Help!

[pennipeg]

Hi everyone, thank you for having this forum to talk to other Moms and Dads who have been through Cushing's. My little guy Eli 9 years old and the sweetest most charming little Chiweenie with loads of personality has recently been diagnosed with Cushing's. The vet started him on Vetroyl and he was so very sick on the drug, vominting and diarrhea, not eating and so miserable. I took him of the Vetroyl and started looking for natural treatment. His biggest symptom that caused us to seek diagnosis was ongoing severe diarrhea and crying with pain when he pottied. The vet said the high liver values were causing the diarrhea so I started him on some Milk Thistle and that has helped a lot. He is eating and not vomiting or crying with pain when he potties. I also tried a product called Cush Away but he hasn't had success taking that either. Do you have any advice about natural treatment?

[Squirt's Mom]

Hi and welcome to you and your sweet Eli!

How is Eli today? Has his digestive system settled down? Is he more like his usual self?

I am concerned about 2 things from reading your post. 1) that Eli was misdiagnosed to start with and 2) the dose of Vetoryl he was given. So let's start with the diagnosis.

You said the only signs he had were diarrhea and crying with he had a bowel movement? While certainly concerning, those are not signs of Cushing's. Could you tell us the results of the tests run to diagnose the Cushing's? Those tests would be the LDDS and/or the ACTH plus possibly an abdominal ultrasound. If you could tell us which values were either too high or too low on the test that shows things like CHOL, BUN, ALP, etc and the same for a test called the CBC those would be very helpful as well. With these results we can help you see if your baby boy actually could have Cushing's or if something else is in play....like liver problems. However, elevated liver enzymes on their own cannot diagnose Cushing's. Your vet should be happy to give you copies of these tests UNLESS you are in the UK....for some reason vets there don't like to share test results.

Now for dosing...Vetoryl should be started at as low a dose as possible. For small dogs that is around 1mg per pound. So if Eli weighs let's say 15 pounds his dose should have been as close to 15mg as possible. Too often vets do not keep up with the many changes this drug has gone thru so are not aware of new dosing guidelines. They refer to textbooks for dosing guidelines that were sadly out of date by the time they were printed. ;) So how much does Eli weigh? The signs you mentioned - "vominting and diarrhea, not eating and so miserable" - are signs that the cortisol dropped too low which happens when the drug dose is too high OR when the dog does not actually have Cushing's...and is a life threatening situation so I am very glad you stopped the drug when you saw these things. That was a good move, Mom! :cool:

Milk Thistle can help with some of the liver enzymes like the ALT but won't help much with ALP. The same for the supplement Denamarin which has the same active ingredient as Milk Thistle with SAMe added. Cush Away and other such products are nothing but ways for unethical companies to prey on the fears of dog parents with false claims. So it's no surprise the Cush Away didn't do much. At most these products mask signs while damage continues within the body. Seeing those test results will help us offer you more meaningful feedback, maybe even some supplements or herbs that might help.

But first, getting those results is the important thing this morning.

I'm glad you found us and am looking forward to learning more about your sweet boy very soon!
Hugs,
Leslie

[labblab]

Leslie has done a terrific job with covering the bases in her reply. So I have nothing to add right now, but still wanted to extend my welcome to you, as well! We’re so glad you and your little boy have joined our family, and we look forward to learning more about him.

Marianne

[pennipeg]

Hi and welcome to you and your sweet Eli!

How is Eli today? Has his digestive system settled down? Is he more like his usual self?

I am concerned about 2 things from reading your post. 1) that Eli was misdiagnosed to start with and 2) the dose of Vetoryl he was given. So let's start with the diagnosis.

You said the only signs he had were diarrhea and crying with he had a bowel movement? While certainly concerning, those are not signs of Cushing's. Could you tell us the results of the tests run to diagnose the Cushing's? Those tests would be the LDDS and/or the ACTH plus possibly an abdominal ultrasound. If you could tell us which values were either too high or too low on the test that shows things like CHOL, BUN, ALP, etc and the same for a test called the CBC those would be very helpful as well. With these results we can help you see if your baby boy actually could have Cushing's or if something else is in play....like liver problems. However, elevated liver enzymes on their own cannot diagnose Cushing's. Your vet should be happy to give you copies of these tests UNLESS you are in the UK....for some reason vets there don't like to share test results.

Now for dosing...Vetoryl should be started at as low a dose as possible. For small dogs that is around 1mg per pound. So if Eli weighs let's say 15 pounds his dose should have been as close to 15mg as possible. Too often vets do not keep up with the many changes this drug has gone thru so are not aware of new dosing guidelines. They refer to textbooks for dosing guidelines that were sadly out of date by the time they were printed. ;) So how much does Eli weigh? The signs you mentioned - "vominting and diarrhea, not eating and so miserable" - are signs that the cortisol dropped too low which happens when the drug dose is too high OR when the dog does not actually have Cushing's...and is a life threatening situation so I am very glad you stopped the drug when you saw these things. That was a good move, Mom! :cool:

Milk Thistle can help with some of the liver enzymes like the ALT but won't help much with ALP. The same for the supplement Denamarin which has the same active ingredient as Milk Thistle with SAMe added. Cush Away and other such products are nothing but ways for unethical companies to prey on the fears of dog parents with false claims. So it's no surprise the Cush Away didn't do much. At most these products mask signs while damage continues within the body. Seeing those test results will help us offer you more meaningful feedback, maybe even some supplements or herbs that might help.

But first, getting those results is the important thing this morning.

I'm glad you found us and am looking forward to learning more about your sweet boy very soon!
Hugs,
Leslie

Thank you so much for your warm welcome and helpful questions. I'm not sure if I'm responding in the right section so please let me know if not. Eli has had 3 good days since coming off the Vetroyl and then the Cush Away (not tried at the same time of course) and just being on the Milk Thistle. He is eating, no vomiting, and more normal BM. This is what I'm using: Vita Pet Life Milk Thistle for Dogs - Liver and Kidney Support, Detox, DHA, EPA, Hepatic Support, Omega 3 Fish Oil, VIT B1,B2,B6,B12, Kidney Stone Prevention - 120 Natural Chew-able Tablets.

Diagnostics were:
ALP-1890
ALT-236
AMY-1295
BUN-55
CRE-1.7
Glucose-300 (Eli is diabetic)
Cortisol baseline-2.1
Cortisol post-18.4
Ultrasound-both adrenal glands enlarged

He is 21 pounds and was started on 30 mg of Vetroyl which made him so sick we thought he was going to die. He was vomiting and had horrible diarrhea and yelped and cried whenever he had to potty. He stopped eating and just laid in his bed when not vomiting or having diarrhea. As I said above, he has had 3 good days since being on only the Milk Thistle and seems to feel much better. I would appreciate any help you can offer.

[pennipeg]

Thank you so much Marianne for the warm welcome. I appreciate what you are doing here on this forum. Thanks for being here!

[Squirt's Mom]

Do you have the ranges for the ACTH? I think 18 is the usual cutoff or upper limit for a normal reading but am not sure. Either way that post of 18.4 is not enough to definitively diagnose Cushing's especially in a diabetic dog. The LDDS should not be used in diabetic dogs however so that leaves you with only the ACTH for diagnosing Cushing's in Eli. Diabetes can and does cause false positives on the Cushing's tests especially if the glucose is not controlled. On the flip side it is very difficult to control the glucose if Cushing's is present. :rolleyes: But a diabetic dog should not even be tested for Cushing's until every option for controlling the glucose has been exhausted and the dog is becoming intolerant to insulin. This doesn't happen quickly but over a long period of time to my understanding. So if Eli is new to diabetes I would be even less sure of him having Cushing's. I encourage you to join our sister group, K9Diabetes, found here:

http://www.k9diabetes.com/forum/

Sadly as is the fate of many online forums, they are not as active as they once were. However you can find much valuable information there. If you are on Facebook, please join this group for canine Diabetes - https://www.facebook.com/groups/CanineDiabetesSupportandInformation/

The adrenals being enlarged on the ultrasound is something we do see in dogs with Cushing's however. But again with the low ACTH result I am still not convinced Cushing's is present. It IS possible that Eli is in the very early stages and if that is the case then you will start to see things like a ravenous appetite, excess peeing and drinking, panting for no reason, seeking cool places to lay, hair loss or failure of the hair to regrow after a cut or shave, and a pot belly.

The dose of 30mg of Vetoryl was too high for him even if he does have Cushing's. The starting dose should have been closer to 20mg per day based on his weight of 21 lbs. I would have been happier with 10-15mg per day to start. ;)

The amylase could be indicative of a problem with the pancreas but without the normal ranges I'm not sure how high that actually is. Vomiting, diarrhea, and lethargy ARE definitely signs of pancreatitis tho so that is something I would be asking the vet about asap. There is a test called the cPL or cPLI that is specific for this condition and I would be talking to the vet about this if Eli starts having the same problems now that the Vetoryl has been stopped. If he continues to improve, then the odds are what you saw was due to the drug.

As for the supplements and herbs you are using, I don't see any problems with them. Keep in mind these things don't work as fast as pharmaceutical drugs so you won't see any lab changed for several months. The ALP won't be affected at all by these things but it is not one of the liver enzymes that need concern you overly much. The ALT, AST, and GGT are the enzymes that tell us something is happening to the liver; the ALP just tells us that the liver is working hard at the moment. I would talk to the people in the diabetes groups tho to be sure these things are alright with a diabetic dog. ;)

I am very glad he is doing better and hope that trend continues!
Hugs,
Leslie

[pennipeg]

Do you have the ranges for the ACTH? I think 18 is the usual cutoff or upper limit for a normal reading but am not sure. Either way that post of 18.4 is not enough to definitively diagnose Cushing's especially in a diabetic dog. The LDDS should not be used in diabetic dogs however so that leaves you with only the ACTH for diagnosing Cushing's in Eli. Diabetes can and does cause false positives on the Cushing's tests especially if the glucose is not controlled. On the flip side it is very difficult to control the glucose if Cushing's is present. :rolleyes: But a diabetic dog should not even be tested for Cushing's until every option for controlling the glucose has been exhausted and the dog is becoming intolerant to insulin. This doesn't happen quickly but over a long period of time to my understanding. So if Eli is new to diabetes I would be even less sure of him having Cushing's. I encourage you to join our sister group, K9Diabetes, found here:

http://www.k9diabetes.com/forum/

Sadly as is the fate of many online forums, they are not as active as they once were. However you can find much valuable information there. If you are on Facebook, please join this group for canine Diabetes - https://www.facebook.com/groups/CanineDiabetesSupportandInformation/

The adrenals being enlarged on the ultrasound is something we do see in dogs with Cushing's however. But again with the low ACTH result I am still not convinced Cushing's is present. It IS possible that Eli is in the very early stages and if that is the case then you will start to see things like a ravenous appetite, excess peeing and drinking, panting for no reason, seeking cool places to lay, hair loss or failure of the hair to regrow after a cut or shave, and a pot belly.

The dose of 30mg of Vetoryl was too high for him even if he does have Cushing's. The starting dose should have been closer to 20mg per day based on his weight of 21 lbs. I would have been happier with 10-15mg per day to start. ;)

The amylase could be indicative of a problem with the pancreas but without the normal ranges I'm not sure how high that actually is. Vomiting, diarrhea, and lethargy ARE definitely signs of pancreatitis tho so that is something I would be asking the vet about asap. There is a test called the cPL or cPLI that is specific for this condition and I would be talking to the vet about this if Eli starts having the same problems now that the Vetoryl has been stopped. If he continues to improve, then the odds are what you saw was due to the drug.

As for the supplements and herbs you are using, I don't see any problems with them. Keep in mind these things don't work as fast as pharmaceutical drugs so you won't see any lab changed for several months. The ALP won't be affected at all by these things but it is not one of the liver enzymes that need concern you overly much. The ALT, AST, and GGT are the enzymes that tell us something is happening to the liver; the ALP just tells us that the liver is working hard at the moment. I would talk to the people in the diabetes groups tho to be sure these things are alright with a diabetic dog. ;)

I am very glad he is doing better and hope that trend continues!
Hugs,
Leslie

Thanks so much for all the good information. Here is what I found on the web concerning ACTH values: The values for ACTH In the dogs with nonadrenal illness, basal serum cortisol varied between <1 and 18.58 μg/dL (between <28 and 516 nmol/L). Basal serum cortisol was ≤1 μg/dL (≤28 nmol/L) in 37 dogs, ≤2 μg/dL (≤55 nmol/L) in 165 dogs, and >2 μg/dL (>55 nmol/L) in the remaining cases.
I definitely feel you are right about the Vetroyl dosage. The 30 mg almost killed him! I am glad you shared your doubts with me about the diagnosis because I am feeling that too. He has a healthy glossy coat so no hair or skin issues. He does drink and pee a lot but always has since he became diabetic. He is doing very well right now since starting the Milk Thistle concoction. He is eating and sleeping well and now has normal, formed potties so the diarrhea and pain are gone. He has always had some difficulty with bowl movements and getting diarrhea easily but this time it was extreme which led down the path to Cushing's dx. I will definitely look into the diabetes forum. Thank you so much for your helpful input and for this forum!

[Squirt's Mom]

Oh I am so very glad Eli continues to improve! That is good news for all! Please keep in touch and let us know how he is doing....you and your baby boy are part of our little family here now and we want to know who things are going.

Hugs,
Leslie

[Remy’s Mom]

You have been given fabulous advice here on this forum. Lots of knowledge here!! I just wanted to jump in and mention that pancreatitis is often a complication of diabetes and what you were describing with Eli along with the elevated liver enzymes might have been an attack of pancreatitis or gallbladder/bile duct issue. To me his ACTH test was too borderline to conclude Cushings. The 30 mg dose seems much too high for a small dog to start. I have an 18# Bichon who didn’t have excessively high readings but definitely indicated Cushings and he is on 10mg once a day. His follow up ACTH was very much within normal range so this dose was certainly enough and no reason to give him more at this time. If you haven’t already and can afford it I would suggest seeing a board certified internist, perhaps with an endocrinology specialty or interest if at all possible. As a diabetic Eli can easily have symptoms indicative of a number of conditions and it isn’t always easy to diagnose things correctly even for an internist. It can be a real mystery a times. I am also going to throw in for everyone with a ‘senior’ dog over 8, start to include blood pressure screening at least once a year and move up to twice a year as they age. Too often, BP is not checked and even when medication has been prescribed it is simply refilled without ever rechecking the blood pressure to know if the dose needs to be adjusted. I actually had a little poodle who went blind because her vet did not connect her vision issues to her kidney failure and her high blood pressure. Kept saying it was her cataracts. Her blood pressure had gotten up in the 200s and her retinas detached. It broke my heart and since then I have become
something of a fanatic as far as checking blood pressure. It can be a bit difficult as so many dogs are nervous and tense at the vet and their BP may be somewhat elevated. But given the damage hypertension can do it is important to check it periodically IMO. Also,since Eli is diabetic he may predispose to kidney issues. His BUN is a bit high at 55 but a high protein diet or dehydration could contribute to that. His elevated creatinine would be more suggestive of possible kidney issues. Excessive drinking, peeing, lethargy, loss of appetite, vomiting and even diarrhea can all be indicative of kidney failure so given Eli’s diabetes I would sure have your vet recheck all of this very carefully and preferably, see an internist who specializes in these complex cases. So glad to hear your sweet boy is doing better. Best of luck with him!!
Claire