Cody diagnosed with cushings

[jac6781]

Hi my name is Julie. My dog Cody is a 12 year old bichon and was just diagnosed yesterday with cushings. I've been reading posts here and they have given me more questions for the doctor so I put a call into her today and am also going to the vet this afternoon to pick up the last two bloodwork results from the two previous regular bloodwork and cushings tests to post. I am going to ask if the cushings is adrenal or pituitary but I have a feeling she doesn't really know cause we haven't done an ultrasound but I will ask. The reason she suspected the cushings was because he had elevated liver enzymes in his annual bloodwork a year ago. He got tested with 2 different tests for cushings and it didn't come back as a definite positive plus he wasn't showing any other signs except drinking a lot but that could have been because of the COPD medication he's on. He still had elevated enzymes this year so she did another cushings test and she said that he has it. He does seem more hungry now, still drinks a lot, has a bit of thinning hair on his back and his belly looks grey instead of pink. He has other medical issues as well. He had 2 bouts of pancreatitus but not recently. He has bladder stones, a rectal hernia (not large), a heart murmur and the COPD cough. The bladder stones and hernia aren't bothering him so we are just watching them. When I talked to the vet yesterday she was good at describing the pros and cons of treatment and we decided to bring him back in 3 months and do an xray to see how his heart is and a blood panel because after she told me about the treatment and the possible side effects including one patient that died because her gland totally shut down and she was in between blood tests and they didn't know until it was too late TOTALLY freaked me out! He is my baby and the thought of the medicine possibly ending his life versus just doing nothing right now because he's still energetic and doesn't seem to be bothered by it much worries me. But it sounds like if I do nothing he could get diabetes and a host of other issues that if he gets to that point putting him on the medicine will be too late to fix. I'm so confused ☹. Anyway I will post again when I get a copy of the bloodwork. Thanks for reading and any comments would be appreciated.

[Squirt's Mom]

Hi Julie,

Welcome to you and Cody! :)

I am probably not the best one for you to hear from first off because of my experience with my little Trinket. But I will share her story anyway along with her sister's so you gain a better understanding of just how difficult it is to accurately diagnose canine Cushing's especially in the face of other health issues. Trink also had COPD as well as anal gland disease, colitis, allergies, was blind, and a few other issues when she was diagnosed with Cushing's. Her tail was getting the tell-tale appearance of a rat tail, her appetite was increasing, she was peeing and drinking more, labs were off a bit, and her ACTH was literally off the charts when it was done the first time. But because of all the other things she was dealing with I questioned the diagnosis of Cushing's. The dog who introduced me to the Cushing's world was her sister, Squirt, and when she was first tested Squirt tested positive on all the tests she had - LDDS, HDDS, ACTH, and UTK panel. But when we did the abdominal ultrasound a tumor was found on her spleen. Once that tumor was removed her cortisol returned to normal levels - the stress from the tumor had caused false-positives on ALL those tests. So Squirt's journey made me overly cautious about Cushing's diagnoses anytime another health issue was in play and Trinket certainly had other issues. However I also didn't want to add to her woes IF Cushing's was in fact present so I chose to use Lysodren. It helped with her signs. However I continued to question the diagnosis because the monitoring ACTHs never went back to normal - they remained high tho not off the charts like in the beginning. During Trinket's last weeks none of her vets could tell me what was causing the things she was going thru then so when she passed I had a necropsy done (autopsy for animals). That proved what I had always suspected - she never had Cushing's. Her adrenal glands were normal and they would not have been had she actually had Cushing's.

So I strongly advise that you have that ultrasound done before you start treating Cushing's AND that you not rush into starting treatment until you are convinced, NOT your vet convinced but YOU, that she does have the disease. Cushing's is a slow progressing condition, taking years to do damage but treating a dog who does not have Cushing's can quickly cause serious problems. Thankfully that did not play a role in my Trinket's death or I'm not sure I could function from carrying that quilt. Her death was unrelated to her medications or known conditions. So do.not.rush. Take your time, get that ultrasound, learn all you can about the disease, ask us and your vet every question you can think of, LISTEN TO YOUR GUT and then decide if treating is indeed the right path for your precious baby. The odds are you have plenty of time, use it. ;) A few weeks or even months won't matter more than likely but rushing into treatment could.

I'm glad you found us and am sure others will be along soon to share their thoughts with you as well. Know you are part of our little family here now and we will do anything we can to help you and Cody along your journey.
Hugs,
Leslie

[jac6781]

Thank you for replying. I agree that jumping into starting treatment is not what I want to do at this time. Now that I have his medical records I am thinking of getting a 2nd opinion from a specialist and having an ultrasound done. I feel better knowing that what I thought is in line with your thinking too. Here are the test results:
10/28/16 (first test done after bloodwork showed high liver enzymes)
ACTH STIMULATION TEST
PRE 8.2
POST 21.9

7/20/17
DEXAMETHASONE SUPPRESSION TEST
Pre 4.3
Post 4 hr. .2
Post 8 hr <.2

4/17/18 - Senior profile Blood test
High ranges are for
MCH 26.7 (Not sure what that is)
ALT 180
ALP 877

10/29/18 Alk Phosphate test
ALT 158
ALL 996

REDID ABOVE TEST ON 12/6/18 after putting him on milk thistle didnt really help

ALT 197
ALP 966

12/18/18 ACTH STIMULATION TEST
PRE 4.7
POST 25.4

What do you think about CushAway? I talked to the vet and she said it would be ok to try.

[lulusmom]

Thank you for posting those test results. It sure looks like a clear progression of cushing's to me and suspect that if you were to repeat the LDDS today, it would most likely be positive. FYI, MCH is an abbreviation for mean corpuscular hemoglobin and 26.7 pg is an extremely mild elevation most likely caused by fat in the blood or hemolysis caused by a not so wonderful blood draw. No doubt your vet is not concerned with that number. There is no way for your vet to know whether Cody has pituitary cushing's or an adrenal tumor. An abdominal ultrasound is the most favored test to make that determination. Based on the information you have provided it does look like Cody is symptomatic and may benefit from treatment. We've been around here for many, many years and have followed more case studies than most general practice vets will see in a lifetime or three. LOL Your vet's story about having a dog die from a fatal addisonian crisis is extremely rare and without knowing complete details such as dose, timing and results of the acth stimulation tests, I would not automatically assume that the drug was the sole cause of that unfortunate dog's demise. If proper dosing and monitoring protocols are adhered too, risk of adverse effects are greatly mitigated and in a lot of cases completely eliminated. I would hate for you to opt out of treatment because the only information you have about the drug is a horrific story about one dog's very unusual circumstance. To answer your question about CushAway, this is an online remedy that may help dogs with mild symptoms but at some point, symptoms will increase and eventually overcome the effects of any of these types of "alternative" treatment. None of the companies selling these products have done any clinical trials that would prove the safety and efficacy of their products and rely solely on customer reviews as their so-called proof. Ironically, I have seen a few rave reviews over the years posted by a few of our members who reached out to us when an online product was doing nothing for their dog. If it were my dog, I would save my money for an abdominal ultrasound. Given that Cody has other issues going on, I personally think asking for a referral to an internal medicine specialist is an excellent idea. The specialist can do the ultrasound and validate the diagnosis. A specialist can also provide a great deal of insight into Vetoryl as they likely prescribe that drug every day of the week. I'm glad you found us and please keep us posted.

Glynda

[jac6781]

Thank you so much for your feedback. As soon as the holidays are over I will be making some calls to get Cody into to seeing a specialist. I looked at your lists online and it says there is one about 45 minutes from me in Murrieta, Ca. so I will try there.

[lulusmom]

I am happy to hear that you will be getting a consult with a specialist. I am from So Cal and miss having so many specialists within an hour's drive. I remember when there was nothing in Murrieta and the 15 freeway didn't exist and you took Rt 395 to get there. When I was a kid, the 60 nor the 10 freeways existed and you had take Mission Blvd all the way to L.A. We did have cars back then though. LOL Anyway, I did a search and found you have an internal medicine specialist in Murrieta. There are a lot more of them within 45 minutes but then, 45 minutes in So Cal may be five miles or fifty on a good day. :) I've provided a link to my search below. Happy Holidays and I'll be anxiously awaiting your update after the consult. Of course, don't hesitate to keep us posted or ask questions in the meantime.

http://find.vetspecialists.com/search_results?tid=2&ttid=9&location_value=Murrieta%2C+CA%2C+USA&city=Murrieta&county_sn=Riverside+County&adm_lvl_1_sn=CA&country_sn=US&location_type=locality&stateSearch=CA&swlat=33.5133629&nelat=33.641557&swlng=-117.278596&nelng=-117.11828509999998&lat=33.5539143&lng=-117.21392320000001&faddress=Murrieta%2C+CA%2C+USA&place_id=ChIJ8fICxT9924ARj-3Unfku1BI

[jac6781]

So I took Cody to the specialist in Murrieta to get a consult and an ultrasound. After checking him out, looking at the records from his regular vet and the ultrasound she said in her opinion he should get treatment. She said his gallbladder looked sludgy and his liver and both adrenal glands are enlarged but there are no tumors on any other organs. She said she believed it was pituatary. She said she would start him on a very conservative dose of Trilostane if we decided to treat it. She also said that 2 weeks after we start he will come back for a test than if the dose is ok once a month for 2 months. If he seems to be doing well she said she would do the Pre-Vetoryl Cortisol monitoring like they do in England to monitor his progress. She also recommended doing an echocardiograph to check on his heart murmur and possibly consider removing his bladder stones because one of them is an inch large and his bladder lining looks irritated but only after his cushings is stabilized. There is also something on his liver that they may biopsy when they do the bladder surgery. So much to digest. She is supposed to send the results to my vet and give her a call. Also they did a urinalysis and a cystitus profile to see if maybe the inflammation in the bladder was due to a bacterial infection. I should know by the end of the week.

[Harley PoMMom]

Her plan sounds pretty good to me. What is the Vetoryl dose she wants to start him on? And did she tell you that it is vital to give the Vetoryl with a meal so that it is properly absorbed? Also with Vetoryl, a dosage increase is not recommend until the dog has been on treatment for a month because cortisol can continue to drift downwards for the first 30 days of treatment.

I'm so glad that you took your Cody to see an IMS, and to me, it looks like she knows what she is doing.

Lori

[jac6781]

She did not tell me the dosage but when I talk to my vet (After she talks to the specialist) I will find out. Thanks for the other information too. I will make sure to convey that to the vet as well if she doesn't tell me herself.

[Squirt's Mom]

So you are aware - the recommended starting dose is 1mg per pound. So a 10 lb dog should start with 10 mg. The old starting dose was 3mg per lb and dogs were getting very sick so Dechra lowered it to 1mg/lb a year or so ago. Not all vets are aware of the change but now you are so you can be on guard just in case.

[jac6781]

Thank you for that information. He weighs about 18 pounds so would it be 18mg or does it go in increments of 10?

[Harley PoMMom]

At 18 lbs, 18 mg is ideal but if your using brand-name Vetoryl than you could start out at 10 mg or purchase some 5 mg capsules and start at 15 mg. I would recommend not starting any higher than 18 mg.

Lori

[jac6781]

When I was talking to the specialist she said that she uses a compound pharmacy and gives it in a liquid so the amount can be easily changed and the dosing more exact. I mentioned what I had read on here about compounding not being regulated and how it may not be consistently the same each time it's done. She told me she knew about that and they use 2 pharmacies that she has had good results with. She also said that if I felt more comfortable using the actual Vetoryl we could do that too. What do you think?

[Squirt's Mom]

I have used compounded meds from Diamondback Drugs and feel very very comfortable with them. I have never had any issue. They will be glad to work with any vet....all they need is a prescription.

[jac6781]

Good to know. Thank you! ��

[jac6781]

So the specialist and my regular vet finally got together and they both want to start him on 10 mg 2x a day. My vet is going to get capsules which I'm hoping aren't too big for him to take. She said if he won't take them we may have to go with the compounded medicine so we'll see. Do you think I should ask her if we can start with 15 mg. instead?

[Squirt's Mom]

Personally I would want the 15mg/1x/day or compounded so it could be taken twice a day. If you go with the 20mg/2x/day watch carefully for any signs of nausea/vomiting, loose stools/diarrhea, loss of appetite, lethargy. If you see ANY of these signs stop the drug immediately and call the vet. If the signs you saw don't go away in 24 hours or less have an ACTH performed asap to make sure the cortisol has not dropped too low.

You got this! Don't worry too much - you have us on your side all the way!
Hugs,
Leslie

[Harley PoMMom]

The recommended starting dose of Vetoryl is 1 mg per pound of the dog's weight so for Cody's weight of 18 pounds that would be mean a dose no higher than 18 mg. Since the total daily 20 mg (10 mg BID) dose that the vet is advising is just a tad bit higher I think it is a reasonable starting dose, however, you still need to look for symptoms of cortisol dropping too low which are diarrhea, vomiting, inappetence, lethargy, or Cody simply not acting himself, if any of one of those symptoms are observed than the Vetoryl has to be stopped.

Also, the Vetoryl has to be given with a meal to be properly absorbed and the timing of those monitoring ACTH stimulation tests are very important. Is the vet going to be checking his cortisol with a full ACTH stimulation test or using the pre-pill method?

Lori

[jac6781]

Thank you Leslie. It is freaking me out. His stools are soft but they are formed and not runny. He doesn't eat a lot but if he refuses to eat all day I know there's a problem. As for lethargy he sleeps a lot during the day but when it's time for his walk he's raring to go and I have trouble keeping up so if he doesn't go like he normally does it will definitely be a problem! I will keep a watch for all the signs and bring him in ASAP. Better to be safe than sorry. I think I will call the vet and ask her about the 15 mg. vs. the 20 and see what she says.

[jac6781]

Thank you Lori. When you say give with a meal do you mean a full on meal or can he just have some food. The reason I'm asking is he only really eats once a day but I would be able to give him the morning dose with a little bit of food. i tried feeding him twice a day but he doesn't seem interested in the food in the morning and it would just sit there all day so I just stopped giving it to him.

[Harley PoMMom]

It should really be given with a full meal, but hey, some dogs just don't want to follow the rules!! Is there something he just loves to eat? I think that a can of dog food would work or maybe even try giving him some hamburger/rice combination?? Also, adding extra yummy things to his food may work?

[jac6781]

He already eats canned dog food but maybe if I gave him some people food he would be more inclined to eat that in the mornings. He's just not a real big eater. I've tried different dog foods and right now he's on science diet for 7+ year old dogs Turkey barley and also the beef. He does like cooked chicken. We had to feed him that with rice when he had pancreatitis (although he ate around the rice.) Maybe I'll cook up that for breakfasts. He likes scrambled eggs too so that's another option.

[Harley PoMMom]

My Harley wasn't a fan of the rice either, he did like pasta and potatoes so they could be an option, oh, another one is oatmeal.

[jac6781]

Wow never thought of oatmeal. I will try that at too since I eat that for breakfast too lol! Thanks ��

[Squirt's Mom]

I was gonna suggest eggs. I've never had a dog turn down fried eggs with runny yolks! :D Also consider stinky foods like the water from a can tuna or salmon, or sprinkle a little Parmesan cheese on top...or canned tripe is almost always a winner tho the fats may be a bit too high so you would want to use just enough to give a scent to the food, maybe 1/2 tsp mixed with some warm water and poured over the food.

[Joan2517]

Lena loved eggs. She got them every morning so I was sure she had her full meal. She also liked the wet dog food, not the canned, but the gourmet ones. Or I would make her a cheeseburger. After a while, she would not take the Vetoryl no matter how I tried to hide it, but she still got whatever she wanted to eat.

Gable hasn't given me any trouble eating, except for a few days in the beginning of Vetoryl. I mixed a little bit of the Caesar wet food that I feed to my little girls and he ate it right up. Now I get the wet food out for the girls, tell him to keep eating his dry food, then put his pill in a spoonful of that and we're good.

[jac6781]

UPDATE: Sorry it's taking me so long to post again but here is an update on Cody.
So he started out at 10 mg of Veteryol 2x a day and after 2 weeks was tested and seemed good. After the 3rd week though he became listless and wouldn't eat. The vet suggested taking him off for a week then starting him back on a lower dose. He started getting back to his old self and we started up again at 15 mg. total a day. Two week test was fine but week 4 he had a seizure. Scared the heck out of me.
I rushed home to emergency where he had another seizure. His electrolytes we're low so the gave him anti seizure meds and an IV to get his electrolytes stabilized.
The next morning I was able to take him home but he is on anti seizure meds now (which I'm not too thrilled about). They wanted to try the Veteryol again at an even lower dose but I refused. He wasn't urinating in the house (we have a dog door) and although he drinks more than normal, has a pot belly and is losing his hair I don't think it's worth going through that again. They mostly started him on it due to testing results which showed high cortizol, high liver enzymes and some protein in the urine.
I'm going to let them keep monitoring him for now but I would prefer to just treat the symptoms because he seems much better off the medicine than on it. I may have to find another vet though because every time I go in they try to get me to start him up again.

[Harley PoMMom]

Hi Julie,

I am so sorry to hear about these issues with sweet Cody and I hope that he is feeling much better soon. Could you do us a favor and post the results of those monitoring ACTH stimulation tests, and were these a complete ACTH stimulation tests with a post draw performed or were they the "new" pre-pill method? Also, I see that his electrolytes were unbalanced, was this just the potassium and sodium or were the other minerals abnormal too? Has a recheck been scheduled for his cortisol and electrolyte levels?

Another concern I have is that in your first post you mentioned that Cody has bladder stones, have they been removed?

Sending huge hugs to you and Cody, Lori

[Squirt's Mom]

I am so sorry for the things that have been happening with Cody! :( Bless your hear and his. I don't blame you one bit for not wanting to try the Vetoryl again. And I am NOT pushing you to treat but simply want you to know there is another option if you are in the US. Lysodren can also be used and it works only on the adrenal glands. Vetoryl works along the HPA axis, or path. HPA stands for hypothalamus, pituitary, adrenal. Many things are controlled via that path, not just cortisol production. So Lysodren might be something to think about IF the signs become more than you and/or Cody can deal with. For now however, I would also choose to focus on the seizures and let the Cushing's slide to the background. ;) And if the vet cannot understand your preferences and work within that parameter I would be looking for another vet that would, too.

Know we are here anytime you wish to talk.
Hugs,
Leslie

[jac6781]

These were the results of the test when he was brought in after his seizures:

CBC:WBC 13.47, NEU 11.3, HCT 45.7%,, PLG 465
CHEM: BUN 27.9m crea 0.6, GLu 115, Tcho 332, alt 363{h}, ci119.1, lAC 4.1{h}, pcv/tp 56\8
d dIMER SUBITTED
dOPPLER bp 153MMhG
It said blood tests revealed high potassium and low sodium. The gave him anticonvulsant meds and kept him overnight. They sent him home with kepra for the seizures. That was back in August. Just last night 11/7 he had another seizure. Brought him into emergency where they kept him over night giving him basically the same treatment they did before. Midazolam to stop the seizures the Kepra but it didn't seem to stop them long term. He's still in the emergency room where they are now trying a drug called zonisamide along with the Kepra. I am praying this works and I can take him home tomorrow :-( . I'm really scared if they can't get them to stop. The last cushings tes he was was the regular ACTH test and according to the doctor it looked good. But it looked good the first time too and then things started going downhill. He got bloodwork this time and a urinalysis also to make sure there wasn't something physically going on to cause the seizures but it came back OK. I read somewhere that dogs that have the pituatary tumor sometimes it grows and can cause seizures. I'm hoping that's not the case because it sounds like it could cause worse unmanageable problems. He hasn't had his stones removed because sometimes seems to always be happening.

[jac6781]

I am definitely focusing on the seizures now. It's so scary and I feel so helpless :-(

[labblab]

I’m so sorry that little Cody is having such a hard time right now, and really hope you’ll be able to bring him back home today. I know how scary these seizures can be. My non-Cushing’s Lab girl started having grand mal seizures at age six for reasons we were never able to determine. We were very lucky, though, that they were totally controlled by medication for the rest of her life. She was treated with phenobarbital, which is an older generation drug, but it worked well for her. I know there are newer choices now, so hopefully the vets will be able to hit on a combo that works well for Cody, too.

I do have a couple of questions about timeframe. When you wrote before, it sounded as though the first seizure occurred back around February or March, after Cody had been on the Vetoryl for only about 4-6 weeks, first on the 20 mg. and then on a lower dose. You said he had a couple of monitoring ACTH tests at that time which were fine. But now you mention that the seizure occurred in August? Was that a second seizure? Had he been taking any Vetoryl or had his cortisol checked again since the early spring?

I apologize for these additional questions, but the answers will help us with a better overall picture of things. And if his cortisol level has never been checked again since last spring, and especially since the seizures began, I believe I’d want to make sure it’s still OK. Even if all his other bloodwork is OK this time around (including his potassium and sodium?), I’d still be curious about his cortisol. I’d also want to know specifics about his thyroid level since low thyroid levels can trigger seizures.

Have you ever returned to see the specialist? Is the specialist also urging you to restart the Vetoryl? I surely do understand why you’re reluctant to do so. I would be, too, but I’m just curious as to what the specialist’s take on all this is. While seizures are not one of the more common symptoms of enlarging pituitary tumors, I believe they can sometimes result. Anyway, I’m wondering whether the specialist may have some other suggestions as to the best path forward.

In the meantime, once again I’m surely hoping that Cody was stabilized overnight and will soon be heading home! Please do let us know.

Marianne

[jac6781]

Marrianne his first seizure was in August after the second time we started the veteroyl. He was cut down from 20 to 15 by then. We stopped the Veteroyl after the seizures because my thinking was it caused the low enzymes even on such a low dose. He was put on levectrim and seemed to be doing well until this past Friday when he had another seizure. He's been in the emergency hospital since then. They've been trying different things and he never seems to make the 12 hours mark with no seizures that they say he needs to do before he goes home. Last night they put him on a medazolan drip after trying a larger dose than he was taking of levectrim and also a different drug called Zonisamide. I pray this works and I can take him home today. I miss him so much. We visited him for two hours in the hospital yesterday and while we were there he ate, drank, went for a walk outside and other than being a bit spacey seemed ok. But later last night had another seizure. That's when they decided to start the drip. Send prayers �� if you believe in that. We both sure need them right now. ��

[Squirt's Mom]

((((((((((((((((HUGS)))))))))))))))) for you, belly rubs for Cody, and prayers rising for all along with healing and strengthening energies flying his way and yours.

[jac6781]

Thank you so very much!

[Harley PoMMom]

Prayers being said and sent for you all...also sending huge loving hugs.

[labblab]

Me too!!!

Marianne

[jac6781]

Thank you so much. I am praying he can go home today. I will keep you all posted.

[Joan2517]

Prayers and hugs for you and Cody!

[Budsters Mom]

Thinking of you and Cody this evening and sending healing energy your way.

[labblab]

Just checking in again on you and Cody. Hoping so much that you’ll soon have some good news to share.