New Diagnosis not sure where to go from here or what to expect

[izzyq]

Hi everyone. I have been reading some on this forum and thank you all for the amazing advice and information you provide. Unfortunately I am coming in with a new diagnosis of Cushings for our 11 year old Goldendoodle, Shelby. About 10 months ago Shelby started developing cysts that would come and go, sometimes getting very large on one of her paws. Before this she was an energetic, fun-loving dog, still very puppy-like in her personality. She weighed 46 pounds, loved to jump over 4 foot fences if she was on one side and we were on the other, and was overall in really good health. She does have a liking for swallowing socks and has had 2 removed surgically in her 11 years of life. These cysts made it harder for her to run and jump at times but she was still our happy girl.

About 5 months ago she started acting "old". We thought maybe she had a sock inside, but she was urinating, pooping, eating and drinking fine so we figured we wait and see. Often, she leaves deposits of her sock feedings in our backyard and then she's back to normal immediately. Or we thought she is 11 and these cysts have slowed her down a bit so we waited and watched. She would be herself 1 minute but then a little sad and slow the next day. Looking back she was definitely drinking more water than usual but not excessively and she wasn't eating her normal amount of food, which we though might be related to an internal sock but when given hard boiled eggs, chicken, rice, soft food she ate everything we gave her each day. She has ALWAYS been a picky eater so this was not abnormal for her.

After many vet visits, blood work, urine sample, sonogram, etc. she has been diagnosed with Adrenal Cushings Disease and the vet wants us to try medication. I'm trying to get more information on reasonable expectations for her quality of life, probable response to the medication and overall prognosis. I feel like in the past 2 months I have completely lost my dog. She is slow to get up on her feet, sometimes needing assistance on our wood flooring, especially with a cyst on the pad of 1 front paw, she is unable to get herself in our cars and she almost always just seems sad. She continues to drink more water than in the past and eats when given chicken, rice, pumpkin, eggs but never just her normal kibble. She has the pot belly and our "non shedding" dog is leaving tufts of hair all over us and the house and looks like she just got a haircut this week when in fact it's been months. It is breaking our hearts.

Her abnormal results on blood/urine testing from the vet are as follows:
ALT (SGPT) is 275 (HIGH) normal range: 1-118
Alk Phosphate is 919 (HIGH) normal range: 5-131
GGTP is 36 (HIGH) normal range:1-12
BUN/Creatinine Ratio is 32 (HIGH) normal range is: 4-27
Precision PSL is 240 (HIGH) normal range is: 24-140
Platelet Count is 406 (HIGH) normal range is: 170-400
Neutrophils 11620, 83% (HIGH) normal range is 2060-10600
Monocytes 1260, 9% (HIGH) normal ranges 0-840

Urine Protein 2+ (HIGH) normal range is negative

Sonogram Abnormal Results:
Liver: subjectively large but there was normal vascular pattern and no masses found
Adrenal glands: both glands are large. 1.3 X 1.0 cm ecgogenic and homogenous nodule seen in cranial pole of right adrenal gland.

Cortisol Testing Results:
8:45 am 4.2 (normal)
12:45 pm 4.4 (HIGH) normal range: 0.0-1.4
4:45 pm 5.8 (HIGH) normal range 0.0-1.4

We just feel like we are not sure what to do. The vet wants to put her on 25mg of Trilostane 2x/day. This is based on her weight at the vet of 53 pounds. I suspect this increase in weight was due to us adding eggs, chicken, rice, etc. to her kibble but would expect her weight to go back to her normal 46 pound range. She is currently 50.2 lb at home and leaves kibble in her bowl each day. I understand it will need to be given with food, will a piece of meat or cheese work or des it need to be more substantial than that. As I said she has never been a big eater, she spits treats out so twice a day may be difficult. If I continue with chicken, eggs, pumpkin I can get her to do it once a day until not sure about twice. What can we expect with this medication? Will she just not deteriorate more or will she improve a lot? The idea of taking her to the vet regularly for testing makes me uncomfortable, she just hates going but she is deteriorating quickly without medication so we know we need to come to a decision on all this soon. I want to do what is right for her and although she doesn't complain (it's not her style) we feel she is unhappy and most certainly not herself. Any help or advice is welcome.

[labblab]

Hello and welcome to you and sweet Shelby, although I’m certainly sorry for the problems that have brought you to us. I truly can empathize with your worry and uncertainty, especially given Shelby’s age. It can be really hard to separate out degenerative issues that are merely a result of aging vs. symptoms of disease. My own nearly 11-year-old non-Cushing’s Lab has rapidly “aged” over the last six months or so, too. She’s somewhat small for a Lab, so we were hoping that she might have a longer functional lifespan than some of the bigger dogs. Like Shelby, she had been jumping into the SUV with no problem and enjoying lengthy walks. But fairly rapidly, her strength and stamina have waned. I mention this only to highlight the fact that multiple factors may be at play here, some of which may be treatable and some may not.

However, based on the ultrasound results, your vet has diagnosed Shelby with Cushing’s caused by an adrenal mass, and her lab profile is indeed consistent with a dog who has the disease. The fact that both adrenal glands are enlarged is more typical of Cushing’s caused by a pituitary tumor. But there are various types of adrenal tumors, however, and I don’t know the intricacies of presentation of them all. I do know that some are benign but some are malignant. Whether or not your vet suspects that the tumor may be cancerous might have important implications in terms of prognosis. Also, proximity to important blood vessels — and likelihood of invasion — can also be an important factor in terms of outcome.

I’m guessing the vet has mentioned that surgery does offer the potential for a total cure in some cases. However, adrenal surgery is risky and a very expensive undertaking. Not every dog is deemed a good surgical candidate, and age is certainly a consideration. If surgery is not considered to be an option, then medication is the other treatment option, as you already know. Trilostane can definitely ease Cushing’s symptoms in many dogs. My main worry with Shelby is her already picky appetite — you don’t want to worsen her inappetance by giving the medication. But you can always give it a try and see whether it helps her in terms of symptoms, or instead worsens things. If so, it can simply be discontinued. The medication is best metabolized in conjunction with a full meal, so under the circumstances you’ve described, I’d press your vet to let you begin with once daily dosing if you do decide to give it a try.

I know these decisions are difficult to make, and I’m wondering whether you’ve had the opportunity to consult with a vet who is specialized in conditions such as these. As I wrote above, finding out more about the nature of the tumor itself might help guide your decision going forward. You may have already seen a specialist (or your current vet may be one). But if not, it may give you some peace of mind to have the opportunity to discuss the overall prognosis in greater detail. Just a thought.

Anyway, we’re really glad you’ve found us, and we’ll do our very best to support you as you move forward, regardless of your treatment decisions.

Marianne

[Harley PoMMom]

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

Marianne has given you some great information and I agree with everything she has said. I just have a comment regarding her picky appetite, I see that the Precision PSL is elevated which is associated with pancreatitis. Pancreatitis can be painful and may hinder the appetite in a dog. Feeding a very low fat diet is important, also administering pain medication could be helpful as a dog in pain usually does not want to eat. Did the vet say anything about the elevated Precision PSL? If not, I'd definitely mention this to the vet.

Again, welcome to the family and know we will help in any way we can.

Lori