Aloha from Hawaii - My 1st post - Navigating Ely's Cushings

[Ada & Ely]

Aloha,
I'm Ada and my dogger is Ely.
Ely is almost 11yrs, @ 40 lb "poi dog" Corgi/Shepard looking mix.

I have suspected Cushings for about a year or so and finally got the $ together and found a vet who was willing to work with me to do the testing and labs. We are on the Big Island of Hawaii and 2 hrs from the Vet I'm working with. Sigh.

I found this site a couple months ago and have been reading and learning a lot, thank you. I still have so many questions and concerns. (Also, I’ve been trying to figure this site out. I already wrote this whole post and lost it as the site signed me out, humbug!)

I figure I will start with Ely’s labs. I have them in an album called “Ely’s Labs” I just have to figure out how to add them to this post, or perhaps they are already available to view?

Ely has all the Cushing symptoms, some are more pronounced than others. His first symptoms were the muscle weakness and arthritis, slowing him down, then bot-belly, then skin issues, then increased thirst and urination, then the hunger, then the licking of this paws. More hair loss and weakened immune system.

Increased Anxiety
Mood changes - stubborn and insubordinate little dude now.
Lethargy & Depression
Increased thirst and urination - strong
Increased hunger – he is revonous!
Panting – off and on
Pot-bellied appearance to abdomen
Recurrent infections of skin, ears, eyes,
Hair loss and very slow regrowth
Licking his paws – strong impulse
Muscle weakness back lags and now front too.
Thin skin, dark pigmentation spots, black dirty skin under his chin, black bumps or nodules appearing here and there, white scaly patches, hard calcium deposits on his skin on the bald patches. The hair loss is mostly under his arm pits and flank.

He has had an abdominal ultra sound, no sign of a tumor but his liver is enlarged and unhappy. Wondering if that is from Cushings or something else. He has a heart murmur but cardiologist said that won't be the end of him, I think implying the liver and possible Cushings might take him first.

I will start with this post and then add another post with my questions and update on what is happening with Ely and where we are at. As next steps is where I’m looking for some guidance.

Thank you in advance for all your time and energy. From what I’ve read so far you all are so knowledgeable, supportive and kind. Please be patient as I learn how to post on this forum.

Warmly,
Ada & Ely

[labblab]

Dear Ada,

Hello and welcome to you and sweet Ely! I will return later on today and write a much more detailed reply, but I wanted to quickly welcome you and to reassure you that you’ve uploaded all the photos and lab info perfectly. There’s no need for you to try to include them in a reply because they’re easily available for us to view them in your photo album. You’ve done a wonderful job of introducing Ely to us and also summarizing his current situation. Even at just a quick glance at all the info, he definitely appears to be a Cushpup. So I’m delighted that you’ve found us and started posting! As I say, I’ll return later after I’ve had a chance to review all of his results. In the meantime, he looks like such a sweet, sweet boy!! For sure, we’ll do our very best to help you guys with our feedback and suggestions.

So once again, welcome, and stay tuned…
Marianne

[Ada & Ely]

Thank you for your warm welcome and reply Marianne,
Take your time : )

I'm going to add some more info now about where we are at.
Ely has been diagnosed with Cushing’s and it looks like he is Hypothyroid as well.

Hypothyiroid:
Is the Chushing’s causing the Hypothyroid or vice versa? Or is this independent of the Chushing’s? Will the Hypothyroid resolve once on Vetoryl? Should I start treating both or start with the Vetoryl and then treat the Hypothyroid if it doesn’t resolve? Is this a common combination for dogs with Cushing's?

Vetoryl:
My Vet started (40lb) Ely on 60 mg of Vetoryl once a day. (I was already nervous about this thinking it was too much, but wanted to be compliant, and this was before I read about larger dogs needing less Vetoryl. He had a strong negative reaction. First day he was lethargic but not too bad, second day he was really out of it, didn’t want to eat, which is crazy for him, he had diarrhea, was nauseous, disoriented and very weak, it was super scary. So, I stopped the Vetoryl of course and told my Vet right away. I read your site and found the dosing for larger dogs study and sent it to my Vet.

The vet has now given us 30 mg to try. I’ve been waiting for him to fully recover and feel better before I start. I seems like he was a little better a few days after I stopped the Vetoryl, as if a lower amount was lingering in his system and having a good effect. Has anyone found that to be the case? The Drug maker says it only lasts 24 hrs but I think it might last longer? (Curious)

So… I haven’t started the 30 mg yet, I’m a bit nervous. Was going to give it a try here soon after I got some feedback from the forum. Are there other 40 lb dogs that have done well on 30 mg of Vetoryl?

Paw Licking:
Cushing’s or environmental allergies or nervous discomfort, arthritis? I’ve been wondering because before the Cushing’s he never did this. Thoughts?

Trifexis:
Ely has been on this because of the heartworm in Hawaii and he snatches up all sorts of poop, chicken, goat, cat, to name a few. Grose. But it’s really hard to control so the worm med is important too. If he wasn’t so ravenous all the time maybe his interest in poop would subside?
My question is – Is Trifexis ok for Cushing’s dogs and his enlarged liver status? He seems to tolerate it well. I don’t like feeding him poison, but don’t want him to get heartworm or parasites either.

(Also, I now have 28, 60mg capsules of Vetorly I can’t use. Is there a thread or contact where we can trade or sell to other members who need it? it was about $100 for 30 caps, sigh. Or should I hold on to it in case Ely’s tolerance changes?)

Diet:
My next line of questioning is about diet and herbs and what folks have found effective and or helpful? My boy’s belly has really been sensitive lately. I would love to move to fresh food, but don’t want to over whelm his system right now. Also if I start the meds I want to be sure I'm isolating a single change at a time. He’s been doing ok on Canidae Salmon & Sweet Potato (dry kibble) for a while now. If you can guide me to a "Diet for Cushing's" thread if one exists I would be grateful.

Sorry for bombarding you with questions! If you can guide me to other threads that’s helpful too.

Thank you again for all your help.
Warmly,
Ada & Ely

[labblab]

Hi again!! I apologize so much that it will be tomorrow before I can get back here with a more informative reply. This has just turned out to be a busier day for me than I expected. But your questions are excellent, and I certainly intend to return tomorrow!

Talk to you then!
Marianne

[Joan2517]

Hi and welcome from me, too. My Gable was very sensitive to the Vetoryl. He was 80lbs when finally diagnosed, but we started him on 40mg. He did okay for about a year, but then needed to stop and restart at lower, I think it was 10mg. He wound up staying at 5mg for a couple of years. Lower is better as you can always increase the dose in increments to find the right balance.

[labblab]

OK, here I am — I made it back! Once again, thanks for all the great background info you’ve provided. There is such a lot here that I won’t be able to address everything in detail in one reply. But let’s start with some of the most important points, including your specific questions. I truly have no doubts about Ely’s Cushing’s diagnosis. He suffers from so many classic observable symptoms as well as lab abnormalities. In terms of his labs, he has elevated liver markers, elevated platelets, and abnormal white blood cell counts that correspond with a pattern called a “stress leukogram,” caused by the presence of elevated circulating corticosteroids. Among the observable symptoms are the presence of those white calcifications on his skin. Although a skin biopsy would be needed for total confirmation, those bumps definitely look to me to be “Calcinosis Cutis,” which is almost uniquely associated with elevated cortisol. There can be a few other causes, but when seen in a dog who exhibits other Cushing’s symptoms, it’s virtually a certainty that high cortisol is the culprit.

So in terms of symptoms, sadly Ely seems to be a poster child for Cushing’s, and it is no surprise to me that his diagnostic LDDS test was positive for the disease. One note about those LDDS test results: the pattern that Ely exhibited can be found in dogs that suffer *either* from an adrenal tumor or a pituitary tumor. But since you report that he’s had an abdominal ultrasound and no tumor was seen, we’ll assume that he’s indeed suffering from a pituitary tumor.

Moving on to your questions. First, let me stress that I am not a vet, so my thoughts are that of a layperson. But based on my many years on this forum, here’s what I’m thinking. We’ll lead off with Ely’s low T4 level. As it sounds like you’re already aware, low thyroid readings can be secondary to certain conditions such as Cushing’s. If that’s the case, supplementation may not be necessary and the thyroid levels can normalize on their own once the primary problem has been treated. In Ely’s case, though, he had a high TSH level in combination with his low T4. I believe this pattern is more commonly found when a dog truly suffers from hypothyroidism in its own right, and supplementation may indeed be helpful to him. If money was no issue, a specialized thyroid blood profile could be very helpful in sorting things out. For instance, here’s a link to Michigan State’s information page about thyroid testing. They are nationally known for their expertise, and if you can plow through this page, you’ll know a lot more about canine thyroid function! However, I’m guessing you’re needing to make careful decisions about how to spend your money on testing. What does your vet think about thyroid supplementation?

https://cvm.msu.edu/vdl/laboratory-sections/endocrinology/thyroid-function-in-dogs

Next, regarding the Vetoryl dose, I’m so glad Joan has told you about her experience with her big boy, Gable. Dogs truly react to Vetoryl in a very individualized way depending upon how they metabolize the medication. As Joan can attest, we’ve seen big dogs stabilized on very small doses, and little dogs that require quite large doses. That’s why the monitoring testing is so important, and why starting low and working up is the preferable way to go. And as you’ve unfortunately discovered, aside from safety reasons, it’s better to start with lower dose capsules that you can combine as opposed to being stuck with higher dose capsules that you can’t use. We don’t permit folks to offer out medication for sale or exchange here on the forum, but I’ll send you a message later with a suggestion or two.

Paw licking is a interesting question. My own Cushpup licked his paws obsessively until we started treating him with Vetoryl, and then he magically stopped. So I’d be tempted to say there must have been some connection, but my two subsequent non-Cushing’s girls have also been pretty intense paw-lickers, as well. So I truly have no answer to that.

As far as Trifexis, I’m unaware of any contraindication to using it in Cushpups, but I’m betting you can contact the manufacturer to see if their own research would point to any concerns. I always continued to give my own Cushpup his heartworm and intestinal worm medicine because we live in an area where heartworm is very widespread, as well.

And lastly, I will punt to another one of our staffers, Leslie, regarding your questions about diet and supplements because she is far more knowledgeable than I am in those areas. I’m hoping she’ll be stopping by soon to chime in about those questions as well as any other thoughts about Ely’s situation.

OK, I’ll go ahead and close for now, but hopefully this will get us started!
Marianne

[labblab]

I forgot to add one other observation from his labwork. I see that the specific gravity of his urine is low (dilute urine is indeed typical of Cushpups), and that blood was detected in his urine. The blood would be typical of a urinary tract infection, which is also very common with Cushpups. The presence of bacteria can be hard to initially identify in dilute urine samples, so performing an actual extended culture is often recommended for Cushpups with suspected UTIs. An untreated UTI could certainly contribute to excessive thirst and urination, so this might be another issue to discuss with your vet unless you’ve already done so and ruled it out.

[Ada & Ely]

Wow, Thank you for all your info so far. You too Joan.
I understand more now. It seems like every dog is unique when it come to how their body is in balance and metabolizes, and dosing can be very tricky.

Marianne, thank you! I will look into the extended urine culture, that makes sense. I'm trying to be as respectful as I can with my Cushing Vet & clinic to help suggest things with out rubbing them the wrong way, and letting them know I've been reading a lot. It's a dance for sure.

Well I gave Ely his first 30mg Vetoryl today! And so far I don't see any adverse effects. If he continues to have a good day I will administer again tomorrow. I'm not sure how soon I should expect to see any change? The adverse effects came on fast. So I will keep a close watch and report back. I will have his levels checked in 14 days if all goes well, and post them here.

One other thing I didn't share was about his Hypothyroid. Ely's hometown Vet, (The one in my town that we see for common things but not his Cushing Vet.) Did believe he was Hypothyroid as well and gave us some little blue thyro-tabs. I was afraid to start these without knowing more about his Cushing's first. So I believe Marianne, you are saying, wait to see if the thyroid level nornmalize on the Vetoryl first? But, like you said,...

"In Ely’s case, though, he had a high TSH level in combination with his low T4. I believe this pattern is more commonly found when a dog truly suffers from hypothyroidism in its own right, and supplementation may indeed be helpful to him."

So, I thought I had done the most intensive Thyroid panel there was, guess not. Darn. I will try and read the Michigan State paper on Thyroid Testing, looks in-depth and fun, ugh. The hormone cascade is confusing and complicated indeed. I will talk this over with my Cushing Vet in a couple weeks or email her about that.

I found the fb group on Calcinosis Cutis! This will be helpful too. Ely's isn't that bad, but it will be good to nip it in the bud before it does. And I'm looking forward to some guidance on diet and herbs from Leslie!

Looking forward to learning more as Ely and I move through this together and with you all. We don't feel so alone now. This is meaningful what you all are doing here!

Mahalo nui loa,
Ada & Ely

[Joan2517]

Gable was also hypothyroid and taking soloxine along with the vetoryl. We started thyroid meds before he was finally diagnosed with Cushing's. It took a while to get his hypothyroidism under control along with the vetoryl. When his cortisol dropped dangerously low and we had to stop the vetoryl (which was 40mg or 30mg, I can't remember), it was due to the dose of soloxine being too much, which we lowered. We also lowered the vetoryl.

All of this just shows that testing and changes in dosing will happen and is normal in treating Cushpups. As time-consuming and nerve-wracking as it is, I would do it all over again if I could have my Lena and Gable back.

[labblab]

Hello again! Thanks so much for posting those earlier thyroid results for comparison purposes. They look to be the complete kind of panel that I was talking about, and with the addition of the new testing, you may already have all the info you need to go forward in terms of supplementation. His TSH was already slightly high in the earlier testing, and even higher now in addition to the low T4 readings. I sure wish I was more knowledgeable about thyroid treatment myself, because it looks to me that he *is* hypothyroid, but I’m no expert in analyzing the results. In conjunction with what Joan has written above, here’s one thought to throw out there, though. Maybe go ahead and give Ely a few weeks to get his cortisol lowered and controlled with the Vetoryl, and once he’s stabilized on the Vetoryl you can retest his thyroid so as to better assess whether/how much thyroid supplementation would be optimal for him. If he’s truly hypothyroid, it does seem a shame to hold off on supplementing right away. But sometimes juggling too many moving parts all at once can lead to some degree of confusion. So that’s just a thought that I have.

We started my own Cushpup on thyroid meds before we had even confirmed the Cushing’s and without the benefit of the kind of advanced profile that you have for Ely. And unfortunately, once you’ve actually started thyroid supplementation, thyroid blood panel results will be skewed in terms of diagnostic value. You have to stop the supplementation for a time if you want more diagnostic info. We never ended up stopping his thyroid meds, but we also never knew his true thyroid picture — whether he was genuinely hypothyroid or whether his levels were low due to Cushing’s. I guess it didn’t really matter since the supplementation kept his thyroid readings in normal range. But I do think back on my own experience and will always have questions about it, myself.

Anyway, I hope Ely is continuing to tolerate the 30 mg. well. You’re doing a great job, mom — hang in there!!

Marianne

[Ada & Ely]

Thank you Joan & Marianna,

Couple more questions...

So, Ely is on day 3 of the 30mg am dose. He seems pretty much the same, his appetite sure hasn't changed, he seems just as ravenous as ever. On the 60 mg he didn't want to eat at times, so I know at lest it's not too much. He ran a bit on our walk today which was nice but not unheard of pre Vetroyl. He seem himself, but still his "Cushing self'. I will keep watching for other signs. I have read from some that it can take some days or weeks to see results. He was doing pretty good before we started treatment, so I almost didn't want to start with the 30mg. I wonder if cortisol levels are just always changing? I believe from his last labs his level is not crazy high, so can they drop rise naturally from time to time? I will talk to my Vet on our first visit to test his levels, about his hypothyroid. Unfortunately she hasn't been super on top of her Cushing's treatment research. So I will try to explain some of what I learned and discuss next steps.

Still no data on diet from Leslie... Just so curious how I can support him better that way. I have read so many contradictory things on it. Also looking to learning about treating his skin issues, I read that Neosporin is ok to put on his leasions, any thoughts on skin care? Medicated shampoos, salves or creams?

Thank you so much!
Ada & Ely

[Ada & Ely]

Another important question:
I have read a few post about this:

Quivering/tremors on Vetoryl?

After that first couple doses of 60mg that were too high, his lower jaw started to quiver at times. He use to do this in anticipation of getting out of the car to poop and hike, out of excitement. But that was a few years ago, pre Cushing's. He came up to me this morning pre oil and breakfast with the quivering jaw, this is 24 hr post pill. So I'm just wondering about the possibility of the quivering jaw and other tremors of his back legs, which he has had before from the arthritis & weakness I thought was symptoms of the Cushing's. Just seeing if this might be an average symptom or a reaction from the Vetoryl or a bad one which I should be careful of & stop the Vetoryl!? I'm about to give him his 4th dose of 30mg with his morning breakfast. I'm so nervous about making him feel worse then when not on Vetoryl. And Yes we are too very watchful eagle eyes at this stage looking for any and all changes!

Is it possible to look or see more Cushing's-y symptoms from the Vetroyl?


Sorry I have so many questions and I'm so apprehensive.

Thank you for any reassurances,

Ada & Ely

[labblab]

Hi again, Ada! I definitely understand your anxiety re: all this stuff, and especially about starting the Vetoryl treatment. As far as Ely's jaw quivering, I don't have any explanation for that. I personally would guess, though, that it's unrelated to the medication, especially since you saw it happening on occasion some years back. And as far as the hind leg quivering, like you, I would tend to think that's due to muscle weakness from the Cushing's or discomfort from arthritis. So unless you see something changing significantly in that regard, I would continue giving the Vetoryl. I know that throughout the years, we've had several folks comment about seeing weird shivering episodes in their Cushpups (myself included!). In most of these cases, though, the episodes seem to be different from what you're describing, in that they tend to involve shivering around the neck and shoulders, and down the back. In those instances, sometimes the episodes preceded treatment and sometimes they were subsequent to treatment. Bottom line is that I still don't know any specific explanation for those types of episodes. But as I say, trembling of the hind legs is not at all uncommon for Cushpups due to muscle weakness. So unless you see a significant change in his legs or jaw, I would be continuing with the Vetoryl.

You had asked earlier about the timeframe for seeing improvements. And yep, it can really vary. Typically, improvements in thirst/urination/hunger will precede improvements in muscle strength, skin issues, and coat. The former can get better within the first couple of weeks if the cortisol level is being lowered sufficiently; the latter can take a few months. Calcinosis Cutis especially can take a longer time than you'd wish to improve. I'm very glad you've found the Facebook CC group, because it sounds as though they will be able to offer you the most comprehensive suggestions in terms of treatment and skincare. I'm guessing you've already seen our related thread here, and that's probably where you found out about the Facebook group. But if not, here's the link to our forum thread:

https://www.k9cushings.com/forum/showthread.php?8909-Calcinosis-Cutis-treatment-thread

I wish I could give you some specific suggestions myself re: shampoo or lotions, but as I say, the Facebook group will be much more up-to-speed about those things. Also, I'll try to flag Leslie to let her know that you're hoping to get some feedback re: nutrition and supplementation, as well.

I hope I've addressed most of the things you're wondering about today, but if not, don't hesitate to give another holler since I'll keep circling back. You can never ask too many questions -- that's what we're here for! But for right now, I think you're good to go in terms of continuing with the Vetoryl unless you start seeing other negative changes.

Marianne

[Ada & Ely]

Marianne,

Thanks again, especially for making me feel so comfortable about asking questions!

Today was not a good day for Ely. The jaw quivering was really bad, off and on all day. Like I said before he hasn't done this for quite a few years and when he did it was minimal and around something exciting. I'm only seeing it again now since we started the Vetoryl, and there wasn't anything to be excited about today. Also his eyes where real droopy and red cognitive tissue. He ate but just picking at his food, super low interest, but was ok with treats. He didn't seem interested in drinking, I know that his desire to drink will lessen with the meds but this was a bit much. He seemed out of it, physically slow, uncoordinated, didn't want to go for a walk this morning, which is unheard of. He seems really scared of everything, high anxiety. His stool was solid but some mucousy blood in it. He was also panting quite a bit, more Thant usual, and it's been a very cool day here in Hawai'i, in the low 70's. I'm going to stop the meds again. I think it is still too high. He seems way better off it, then on it. I will take another break and see if he comes back to his baseline, then maybe I should just start with 5 mg and see how he reacts for a few days, then I can go up from there. I really wish we started at 5mg. Ugh.

Tonight he seems a little bit better, but still a bit out of it and sluggish.

Would love to hear your thoughts

[labblab]

I totally agree with stopping the Vetoryl under these circumstances. I’m so sorry you two are having such a rollercoaster ride at the moment!! It does sound as though Ely is very sensitive to the Vetoryl, and that restarting at a much lower dose ultimately would be the way to go. If he doesn’t bounce back quickly this time around, I’d ask your vet for some low dose prednisone to bridge the gap until his natural cortisol production rebounds again. But hopefully you’ll see him returning back to baseline on his own within another day or two. Please do keep us updated!

[Joan2517]

I would stop it, too. Starting up again at 5mg sounds good. Can you get a resting cortisol test done just to see what his levels are at? That is what I always did with Gable when this happened with him. At one point we even discussed lowering it to a compounded 2.5mg, but the 5mg worked and he was on it for years.

[Ada & Ely]

Aloha again!
Thank you for your feedback. He seems so much better already today! I will talk to my Vet today and work though a plan. I fully believe I should get a resting Cortisol test to see where he is before I start again. And I'm defiantly going to suggest we start at 5mg.

I will let you know what we come up with and how it goes from here.

Thank you!
Ada & Ely

[Squirt's Mom]

Hi Ada,

Welcome to you and Ely! Sorry for the delay in getting with you. Diet will have no impact on the disease itself but a good diet can help a host of issues in general. The issue for our cush pups is just what you mentioned....not making too many changes early in treatment. The signs of the cortisol going too low are the same as is often seen with diet changes - digestive upsets. So any change in diet needs to be made after the pup is settled on a dose for treatment and doing well. Then the main thing you want to look for is the fats. While there is no real clear-cut connection between fats, Cushing's, and pancreatitis, it does seem that cush pups are more prone to this condition in general so we still try to keep the fats at the low end of the scale - typically less than 17% of calories from fat. Unless there is another condition that IS dependent on diet like diabetes, IBD, etc. there is really no need to worry about diet for a cush pup. Whatever food works best for your baby is the best diet for your baby...and diet is highly individualized for them just as it is for us. With Ely having a sensitive tummy I can understand wanting to look into something other than commercial kibble (dry foods) as wet foods are typically easier to digest. If you are interested in home cooking I can recommend two good canine nutritionist who can design a diet for your baby based on HIS specific needs and things like environment etc. They are Monica Segal and Jody Zesko. You can find Monica here:
https://www.monicasegal.com/

You can find Jody here:
https://www.spotoncaninenutrition.com/

I have used diets by Monica in the past and am currently feeding a diet by Jody. All the dogs have done very well and both ladies have been easy to work with. They will make sure the diet is balanced using supplements and vitamins as needed so we aren't left trying to figure that gigantic puzzle out ourselves!

As for herbs and supplements, I use them for specific purposes for the most part such as things to support joint health like GlycoFlex or Dasaquin, SAMe for liver support, melatonin to help relax as needed, PS100 for mental acuity. Herbs again would be specific such as milk thistle or schisandra for liver support but there are some you should steer clear of with a cush pup. Dandelion is often included in OTC products such as CushX, Adrenal Harmony, etc touted to "treat" Cushing's but dandelion is a diuretic and our babies are already peeing enough so I don't like to use this herb with my cush babies. Another is Ashwaghanda, and another is licorice....both of these herbs are adrenal stimulants used to treat Addison's which is the opposite of Cushing's. But the same applies to supplements and herbs as to food....you don't want to make any changes or additions in the beginning of the Cushing's journey unless absolutely necessary in order to prevent confusion. If you have any questions about a particular herb I'll be glad to try to help...just ask.

Hugs,
Leslie