PDA

View Full Version : Hello all, looking for advice with our baby Minnie



Minnie's Mom and Dad
08-22-2018, 11:51 PM
Hello everyone,
We were just told today that our little 5yr old Yorkie has the pituitary type Cushing's syndrome. She had a clean vet visit including blood work back in March of this year. In July she began to gain wait (1 1/2 lbs), drinking alot, peeing alot, infrequent accidents in the house that are very unlike her.
She went from sleeping in our bed all night to sleeping on the floor (could get onto the bed any more) and wanting to go out almost every 90 minutes to 2 hours. Panting alot, and eating alot. Previous to July she loved to take long walks and now frequently refuses to walk very far. We took her to the vet late in July and they stated her liver enzyme levels were slightly elevated. We had her on an anti-biotic and a liver supplement for 2 weeks. The vet suspected a possible UTI. She showed improvement over the next two weeks and became fairly active again, but this was very short lived.

Last week all of the symptoms returned. She even had a small bout of blood tinged diarrhea. On Monday they did another liver enzyme level test and her GGT levels were high ( i'll get the actual #'s from the vet tomorrow) I believe he said her ALP was 91 ( in the normal range?) . The Vet even stated he didn't expect Cushings because this ALP # is typically 10 times as high in his typical Cushing's patients. They also found blood in her urine and have prescribed another 2 weeks of clovomax anti-biotic (sorry my spelling may be incorrect).

On Tuesday we took her for the LDDS test. The vet stated her system didn't suppress like it should have and the results are pointing to the pituitary Cushing's

Since the phone call we have been devastated. Finding this website helped us feel a little better. Everything we've read so far states life expectancy is 2 to 3 years. I'm hoping we've caught this early enough to begin treatment and have her for much longer than 2-3 years.

She's never had any other illnesses.

We're hoping to discuss treatment options over the next couple days. If we're not comfortable with our current Vet, i was able to find an Internal Medicine specialist close by from a link here in the forum. Thank you!

I've tried to read and learn as much as possible about Cushing's over the past couple days and i'm sure this forum will be invaluable.

Any advice or suggestions will be greatly appreciated!!

As soon as i have more specific info regarding her liver enzyme tests and the LDDS test i will post it.

labblab
08-23-2018, 08:43 AM
Hello and welcome to you and to sweet little Minnie! I have only a moment free to write, but I wanted to let you know that I’ve moved your post to our main Discussion forum where more of our members are likely to see your questions and have the chance to respond. I’m sorry that Minnie is having these problems, but so very glad you’ve found us. So once again, welcome, and I’ll return later to write more.

Marianne

Joan2517
08-23-2018, 10:20 AM
Hello and welcome to you and Minnie. Good for you to already have a game plan in mind! Once you post those numbers from the blood work and testing, it will be easier for folks here to try to help. With the blood work, only the highs and lows with the reference ranges. Could you also let us know how much Winnie weighs...

Squirt's Mom
08-23-2018, 11:30 AM
Hi and welcome to you and Minnie! :)

The LDDS is notorious for giving false positives for Cushing's when any non-adrenal condition is present. My own Squirt tested positive on the LDDS, HDDS (no longer used), ACTH, and UTK panel (used to test for elevated intermediate hormones as well as cortisol) but they were all false positives because of a tumor that was found on her spleen with an ultrasound. The fact that Minnie has an on-going UTI gives me enough pause as to the accuracy of the LDDS that I would NOT start treatment for anything right now. I would give her a chance to get completely cleared of the UTI and then if you are seeing signs - thin and darkening skin, pot belly, panting for no reason, voracious appetite 24/7, excessive urination, excessive thirst, accidents in the house - I would test again. I could not trust the LDDS that was just done. Any stress, internal or external, can cause the ACTH to be falsely elevated so that test would also be unreliable as far as I am concerned right now. It is also very unusual for Cushing's signs to suddenly occur. They usually happen very slowly over years leading most parents to think their pup is simply aging.

It will help us to see those test results, as Joan said, because we would expect to see certain abnormalities in a cush pup. The test results will help us get a better idea of what may be happening. We are NOT vets but we have seen thousands of test results in cush pups and others who were thought to have Cushing's yet proved not to later on down the road. ;)

I want you to know that Cushing's is very very rarely a pressing condition so there is no need to panic over waiting for the UTI to clear or to get a more definitive diagnosis. It is a slooow progressing disease taking years to do any real damage. And that 2-3 year thing? pftttttt...that is based on outdated info. Vets are better educated these days, we have more treatment options, parents are better educated and demand better care from the vets (so they HAD to catch up! :D ), and most dogs are diagnosed much later in life when they had no more than a few years left anyway. There are rare complications that can shorten their lives but those are rare. My own baby was diagnosed at 7 and lived to be a bit older than 16, passing from age and not Cushing's. We have had pups here live 12 years with Cushing's! So you just put that nonsense in the trash and don't think about it any longer. You and Minnie are in the best place to learn all you need in order to be her staunchest advocate and care taker IF IF IF she does in fact have Cushing's.

You are not alone, ever. We will be here anytime to talk, listen, and help in any way we can. Never hesitate to ask any questions and feel free to prowl through the threads to learn and be sure to check out our Helpful Resource section where you will find loads of great info. I am glad you found us and look forward to learning more about sweet Minnie as time passes.

Hugs,
Leslie

http://www.k9cushings.com/forum/forumdisplay.php?10-Helpful-Resources-for-Owners-of-Cushing-s-Dogs

Minnie's Mom and Dad
08-23-2018, 01:02 PM
Thank you so much!!

She is on day 3 of her antibiotics, so we'll plan to wait until they are finished and do another urine test before a 2nd LDDS test.

I'm actually waiting to hear back from the initial Dr that saw us and scheduled the test and that will be my 1st question. Why submit her to that test when her system is already stressed with the UTI?

She has had some of the other symptoms beginning of a pot belly, thirst, urination, panting. No skin issues yet. Frequent urination with accidents at night. Muscle weakness. Lethargic

Could some or all of these be attributed to a UTI?

Thank you again for giving us what we really need right now...some hope!!

I'll get copies of all of her tests going back to her annual check-up in March that was supposedly good.

Minnie's Mom and Dad
08-23-2018, 01:23 PM
Hello and welcome to you and Minnie. Good for you to already have a game plan in mind! Once you post those numbers from the blood work and testing, it will be easier for folks here to try to help. With the blood work, only the highs and lows with the reference ranges. Could you also let us know how much Winnie weighs...

Minnie is just over 10lbs at her last visit. She was 9lbs at her annual checkup in March. We were actually just starting to put her on a diet dog food thinking some of the issues (panting, no longer jumping on beds or furniture) were caused by this sudden weight gain that actually seemed to happen from mid June to mid-July. She's always been one to leave food in her bowl for a day or two, especially if she's getting a few table scraps. Now she eats as soon as the food hits her bowl.

Minnie's Mom and Dad
08-23-2018, 08:11 PM
Ok Here are all of the test results. Starting with the latest

8/21/18 4:37PM HESKA LDDST 8hr post - Cortisol 3.6 1.0-6.0 ug/dL
12:40PM HESKA LDDST 4hr post - Cortisol 1.2 1.0-6.0 ug/dL
7:32AM HESKA LDDST Initial - Cortisol 4.7 1.0-6.0 ug/dL

8/20/18 DriChem
Albumin 4.3 High 2.5-4.0 g/dl
Glucose 109 75-125 mg/dl
ALT (GPT) 177 High 0-120 U/l
ALP 91 0-140 U/l
GGT 112 High 0-14 U/l
Total Bilirubin 0.1 0.0-0.5 mg/dl

7/23/18 DriChem ElementHT5
Albumin 4.1 High 2.5-4.0 g/dl
Globulin 3 2.0-3.6 g/dl
Glucose 101 75-125 mg/dl
Cholesterol >450 120-310 mg/dl
ALT (GPT) 181 High 0-120 U/l
ALP 82 0-140U/l
GGT 50 High 0-14 U/l
Total Bilirubin <0.1 0.0-0.5 mg/dl
WBC 7.44 6.00-17.00
NEU 6.62 3.62-12.30
LYM 0.57 LOW 0.83-4.91
MONO 0.24 0.14-1.97
EOS 0 LOW 0.04-1.62
BAS 0.01 0.00-0.12
NEU % 89 HIGH 52.0-81.0 %
LYM % 7.7 LOW 12.0-33.0 %
MONO% 3.1 2.0-13.0 %
EOS % 0.1 LOW 0.5-10.0 %
BAS % 0.1 0.0-1.3 %
RBC 7.4 5.10-8.50
HGB 18.4 11.0-19.0
HCT 52.2 33.0-56.0
MCV 74.2 60.0-76.0
MCH 26.1 20.0-27.0
MCHC 35.2 30.0-38.0
RDW% 13.6 12.5-17.2
PLT 368 117-490
MPV 8 8.0-14.1
BUN 9.3 9.0-29.0
CREATININE 0.5 0.4-1.4
PHOSPHORUS 4.4 1.9-5.0
CALCIUM 11.4 9.0-12.2
TOTAL PROTEIN 7.1 5.5-7.6

SODIUM 146 141-152
POTASSIUM 3.9 3.8-5.3
CHLORIDE 102 102-120

Please let me know if any further info would be helpful. I think this is all i have in the way of test results.

I forgot to mention that the vet suspected blue-green algae toxicity based on the 1st results (7/23) and prescribed 10 days of CLAVAMOX at 62.5mg and DENAMARIN 90MG.

She is currently taking 125mg CLAVAMOX twice daily for 14 days. (Vet says we should see noticeable improvement by Monday)

I also spoke with the Vet today and she doesn't believe there is a chance of a false-positive. And with the LDDS test along with the symptoms she believes treatment is our next course of action, if that is what we decide. She suggests a liquid form of vetoryl and wants to wait and see how Minnie is after the antibiotics are complete.

Minnie was able to complete about half of her normal evening walk today with a little help being carried every so often. She has a little tremor in her rear legs from time to time, especially when squatting to go potty.

Harley PoMMom
08-25-2018, 01:57 PM
As Leslie mentioned, the LDDS test can yield a false positive result when a dog has a non-adrenal illness. And even though Minnie's symptoms along with some of those abnormal blood work levels are commonly seen in dogs with Cushing's I'm just leery of that LDDS result when the UTI was present during testing.

My advice would be to have her urine cultured, waiting at least a day or two to collect urine after the completion of the antibiotics. An UTI will make a dog drink/urinate more and can also cause panting so these symptoms that Minnie is exhibiting could just be from the UTI.

Lori

Squirt's Mom
08-25-2018, 02:09 PM
If this were my baby, there is no way I would start treatment until the terms I mentioned were met - the UTI is completely healed and has been for a while and the signs of Cushing's are still present. These drugs are very very powerful so I prefer to always wait until diagnosis is much better defined than Minnie's is at the moment. But that's just me. If I had started treatment on my dog when she was first diagnosed she would have died from a tumor that wasn't found until an abdominal ultrasound was done. ;) So I never take risks nor advocate anyone else take risks in starting treatment with a questionable diagnosis....regardless of what a vet may say. :)

labblab
08-25-2018, 05:44 PM
Hello again from me, too! I’m so glad you’ve been greeted by other folks, and I apologize for the delay in my own return to you. You’ve already been given a lot of helpful info and food for thought, so I’ll just go ahead and add a few additional thoughts of my own. It is indeed the case that Minnie exhibits outward symptoms and certain lab abnormalities that are consistent with Cushing’s. The excessive/thirst/appetite, panting, muscle weakness and exercise intolerance all fit, as do elevated cholesterol (although not noted as high on your list, it looks like it was high), certain white blood count abnormalities, and mildly elevated ALT. As your vet has already noted, what does NOT fit is Minnie’s normal ALP. Also, her GGT is highly elevated and has more than doubled within the past month (it is now eight times normal range) whereas only mild to moderate elevation would be expected. The normal ALP is really atypical.

As far as the UTI, I certainly can’t argue with the fact that, ideally, you’d prefer that a dog be infection-free at the time of LDDS. However, untreated Cushing’s can result in recurrent UTIs that are very difficult to fully eradicate. So sometimes I think it’s reasonable to proceed with the testing even when a UTI is present since the dog may never fully “clear” while circulating steroid levels are significantly elevated and the dog’s immune system is compromised. However, the point is well taken that Cushing’s is normally a slowly progressing disease, and you typically should have the opportunity to at least try to eliminate the infection in order to see whether that normalizes some symptoms.

I am not well versed enough in liver values to know exactly what to make of the rapidly elevating GGT. But if it were me, that value, in conjunction with the normal ALP, would be enough to encourage me to seek an additional opinion from your local internist prior to starting treatment. As Leslie has noted, Cushing’s symptoms typically don’t acutely emerge over a short period of time. So even though Minnie’s picture does seem consistent with Cushing’s in certain ways, there are enough question marks to make me scratch my head. One diagnostic tool that an internist might recommend is as abdominal ultrasound. Although that would involve additional expense, it might clarify whether or not there are primary issues with Minnie’s liver or gallbladder, for instance that might account for those uncharacteristic enzyme readings, or any other organ abnormalities that might account for her Cushing’s-like symptoms. Sometimes spending a bit more money upfront can make a big difference as far as arriving at a truly accurate diagnosis.

So once again, just a few more thoughts for you to consider,
Marianne

Minnie's Mom and Dad
08-26-2018, 02:06 PM
Again, thank all of you so much for the advice/suggestions!

Well today is only the 5th full day (of 14) of the antibiotics and she is slowly beginning to change.

The panting is gone. She's not had an accident in the house is 3 days. The last two nights she's gone about 5 hours without having to go out. Last night and today she's left food in her bowl and is not drinking any where near as much water as before.

She still is lethargic. One symptom that she has yet to show is the hair loss.

Its very good to see her making this slow progression back to her normal self!!

We'll see what this week brings. I plan on getting a referral to the local Internal Medicine Vet tomorrow, so i can have something set up for her when the antibiotics are complete.

I can't wait to get a definitive diagnosis. The scariest part of all of this is not knowing. Thank all of you again so much. We now know that if it truly is Cushing's, we can handle it.

Minnie's Mom and Dad
08-30-2018, 04:43 PM
A little update:

Day 9 of the antibiotics - Some panting returned...mostly at night. The thirst and hunger are gone. She's barely touched either her food or water bowl today. She also seems to have just a little more energy.

The only internist i could find locally had terrible online reviews, so i managed to schedule consult with another about 90 minutes away...in 2 weeks.

We should be complete with the antibiotics on Tuesday. The plan is to get another urine test to ensure the UTI is completely gone and to run a UCC test too.

Am i correct that if the #'s come back in the normal range on the UCC test than Cushings is not likely?

Squirt's Mom
08-30-2018, 06:24 PM
Yes you are correct. If the UC:CR is normal, it is highly unlikely Cushing's is in play. If the UC:CR is abnormal that still does not mean your baby has Cushing's. It simply means SOMETHING is off and further testing is needed.

I'm glad to hear Minnie is doing better and hope the trend continues!

Minnie's Mom and Dad
09-07-2018, 10:31 PM
Another update:

Finished the 14 days of antibiotics. Minnie still seems lethargic but has more strength. She's been able to finish her walks and is jumping on the couch again. She was running in the yard today too for the first time in weeks. Only other symptom would be some mild panting at night.

We took in another urine sample and just heard from the Dr. She says the urine looks worse than the last test.

We have an appointment with the Internal Medicine Dr this next Wednesday thankfully.

Squirt's Mom
09-08-2018, 09:18 AM
Are the vets running the new test called the SDMA? It is the only test to pick up kidney disease early. Previously we didn't know there was a problem with the kidneys until something like 75% of function had been lost - the BUN and creatinine would indicate problems. Now the SDMA picks up problems MUCH earlier giving us time to work with keeping them as healthy as possible for as long as possible. So if that has not been done, I would want that test just for my own peace of mind.

I'm glad she is showing some improvement and hope they can get to the bottom of her urinary issue soon!
Hugs,
Leslie

Minnie's Mom and Dad
09-08-2018, 03:14 PM
Thank you! I will ask about that test.

Just talked with the vet and we're heading in Monday so they can get a clean urine sample for a culture.
I guess this will help them determine a better antibiotic.

They are also going to do the UC:CR test. The vet said this would "rule in" Cushing's. Everything I've read says it's a better indicator to "rule out".....and it wouldn't necessarily "rule in"

My only concern is that she still has this infection going on. Will that effect the results of the UC:CR test?

Harley PoMMom
09-08-2018, 04:12 PM
You definitely do not want to have the UC:CR test done if an UTI is suspected. Also with this test, the urine must be collected at home because it is less stressful on the dog as stress will cause the cortisol to rise which will be reflected in the results of an UC:CR test.

Having an urine culture and sensitivity test performed is your best bet in identifying what is causing the UTI and it can than be known what the appropriate antibiotic should be prescribed.

Lori

Squirt's Mom
09-08-2018, 06:37 PM
Again you are correct - the UC:CR cannot "rule in" Cushing's. It CAN rule it out if it is normal however if this test is abnormal that does not mean Cushing's. It simply means something is off and further testing is needed. It COULD mean Cushing's but it could ALSO mean other things.

Minnie's Mom and Dad
09-13-2018, 10:43 AM
We're hoping to hear today from the vet with an antibiotic recommendation based on the culture.

We had our visit with the Internal Medicine Dr yesterday. They did an ultrasound that revealed enlarged adrenal glands. Normal is less than .5 cm and Minnies are between .6 and .65cm. It also revealed an enlarged liver. Everything else looked as it should. The Dr also noted her pulse rate was low at 72 bpm and that her blood pressure was normal.

Based on the ultrasound and bloodwork, and the fact that Minnies not been able to get rid of the UTI the Dr is highly certain that the cause is Cushing's.

Its her recommendation that we start the antibiotic and wait about a week and then begin the Vetoryl.

Harley PoMMom
09-14-2018, 02:12 PM
What dose of Vetoryl is the IMS recommending?

Minnie's Mom and Dad
09-14-2018, 06:10 PM
Just picked up the prescriptions.

3 weeks of Enrofloxacin

2 weeks of Vetoryl 10 mg once daily, starting next Friday

She is right at 10lbs

Squirt's Mom
09-15-2018, 11:01 AM
The dose is spot on - 1mg/lb/day - but watch for any signs that the cortisol has gone too low. Those signs are:

loss of appetite
loose stools/diarrhea
nausea/vomiting
lethargy

If you see any of these once she starts the Vetoryl, stop the drug and call the vet to let them know what is going on. The enlarged liver and adrenals are indicative of Cushing's however you can't let your guard down just in case. Once treatment starts even with a solid diagnosis and no other health issues in play we cush parent must be diligent at all times for signs the cortisol has gone too low. In time, this will be old hat. ;)

I think it's a good idea to wait til a bit after starting the antibiotic. However, if the antibiotic causes any of the signs listed above I would wait until that course was over and she had settled down again. ie if the antibiotic gives her diarrhea, I would not start the Vetoryl until she was finished with the antibiotic. We never want to cloud the picture.

You're doing a great job! We are here with you all the way!
Hugs,
Leslie

Minnie's Mom and Dad
09-16-2018, 03:09 PM
Thank you!!

It's going to be difficult initially because she's been so lethargic lately and hasn't had a huge appetite. Even prior to the Cushing's she's never been a big eater, frequently leaving food in her bowl.

So anxious to get her back feeling well. She's hasn't wanted to even take walks this past week.

Thanks to all of the other forum members that have shared their journeys. The info has been extremely helpful and informative as well as giving us some much needed hope!!

Minnie's Mom and Dad
09-26-2018, 11:31 AM
Hello everyone!

Minnie began her Vetoryl 10mg daily morning dose last Friday, so we are 5 days into it. She is still on the antibiotic as well for another week and a half.

I was really surprised to see the quick changes. The panting was greatly diminished the first night and gone by the second day. (Temps here have dropped so that may also be a factor). Her thirst and frequent urination was better with just the antibiotic but seems even better with the Vetoryl. She back to being the finicky eater she's always been. A little chicken broth over her regular kibble has worked wonders. No noticable side effects. She seems to be more relaxed, especially in the evening. Prior to the Vetoryl she'd be all over the place trying to find a comfortable spot. We've always let her dictate the length of our walks and I was very surprised that after the 2nd day of the Vetoryl she's back to doing our regular 20 minute walks. It's been almost 2 months since she's been able to complete the 20 minute walk.
She's still unable to jump up on the couch or bed...but I'm sure it will take longer to get her strength back.

We'll be back at the vet next week for her 1st ACTH test.

Joan2517
09-26-2018, 11:55 AM
Sounds good!!

joalgopa
09-26-2018, 07:58 PM
To see improvements so fast is very good news!

Squirt's Mom
09-27-2018, 10:52 AM
What a great update! Thank you for sharing the good news and I hope the trend continues!

Minnie's Mom and Dad
10-03-2018, 10:22 PM
Well she was doing great for about 12 days. Even jumping up on the couch.
In the past 2 days the drinking has increased and she's back to her pre-vetoryl lethargy. Even not wanting to walk much at all. She is still eating. We did notice some panting too, but not to the same extent as pre-vetoryl.

We have our first ACTH test Friday thankfully. It's so hard to see her not feeling well.

Should I discontinue the Vetoryl? Or stick it out 2 more days and see where her levels are at?

labblab
10-04-2018, 07:18 AM
Oh dear, I’m really sorry that Minnie is backsliding again. Since the symptoms you’re seeing now seem to be more consistent with her behavior pre-Vetoryl, I’d be more likely to suspect that her cortisol is creeping back up again as opposed to dropping too low. For that reason, if she were mine, I’d be inclined to continue giving the medication until tomorrow so that you can get an accurate test of this dose’s effect.

However, if she continues to worsen — vomiting, diarrhea, or extreme lethargy, for instance — I’d not give the Vetoryl this morning and try to move up the ACTH to today.

Please do keep us updated. Since she responded so well initially, it may simply be the case that she’ll need an increase in her dose of Vetoryl. It isn’t unusual at all for dosing to require some tweaking.

Marianne

Harley PoMMom
10-04-2018, 03:38 PM
I'd also have her checked for an UTI especially since the last one she had was difficult to get rid of. Cush dogs are notorious for getting UTI's and because their urine is so dilute that a regular urinalysis may not pick up bacteria it is recommended to have an urine culture and sensitivity test done.

Lori

Minnie's Mom and Dad
10-04-2018, 05:13 PM
Thanks for the suggestion!

We did have a culture done prior to the new antibiotic but she'd only been off the other antibiotic for a few days and they were unsuccessful.

She's almost completed her 3 weeks of antibiotics too. She seems only slightly better today so we've continued the dosing. Will be anxious to get her test results to see where her levels are at.

Minnie's Mom and Dad
10-05-2018, 05:52 PM
After the backslide she quickly rebounded and has been feeling better.

Today was her 1st ACTH test with a starting level of 2.6 and 5.7 after the hour.

The vet feels since she's done fairly well on the 10mg, that we continue with that dose. And that if we continue to see and symptomatic days, we can look at raising the dosage.

The vet also said Minnie should be retested again in about 3 months, sooner if we see any changes.

Minnie's Mom and Dad
10-09-2018, 09:02 PM
Another backslide started last night with panting a good part of the night and lethargic all day and refusing to walk any more than going out to potty.
If we are at 10mg in the morning right now, what would be the next dosage to try?

As always, thank you for all of the advice and support!!

labblab
10-09-2018, 11:20 PM
I’m really sorry you’re having such a rollercoaster ride with Minnie! However, I’m afraid I’m going to advise you to stick with the 10 mg. dose for another couple of weeks yet before considering adding in more. This is because cortisol levels can continue to drift downward during the first month of treatment, even when the dose has not been increased. Minnie’s behavior seems to be really variable day-to-day, so I think you’ll need to step back and see whether a genuine pattern emerges over the next couple of weeks.

Additionally, there’s an alternative monitoring protocol that your vet might consider using with Minnie at the 30-day mark. It is simpler than the ACTH, and only involves testing the resting cortisol level one hour prior to dosing. I’m giving you a link that describes this new protocol in more detail. Take a look, and you may want to share it with your vet, as well. It may end up providing a better guide as to the optimal dose for Minnie. Just so you’ll know, Vetoryl does come in 5 mg. capsules, too. Or if she ends up needing a dose other than what is available in Vetoryl capsules, compounding pharmacies can provide a “custom” dose of trilostane for her on an individual basis. Here’s the link:

http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1252#post1252

Marianne

Minnie's Mom and Dad
11-06-2018, 03:00 PM
Im sorry i haven't posted in a while. It's been 4 weeks since Minnies last backslide and she continues to show slow improvement after a total of 6 1/2 weeks on the Vetoryl.

She's lost a pound (down to 10 1/2) and is back to our daily walks with plenty of energy. Sleeping all night and zero panting. She's been able to get up on the couch by herself but still hasn't attempted getting up on the bed. Eating and drinking also appear normal. I also haven't noticed much change in her skin or fur yet. The vet doesn't want to see her back unit early January, unless we see symptoms return.

We continue to watch her closely, and probably always will! I'm hoping to get her weight down to closer to 9 lbs eventually.

I am so thankful for this forum and all of the advice!

Squirt's Mom
11-06-2018, 05:46 PM
I am glad to hear that things are settling down for your sweet baby girl!

Minnie's Mom and Dad
01-03-2019, 02:30 PM
Happy New Year everyone!!

Just a little update. Minnie had her 3 month follow up ACTH test this morning. Pre 2.6 Post 8.2. Its higher than her 2 week test. The vet feels we should still stick with the current dose and retest in 6 months since she isn't showing any signs/symptoms.

She still has a little pot belly and her fur has thinned a little. She also still has what i believe is calcinosis cutis spots, about 15-20 spots all over her body with the exception of her belly.

The vet also mentioned test results showed she was lipemic and suggested a fast before her next ACTH test.

She still is at about 10 1/2 pounds, not easy getting much exercise when its too cold for walks.

She is also still not able to jump up on our bed but has no issues with the couch. Hoping the next few months will show improvement all around

Squirt's Mom
01-03-2019, 03:22 PM
Hi,

Good to hear from you again but I'm not happy with the report unfortunately. The vet is absolutely wrong about fasting before an ACTH - fasting will invalidate that test. The drug MUST be given 2-4 hours before the ACTH and the drug MUST be given with a meal, not snack, meal. If you vet questions this, tell them to call Dechra, the drug manufacturer.

In addition since you are still seeing signs ( pot belly, thinning fur, inability to jump like before, cortisol increasing) at 8.2 ug/dl the dose should NOT be kept the same but increased, especially if CC has developed. The ONLY way to get CC under control is to get the cortisol into optimal range around 3.5 ug/dl. Other wise Minnie is going to suffer horribly and unnecessarily if it is CC you are seeing. The best to determine whether it is CC or not is to see a Derm vet. With CC things get worse before they get better even when the cortisol is under control, and Minnie's is not under control as evidence by the increased post # so if she does have CC it is going to get very very very bad and quickly if her cortisol is not brought down. Six months is much too long to wait.

Please find a derm vet who can test her skin for CC asap - that is the most crucial thing right now. Then her vet or the derm vet must work to get that cortisol into optimal range. Let us know what you learn about the skin when you find out!
Hugs,
Leslie

Minnie's Mom and Dad
01-08-2019, 04:08 PM
Thank you Leslie!!

We've got an appointment with the dermatologist next Tuesday.

Our vet initially insisted that she be fasted on her 1st ACTH test 3 months ago until i pointed out that it specifically states on the Dechra website that the med MUST be given with a meal.

I've pointed out the lumps and bumps that she's been getting at just about every appointment and the vet never shows any concern and says "they'll probably go away on there own".

Even in the last day or two i've noticed a few more new bumps.

Squirt's Mom
01-08-2019, 06:35 PM
Glad you made that appointment! Let us know what you learn!

Minnie's Mom and Dad
01-14-2019, 05:55 PM
Anxious to hear with the Derm Dr says!! In the meantime i've been looking Minnie over closely for more lumps/bumps and have found what i think is an enlarged thyroid gland in her neck (only on one side).
The noisy breathing and snoring that i attributed to the extra weight may be from the swollen gland.

Glad we have the vet appt tomorrow!!

Harley PoMMom
01-15-2019, 11:42 AM
Good luck with the derm visit today...anxiously waiting with you!

Joan2517
01-15-2019, 12:00 PM
I would be interested to hear what they say about the lump. Gable has one on the side of his neck, but my vet said it was just a cyst.

Minnie's Mom and Dad
01-15-2019, 05:23 PM
Good news! Just looking at Minnie's spots the Dr said they were comedones. He gave us a special shampoo that she has to soak in at least 10 minutes a couple times a week for a few weeks. He said he'd could biopsy any of them, but none of her spots looked like CC to him.

He also recommended a Omega 3 supplement.

Also, the lump on her neck i was feeling was just her lymph node.

Squirt's Mom
01-15-2019, 05:32 PM
YAY!!! Glad to hear this report!

Harley PoMMom
01-16-2019, 10:15 AM
Relieved to hear that those lumps/bumps were comedones and not that dreaded CC. Hopefully the shampoo will work, let us know how it is going!

Minnie's Mom and Dad
08-13-2019, 01:35 PM
Sorry for the long absence.

We watched Minnie for months on the once a day 10mg dose with little to no change. Because she'd not shown any improvement and her cortisol test results were still on the borderline high the vet recommended a change to a twice a day 10mg dose. She's been on the twice a day since mid-June.

We've seen no improvement in her fur/skin and no increased muscle since beginning the vetoryl. She's still unable to jump even onto our couch.

Her skin actually appears worse. Very scaly, dry looking. More comedones. She even has a few spots on her belly beginning to look reddish and irritated :(

We are still holding out hope that we'll start to see some improvement with this extra dose.

Squirt's Mom
08-13-2019, 06:21 PM
Hi,

Good to hear from you again but sorry to hear Minnie isn't showing much improvement. Would you mind getting the last few ACTH results and sharing them with us here? That will help us help you. Thanks!

Minnie's Mom and Dad
01-04-2020, 09:24 AM
I have to apologize again for the long absence.

Minnie seemed somewhat normal since my last post in August, with the exception of the muscle weakness.

In early December we noticed her fur thinning considerably throughout her entire body but more so around her front shoulder area. That area is almost completely hairless now.

She went in a couple weeks ago for a 6 month ACTH test and results were within the normal range. (Before the increase in meds she was always borderline high)(She's been on the 10mg twice a day for six months now)

The vet didn't seem concerned about the hair loss and recommended a fish oil supplement daily.

The muscles weakness has gotten worse over the last few days to the point she cannot climb our carpeted stairs.

I'm thinking the increase in dosage may be doing more harm than good. I know the hair loss is a typical cushing's symptom but shouldn't be happening if her levels are "normal".

I'll get the last two ACTH test results and post them.

labblab
01-04-2020, 12:09 PM
Welcome back to you and Minnie, although I’m very sorry she’s doing poorly right now. Seeing those ACTH results will really help us a great deal in terms of offering thoughts and suggestions. I always worry a bit when I hear that ACTH test results are “normal,” because the normal range for a dog without Cushing’s varies quite a bit from the desired therapeutic range for a dog who’s being treated with trilostane. So before commenting further, I’ll be anxious to see those actual test numbers. In the meantime, though, we really appreciate getting an update even though we wish the news was better for Minnie.

Marianne

Squirt's Mom
01-04-2020, 01:43 PM
Good to hear from you again but I agree with Marianne. Too often we have seen vets who don't know how to read the ACTH results for a dog on treatment. The ranges listed from the labs as normal are not the ranges used for dogs on Vetoryl or Lysodren. So seeing the actual results may provide the answer as to why you are still seeing such strong Cushing's signs. ;)