My dog has had Cushings for over a year...high dosage...would love information!

[jenner1026]

Hello!
First of all, I am so grateful that I found this group. I don't know why it took me so long to find!! I read through a lot of the posts last night to try to get as much information as I could but still have questions about my case :)

My dog Jet is going to be 10 next month and was (unfortunately) diagnosed with Cushings in 2019 after eating things around the house and had to have stomach surgery! He is a 75-80 pound silver lab.

It's been a long road of testing (as you all know) and I am struggling with if I am making the right decisions for my dog.

The shorter version is, I see my regular vet and also a specialist at the emergency vet when I can. His next ACTH is November 25th.
My dog is on a VERY high dose of Vetoryl...in fact...it's the highest dose the emergency vet has ever seen and she has treated so many dogs with this disease. He takes 120 mg with breakfast and 60mg with dinner. We both can't believe it, but it took this many times of trying dosing to get his numbers ok. This is why I am afraid something else is going on with him.

I just told them to send me his last test results again and this is what they said:
Cortisol Serial 2 ACTH
Sample 1 - 4.1 (Range - 1-5 so ok)
Sample 2 - 6.7 (LOW) (Range - 8-17)

Not sure if that helps at all.

I also get nervous about results because he gets SO stressed out at the vet.

Anyway...I guess I just have so many questions and came here for advice. Here's a first few:
- I feed Jet dry kibble (Nature's Balance) and 1/2 can of Science Diet W/D wet food (pate) twice a day. I normally put the pill tablet right in the wet food because he just gobbles it right up. I don't open the pills just stick it right in the food so he eats it all together. No chewing. Is this ok to do? I don't like using the pill pockets because I am trying to keep his weight down!

- He has started to show some signs of possible arthritis. First, he was limping on his front right leg and I thought it was from jumping off the bed but over time I realize, it's actually happening when he first gets up or if he lays on his side for a few hours napping. It seems he gets lame and the leg isn't as strong. He is now on Galliprant for this because Xrays didnt show anything and we thought the Galliprant was ok for his liver. They seem to help.

- That takes me to CBD. I restarted him on CBD - I am giving him NuLEaf Naturals which is highly rated, however both vets cannot give any advice on this CBD. I give him 4-5 drops in the AM and 4-5 in the PM under his gums with my finger. Just started this so not sure of the affect yet. Does anyone else have advice on CBD?

- Along with the front leg, his back legs sometimes tremble/shake. It happens very randomly, usually when he is standing or sometimes pooping. I hope it's also just arthritis forming.

Phew....what a long post. But I figured good to post everything now at once.
Any help is greatly appreciated - it seems like all of the posts I read have dogs on such low doses!!! I am so fortunate to have insurance to help cover the ridiculous cost of this medication and the tests. I am just so afraid that one day it's all going to catch up with him and the meds are going to really make him even worse.

Best,
Jennifer

[jenner1026]

I wanted to reply because I forgot to mention why he was diagnosed in the first place (other than a suggestion when I took him to the emergency vet when he ate a shoe - ugh!)
Jet has always had skin problems in which I was treating with Apoquel which worked well for the itching, but he always still had patches of hair falling out and almost the entire top of his tail is now bald. This was before the Cushings. Now that he's on this crazy dose for Vetoryl, I decided to stop the Apoquel because I just don't like giving him that much medication!

So on top of the skin issues, he also had the pot belly, and was excessively drinking and eating....even eats sticks on the ground when we are on walks like they are treats. It's so frustrating. Also urinating more, but thankfully he does sleep the night and never has accidents.

So since the medicine, his symptoms have gotten a little better but not to a "normal" dog but as you can see at least his cortisol levels are in the range now.
So this is all just so hard to manage for me. Thanks again everyone :)

[labblab]

Hello Jennifer, and welcome to you and Jet! We’re so glad you’ve found us, too :). You’ve done a great job of introducing Jet’s health situation to us — thank you so much for all this info. I want to be able to take the time to read through everything carefully before posting a more involved reply. So unfortunately, that will likely have to wait until tomorrow. But I didn’t want to wait until then to at least greet you! So once again, welcome, and I look forward to writing a more comprehensive reply a bit later on.

Marianne

[LauraA]

Hi Jennifer, I just want to make sure the ACTH Stim tests have been done correctly :) On the day of the test you are giving the meds with food as usual? And the test is scheduled for approx 4 hours later? Also with the skin issues, are the lesions/sores along the neck and back area as well?

[jenner1026]

Thank you both!! I am so grateful for the replies. I am trying to find/figure out how to get replies to the thread emailed to me so I will keep looking that up in the FAQ.

Yes the Stim tests were taken approx. or exactly 4 hours later and I give him the pill the 4 hours before. Most of the time I try to schedule the test mid day so that he can have the pill as normal with breakfast. If it's not exactly with breakfast it might be around an hour before or after, with a pill pocket. I hope that makes sense.

And he has had probably 5-6 ACTH tests already because we started him on 30mg, then 60, then 90, then I think maybe we jumped to the current dose which is the 120 and then the 60 with dinner. So I really hope by now we're doing them successfully. The specialist vet we are seeing next week (who's been treating him throughout this and coordinating with my regular vet) told me it's ok to feed him at 7:30 am, then give him the pill at 8:30, and then his test is at 12:30.

The skin issues vary - always the tail, but the back comes and goes. Right now for instance he is looking great! And I have been trying to bathe him every other week with the medicated shampoo from the vet. But on his belly he gets flaky skin. Nothing on the neck. The top of the head has a weird patch he's had for about a year but I never really tried to "fix" it since it's on his head and not bothering him.

[labblab]

Hi again, Jennifer. Thanks again for this additional info. And once again, we’re so glad to have you here with us. As you can see from my username, I’m also a Lab mom. My avatar is of my Cushpup, Barkis. He passed away over 15 years ago now, but he’s the reason I first joined this wonderful family, myself. Since Barkis, I’ve had two non-Cushing’s Lab girls. The only one still with me now is my 12 year-old Luna. But a Lab-lover I am, and will always be!

Turning to Jet, yes, he is indeed taking a big dose of trilostane. I would be very worried if he was starting off with such a high dose. But since your vet has arrived at this dose on the basis of ongoing monitoring tests — and Jet’s most recent ACTH was well within a safe range — a relatively high dose does seem to be what he’s needing. Given his weight, his current total daily dose is a bit more than 2 mg. per pound, and the research literature states that most dogs end up being stabilized within a range of 1-3 mg. per pound. So as high as Jet’s dose may seem to us, he *is* a big boy, and the dose remains within the overall expected research results.

I’m also glad to read that he’s being tested within that four-hour time frame after dosing. One suggestion I would make, however, is to make sure he’s being dosed along with a meal or within that hour afterward. I would not dose him one hour before eating, because in that situation the trilostane is really being processed on an empty stomach and that can alter the overall effectiveness, and also skew the test results upwards on a testing day. Dechra, the makers of Vetoryl, recommend always dosing along with the meal in order for the drug to be metabolized properly. If your internist is OK with dosing an hour afterward, then I’m assuming it’s because he thinks there’s still enough food left in the stomach to allow the trilostane to be digested alongside. But as a rule, we’ve been told that dosing right alongside a meal is best.

Back when I was treating my Barkis, trilostane had just been newly introduced and he was actually the first trilostane patient for my specialist. Dosage recommendations were quite a bit higher back then, and we started off my 65-pound boy with 120 mg. twice daily for a total of 240 mg. I shudder now to think we started him out that high, but amazingly, his post-ACTH cortisol level never dropped below around 6.0, either. So even though I would never, ever initially start a dog on such a high dose, he’s proof that some dogs do need higher doses to lower their cortisol into optimal range.

As far as Jet’s emerging mobility issues, it’s really hard to know whether muscle-wasting from Cushing’s is contributing, or whether it’s age-related arthritis, or maybe a combination. Both of my non-Cushing’s girls started exhibiting arthritic mobility issues around the age of 10 or 11. My current girl, Luna, just celebrated her twelfth birthday, and has really degenerated quite a bit during this past year. She’s been taking a daily NSAID for quite a while, and we added in CBD oil about six months ago. At first, I thought I saw improvement with the addition of the CBD. But now, she’s backsliding again so I’m fearful that the continued aging is just taking a greater toll. I apologize that I’m not offering any helpful hints about this. But I want you to know that I understand your worry since I share it!

All in all, it sounds as though you’re doing all the right things with Jet. For now, it may be kind of a waiting game to see how the next ACTH monitoring turns out, and to hope to see increasing symptom resolution as more time passes with his cortisol now lowered into a therapeutic range. I’ll go ahead and close for now, but do feel free to add any more thoughts or questions. And I’ll be watching for more updates, as well.

Marianne

[jenner1026]

Thank you Marianne!! You are the best. I did see the pic of the sweet lab and I know you hold him in your heart. What a sweet boy.

Glad to know you aren't alarmed by the treatment right now and thanks for the research results, that helps. I will also hold off on feeding him as close as I can until pill time to make sure his stomach is definitely full (you know how much they love to eat and he freaks if not fed right on time!;) )

I guess for now I just want to confirm with you that you think it's ok to actually shove the pill within his pate wet food? Is it ok to be absorbed that way? He doesn't even chew the wet food - just gobbles it right up and believe he swallows it whole (I cut it in chunks).

As for the CBD, it's so difficult to ensure the dose is enough because no vets really give advice. I hope over time to see some sort of change - I just started him like 2 weeks ago. What NSAID do you suggest for a dog with Cushings? I will see what the specialist says as well if he starts to get less mobile.

Thanks again!!
Best,
Jennifer

[labblab]

Hi again, Jennifer! I think that's just fine that you're giving Jet his Vetoryl in his wet food. Vetoryl capsules are intended to be swallowed whole, so that's great that he just gobbles the food without chewing it. You don't want the capsule to be chewed up; you want it to head directly down into his stomach intact. I always feel so lucky that I have a Lab when it comes to giving medication. I know some dogs can be very picky, but Labs seem to be notorious chowhounds (even without Cushing's!), and my dogs have always been delighted to gulp down whatever pill or capsule I stick in their mouths, just as long as it's wrapped in cream cheese, or soft processed cheese. They swallow it all whole, and down the hatch it goes :-).

As far as pain medication, I'll defer to your specialist. I see that Jet is already taking Galliprant, and that's supposed to be one of the newer, safer pain meds. You do have to be careful with traditional NSAIDS when treating Cushpups due to risks to the kidneys and liver. Also, when cortisol levels are high and uncontrolled, the risk of GI bleeding due to NSAIDs can be elevated. However, once cortisol levels have been stabilized within therapeutic range, some of the newer NSAIDS such as Meloxicam or Previcox may be considered a worthy trade-off in terms of quality of life. As I say, though, that's a question I'd pitch to your specialist. I've asked my own vet about Galliprant, and he says that, based on owners' anecdotal reports, he thinks it sometimes doesn't offer as much pain relief as do some of the traditional NSAIDS. But the safety issues may be an over-riding factor that makes it the better choice.

So carry on!
Marianne

[jenner1026]

Cannot thank you enough!

[labblab]

Hi again, Jennifer! I just wanted to come back and add a little bit more about CBD oil. I know that many vets feel constrained about talking specifics, so I tried to do some reading on my own when I was considering ordering it for Luna. What really prompted me to use CBD was a positive study that had been conducted by the Cornell Vet School with osteoarthritic dogs as subjects. A company named Ellevet had supplied the CBD oil for the study, so I ended up at their website out of curiosity. It turns out that they market CBD products to the public, as well as supplying oil to vet schools with whom they are jointly launching studies. I’ve ended up ordering my oil directly from them.

Beforehand, I spoke on the phone to one of their technical reps who was very helpful re: dosing and other general info. They solely market veterinary products, so that is their total focus and they have several research links on their website. Plus, you can see what their dosage recommendations are for dogs. So regardless of whether you’d ever be interested in ordering from them, you can probably get more info that may help you in your dosage decisions with products from other companies. If you click on one of their oil products, you can scroll down to see a dosing chart based on weight. It will take a little calculation, but you can figure out the dose by mg., and then compare it to what you’re using now. Here’s the link to their website:

https://www.ellevetsciences.com/

Hope they may have some info there that is helpful to you,
Marianne

[jenner1026]

Hi Marianne! Thank you so much for the Ellevet information. Thought I replied earlier but maybe not. I will look into it again - there was a reason I went with NuLeaf Naturals and that was after I did some online research and found the below woman's article. I wonder if her research is all true, but it seemed like she was legit? She didn't have ElleVet rated well. Just curious if you had any thoughts on this but probably not!

https://www.seniordogdays.com/wp-content/uploads/2019/08/ellevet-vs.-kingcalm.cbd_.png
https://www.seniordogdays.com/cbd-for-dogs-reviews-ellevet-kingkalm/

Also, Jet's test is tomorrow - I called the vet and she said it is ok to give him his Galliprant in the AM with the Veteroyl as it will not impact the test. Do you agree with this? Just curious.

Thank you!!!

[labblab]

Hey there, Jennifer! Good luck with Jet’s testing tomorrow! I have to defer to your vet re: giving the Galliprant tomorrow because I just don’t know very much about that medication. I don’t think you’d want to give a med that is either a sedative or a stimulant in conjunction with an ACTH test. But I’d assume an NSAID like Galliprant would be fine, and especially since your vet has said so. Just be sure to give the Vetoryl along with breakfast, OK ;-))).

Thanks so much for the CBD links. I’ll definitely be interested in looking them over. At first glance, there are considerations re: selecting an oil of which I was unaware. So I’ll welcome the chance to learn more, myself. I’ll let you know if I have any new thoughts once I have a chance to review the info.

In the meantime, surely hoping all goes well tomorrow.
Marianne

[jenner1026]

Thank you so much as always. Me too and I will report back with the results!!

[jenner1026]

Hi everyone!
So Jet's results just came back today and numbers look great but have definitely lowered a lot over 3 months!

Pre - 3
Post - 2

The doctor seems to think (after I asked) that we could possibly lower his dose (woohoo!) but I said let's test him again in 3 months and see? What would any of you do with these numbers?

Bloodwork looked good for a dog his age. Liver a bit elevated but due to the Cushings.

They took a free catch urine sample but it was of course cloudy and had some protein in it so it was hard to tell and when I bring him back he may need to have a sterile urine sample so I am hoping they can get this. Stinks that I had to pay for the free catch when it didn't even do anything! Ugh!
(Total bill for the day was $770 - thankful for my Nationwide plan!!!!)

He is also now on Gabapentin and Galliprant for the limping and literally the day after I started the Gabapentin he stopped limping. SO, I decided to stop the CBD for now because I wasn't sure if it was really helping and how many things can I give this dog?!? She told me I could try stopping the Gabapentin in a month and see how he is doing.

Any feedback on any of this would be appreciated!

[labblab]

Hi again, Jennifer, and sorry for the delay in getting back to you. But I do want to say that, if Jet were my dog, I’d definitely want to lower his Vetoryl dose given how much his cortisol has dropped during these past three months. I would be very worried about leaving the dose “as is” without another ACTH test before three months from now. At 2.0, his post-ACTH result is almost at the very lowest point of the safe therapeutic range, so you really don’t want to risk having it drop any lower at all. And it seems possible to me that his increasing mobility issues may be worsened by a cortisol level that is too low for his comfort right now. The very low cortisol may be “unmasking” arthritic issues that were being soothed somewhat by a higher cortisol level.

I know you’ve been slogging through a whole series of testing and dosage changes, but for safety’s sake, a somewhat higher cortisol level is preferable to risking a treatment overdose and Addisonian crash. So if he were mine, I’d try lowering his dose right now rather than waiting.

Marianne

[jenner1026]

I really appreciate your reply. I have been debating what to do since I got the diagnosis! The vet said it is up to me...she didn't take a ton of time on the phone to really think it through but did say we could try going with a lower dose. I wish she was a bit more concerned but I also know I'm not her only patient. I know my dog and I feel like he has been a bit "off lately" with this arthritic stuff.

So, he is on 120 in the am and 60 in the pm. What do you think about doing 60 and 60? OR should I just do the 120 in the am (I just got brand new box, ugh) and nothing in the PM?? The split dose sees better though. I got reimbursed 90% for the new box so not the biggest deal.

And of course, I know you can only suggest and I will always check with my vet before I do the change. If I do change the dose, is it ok to get him tested in 3 months or I need to after the 2 week period again? That's only if you're increasing dosage, correct?

And one last question....I decided to change Jet's food to Nutro Ultra. Jet was on a grain free kibble diet most of his life after his allergies and as most of us know it seems these diets are no longer good due to the heart disease. So, I am going to change his kibble over to this Nutro after doing some research. This will go along with the Hills wet food. I debated doing the Hills dry food but all the reviews over the past year said that they changed their formula and the owners hate it!

So, lots of changes for Jet :(
Thanks for your help.

Best,
Jennifer

[labblab]

I really don’t have a strong opinion either way regarding the 120 mg. once daily or the 60 mg. twice daily. In looking back, it seems as though he was being dosed once daily until this latest addition of the 60 mg. in the evening. Once daily dosing always seems easier to me, but if you are able to feed him along with his medication both morning and evening, then the split dose remains a reasonable option, too. So I’d leave the decision up to you and your vet (how’s that for not being very helpful...;-).

As far as retesting, I’d maybe split the difference and recheck again in six weeks or so? Theoretically, lowering the dose should allow his cortisol to rise again. But longterm adrenal suppression can occur such that dogs may remain more highly responsive to lower doses, and again, you really don’t want his cortisol to continue to drop any further.

Marianne

[jenner1026]

You are always very helpful. I totally understand these things are confusing.
I reached out to both vets and seeing what they say regarding once daily vs twice daily and I agree with you that I do think the current dosing may be a bit too much. Really hoping this all works out :(

[jenner1026]

As a follow up, I also wanted to show you all the results of his Stim tests....here is a list:

(also, i can't really remember dosing for each Stim but I will try to mark it)

9/26/19 - 8.8
13.4
(believe he was on 30mg)

10/08/19 - 9.6
8.0
(believe we moved him to 60mg)

10/21/19 - 8.5
7.1
(believe we moved him to 120mg)

11/14/19 - 6.5
11.9 (odd Post STIM in my opinion)

04/27/20 - 8.1
11
(moved to 120mg AM and 60mg PM)

06/08/20 - 7.3
5

08/27/20 - 4.1
6.7

11/25/20 - 3.1
2.0
(want to move him to 120mg TOTAL and re-test)

Now of course it all depends whether or not the test results aren't totally accurate because of the time of testing or Jet's anxiety levels, but it is interesting to see how the numbers moved.

Best,
Jennifer

[jenner1026]

Hello,
Spoke to specialist vet today and she said to put him down to 60AM and 60PM (split dosing) so I will be starting that tomorrow.
She wants to test him in one month so I will go for the next Stim test on January 6th.

Best,
Jennifer

[labblab]

Jennifer, I do think that’s a good plan. Upon seeing all of Jet’s stim results, it does seem significant that his cortisol level suddenly dropped significantly while remaining on the same dose during this last 90-day period. So I’m in agreement with both the dosing decrease and the test schedule. I’ll certainly be hoping that this works out to be a good arrangement, and of course we’ll be very anxious to hear!

All best wishes in the meantime,
Marianne

[jenner1026]

Good Morning and Happy New Year!!

Just wanted to check in after reading through the recent thread about Frankie. Jet has his next Stim test on Wednesday since he has now been on his new dose of Vetoryl (60mg in AM and PM) for about 4 weeks. She is also going to do a urine sample - can't remember which one she called it, but I know the "free catch" sample did not work. I think this is a good idea to see if anything else is going on with his urine? I am curious as to why she wanted to do the urine test in the first place but I am looking forward to the results. His urine is usually consistently very "white" or light in color, and not "yellow", but I assume that's just from drinking and peeing so much unlike dogs who are dehydrated. Definitely can't say that for Cushings pups! :)

Jet seems to be doing ok on this new dose - water intake seems to be better. Food intake is still a challenge but manageable, and he still has a few small fur patches that are missing. I am really curious to see how his numbers come out this time.

My only concern is wondering if I should be also checking him for something else as well. It seems his bloodwork comes back normal in all other areas or I assume the vet would call is out, correct? I don't know if he was ever diagnosed with Hypothyroidism? This is something different, correct? Do most Cushpups have both?

Other threads here show additional signs of other possible issues so I just want to make sure I am checking all angles but maybe if Jet's tests and bloodwork point to only Cushings it's just how it is for him (which is good!).

Thanks to all :)

[labblab]

Hello again, and I’m sorry it’s taken so long to get back to you! I see that you’ll be heading back to the vet tomorrow for Jet’s ACTH test, so I wanted to quickly add a note beforehand. First of all, from this point forward, I encourage you to ask for actual copies of all of his labwork if you’re not already doing so. Obviously, we are hoping and assuming that our vets will point out to us any irregularities that they are noticing, but with both vets and human doctors, I’ve learned through the years that they are never going to have the same amount of time that we do to really pore over results. We surely hope they’ll see and tell us about obviously worrisome results that fall out of normal range. But it’s really helpful to have copies of those results yourself, so you’re fully aware of any lab changes that are taking place over time.

As far as hypothyroidism, the T4 result on a blood chemistry panel is the most basic indicator of thyroid function. If the T4 reading falls within normal range and a dog is not exhibiting symptoms of hypothyroidism, then further testing probably isn’t called for. However, if the T4 is either too low or too high, then more involved thyroid testing can be done. It is possible for dogs to have Cushing’s and also to genuinely have an underperforming thyroid. However, Cushing’s is a disease that can cause low thyroid readings as a “secondary” result. In that situation, further thyroid testing can help tease out whether the low thyroid reading seems to be a genuine problem in its own right (requiring supplementation), or whether it will likely resolve on its own once the Cushing’s comes under control. So to back up, it’s Jet’s T4 reading that you would be checking in terms of hypothyroidism.

As far as the urine sample, your vet may be wanting to check again for the presence of infection since UTIs are common among Cushpups and can cause excessive thirst and urination even when cortisol levels are adequately controlled. Your vet may also be checking for the presence of any protein in Jet’s urine, since Cushing’s can affect the kidneys in a manner that leads to protein being passed into the urine. Chronic “proteinuria” can cause damage to the kidneys, so if it’s identified, some additional medication may be added to help lower the protein leakage.

All in all, I’m really glad he’ll be heading back in tomorrow for his repeat ACTH. At this point, I don’t know anything specific for you to ask about in advance. But definitely do ask for copies of all his the test results, whenever they are done. That way, you can track any changes and ask specific questions about any abnormal readings that are highlighted on the report.

Good luck tomorrow!
Marianne

[Jonathan]

This thread took me back in time, as I read it...
Meaning, I know exactly what you (we all)are going/went thru.

My girl started high with Veterol, and went like a roller coaster, up and down, so it seemed.
- Thyroid was ruled out at first but did become an issue later, about 7 months later
My daily ritual as it sounds was very similar... Vetrol, Levothyroxine, and Gallaprant.

I dont want to say too much, as I am over 1 year removed, and may have forgot some things, but I kept EVERYTHING, record wise.
So I will try to go back and re-read things Ive kept. And post as my memory kicks in.

I do remember feeling (maybe advised) very strongly about trying to keep the doseage even thru the day... meaning, not one big pounding, or a large then small.
Even split, when possible twice per day.

-- I do remember this was not possible at one point, as maybe Veterol was not available in (example 15 mg?) one odd size I needed, which meant I had to over or underdose.
Either way, that was eventually corrected, so you can kind of dismiss what I just said... it was an issue I faced, that fixed itself.

[jenner1026]

Thank you Marianne - will report back with the full results...I agree and will make sure to get the full panel results this time and maybe someone here can assist me reading them. The way you explained everything is so great so thank you.

Jonathan- thanks for your reply as well! Yes I am splitting his dose equally now in the am and pm (60 and 60) so hopeful this will remain his dose for a while, even if it means buying 2 boxes per month. Please keep me posted if you have any other Info or want to tell the story on your girl.

Anyone know how I can post a photo of Jet on here so you all know what he looks like? :)

[Jonathan]

If you click "Settings" at the top left, then click "My Avatar" under my settings (left side of page) you can add a picture.

Also, you can create an Album under the "My Profile" section..

[jenner1026]

Got it thanks!

[jenner1026]

Hello all! Thankfully Jet got a good result from his STIM test; it was:
6 Pre
4.2 Post

The doctor said I can keep him on this same dose and check in another 4-5 months.

The negative of the day was trying to get his urinalyses done. The free catch sample they took a few weeks ago was not giving a valid result. So they wanted to do a sterile one where he has to lay on his back. Well, Jet was completely freaked out and stressed and would not let them do it. He was being very difficult.
Back to square one...they said the only way to probably get this sample is to sedate him. What would you do in my case? I am not opposed it's just a lot to deal with for a urine sample! I will check in with my regular vet and see what she says.

Lastly, I did have them send over the full labs results of his last 2 STIMs and also his full bloodwork. Is there a way to attach those files here? I see other members listed out the bloodwork and got good responses so I thought maybe someone here could help me decipher them as I am clueless with this stuff. Most is in the normal range but a few pieces are out of range.

Thanks for your help!
Jennifer

[Jonathan]

I have been stumbling around, trying to find a way to help post the attachment/lab results.

But I found a spot, at the bottom of my post preview (permissions) that says I do not have permission to post attachments.
- Im guessing you are in the same situation.?

[labblab]

Jennifer, thanks so much for this update. And Jonathan, thanks so much for trying to help solve the problem re: posting attachments. Unfortunately, no members have permission to post attachments other than photos. I am a computer “dummy,” but I have been told that this is a security feature of the website software so as to minimize the potential for malicious entry of hackers onto the forum. So Jennifer, the most helpful way to let us know about any abnormal lab results is simply to list them in a reply, along with the normal reference range for that particular value. You only need to list values that are marked as being abnormally high or low on the lab sheet, so hopefully there won’t be a lot that are in question.

I’m so glad to hear that Jet’s ACTH test turned out well! The only cautionary note I would add is that the official recommendation of the makers of Vetoryl, as well as many other clinicians, is that monitoring retesting should be consistently performed every three months. So your specialist is stretching out that time frame a bit, and at this stage of Jet’s treatment, if it were me I’d probably choose to at least return at the four-month mark rather than waiting even longer.

As far as the urine sample, I’m so sorry that the ordeal was so stressful for him. Poor boy! This is only a guess, but I’m supposing that the reason why the specialist thinks it’s important to persist in getting a clean sample is to ensure an accurate assessment of the presence or absence of a urinary tract infection. If Jet’s excessive thirst and urination persist even when his cortisol level is being well controlled, an untreated UTI would be a logical cause. So I’m guessing that’s the reason, and if so, it may be a wise idea to go ahead with the sedation if you cannot get a clean sample from a free catch at home. But definitely do discuss the issue further with your regular vet.

OK guys, Happy New Year to you all!!
Marianne

[jenner1026]

I will definitely go for a re-check in May (4 months).

Ok, got it....here are the results, hope it's ok to read:


1/6/21 STIM Test:
Zoasis - Cortisol Serial 2 ACTH
Tube Labeled Pre
Result Verified
Tube Labeled Post
Result Verified
Cortisol Sample 1 HIGH1.0-5.0μg/dL Result Verified 6
Cortisol Sample 2 8.0-17.0μg/dL Result Verified
4.2 Result Verified
THE TEST WAS RUN ON PRE AND POST SAMPLES AS LABELED BY THE HOSPITAL.
HYPERADRENOCORTICISM (HAC): Post ACTH results greater than 20 ug/dL (dog) and greater than 15 ug/dL (cat) are consistent with HAC.



NOVEMBER 2020 BLOODWORK

Zoasis - Superchem, Complete Blood Count, Cortisol Serial 2 ACTH, Anion Gap, Bicarbonate, Total T4

Albumin - 4.5 (Range 2.7-4.4)
**NOTE - Albumin may be falsely elevated due to a Hemolysis 3+, Lipemia 3+ and could be in
the Normal Range.

Alk Phosphatase - 1188 HIGH (Range 5-131IU/L)
**Really don't understand this one

Potassium - 5.7 HIGH (Range 3.6-5.5mEq/L)

Triglycerides - 668 HIGH (Range 29-291mg/dL)
*This one is very high too

Eosinophils - 1 LOW (Range 2-10%)

Total T4 NORMAL 1.5 (Range 0.8-3.5mg/dL)
*Thanks for having me specifically check for this one! :)

I know you all are not doctors, so I really appreciate you looking into this when you all have your own problems! :) I just was surprised nothing was mentioned to me on the really high callouts.

Best,
Jennifer

[Jonathan]

I found myself bringing my girl in, as I noticed times when "her meds were off."
Meaning, sometimes I would go in within only a couple months, maybe shorter. And other times simply as recommended (every few)

The trade off would often be a lesser doseage, which would offset the price of the visit.
(and sometimes vice-versa. Cushings was like a roller coaster for us, but it all balanced out. So it wasnt 'scary' as much as it was realizing/finding the changing, but overall balance, and accepting that there was one.)
- I hope that made sense...!

[Jonathan]

I'm suppressing a little bit, as I am a good year or so removed from this being my "day to day thought."
- But I remember that time/mindset, and thats why Im here.
- Im here for support, to help. Im just a little slow sometimes.

I have kept every single document/test since Gigi was born, it just take me a little bit to go back over things, to get back into that frame of mind.

[jenner1026]

Thank you so much Jonathan for your kind words! I am sure you miss Gigi so much.

[labblab]

Hi again, guys. Jennifer, all of the lab abnormalities that you’ve noted are consistent with Cushing’s. I’m not paying any attention to the albumin since it was only a hair out out of range. But the other readings are ones that we typically see. Highly elevated Alk Phos is a hallmark. It is an enzyme that is associated with liver changes that are consistent with Cushing’s. This elevation does not typically herald damage to the actual functioning of the liver, and often reduces to some extent after cortisol comes under treatment control, but it may never totally return to a normal reading. We Cushparents just come to expect elevated ALKP readings on our Cushpups’ blood chemistry panels. High cholesterol or triglycerides, and low Eosinophils (type of white blood cell) are also commonly part of the Cushing’s profile. Lastly, Jet’s potassium is also only a hair out of range. That may be the result of the Vetoryl treatment. In addition to lowering cortisol, Vetoryl can also lower the level of another adrenal hormone, aldosterone. Aldosterone controls the balance of sodium and potassium in the body, and if aldosterone production is oversuppressed, potassium levels can climb abnormally high. This can be a serious situation, so that’s another reason why blood chemistries should be periodically monitored alongside cortisol levels in order to make sure that the potassium and sodium levels do not get too far out of “whack.”

So bottom line, Jet looks pretty much like a typical Cushpup in terms of these lab values, and hopefully you may see a return towards more normal levels as his treatment continues over time.

And Jonathan, again, it is so kind of you to take the time to share Gigi’s experiences with the rest of us. Your support is a genuine gift, and I believe that Gigi would be so proud of her dad. By helping others, you are honoring her memory and bravery, and you are blazing the trail forward for those who are following in Gigi’s paw prints. You’re doing good, and we’re grateful to have you here with us!

Marianne

[MacMajor01]

Hi Jennifer,

I just wanted to quickly note that there are no side effects or prolonged use issues with Apoquel at all. I understand not wanting to drown your pet w/a ton of pills though. My dog is on Vetoryl and the only reason I don't have him on his Apoquel is because I can't afford it! Otherwise, that is one miracle drug I whole-heartedly believe in! :)

[jenner1026]

Thank you! :)

[Squirt's Mom]

Talk to the vet about an allergy drug called CytoPoint. It is an injection and is not a steroid so it won't cause cush signs nor interfere with cush treatment. This drug was given to 2 of my babies and it was truly miraculous! Both needed less than 4 injections and their allergies never returned. Not all dogs have had this same reaction but it is not uncommon. So it would be worth having a conversation about it at least to see if it is affordable and if the vet recommends it for your sweet baby.

Hugs,
Leslie

[jenner1026]

Hello everyone! I hope everyone is enjoying the beginning of spring!

Jet had his 4 month check up today with an ACTH Stim Test. Will report results as soon as I know them.

He also is having a Urine Test done again since the last one was inconclusive. Let's see how that comes back as well!

Best,
Jennifer and Jet

[labblab]

Welcome back, Jennifer! So good to hear from you again, and we’re anxiously awaiting Jet’s test results right alongside you ;-). At this point, how is he doing in terms of symptom control?

Marianne

[jenner1026]

Thank you Marianne!

In terms of symptom control his skin looks the best it's been in a long time and even some fur is growing back which is nice. He still drinks and pees a lot but not uncontrollably. My main issues with him now would be that his bones sometimes give a crack when he gets up after laying down for a while but he is still able to jump on the bed and do all of those things. Continuing with 1 Dasuquin soft chew each day. Also, he does have some fatty deposits/lumps showing up but the vet said they are fine??

Also they just got back to me on the tests...Jet's numbers continue to look good so no changes to his meds.

PRE - 2.7
POST - 5.7 (LOW) - but she didnt seem to think this was a problem, so no meds change

Urine -
Protein - 42.1
Creatinine - 35.3
Ratio - 1.2 (High)

URINE P:C RATIO INTERPRETATION ---------------------The urine P:C ratio must be evaluated in conjunction with urine sediment findings as gross hematuria or inflammation can cause elevated ratios.
Urine P:C ratios >/= 0.5 in dogs & cats indicate overt
proteinuria and are evidence of persistent renal proteinuria when found repeatedly (3 or more samples obtained 2 or more weeks apart) and are unable to be attributed to a pre-renal or post-renal cause. The urine microalbumin test is a more sensitive test and will be positive before overt proteinuria is detected.
In dogs, persistent renal proteinuria with urine P:C ratios >/= 2.0 is usually due to glomerular disease.

Let me know your thoughts, if any :)

Best,
Jennifer

[labblab]

Hi Jennifer! Yep, those ACTH results look good so I wouldn’t be changing the medication, either ;-). Good job.

As far as the fatty lumps, or “lipomas,” all my Labs have developed them as they aged. They truly are generally nothing to worry about. We had to have a large one removed from our Cushdog, Barkis, because it was right behind one of his front legs and was interfering with his gait. But both of our girls have had large fatty lumps, too, that we just left alone. My Luna now has a big one on her flank that hubby affectionately refers to as her “hockey puck” — it’s that big now! But it doesn’t bother her at all, so we just leave it alone.

As for the urine results, this test did indicate some protein loss. Protein ought not to be showing up in the urine under normal conditions. However, “proteinuria” can be caused by several different issues, including primary kidney problems. As it turns out, though, Cushing’s is a disease that can secondarily cause protein to leak from the kidneys into the urine. If the level of protein is high and continues for a lengthy time, some degree of kidney damage can result. For this reason, it’s good that your vet is keeping an eye on this. If Jet continues to exhibit proteinuria in subsequent tests, then your vet may very well add some more oral medication to his regimen. If she’s said nothing about this yet, I’m guessing it’s because she wants to wait and see whether or not the protein loss persists or worsens.

So overall, I think this is a good report, though. Continuing best wishes to you and Jet, and please continue to update us as time goes on.

Marianne

[jenner1026]

Thank you so much, Marianne, your reply is so appreciated. I am so thankful I am here. I will definitely keep everyone updated!

[Harley PoMMom]

Has Jet's blood pressure been checked lately? Elevated blood pressure can weaken the blood vessels in the kidneys. This decreases their ability to reabsorb to protein, which flows into the urine.

Lori

[jenner1026]

Has Jet's blood pressure been checked lately? Elevated blood pressure can weaken the blood vessels in the kidneys. This decreases their ability to reabsorb to protein, which flows into the urine.

Lori

Hi Lori! You know what, I am not sure actually...when is that normally checked? Is it normally done during a Stim test? I can call to ask...

If it wasn't, I guess I will need to make sure it is at his next exam?

Thanks for the tip.
Jennifer

[Harley PoMMom]

For optimal results, blood pressure checks are done when no other tests are going to be performed, one wants their dog to be as calm as possible. When I had my Harley's BP checked, the tech would put us in a room and no one would come in for 10 minutes, I would try to calm him down as much as possible, he didn't like going to the vets, can't say I blame him. They would take at least 3 readings and average them, we found that one of his paws was more favorable to him than the others so they always took the readings from that particular paw.

Hugs, Lori

[jenner1026]

Good to know. That seems almost impossible since Jet gets so freaked out every time he has to go. I will inquire with my vet though. Thanks for the tip!

[jenner1026]

Hi all,
Jet will be going for his next stim test next week. It will be a little bit of a different type of visit because they want me to drop him off for the day. I believe the specialist is not doing regular appointments that day but they are making a exception for him?

Anyway...I really need them to do this urinalyses. Jet seems to be whining a bit at night to go out, and sometimes he just pees and pees even after not having much water. The last 2 times he would not let them do it. I am wondering if i will need to sedate him to get this test done. I am worried something else may be going on!

I also will check in again regarding his BP because that's another good tip.

Wondering if there is anything else I should be checking. I will report back with results.

Thanks!
Jennifer

[jenner1026]

Hi All,
Jet had his stem check up last week. The results came back great at Pre 2.3 and Post 2.8. The vet is going to check him in 3 months and thinks we're getting close to lowering his dose, which would be great.

I brought in some urine samples that I had kept in the fridge (eww) and this is what she said on the results on email:

His urine showed no protein!!! So we can put that to rest for now. ​It does show he is drinking in excess despite very good control of his Cushing's disease. In his case it could be anxiety driven OR it could still be related to the Cushing's disease as there is a small number of cases that despite adequate control remain apt to drinking and urinating in excess. There is something we can try for this (DDAVP injections) if you think this is still an issue affecting your and his quality of life. If so we can discuss if further when I return to the office.

Is anyone familiar with the DDAVP injections and do you recommend it?

Jet urinates a lot when he does go out, no matter the timing. He doesn't really beg to go out unless its in the evenings (like right now), and I always think he has a UTI but I guess not! It's just strange.

Thanks for all of your help.

[jenner1026]

Oh and I forgot to have his blood pressure checked, ugh! Unless they did that with the exam...sort of wish they did because the visit was $660 :( :( :(

[labblab]

Hi again, Jennifer! Thanks so much for giving us this update. I apologize for the delay in replying to you, but this has turned out to be a busy day of chores for me. I do want to add a couple of thoughts, but I'm afraid they'll have to wait until tomorrow. So thanks for your patience, and I'll be back again a bit later on.

Marianne

[lulusmom]

Hi Jennifer. I am sure Marianne will have some input for you when she has time to check in but I wanted to address your question about the DDAVP injection based on my own experience. DDAVP is a synthetic form of the anti-diuretic hormone (ADH) which regulates the amount of water in the body and increases sodium and water absorbed by the kidneys. It is rare that a dog being treated with Vetoryl does not see a complete resolution of excessive drinking and peeing but a small number of dogs will still have an ADH deficiency. If this were to be your dog's problem, DDAVP would likely be effective. My second cushingoid dog was a shelter rescue so I knew nothing about his history. Unfortunately, his excessive drinking and peeing never resolved with trilostane or mitotane treatment despite excellent control of cortisol His urine specific gravity (USG) never improved and stayed at a pretty consistent 1.008 which is quite low. If your vet is suggesting DDAVP, I have to assume your pup's USG is also below 1.015. Unfortunately my dog did not respond to either the DDAVP eye drops or pills so he was ultimately diagnosed with nephrogenic diabetes insipidus. To correctly diagnose diabetes insipidus through testing, a water deprivation test is done but I did not want to subject my dog to that so we did a trial with DDAVP. That is what most vets recommend so there is no reason why you can't give it a try. If there is an ADH deficiency, a dog usually responds quite quickly. I hope this helps.

Glynda

[labblab]

Welp, I finally made it back again — sorry for the delay! I’m really glad Glynda stopped by in the meantime, and especially because she’s had first-hand experience with this treatment. Coincidentally, you’ll see that another of our new members has already been using DDAVP injections with her dog, so you may want to check out her thread:

https://www.k9cushings.com/forum/showthread.php?9486-Hera-11-years-old-(Cushings-amp-Diabetes-insipidus)

Given Glynda’s thorough response, I really only have a bit of context to add. I’ll give you a link below that explains Diabetes Insipidus in greater detail. As Glynda has mentioned, there are two forms. Her dog suffered from the “Nephrogenic” form, but the one that we see most often among Cushpups is the “Central” form since it arises from a tumor in the pituitary gland, just as does Cushing’s itself. DI is an uncommon ailment among dogs in general, but we have seen our share of the Central form here due to the pituitary tumor linkage. DDAVP can and has been helpful in a number of these cases. So as Glynda says, I see no reason not to give it a trial run if your vet thinks it’s a good idea. Here’s the explanatory link, and definitely do let us know what happens if you decide to give it a try.

https://vcahospitals.com/know-your-pet/diabetes-insipidus-in-dogs

Marianne

[jenner1026]

Thanks to you both. Not sure why I didn't get a notification there were replies- I will look into that.

This is so helpful and I am going to talk to my vet about it. Sounds like it could be something that could work!

Glynda, sorry it didnt work for your dog. Did they start with the drops or injections?

[jenner1026]

Hi everyone and Happy New Year!
A little update on Jet - reached his 11th birthday on Christmas :)

He is pretty stable and still taking the 60mg AM and 30mg PM dose of Vetoryl. He is currently on no other medications. He always had gas problems (ugh) but the Nutro food I had him on was making it even worse....so, we switched him to Purina Pro Plan EN fiber balance and seems to be working well. He also takes 1 of the Purina probiotic packets a day to help with the GI issues.

In regards to Cushings, he is still drinking and peeing a lot, but nothing too uncontrollable. I have him on a routine. He went on Friday for his latest STIM test and I am waiting on the results. When I saw the vet we talked again about the DDAVP injections and I just don't have the ability to do that. I live alone and the thought of giving Jet injections once or twice a day seems miserable and too much for me to handle.

My bigger concern as he gets older now is the hing leg weakness and possible arthritis. I continue to give him 1 Dasuquin supplement per day. Don't see a ton of change but I am not too sure? Sometimes when he gets up his bones creak like an old man. It's so strange. I just hope over the next year or 2 it doesn't get worse but I am sure it will...

I will report back with his STIM results after I get them.

Regards,
Jennifer

[Squirt's Mom]

Thanks for the great update, Jennifer! It's always good to hear a pup is doing well! My Bud is a larger dog, for me anyway at 50 lbs, and he is starting to show some signs of arthritis. I worry about being able to handle him physically if he gets bad....I don't know that I can lift him and I too live alone so I hope neighbors will be around if that time ever comes. I've got him and my Pug on Glycoflex III and it does help but I'm looking at other things to add as time passes.

Do let us know the test results when they come in. Based on the signs that are still present he may need a little increase. But the numbers will let us know.

Hugs,
Leslie

[jenner1026]

Hi lovely friends! I hope everyone is well. I visit from time to time - you all are so helpful and amazing.

An update on Jet (not a great one but could be worse....):

Jet had been doing pretty solid on Vetoryl for the last year. Taking 60 mg in the am and a rotation of 30 and 60 in the pm. He had 3-4 ACTH tests in a row that came back perfectly in range. Was doing tests every 4 months.

Always eating and drinking like crazy - I could barely get his bowl on the floor and he would be barking and barking for his food! Peeing a lot. Normal bowels.

I went on vacation in July and returned on August 7th. Since I have been back he has slowly lost interest in food and water. He gets a combination of Hills Rx wet food (which he will mostly eat) and rx kibble (which he does not). He also has started having arthritis so he is on 1 dose of Rimadyl as well. That is working well for his arthritis. For a dog who went from being so ravenous to this - it's just simply odd!! He sleeps a ton now too and doesn't want to get up in the mornings - in the past he would cry for me to get up!

I spoke with his vet last night and she unfortunately thinks he may be suffering from a macrodenoma. Thank God you all have a wonderful thread in this forum that I have read through and understand what other pups have gone through!

Jet is almost 12....so I wouldnt do anything too extensive...but, I do think it's a good idea I get an MRI for him to see the size of his tumor and if in fact it is a macrodenoma. If so, I can figure out a treatment plan from there.

I believe the options are radiation, surgery or trying doses of prednisone with the Vetoryl to see if it would at least help and have him start eating normally again.

If anyone has any advice happy to take it! I would also like to know from others once they started seeing symptoms like these how long before it got even worse...just so I understand approximate timing. Thank you all!!

Jennifer

[labblab]

Hi Jennifer and Jet! We’re always glad to see you, but definitely wish your news was a bit different this time around :-(. It sounds like you’ve made a good start reading through the Macroadenoma thread, though. And I’ll plan to stop back by tomorrow to add a couple more thoughts. In the meantime, though, I wanted to greet you two once again. And as I say, I’ll be back.

Marianne

[labblab]

OK it's me back again. I wish I had some great words of wisdom to add, but if you've read the Macroadenoma thread, you already know the story of my own journey with my boy. If you're able to have the imaging done, I do think that may give you a greater sense of peace regarding the path forward for Jet. Since I didn't do that myself, I'll always have some question marks hanging over my head. And if the macrotumor is confirmed, perhaps the size and growth pattern will offer some clues as to timing and optimal treatment approach.

I've always thought that it's such a cruel twist of fate when this sledgehammer of a diagnosis hits after we've finally gotten the Cushing's symptoms themselves under control. It's like winning the battle but losing the war. But it is what it is. And I'm afraid that there's no set time frame that I can offer out to you. As you probably noted on that thread, there are some similarities to most all of our stories, but also individual patterns.

I do want you to know how sorry I am that you may be dealing with this, though. And I encourage you to return and update us with any additional news. Sadly, we don't have many registered members posting here any more. But I suspect there are still a number of folks who read what's written. So whenever we can add any new info or thoughts regarding current treatment approaches, I believe it's always a help to other parents as well.

Best wishes to both you and your sweet boy. And truly, also the best luck possible to you in the coming days.
Marianne

[jenner1026]

Thank you, Marianne. I am sad :( :(

[labblab]

I surely understand. I’m so sad for you, too. I’m sending healing thoughts to you all. I so wish I could do more!

[mytil]

Hi Jennifer and sweet Jet,
I do not have any experience with Macroadenomas but I wanted you to know I am truly thinking of you both. Please keep us posted.
Terry