Koli - 9 year old Slovensky Cuvac

[KaJonckh]

Hey all,

My name is Karl and I'm here to figure out some things about my dog, a 9 year-old (10 in february) Slovensky Cuvac.

She has been on propalin for a little over a month for incontinence due to her urinary sfincter not closing perfectly (quite common in sterilised female dogs) and it was working quite well. But since Sunday the 5th of July her drinking habit completely switched from normal (2L per day) to extremely excessive (20L per day). I called my vet and they did a general blood and urine test, most values were normal, except for higher GPT (ALT) and slightly higher cortisol in blood; and very low urine density. Diabetes mellitus and kidney disease were thus excluded, but Cushing's disease came up. This morning we ended the 3 day urine test to measure the cortisol/creatinine ratio with dexamethasone administered between sampling of day 2 and 3. And the results just came in. All the values were huge (864.58, 759.73 and 908.12). Vet has never seen values this high. And he already wants to start Vetoryl.

But I'm a bit conflicted. The only symptom she has of Cushing's is the increased drinking and urinating. No increased appetite, she even eats less (she even refused to eat some boiled chickenbreast this morning). Her fur and skin both still look perfect. She doesn't have a saggy belly and even lost some weight. Her energy went down over the first week and has stabilised now, but I would also be tired if I had to pee every 2 hours and didn't eat much.

So my questions to people who own dogs with Cushing's or veterinarians on this forum: Is it possible for Cushing's disease to have such a sudden onset? Such a high cortisol/creatinine ratio without any other physical symptoms, except the drinking/urinating? Are there any other diseases that cause the described symptoms and labvalues? Would you recommend any other tests to be done before starting Vetoryl treatment?

Thanks in advance!

Karl

[labblab]

Hello Karl, and welcome to you and Koli. Thank you so much for all this helpful information. My first reply to you here will be brief, because I want to have a bit of time to think over Koli’s situation more carefully. But I do understand your hesitation about rushing into Vetoryl treatment. Under the circumstances, I would be having the same hesitation. Cushing’s is typically a slowly developing disease — acute symptoms do not usually appear overnight. And as you say, Koli is lacking most of the more typical symptoms, anyway. Given the timing of everything, I wonder whether the propalin may be involved in this sudden change. At any rate, I want to think things over a bit more.

For the benefit of our U.S. readers, I am assuming that you and Koli live outside of America. What you’ve described as her diagnostic Cushing’s test is a dexamethasone test that is most commonly used in Europe. So it’s indeed a bona fide test — just one that some of our readers will be unfamiliar with.

And with that, I’ll close for the moment. But I shall return, and in the meantime, welcome!
Marianne

[KaJonckh]

Hey labblab,

Thanks for your answer! If you need any other info about Koli's case, let me know and I'll send it through. And yes we do live in Europe, Belgium to be exact. And after all the googling I did about Cushing's before the test I was also surprised that no LDDS test was done, but just a UCCR with dexamethasone dose.

Small update: talked to my vet again and since her UCCR didn't go down after the day of dexamethasone, we've decided to first have an echo done of her adrenal glands and maybe even a CT scan of her pituitary gland.

[KaJonckh]

Hey again,

This morning I called the animal hospital and the earliest possible appointment for a consultation with the endocrinologist and an echo is 27/07, so about 1.5 weeks. So I decided to already start her on a 60mg dose of Vetoryl (she weighs 26.8kg/~59pounds). The price here is 91€ (103$) for 30 capsules, which in my opinion isn't that expensive. 3€ per day for something that may give her a completely normal life until the end, is nothing. I know people that spend alot more each morning on a coffee at Starbucks.

Due to the extremely high concentration of Cortisol in her urine, the vet is very worried that it's an adrenal tumor though, so our disposition isn't that great right now. The only thing we're holding on to now, is that a tumor doesn't normally show up this sudden and starts pumping huge amounts of cortisol in her bloodstream, but that's something I'll have to wonder about until my consultation with the endocrinologist.

Last night (atleast my current insomnia does me some good) I was reading some websites about holistic medicine to treat Cushing's Disease. I'm normally not a huge advocate for holistic medicine, but it can never hurt to try ofcourse. From what I've seen CBD oil, melatonin, lignans and some chinese herb mixtures can help control the disease and keep the dose of Vetoryl low. Is there anyone here who has any experience with holistic medicin to treat Cushing's Disease? I'll also look around on this forum, but if someone is faster at answering than I'm at searching, it's greatly appreciated.

Thanks!

Karl

[labblab]

Hi again, Karl. By now, you’ve probably had the chance to research some of these options yourself. But I’ll go ahead and add a few thoughts, as well.

First, as you know, the primary goal of treatment for conventional Cushing’s is to lower the elevated cortisol that’s being generated by the presence of a pituitary or adrenal tumor. At this point, we know of only two commonly used prescription medications that are capable of doing this in the majority of dogs afflicted with the disease: Vetoryl (trilostane) and Lysodren (mitotane). Another Rx medication, Anipryl (selegiline), has shown positive results in some dogs who suffer from tumors located in a particular area of the pituitary. However, for most dogs, the tumors are located elsewhere and they don’t benefit from improvement. So if elevated cortisol is the issue, the most effective treatment is generally one of those two meds. Researchers are trying to identify other treatment possibilities, but so far nothing else is commercially available, at least here in the U.S.

As for melatonin and lignans, they have been recommended as potential treatments for dogs suffering from elevated adrenal hormones *other* than cortisol. This condition is sometimes referred to as “Atypical Cushing’s,” and a lot of questions remain as to the actual significance and ramifications of elevations in these other hormones. However, some dogs who exhibit outward symptoms consistent with Cushing’s are found to have normal cortisol levels, but elevations in other hormones. Treatment with melatonin and lignans has resulted in symptom improvement in some of these dogs. But it generally takes a long time to see any results (weeks rather than days), if the two supplements help at all. And if elevated cortisol is the problem, they are not sufficiently effective treatments since they have only minimal effect, if any, on cortisol.

As far as Chinese herbs, we’ve had a few members over the years who have tried various combinations but I’m afraid I have no knowledge in this area. One warning I would offer about trying any herbs or supplements: don’t start them until your dog is stabilized on the Vetoryl. As you start your treatment, you’ll be watching Koli closely for any possible side effects. You don’t want to confuse the issue by starting another new treatment at the same time, thereby risking an interaction or an ill effect that is the fault of the supplement rather than the Vetoryl.

Lastly, I’ve not personally heard about CBD being helpful with Cushing’s. I’m currently giving CBD oil to my aged Labrador for osteoarthritis pain, and I do think it’s helping to make her more comfortable and mobile. I know clinical trials are also underway here in the U.S. to assess CBD treatment for epilepsy and palliative pain relief. But as I say, I’ve not heard of it being recommended for Cushing’s, per se. But if you find any related research studies, please do feel free to share them with us here. That would be helpful information for us all.

So to summarize, if Koli does suffer from elevated cortisol caused by a tumor, her Vetoryl will be the single most important treatment for her. I’ll remain most interested in what the endocrinologist has to say, though, because her sudden symptom onset does still puzzle me, especially in conjunction with the start of the propalin. Another oddity is the elevation in her ALT without accompanying elevation in ALP. Although some Cushing’s dogs have high ALT levels, virtually all dogs exhibit elevations in their Alk Phos. So the fact that Koli’s level was normal is uncharacteristic. So please do keep us updated, both as to how she’s feeling and also as to your specialty appointment.

Marianne

[Squirt's Mom]

Hi Karl,
Welcome to you and Koli,

First how is your baby girl doing? I am VERY concerned that Vetoryl was started without any diagnostic testing. In addition I am very concerned about the dose she was started on. Recent studies have shown that larger dogs should start at no more that 30mg once the disease has been confirmed....which it has not in your sweet girl. So I am really worried about how she is doing and look forward to hearing from you again very soon.

Hugs,
Leslie

[labblab]

Hi again, Karl, and I hope that things are going well for you and Koli. I think you’d said that her specialty appointment is scheduled for Monday — I’m sure that day can’t come too soon! We’ll all be anxious to hear the results.

I also wanted to stop back to try to explain more about the oral dexamethasone test that Koli took. In the past, I have seen formal interpretive guides, but of course, since I’m wanting to find them, I cannot find any again today :-((. I’ll keep looking and will post one if I come across it again. However, it is indeed a bona fide Cushing’s diagnostic test, although it is not commonly used and especially not here in the U.S. Here’s a blurb that I *was* able to find:


For those patients who cannot be hospitalized, an oral dexamethasone suppression test can be considered. Samples for UCCR are taken on 2 consecutive days and then 3 doses of dexamethasone (0.1mg/kg PO) are given at 6- 8 hour intervals and urine collected again the following day. A decrease in the UCCR to < 50% of the mean basal values is consistent with PDH. Lack of suppression does not discriminate between PDH or AT. Changes in metabolism of dexamethasone may influence the results of any of the suppression tests.

https://www.mspca.org/angell_services/canine-hyperadrenocorticism/

So a specialized test for Cushing’s was indeed performed. However, just as for the other Cushing’s diagnostics, other systemic illnesses or stresses can result in “false positives.” For this reason, I think we’ll all welcome the specialist’s feedback next week.

Marianne