointment this morning. He's still at the vet. But I did pick up his blood work results.

These are the results that were abnormal from 9/18/2017 and 8/18/2018, as well as the corresponding value from those dates if one date was normal.

_____________ 9/18/2017 ______ 8/18/2018 __ Reference Normal

ALKP...................... 63 .................... 678 (high) ....... 23 - 212
Amylase ............ 2,500 (high) .......... Not done ....... 500 - 1,500
Lymphocyte ......... 1.13 ................... 0.84 (low) ....... 1.0 - 4.8
Basophil % ...........1.4 (high) ............ 0.2 ................ 0.0 - 1.1
RBC .................... 7.64 ................... 8.63 (high) ..... 5.5 - 8.5
Hemoglobin ........ 20.3 (high) .......... 19.9 (high) ...... 12 - 18
Hematocrit ......... 56.55 (high) ......... 61.1 (high) ....... 37 - 55
MCH .................. 26.6 (high) .......... 23.1 ................ 19.5 - 24.5

So... hopefully this means something to you all. I've no idea about these. Though obviously the most relevant one ALKP is much higher than normal.

[Gingerbeer]

Hi welcome!my boxer girl mona is also 6 years old,and she was diagnosed in july�� she had the same sypmtoms.i hope kobe will be healthy with treatment.sorry i dont know much about tests results but the friends in here will help you

[labblab]

Hi again, Glen. Thanks for posting these results. Both the elevated ALKP and the low lymphocytes are characteristic of Cushing’s. The high circulating cortisol of Cushing’s can produce abnormalities in white blood count profiles known as a “stress leukogram.” Low lymphocytes are the most common expression of this effect. I’m guessing that the very mild elevation in the red cell counts was simply the result of dehydration at the time the blood was drawn and don’t really signal much. We’ll surely be anxious to find out how things went today.

Marianne

[FoxFire]

Thanks Gingerbeer! Great to hear from another boxer parent. Don't they have the most adorable derpy faces? :D And ridiculous energy (when they aren't ill). Have you begun Mona on any medications? If so which one(s) and how has she been doing on them? Have there been any negative effects? As much as I'm worried about this disease, I'm also worried that the medication could be problematic.

Edit: P.S. Just read the thread you started Gingerbeer. So I guess that answers all the questions I had above. Sorry to hear that Mona is still having some issues, perhaps with getting the correct dosage, or perhaps with an additional disease along with the Cushings, the thyroid problem. That could surely complicate things I expect. I hope Mona feels better soon!


Thanks Marianne, Great to hear from someone with a lot of knowledge and experience on this disease. So these blood results are consistent with Cushing's. That's what I expected to hear. Kobe had his 8 hour test today, but I won't find out the results until Friday. I'm still hoping it turns out to be something not so serious. Though I'd definitely prefer it be something treatable like Cushing's than something worse. Looking at the paperwork from today, the test they did is called Dexamethasone Suppression Test - RefLab (ES), which was $200 for that test (if that price means anything, hopefully I was charged a usual price for that sort of test). Is that test the same as the LDDS test you mentioned?

Reading other threads I've noticed that it's said that the LDDS can have "false positives". Is there any way to know if you do get a false positive?

Kobe did finish his course of anti-biotics. I'm not sure it helped his paws much. They still seem kind of red and swollen. Maybe not quite as swollen. Presumably it helped the infection he had on his 'boyhood' :rolleyes: .

Things I've noticed since the vet first suspected he had Cushings (based on the symptoms I described and the blood test), since he was on the antibiotics, is that he might not have been drinking quite as much. He still drinks a lot, but then he was always a big drinker. I feel like he's still drinking more than usual, but less than he was 2 weeks ago. He hasn't had any more accidents in the house, but then I'm being much more diligent with getting him outside, even if he's not asking to go out. He does seem like he's had a bit more energy lately, though still he sleeps A LOT, and he's still a lot more lethargic than he was say 6 months or more ago. He's been a bit more willing to go on walks, even somewhat longer walks (especially if he knows we're going to the ice cream shop). However, he seems like he's more reluctant to go up and down the stairs at home. He will still jump up on the bed, but more frequently chooses to sleep on the floor or in his kennel where his doggie bed is. Finally he seems to be panting less than he was 2 weeks ago, before he had his antibiotic course.

So... I guess now that the symptoms have subsided A LITTLE bit, I'm concerned about what might happen if I get a false positive on the test for Cushings? What might happen if he started on medication and it wasn't necessary? Will I know it's not right?

I'll discuss this all with the vet when the results come in, but any insight would be very appreciated. Thanks!

[labblab]

Hi again, Glen. I’m glad to hear that Kobe seems to be doing a bit better. As far as a possible “false positive” on the LDDS, there’s really no way to know if that’s the case — that’s why it’s best to rule out as many non-Cushing’s stressors as possible in conjunction with the testing. If a dog exhibits symptoms consistent with Cushing’s and there are no other known bodily stresses, then we have greater confidence that a positive result on the LDDS is genuinely reflecting the presence of Cushing’s. It’s like that old saying, “If it walks like a duck and quacks like a duck....”

To ease your mind, however, there’s not a need to rush into Cushing’s treatment until/unless you feel comfortable with the decision. If you genuinely think that Kobe’s symptoms are improving right now, then by all means, discuss that with your vet. If Kobe truly has Cushing’s, we would predict a return and even a worsening of symptoms over time. So even if his LDDS is positive, you may choose to hold off on treatment for the time being in order to see what develops. You can always choose to treat at any time in the future — whether it’s only a matter of days or instead a matter of months — if the situation changes and his symptoms rebound once again.

Marianne

[Harley PoMMom]

Could you measure how much he drinks? The normal amount of water a dog drinks is 1 ounce per pound of the dog's weight.

[FoxFire]

Thanks Marianne. I appreciate your insight. I'm hoping to be as prepared as possible before deciding what to do, so it's good to know I have time to get all the information where I'm comfortable and can think over what path to take.

Though I am eager to get my happy-go-lucky pup back to his old self, where he's rearing to go for walks, and go to the dog park, and see and play with his friends and other people.

Like I said since the antibiotics he's been a little bit better, but his energy is still very low compared to how he used to be.

Speaking of stressors in Kobe's life, I wonder if it could have anything to do with the stress I've been under myself in the last few months and if he is sensing that and it stresses him out? Could I be raising Kobe's cortisol levels just by being stressed out myself and, since dogs are so empathetic, he is getting stressed. Hmmm.

I mean it's not like I'm constantly stressed out around him, and when I am feeling stressed or angry, seeing him actually alleviates a lot of it. And giving him a hug calms me down significantly. In fact, he's sweet because if I happen to get angry over something and he senses it or sees/hears me, and knowing I'm not angry at him (which is practically never), he'll actually come running over to me in order to calm me down. Ha. Apparently he realizes that he calms me down and wants to do so. I know dogs aren't big fans of restraining hugs, so I only hug him very gently and lightly, but right away I feel any stress or anger draining away, my blood pressure and heart rate drop immediately. It's very Zen, but I hope that isn't draining into him and he's absorbing my stress. :(

I'd been thinking about that recently and trying to remain more calm around him. At least outwardly so, but I know dogs can pick up on things regardless, so I need to work on resolving the stressors in my own life.

But then it's sort of a catch-22, because going for long walks with him, getting that exercise, helped alleviate a lot of stress, but now he's much less interested in going for walks, so that outlet isn't there. I should probably start getting more exercise without Kobe, until he's feeling up to our walks again.

* sigh * Our poor dogs. Us humans are so incredibly lucky that they put up with us and they don't even complain about it. (Well as far as we know. I can only imagine what they say to other dogs at the dog park. :D )

[FoxFire]

Could you measure how much he drinks? The normal amount of water a dog drinks is 1 ounce per pound of the dog's weight.


Thanks for the suggestion. Yeah I should probably keep better track of exactly how much he's drinking so I can tell for sure if it's more or less.

I feel like he's been drinking less than he was a couple weeks ago, yet still more than is normal for him and which he was drinking previously. I'm still filling his dish more often than I was just a few months ago or even last summer.

[Squirt's Mom]

Hi Glen,

I've been reading along but didn't have anything to add so just lurking on Kobe's thread like a stalker. :D

Reading your thoughts on sharing stress, I have wondered the same with some of my babies who were particularly intune with me. Bud is the one living now who has that ability to sense when I am in distress and he comes to me, putting his head in my lap if at all possible. Somewhere along the way, someone abused Bud before he came to me and I think he senses we share that trauma as well. The merest contact with Bud during those harsh times is enough to drain away most of my angst but, like you, I worry about how Bud processes what he absorbs from me. So I do my best to give him much more fun times than those hard times. He and I spend mornings and evenings in the bed, just he and I, with lots of contact and talking. We play with his toys often; when we go for walks he is the boss and we stop to sniff what ever he desires....and I often bend down to sniff with him (or pretend to anyway! ;) ). When something in the distance catches his eye, I look there as well and talk about what he sees, tho often I have no idea what he sees! But those little things seem to mean a lot to him. I also take steps away from him to deal with my issues and Mother Nature is best at that for me. Spending a little time outside soothes my Soul every time, even if it's just sitting in the yard and listening to the wind and birds. That old saying, "take time to stop and smell the roses" is very much true in my life. I am prone to walking in the fields and woods near my house and have been seen more than once hugging a tree or kissing a tiny bloom. Silly? Maybe for some but not for me - those simple things are deeply healing for me. I am able to leave a lot of crap in Mother Nature's gentle hands. I have no doubt whatsoever that Kobe loves you as much as you love him nor than he is fully capable of handling just about anything you feel and process it easily, except anger directed at him. Just as Bud loves me and I him. It is our job to find ways to make life the easiest possible for the little Souls in our lives who bring such healing to us...and mine is going outside. So take those walks alone and don't forget to stop and hug a tree every now and then. :)

Hugs,
Leslie

[Joan2517]

I think it is so true that they are tuned into our stress. Sometimes I wonder if my stressful life played any part in Lena developing Cushing's. She always knew when I was unhappy or upset and would do whatever she could to distract me. After she died, I was in so much pain and despair. Gable was the one who took over comforting me. He checked on me every hour or so the day that she died and for weeks after, while I lay on the couch and either slept or sobbed. He mourned for her almost as much as I did.

Now I don't let him or the rest of them see so much anymore. Like Leslie, I find my own time and place and let them be their carefree selves. Now that he's on the meds, he seems so much happier. The stress is gone from his face and he's playing with Cooper again. I can always tell when he's had a good day. I come home from work and every toy is out of the baskets and strewn all over the house! I had forgotten how playful and happy he used to be...feels good.

[Squirt's Mom]

I want to make something clear - I don't for one second believe we make our dogs sick by "using" them to relieve stress. I believe that is one reason why they were created as they were - to be companions, to be comforts, to ease us when needed. Unless a dog is living in a violent environment where they hear screaming and yelling, things are thrown and crashing around, and other violence then what we are feeling does not make them sick. We do not make our dogs sick with the stresses in our lives. IF the dog does live in a violent environment then, yes, it is very possible to damage them mentally and spiritually. So I want to make that clear.

As for our stresses causing Cushing's - NO. To date there are no known causes for Cushing's other than the Iatrogenic form which is caused by exposure to steroids and can be "cured" by removing the steroids. Not diet, not vaccines, not stress, nothing has been proven to cause Cushing's so far. Hopefully some day research will provide that answer but so far, no.

So you nor Joan should feel the least amount of guilt or concern that you may have caused Cushing's - you didn't, I promise.

[Joan2517]

Of course in my mind, I knew that, but it's still nice to hear!

[Squirt's Mom]

((((((((((((((((((((((((hugs)))))))))))))))))))))) )))))

[Squirt's Mom]

I absolutely adore John O'Donahue and when I ran across this today I thought of you.


When the mind is festering with trouble or the heart torn, we can find healing among the silence of mountains or fields, or listen to the simple, steadying rhythm of waves. The slowness and stillness gradually takes us over. Our breathing deepens and our hearts calm and our hungers relent. When serenity is restored, new perspectives open to us and difficulty can begin to seem like an invitation to new growth.

This invitation to friendship with nature does of course entail a willingness to be alone out there. Yet this aloneness is anything but lonely. Solitude gradually clarifies the heart until a true tranquility is reached. The irony is that at the heart of that aloneness you feel intimately connected with the world. Indeed, the beauty of nature is often the wisest balm for it gently relieves and releases the caged mind."

John O'Donohue
from Beauty

[FoxFire]

Hi Leslie,

Thank you for your perspective, and thank's for the quote from John O'Donohue. Very helpful.

It's good to hear that it was nothing I might have done that would have caused Kobe to develop this malady. He is such a comfort as our canine companions always are, so you can't help but wonder if our troubles weigh on them. It's only been over the last several months that he'd gone from his happy-go-lucky self to being so lethargic and disinterested in the things he's normally likes to do, preferring now to just lay around and sleep. And of course eat and drink (and drink some more) and potty.

I'm the same with Kobe as you are when we go out for walks. He's pretty much the boss, and decides which way we're going to go, and gets to stop as often as he likes to sniff whatever he likes. Sometimes just wanting to stand in one spot for 5 minutes only sniffing the air. I can only imagine what the neighbor's think when I'm heading in one direction and Kobe decides "Nope. We're going this way." Stops me and makes me go in the direction he wants to go. LOL Now they know who wear's the fur in that house. :p

And Joan, you're right, our dogs are so good at sensing our emotions, and wanting to make us feel better when we're down or upset.

So.... today was the day to get Kobe's 8-hour test results from the vet.

But... before that, this morning, after Kobe was let back in from his morning business, we noticed that his jowls were VERY swollen (as well as some swelling around and above his left eye). When I felt them, they weren't all soft and fleshy as they normally are but felt very thick and firm. It was clear he was having an allergic reaction to something, but didn't otherwise seem in distress. We've been having an issue with wasps trying to build nests around the deck, and I can only imagine that Kobe had a run in with one of them. I immediately called the vet, and she said to give him four Benadryl tablets (Kobe is 94 lbs), and if the swelling hadn't gone down in 30 minutes to an hour, or it seemed like he was having any breathing issues, to bring him in for a steroid shot.

Well after an hour with the Benadryl it seemed like the swelling might have dissipated a little bit, but not much. So, since I was waiting on his test results, I figured I'd best take him in, and could consult with the vet directly since the test results were expected to arrive soon anyhow. She examined him and agreed it appeared to be the aftermath of an encounter with a bee or wasp. I decided that it would be best for him to get the steroid shot to get the swelling down sooner and the vet said it wouldn't interfere with what she also informed me WAS a positive test result for Cushing's disease (and the fact that he already has too much cortisol floating around in his blood). Fortunately Kobe is always very good about getting shots. Barely seems to notice when they are given.

As for Kobe's Cushing's diagnosis, here are the test results from his LDDS test.

Cortisol Sample 1 .... 2.4 .......... (Ref 1.0 - 5.0)
Cortisol Sample 2 .... 2.0 (HIGH) (Ref 0.0 - 1.4)
Cortisol Sample 3 .... 2.1 (HIGH) (Ref 0.0 - 1.4)

Diagnosis : Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8 hours post-dex.

So now I'm told that Kobe will need an appointment with an Internist to have an ultra-sound done in order to determine if it is Pituitary Dependent or an Adrenal Tumor, which apparently is important to know.

They want to start him on 60mg of Vetoryl (trilostane), and then test him after 2 weeks to see his response. Isn't 2 weeks too early? I thought it was 30 days to retest. I didn't want to question the vet at the time. Since it's $300 I don't want to have to do have to test too often (I honestly don't know why these things need to cost so much :confused: ).

As you said, it's not like he needs to go on the medication immediately. Once I'm comfortable that I'm doing the right thing, I can proceed. I just want to do this in the smartest healthiest (and ideally most cost-effective) way possible. The vet referred me also to an online pharmacy which can supply the Vetoryl at substantially cheaper prices. She said they have it for $65 for a 30 day supply, as opposed to $100 through the clinic since they need to special order it. I simply need to have the online pharmacy Allivet send them the prescription for them to authorize).

So I may wait until after Kobe has had his ultrasound and I know more about where we're at before ordering that.

The vet said they do have some other patients with Cushing's, so it would seem they are familiar with treating it. And interestingly enough the vet ALSO has a dog with Cushing's, and has been on Vetoryl since February (only 10 mg as she's a little dog). The vet said her pup has responded well to it, though has recently started drinking more water again, so she is getting retested to see if her dose needs adjusting, though it could simply be the warm weather.

Anyhow, right now Kobe is sleeping like a baby comfortably having wedged himself between pillows on the bed, making him look supremely comfortable. Heh.

[FoxFire]

Hi friends,

Just wanted to give an update on Kobe, who just turned 6 last Friday! By the way, I just realized I hadn't mentioned how his name is pronounced, since just about everybody pronounces it incorrectly. His name is pronounced Kobay (like the Japanese city and its famous beef). I think I'll edit my original post to make note of it.

So I just received Kobe's medication from Allivet. He'll be on 60 mg of Vetoryl once daily starting tomorrow (Wednesday). Then he is scheduled for his follow-up ACTH two weeks later on the 26th. Kobe is 94 lbs (a good 10 lbs overweight, though the vet would like him to lose at least 5 lbs). So his starting Vetoryl dose is below the typical starting dose. I'm happy this is what the vet decided, since I'd rather start lower. Especially since Kobe's symptoms have dissipated slightly since his infections were taken care of. I still of course worry about false positives on his tests, and maybe this medication isn't right for him. Hopefully that is something which will be evident with his follow up blood work.

As for Kobe's symptoms. Though he hasn't started medication yet, he isn't panting quite as much as he had been. Though even minor amounts of exercise will get him panting. His drinking seems somewhat less than it had been. I've been monitoring it over the last few days and I believe the volume is still likely excessive for his weight (see below).

He has since had two more accidents in the house, despite my ensuring he is put out regularly even if he isn't asking to go out. And on occasion when he's been put out, despite not asking, he's let pee out rushing across the deck and down the stairs before getting to the grass (sometimes nearly tripping down the stairs). He also peed in the driveway after getting out of the car, being unable or unwilling to walk over to the grass first. One of his accidents in the house was a surprise to me. Because he had just been put out 30 minutes before and peed a small lake's worth. So it was surprising to me that after getting a snack of some plain ground beef I'd been frying up for tacos, and presumably having a drink, downstairs where his food and water dish are, I came down to find he'd peed on the rug. Perhaps he was overly excited for getting the ground beef, which is a rare treat. But I was surprised he had anything left in his bladder!

He is more reluctant to go up and down the stairs (maybe due to muscle weakness as I've read), so perhaps he just didn't want to come upstairs to let anyone know he needed to go out.

He is still very lethargic and sleeps nearly all day, and is reluctant to go on walks. Usually wanting to come back home right away, though sometimes he will stay out and walk longer. And he is hungrier than usual. Begging for food or treats more often.

He has been slightly more of his friendly self when greeting other people or dogs, though nowhere near his typical self.

So.. I guess he's still exhibiting typical Cushing's symptoms, even though they seem less to me than they'd initially been. I'd feel better if these tests were more definitive about his actually having it.

Here is Kobe's water consumption. Again he's 94 lbs ( 42.6 kg)

9/ 4/2018 3500 mL
9/ 5/2018 3800 mL
9/ 6/2018 3600 mL
9/ 7/2018 3000 mL
9/ 8/2018 3500 mL
9/ 9/2018 4200 mL
9/10/2018 3800 mL

Presumably this is too high. Though I'm not sure if this is VERY excessive or not. As I'd mentioned previously, Kobe had always been a big drinker. His current water consumption is more than usual for him, though I can't say it's currently A LOT more than usual. Prior to his antibiotics for what was an infection on his paws and his penis (perhaps also a UTI), I'm certain he was drinking even more!

He will still empty his water dish at least a couple of times a day (which I've taken to not filling all the way up). I will fill it back up right away. Sometimes he'll continue to drink, but other times he won't. Perhaps if I'd put more water in his dish initially he'd continue to drink that until empty, yet chooses not to if he empties a half full dish and then I fill it up half way again.

In any case. I will keep you all posted on Kobe's progress with his starting of Vetoryl tomorrow. He also gets his ultrasound on the 19th.

[Squirt's Mom]

Good to hear from you! I had to convert ml to oz so I could see for myself how much water would be considered normal. At 1oz per lb, Kobe would consume 2779.91ml of water so he is a bit over what would be the high end of normal water consumption for dogs (1/2 - 1 oz/lb). Whether this is excessive for a normally heavy drinker would be hard to determine unless you were keeping up with his consumption prior to the Cushing's signs appearing...but for general purposes he is drinking more than a 94lb dog normally would.

Good luck with the ultrasound and I hope it shows nothing more than abnormal adrenal glands which is what we expect with a cush pup. Let us know what the comments on the US are when you know.

Hugs,
Leslie

[FoxFire]

Thank you Leslie,

I'm wondering if anyone knows, since I start Kobe's Vetoryl tommorow the 12th, and he doesn't have his ultrasound until the 19th, would his adrenal glands appear normal by then, given that he'll have been on the medication for a week? Or would they still be expected to be abnormal despite taking the medication?

[labblab]

Glen, if Kobe were my dog, I would not start the Vetoryl treatment until after the ultrasound next week. Ironically, Vetoryl treatment can actually increase the size of the adrenal glands rather than lessen them, thus kind of muddying the water in terms of diagnostic imaging. I don’t know whether this effect occurs as rapidly as within just one week’s time. But still, since you’ve had lingering questions about the accuracy of the Cushing’s diagnosis, I’d want to see the ultrasound results before starting treatment and before any new variables are introduced. Even if Kobe truly has Cushing’s, waiting one more week to start treatment is no biggie.

If you’ve already given him today’s first dose, that should also be no big deal. But as I say, if he were mine I would give no more medication until after the imaging has been done.

Marianne

[Squirt's Mom]

I agree with Marianne about the ultrasound. In fact, I wouldn't even have paid for the drug until after the ultrasound. It would have sat right where the vet put it until after the US proved nothing else could be causing his issues. ;) IF you have started the Vetoryl already, I would not give any more until after the US.

Hugs,
Leslie

[FoxFire]

Oh okay. Thanks.

My first inclination was to wait until after the Ultra-sound (indeed to even purchase the medication). But then after it turned out that it would be a couple weeks to get him in for that and given that Kobe had another accident in the house and is still acting very lethargic I figured I'd start him on it.

Well... I did give him his first dose this morning. Just a few hours ago. So far... no change. Ha!

But I'll wait till after his ultra sound to give him any further medication. Thanks for the advice.

[FoxFire]

Today Kobe is especially tired. He normally runs upstairs and to the door when the kids get off the bus to greet them. Tail a wagging, though he hasn't run around like a maniac in several months.

But today, when they got home, he just stayed downstairs in his kennel (which he goes to when he doesn't want to be bothered, and has a nice soft bed and some stuffed toys in it).

By-the-way,he's now laying on the floor barking in his sleep as I type this. :D

Anyhow, yesterday although he only had his first and only dose of Vetoryl (I didn't give it to him today and will wait until after his ultrasound to continue), he actually seemed a little bit more chipper and energetic than he had been. We even walked a good distance to get ice cream, which is often a good motivator to him to push through with a longer walk these days.

Now today he's EXTRA tired. I'm wondering if this has anything to do with his dose of Vetoryl yesterday and rebound from not getting any today. I know lethargy on Vetoryl is a bad sign (though how can you tell if the dog is already lethargic, I guess just being extra tired), but he hasn't had any today. And yesterday he seemed to perk up just a bit on his first and only dose. I suppose I won't know until he's back on the medication and has taken it for a few days.

I imagine Vetoryl is quite bad to take if he does't in fact have Cushings. What sort of signs would I expect to see if that's the case? And presumably this would be evident on his ACTH he gets 2 weeks after starting.

[labblab]

Glen, I’m doubting that the one dose of Vetoryl would prompt a dramatic behavioral shift within a single day’s time. So it may just be coincidental that he was more active yesterday, and more quiet today. But you’re right that you’ll be better able to evaluate the medication’s true effect when Kobe has been taking it consistently for multiple days. Having said that, I did see noticeable improvement in my own dog’s excessive thirst/urination after only 2-3 days of treatment, so you never know — maybe the Vetoryl did help him to feel better yesterday.

If and when you do start regular treatment, effects of overdosing can include such things as loss of appetite, vomiting, diarrhea, and lethargy. I don’t think that Kobe’s tiredness today — 48 hours after dosing — is likely due to overdosing, though. So hopefully he’ll be back to feeling perkier again tomorrow. Do let us know.

Marianne

[FoxFire]

Thank Marianne.

Yeah, I figured it may just be my hopeful imagination that he showed improvement on a single dose. Though he's definitely been sleepier today. That could be due to taking a longer walk yesterday. It's strange to me that I'm hoping that once Kobe's had his ultra sound that they do find it's Cushing's, simply because I'm worried that they'll find out it's something worse, untreatable, and/or fatal. :( Of course I'd be thrilled if they said it was something other than Cushings and was easily curable or operable with a high success rate.

On another note though. While he had no medicine today he's actually drank less water today! He greedily ate his dry food breakfast and some treats afterwards. Had a bit of cheese during the day (which he'll NEVER turn down). Before dinner he happily scarfed down some more of his favorite treats (chicken wrapped sweet potato). But when I put his dinner out (more dry kibble) he didn't touch it. Later I gave him a small dish of plain cooked ground beef we had left over from tonight's dinner, and he ate it with gusto. Yet he still hasn't touched his dry kibble!

This is actually more like him. Since before his Cushing's symptoms started he wouldn't want to eat his dry food unless I mixed in some wet with it. I'm not going to mix any in now to see if he'll eat it, since he needs to lose some weight anyhow. :p Though I suspect if I offered up some more chicken wrapped sweet potato, he'd gobble it right up. I will give him some treats before bed, just to make sure he's not losing his appetite. If he turned those down I'd be suspicious.

Meanwhile he sleeps and sleeps.

Thanks for the info on what to look out for once he starts regular treatment. I'll be keeping a close eye out for those things when he does.

[FoxFire]

Just FYI...

Kobe did wind up eating his dinner of dry kibble last night. Much later than usual. After I primed the pump by giving him one of his favorite treats. Apparently he realized "Hey I'm still hungry".

So he ate his dinner, and then begged for more treats.

Surprisingly his water consumption was only 2500 mL yesterday. Though today he looks to be on track toward the more recently typical 3500 - 4000 mL (1 Gallon).

[Harley PoMMom]

Glad to hear that Kobe finally gave in and ate his kibble, they sure do keep us on our toes!

[FoxFire]

Indeed they do Lori. :)

Hello Cushpup friends,

Just wanted to give an update on Kobe's ultrasound. So it would appear that Kobe is one of "lucky" 15% that have an adrenal tumor. Well... the doctor's diagnosis was "Suspect a Functional Adrenal Tumor". The tumor itself wasn't imaged (presumably it was too small to distinguish). I was there during the ultra sound and she didn't point out a tumor on the adrenal gland. Just that one of Kobe's adrenals was larger than normal, while the other was normal size. It was weird though because from what the doctor could tell (and honestly I don't know how they can make heads or tails out of those fuzzy ultrasound images) only one side of Kobe's adrenal was enlarged, while the other side of that same adrenal gland was not.

What the doctor wrote there was that "The left adrenal gland is normal size, but the right is a little wide. This could be the start of a benign adenoma. "

Also she noted that Kobe "did not have the typical big white liver, but could happen over time."

She said that while surgery is the treatment of choice for adrenal tumors that symptoms can sometimes resolve with Trilostane/Vetoryl.

For the time being she recommended that Kobe continue on Vetoryl and if he improves and then later develops symptoms again she can recheck the adrenal glands. Though thankfully, she said it will be at a much reduced cost. Not sure why. Maybe because she only needs to check the adrenals or because it's wrapped up in the original testing. :confused:

In any case Kobe is only getting 60mg of Vetoryl, which I started the next day (Thursday). That's lower than his weight would typically require, but it may be enough. We'll see. He's now had his 3rd dose.

He seems to be tolerating it well. He's had some "soft-serve" poops. But then that's not entirely atypical for Kobe, though it's more frequent than he usually would have that, so I'm not sure what to think about that yet. He hasn't vomited. His appetite is still good, still overly good. And he's been sleeping as much as usual, maybe a little perkier since he started his Vetoryl. He seems more willing to go up and down stairs and jump on the bed. He did have another pee accident in the house yesterday, but this time it was at the back door, so apparently he WAS wanting to get out, and was able to get himself to the back door first, but apparently couldn't hold it long enough to alert anyone and for someone to notice he needed to go out.

The doctor did find a little fat around his heart (she briefly looked at it). But then he's not been exercising much. Still.... I have to cut back on his, daily yet fairly small quantity, cheese intake (or get fat free cheese for him, does that even exist?), and trips to get ice cream (though it's cooling off now anyhow and the ice cream place will soon be closing for the season).

*sigh* Why do so many of the things which make life worth living have to be bad for us (and dogs) :rolleyes: Food wise anyway.

Well, 10 days till Kobe's followup ACTH. I'll let you all know how it goes.

Thanks for the support!

[Harley PoMMom]

I'm not sure if anyone posted that Vetoryl has to be given with a meal to be properly absorbed, so in case not, I just did! Keep us updated!

[FoxFire]

Thanks Lori,

Yes I do recall reading that, so Kobe has been taking Vetoryl with his breakfast.

Today is his 4th consecutive dose. I do believe he's been perking up a little bit more each day. And I'm pretty sure it's not just my imagination. :o

Today he showed a bit more of the energy and excitement he used to have when I'd return home. Not yet where he was, but a noticeable improvement. He is still sleeping more than usual, but I think even that has improved a bit. We went on a fairly lengthy walk this evening and while it is still slower going than months ago, there were times when he was actually out ahead of me and making me have to pick up MY pace to keep up. How long before I'll need to jog or run to keep up with him again I wonder. (Although to a degree I have to imagine some slowing down is just his getting older. I don't expect him to have puppy energy).

Yesterday his water consumption was the lowest since I've been recording it. Only 2400 mL (81.1 oz) . The day before he was 3300 mL. Prior to the Vetoryl he was usually over 3000 mL (101.4 oz) and as high as 4200 mL (142 oz)! He didn't spend forever lapping up water yesterday, or today either. Though it has been cooler the last couple of days, so.... maybe that is part of it.

His stool has run the gamut over the last few days (even during a single day) from normal, to soft, and this evening while returning from our walk he had a small quantity of runny stool. Not sure what to make of that. Maybe just all the walking got his bowels moving quicker than usual.

I'll let you all know how he progresses.

[Harley PoMMom]

So glad to read that you are seeing improvement...YAAA Go Kobe!!!!! If Kobe's follow up ACTH test results are good and the diarrhea is still looming you could add some plain canned pumpkin to his food to see if it would firm it up.

[FoxFire]

Hello Cushpup friends.

Sorry for the lack of updates. Kobe just had his ACTH test last Wednesday, and I didn't get the results until Friday.

I'm sorry I don't have the detailed test results sitting in front of me as I need to pick them up at the vet (they don't e-mail them for some reason). However the vet did call me on Friday, and said that Kobe's ACTH results, I believe 4 hours (maybe it was 6, I don't remember now) after his morning 60mg dose of Vetoryl was 3.0 and he ought to be in the range of 1.5 to 9.0 . So he's definitely in the good range, though near the low end. He will have another test at the 30 day mark.

The vet is concerned that prior to his test he could be going even lower, perhaps too low, given my observations that he does get even more lethargic soon after he's been dosed (which is a bit hard to tell since he's already lethargic with the Cushings), and then perks up later in the day. She said she called Dechra and had a long conversation with them about Kobe. They said it should be fine to keep him on 60mg though it would be worth trying him on dosing 30mg twice daily, to keep his cortisol levels more even throughout the day.

I'm wondering what the community's thoughts are on this, and has anyone had better or worse results with twice daily dosing?

If I switch to 30mg twice daily Kobe will need the ACTH test again at 2 and 4 weeks out from the dosing change. I decided to get Care Credit as his expenses mount. Also since I thought in case he does need surgery. Though in speaking with the vet it was decided not to go that route for the time being.

As for other observations, Kobe's drinking has continued to reduce to the point that he only drank 1.7 L (57 oz) yesterday. Now I'm beginning to wonder what's too low! Heh. He hasn't had any more accidents in the house EXCEPT for the same day he was at the vet for his ACTH test. I was unable to monitor how much he drank that day. Later that evening he peed near the back door again. Maybe whatever they give him for ACTH did something as well.

His appetite is still good. Still too good. Though there are days where he takes longer to decide if he'll eat his dry kibble. He was always used to getting some wet mixed in just to get him to be interested in it, but since the Cushing's kicked in he would inhale it without anything mixed in. He always wants snacks though. Unfortunately he put on more weight at his last vet visit, so I (and the kids who like to sneak him cheese knowing how much he loves it) have to be more disciplined in giving him snacks.

I actually found fat free cheese, which as you can imagine is pretty nasty. Ha! In fact, I didn't think there was ANY cheese Kobe wouldn't scarf down like a starved Velociraptor, but alas he refused to touch the stuff! :D Oh well. He likes low fat cheese, so he'll only get it wrapped around his medication.

His energy level seems to be up and down. Seems about every other day that he's willing to go on longer walks. He is more willing to go up and down the stairs than he had been. Jumps up on the bed more. And greets people at the door again. Still he does sleep A LOT still. I'm hoping his energy returns in time, and particularly if I can get some weight off him. The vet said he could be experiencing more aches and pains now that there isn't so much cortisol in his system which will mask those aches and pains. She believes he could be experiencing some arthritis and asked me if I'd like her to prescribe some medication for it to see if it helped. I decided to hold off on that for now.

She did give me some medicated wipes for his paws which are still a bit red and swollen. Hopefully those will help.

Also she prescribed him some Pro-biotics to sprinkle on his food once daily. The pumpkin did help Lori, thanks! He hasn't had any more diarrhea. But his stool has still been a bit softer and mushier as the day goes on than is ideal. We'll see how adding the pro-biotics helps.

So, I think that's about it. Hope everyone else and their cushpups are doing well. Haven't had a chance to read the forum lately, but I'm going to get to that in a bit.

[Harley PoMMom]

Hi Glen,

Definitely get those ACTH stim results so we can be absolutely sure what Kobe's cortisol levels are. Now, if his post is 3.0 ug/dl than that is really good, however, if it seems that Kobe does get lethargic right after his dose of 60 mg of Vetoryl splitting it into 30 mg doses and giving it twice a day could be better as this would help keep his cortisol on a more even keel. When a cushdog has diabetes it is strongly urged to administer Vetoryl twice a day for that reason so even though Kobe doesn't have diabetes the twice a day regimen, I think, could be beneficial.

Regarding the arthritis, sometimes this is unmasked when a cushdog starts treatment because, as the vet stated, that abundance of cortisol is now lowered. Some of our members have tried Adequan shots for their arthritic dog and it seems to help. Fish oil, especially wild salmon oil, has anti-inflammatory properties. I found this article to be informative regarding canine arthritis and treatments: http://www.whole-dog-journal.com/issues/10_3/features/Canine-Arthritis_15910-1.html

We also have a thread where natural anti-inflammatories are discussed: Joint support supplement (http://www.k9cushings.com/forum/showthread.php?t=5005)

Here's a link with info regarding Adequan: http://www.fda.gov/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm116139.htm

I'm also including this link to an article, regarding arthritis, on the Dogaware site that lists medical and other alternative therapies: http://dogaware.com/health/arthritis.html

Glad his appetite is still good and that he seems to be doing well, I also hope the Pro-biotics help with his stool.

Lori