Sausage Dog with ? Cushings

[Pinkcat]

Hi I’m new to this and forums but need a bit of help. I have a 5 and a half year old sausage dog who has many symptoms of cushings, so much so that a vet specialist said if she had a room full of students she would expect them to diagnose her through looking at her alone. She is having the tests this week to confirm but has significant hair loss, pot belly some muscle weakness around her head and no longer wants to go for walks but is eating drinking can do the stairs and happily plays with toys running round and chasing them at home and isn’t excessively urinating. My questions are how do we know how long we will have with her approximately (ie what stage is she at) and we’re trying cbd oil does anyone have experience of it. We also know she will need medication but has allergies she’s been treated for her whole life so the extra steroid has left her skin much better than before. Thank you for any advice

[Joan2517]

Welcome to the forum. Could you post any blood work she has had done here, please? Just the highs, lows with the reference ranges. You mention that she's been on steroids her whole life, is she still? And on what dose? Steroids will skew any testing for Cushing's as it raises the cortisol anyway. Cushing's dogs will drink and pee excessively, does she do that? Others who are more knowledgeable than I am will need this information to try to help you and answer some of your questions.

We look forward to learning more about your little girl.

[Pinkcat]

Welcome to the forum. Could you post any blood work she has had done here, please? Just the highs, lows with the reference ranges. You mention that she's been on steroids her whole life, is she still? And on what dose? Steroids will skew any testing for Cushing's as it raises the cortisol anyway. Cushing's dogs will drink and pee excessively, does she do that? Others who are more knowledgeable than I am will need this information to try to help you and answer some of your questions.

We look forward to learning more about your little girl.

Hi she’s getting the blood work done on Wednesday I’ll ask for results and post. She’s been on apoquel since being about 15 weeks old but I believe these are NSAIDS - she’s had the odd injection of steroid when skin flared up over the years and some topical use of human steroid cream during flare ups - but nothing excessive - she also tried densensitisation through injections but was stressful. She drinks a fair bit maybe 4 small bowls a day but doesn’t excessively wee - had one episode of weeing indoors in October but under care of our dog nanny so stress levels up and had a bad urine infection in august which had blood in for a while treated with antibiotics. I’ll get blood work this week - thanks for replying

[labblab]

Hello and welcome from me, too! I’m so glad Joan has had the chance to greet you already, and I’ll also be back, probably tomorrow, when I’ll have more time to write. But I wanted to be sure and say hi to you and your sweet girl today!

We’re so glad you’ve found us, and I’ll be back.
Marianne

[labblab]

OK, here I am back again! Mainly, right now I want to reassure you that we’ve had many dogs on the forum who have done well and lived out their natural lives subsequent to starting Cushing’s treatment. For a dog your little girl’s age, not only are we hoping to improve observable symptoms, but we’re also hoping to halt the progression of possible longterm internal damage that the disease might cause. So it’s great that you’re going forward with the testing at this stage. You’re right that for dogs with allergies, lowering the elevated cortisol can be a double-edged sword. But hopefully some additional skin treatments can end up being added if her allergies start to flare again.

Right now, the most important thing is to gather as much information as you can, which is exactly what you’re doing. Before launching into a lot more discussion, though, it probably makes sense to wait until we get the results of her tests on Wednesday. That will help us to focus our attention on the most pressing issues. So once again, I’m going to hold off on saying a lot more today.

Do let us know how the testing turns out, though, and we’ll go from there!
Marianne

[Pinkcat]

OK, here I am back again! Mainly, right now I want to reassure you that we’ve had many dogs on the forum who have done well and lived out their natural lives subsequent to starting Cushing’s treatment. For a dog your little girl’s age, not only are we hoping to improve observable symptoms, but we’re also hoping to halt the progression of possible longterm internal damage that the disease might cause. So it’s great that you’re going forward with the testing at this stage. You’re right that for dogs with allergies, lowering the elevated cortisol can be a double-edged sword. But hopefully some additional skin treatments can end up being added if her allergies start to flare again.

Right now, the most important thing is to gather as much information as you can, which is exactly what you’re doing. Before launching into a lot more discussion, though, it probably makes sense to wait until we get the results of her tests on Wednesday. That will help us to focus our attention on the most pressing issues. So once again, I’m going to hold off on saying a lot more today.

Do let us know how the testing turns out, though, and we’ll go from there!
Marianne

Daisy had the tests yesterday for thyroid and to test for cushings - two tests for cushings an hour apart. The vet has rang and said that both have come back normal but she herself would have predicted they would be positive from looking at her. She has offered a third test that may pick it up which daisy has to go in for the day and have three tests done throughout the day. We will pay to have this done but it will be traumatising for Daisy - any advice please ? How can she look so cushings like but be negative - any differentials anyone may know of please ? Thanks

[labblab]

Thanks so much for returning with Daisy’s test results, and yes, I hope I can help you make more sense of things. There are two different blood tests that vets can perform when attempting to confirm a Cushing’s diagnosis. Each one has different strengths and weaknesses. It sounds as though Daisy first had the ACTH stimulation test, which involves first taking a baseline blood sample, then injecting an agent designed to stimulate the production of cortisol produced by the adrenal glands, and then taking a second cortisol reading one hour later. The strength of this test is that a “positive” result on this test is pretty specific to Cushing’s, meaning you can place a fair amount of trust that a dog with a positive result truly has Cushing’s. The weakness is that a significant number of dogs who *do* have Cushing’s will turn up with a “false negative” result on this test, especially if their disease is caused by an adrenal rather than a pituitary tumor.

The second test, a Low Dose Dexamethasone Suppression test (LDDS), reverses this scenario. This means that it is less likely to miss making a Cushing’s diagnosis in a dog who does have the disease. But it is more likely than the ACTH to come back with a “false positive” result in a dog who is suffering from some disease or illness other than Cushing’s that is placing stress on the dog’s system. This is the 8-hour test that your vet wants Daisy to take now. It involves a baseline cortisol draw and then two subsequent blood draws after an agent is injected that suppresses cortisol production in normal dogs. In Cushpups, so much cortisol is being produced that it ultimately breaks through the suppression by the end of the test.

Since Daisy seems to exhibit many outward symptoms that are consistent with Cushing’s, I do understand why your vet is suggesting this further testing for confirmation. For Daisy’s sake, if she does have Cushing’s, it’s too bad that she didn’t test positive on the ACTH the first time around to save the additional testing. However, one additional advantage to the LDDS is that the pattern of the test results (if positive) can often differentiate as to whether the dog has a pituitary or adrenal tumor.

Subsequent to Daisy’s ACTH, the only alternative to the LDDS that I’m aware of would be a urine test called a UC:CR, or Urine Cortisol to Creatinine Ratio. This test involves measuring cortisol that is found in the urine. We’ve been told by specialists that the best way to get reliable results on this test is for the owner to collect a sample of the dog’s urine first thing in the morning on three successive days — at home — and then to pool and refrigerate the three samples to be taken to the vet for analysis. There should be as little stress as possible for the dog or else the test will be skewed. This is why the samples should be gotten at home and not at the vet’s. Cushing’s can be definitively ruled out for a dog with a normal result on this test. A dog with an elevated cortisol result may have Cushing’s, but a further test would be required for confirmation. In Daisy’s case, this would be the LDDS that we talked about above. So since you might find yourself right back at this place again, I don’t whether the intermediate step of the urine sampling would seem worth it to you to even consider or to discuss further with your vet.

I hope all this makes some sense to you, but please don’t hesitate to ask any more questions that come to mind. I know all this testing is stressful to both you and Daisy, and for that I’m so sorry!

Marianne

[Pinkcat]

Thanks so much for returning with Daisy’s test results, and yes, I hope I can help you make more sense of things. There are two different blood tests that vets can perform when attempting to confirm a Cushing’s diagnosis. Each one has different strengths and weaknesses. It sounds as though Daisy first had the ACTH stimulation test, which involves first taking a baseline blood sample, then injecting an agent designed to stimulate the production of cortisol produced by the adrenal glands, and then taking a second cortisol reading one hour later. The strength of this test is that a “positive” result on this test is pretty specific to Cushing’s, meaning you can place a fair amount of trust that a dog with a positive result truly has Cushing’s. The weakness is that a significant number of dogs who *do* have Cushing’s will turn up with a “false negative” result on this test, especially if their disease is caused by an adrenal rather than a pituitary tumor.

The second test, a Low Dose Dexamethasone Suppression test (LDDS), reverses this scenario. This means that it is less likely to miss making a Cushing’s diagnosis in a dog who does have the disease. But it is more likely than the ACTH to come back with a “false positive” result in a dog who is suffering from some disease or illness other than Cushing’s that is placing stress on the dog’s system. This is the 8-hour test that your vet wants Daisy to take now. It involves a baseline cortisol draw and then two subsequent blood draws after an agent is injected that suppresses cortisol production in normal dogs. In Cushpups, so much cortisol is being produced that it ultimately breaks through the suppression by the end of the test.

Since Daisy seems to exhibit many outward symptoms that are consistent with Cushing’s, I do understand why your vet is suggesting this further testing for confirmation. For Daisy’s sake, if she does have Cushing’s, it’s too bad that she didn’t test positive on the ACTH the first time around to save the additional testing. However, one additional advantage to the LDDS is that the pattern of the test results (if positive) can often differentiate as to whether the dog has a pituitary or adrenal tumor.

Subsequent to Daisy’s ACTH, the only alternative to the LDDS that I’m aware of would be a urine test called a UC:CR, or Urine Cortisol to Creatinine Ratio. This test involves measuring cortisol that is found in the urine. We’ve been told by specialists that the best way to get reliable results on this test is for the owner to collect a sample of the dog’s urine first thing in the morning on three successive days — at home — and then to pool and refrigerate the three samples to be taken to the vet for analysis. There should be as little stress as possible for the dog or else the test will be skewed. This is why the samples should be gotten at home and not at the vet’s. Cushing’s can be definitively ruled out for a dog with a normal result on this test. A dog with an elevated cortisol result may have Cushing’s, but a further test would be required for confirmation. In Daisy’s case, this would be the LDDS that we talked about above. So since you might find yourself right back at this place again, I don’t whether the intermediate step of the urine sampling would seem worth it to you to even consider or to discuss further with your vet.

I hope all this makes some sense to you, but please don’t hesitate to ask any more questions that come to mind. I know all this testing is stressful to both you and Daisy, and for that I’m so sorry!

Marianne

Thank you so much for explaining this. We will just go ahead with the next set of tests and see what that brings - thanks again - so good to be able to run this by someone who knows ! Xxx speak soon

[Pinkcat]

Thanks so much for returning with Daisy’s test results, and yes, I hope I can help you make more sense of things. There are two different blood tests that vets can perform when attempting to confirm a Cushing’s diagnosis. Each one has different strengths and weaknesses. It sounds as though Daisy first had the ACTH stimulation test, which involves first taking a baseline blood sample, then injecting an agent designed to stimulate the production of cortisol produced by the adrenal glands, and then taking a second cortisol reading one hour later. The strength of this test is that a “positive” result on this test is pretty specific to Cushing’s, meaning you can place a fair amount of trust that a dog with a positive result truly has Cushing’s. The weakness is that a significant number of dogs who *do* have Cushing’s will turn up with a “false negative” result on this test, especially if their disease is caused by an adrenal rather than a pituitary tumor.

The second test, a Low Dose Dexamethasone Suppression test (LDDS), reverses this scenario. This means that it is less likely to miss making a Cushing’s diagnosis in a dog who does have the disease. But it is more likely than the ACTH to come back with a “false positive” result in a dog who is suffering from some disease or illness other than Cushing’s that is placing stress on the dog’s system. This is the 8-hour test that your vet wants Daisy to take now. It involves a baseline cortisol draw and then two subsequent blood draws after an agent is injected that suppresses cortisol production in normal dogs. In Cushpups, so much cortisol is being produced that it ultimately breaks through the suppression by the end of the test.

Since Daisy seems to exhibit many outward symptoms that are consistent with Cushing’s, I do understand why your vet is suggesting this further testing for confirmation. For Daisy’s sake, if she does have Cushing’s, it’s too bad that she didn’t test positive on the ACTH the first time around to save the additional testing. However, one additional advantage to the LDDS is that the pattern of the test results (if positive) can often differentiate as to whether the dog has a pituitary or adrenal tumor.

Subsequent to Daisy’s ACTH, the only alternative to the LDDS that I’m aware of would be a urine test called a UC:CR, or Urine Cortisol to Creatinine Ratio. This test involves measuring cortisol that is found in the urine. We’ve been told by specialists that the best way to get reliable results on this test is for the owner to collect a sample of the dog’s urine first thing in the morning on three successive days — at home — and then to pool and refrigerate the three samples to be taken to the vet for analysis. There should be as little stress as possible for the dog or else the test will be skewed. This is why the samples should be gotten at home and not at the vet’s. Cushing’s can be definitively ruled out for a dog with a normal result on this test. A dog with an elevated cortisol result may have Cushing’s, but a further test would be required for confirmation. In Daisy’s case, this would be the LDDS that we talked about above. So since you might find yourself right back at this place again, I don’t whether the intermediate step of the urine sampling would seem worth it to you to even consider or to discuss further with your vet.

I hope all this makes some sense to you, but please don’t hesitate to ask any more questions that come to mind. I know all this testing is stressful to both you and Daisy, and for that I’m so sorry!

Marianne
Hi again, daisy is booked in for second round of tests on wed next weekbut I ve just noticed something on daisy tonight - it’s top of her chest into her neck a purple black big what looks like a thick bruise ! Has anyone experienced this - id upload a pic but not sure how - just checking this isn’t an emergency really

[labblab]

It does sound like a bruise, but I don’t know why she’d be bruised in that location. Since she had blood testing done on Wednesday, I’d think she might have bruising from that, except I think this would be a strange location for them to have given her an injection or drawn blood. To be on the safe side, I’d contact the vet if you can in order to get their thoughts about it.

Marianne

[Squirt's Mom]

They often had to take blood from my Squirt's neck because her veins were small and moved around quite a bit. Her neck was often bruised as a result but the bruising never went down into the chest area. Please let us know what the vet has to say about this. If your baby isn't acting as if anything is bothering them then I wouldn't worry too much but if it seems to be bothering her I would see about getting her seen sooner just in case. I'm a bit ole worry wort tho. ;)
Hugs,
Leslie

[labblab]

Thank you so much for sharing your experience with Squirt, Leslie. For all I know, blood has been drawn from my dogs’ necks, too, but their fur has always been so thick that I don’t think I’d ever see it even if they were bruised. I know *I* bruise horribly whenever blood is drawn on me, so I just expect it for myself — just never seen evidence on my dogs…

[Pinkcat]

They often had to take blood from my Squirt's neck because her veins were small and moved around quite a bit. Her neck was often bruised as a result but the bruising never went down into the chest area. Please let us know what the vet has to say about this. If your baby isn't acting as if anything is bothering them then I wouldn't worry too much but if it seems to be bothering her I would see about getting her seen sooner just in case. I'm a bit ole worry wort tho. ;)
Hugs,
Leslie

Thank you for this bit of insight - doesn’t seem to be bothering her at all just alarmed us - I will keep an eye and get checked if needed - I’ll keep you posted thank you all for being someone to ask these questions too ❤️

[Pinkcat]

Thank you for this bit of insight - doesn’t seem to be bothering her at all just alarmed us - I will keep an eye and get checked if needed - I’ll keep you posted thank you all for being someone to ask these questions too ❤️

Hi we have had daisys results back this afternoon and they are unfortunately positive and the vet said pituitary - they are doing a prescription for her to start medication on Saturday I can pick up tomorrow - she has offered surgery but didn’t really advise it but said she may do well on the medication. I must say that we now have her on full spectrum cbd for a few weeks and have a seen a good difference in how thin her coat is so we will keep going with that and vet is fine about us administering it. Any advice or guidance would be appreciated please. As for the bruise it is going down and she did have bloods taken from her neck but the vet thinks she bashed herself so not sure . Thanks again for any advice

[labblab]

I surely understand why a positive result is a daunting one for you, but the silver lining to the cloud will hopefully be that now you have a diagnosis that can support beginning helpful treatment. I’m assuming you’ll be given Vetoryl for Daisy, and my biggest piece of advice is to request your vet to start at a lower dose and work upward if needed. Research and real-world clinical experience has shown that dogs tend to experience far fewer medication side effects if they begin at a low dose and only increase if the monitoring results support it, as opposed to starting at a high dose and having to lower it if side effects are suffered. The manufacturer of Vetoryl and most specialized clinicians recommend a starting formula of no more than 1 mg. per pound, or 2.2 mg. per kilogram. So before paying for and bringing home the Vetoryl, I encourage you to check with your vet regarding the starting dosage she is recommending. Vetoryl capsules cannot be opened or split, so if you end up with a capsule dose that’s higher than Daisy can tolerate, those capsules are essentially wasted whereas smaller dose capsules can always be combined if the dose needs to be increased.

Here are some other tips re: the use of Vetoryl. Do take a look and don’t hesitate to ask about any questions!

https://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Vetoryl-(trilostane)-Dosing-amp-Monitoring-with-ACTH-Stimulation

Marianne

[Squirt's Mom]

I am assuming "sausage dog" refers to a Dachshund :D and most of the representatives of this breed are under 40 pounds in weight. BUT just in case I am mistaken on the breed OR in case you have a pup on the LARGE end of the scale....you do not want to start at more than 0.05mg per pound per day with a max dose of 30mg per day. Larger dogs seem to metabolize this drug, Vetoryl, differently requiring much smaller starting doses that are recommended in the Dechra literature. And as Marianne said, all dogs regardless of size should be started on the lowest possible dose.

The reason I want to speak up was that Dechra knows about the large dog dosing studies and refuses to change their literature. So vets are starting dogs on doses that are making them very sick....or worse. The correct starting dose is very important so do you mind sharing how much your sausage weighs and what dose of Vetoryl the vet has prescribed?

Thanks!
Leslie

[Pinkcat]

I am assuming "sausage dog" refers to a Dachshund :D and most of the representatives of this breed are under 40 pounds in weight. BUT just in case I am mistaken on the breed OR in case you have a pup on the LARGE end of the scale....you do not want to start at more than 0.05mg per pound per day with a max dose of 30mg per day. Larger dogs seem to metabolize this drug, Vetoryl, differently requiring much smaller starting doses that are recommended in the Dechra literature. And as Marianne said, all dogs regardless of size should be started on the lowest possible dose.

The reason I want to speak up was that Dechra knows about the large dog dosing studies and refuses to change their literature. So vets are starting dogs on doses that are making them very sick....or worse. The correct starting dose is very important so do you mind sharing how much your sausage weighs and what dose of Vetoryl the vet has prescribed?

Thanks!
Leslie


Hi daisy is a miniature daschund and currently weighs 6kg ( her usual is around 5.5 but has increased since her reluctance to go out- so we’re working on that once medication kicked in) she is taking a 10mg tablet once a day - vet is just doing a check up in 14 days no bloods but I assume bloods may be gone at 30 days. I am shocked that these tablets are £90 for one months supply 🙈. We are due to go to london for four days in April and daisy was going to the dog nanny does anyone think it will cause her stress levels to be too high or should we carry on as normal? Thanks

[labblab]

I’m very relieved to hear that Daisy is taking 10 mg. of the Vetoryl — that sounds like an appropriate starting dose given her weight, so that is good! And yes, as long as she is looking well with no evidence of side effects, we know that some vets are waiting until the 30-day mark to monitor the blood level. But you should definitely wait no longer than that for the first blood draw.

As far as your trip, if Daisy seems to be stable on her medication by April, I would think it would be fine for you to take your short trip unless you have reason to think that the stay with the nanny is typically upsetting to her. Otherwise, I think you should be good to go.

Good luck in the meantime, and do let us know how things are going!
Marianne

[Pinkcat]

I’m very relieved to hear that Daisy is taking 10 mg. of the Vetoryl — that sounds like an appropriate starting dose given her weight, so that is good! And yes, as long as she is looking well with no evidence of side effects, we know that some vets are waiting until the 30-day mark to monitor the blood level. But you should definitely wait no longer than that for the first blood draw.

As far as your trip, if Daisy seems to be stable on her medication by April, I would think it would be fine for you to take your short trip unless you have reason to think that the stay with the nanny is typically upsetting to her. Otherwise, I think you should be good to go.

Good luck in the meantime, and do let us know how things are going!
Marianne

Hi

Just a little update on daisy. We had started to see a great improvement in her fur regrowth even before starting the vetoryl which could only have been down to the CBD oil but there is a massive improvement now she looks lovely compared to before. She has really picked up and been getting out for a few walks and is due blood work in the morning. We have noticed over the last five days that daisys drinking has realy picked up again and she has left a bit of her tea tonight (never known!) and I wondered how quickly the improvements can tail off from the tablets please ? It may just be a coincidence though xx

[Squirt's Mom]

Hi Pink,

Can you tell us what the results of the latest ACTH or PVC test were? Daisy should have had at least 2 monitoring tests by now. That may hold the answer to your question.

In general, Vetoryl is not a stable drug meaning that the control over the cortisol can change with no warning or known cause. So a dog might do very well for some time on 30mg a day then suddenly starts peeing a lot again and the ACTH shows the cortisol has indeed risen since the last test. OR the opposite happens and the cortisol drops too low causing things like loose stools/diarrhea, nausea/vomiting, loss of appetite, and/or lethargy. This is why keeping up the testing with this drug is crucial. ;) It is the only way to have any idea of how the drug is working at that time.

So the blood work just done will hopefully let you know where the cortisol is. Bear in mind....an increase in drinking and/or peeing can also indicate the cortisol is too low so good for you to notice this change. :cool: Being observant is a very important part of treating Cushing's and it looks like Daisy's mom is doing a great job!

Let us know what the test results are when you get them!
Hugs,
Leslie

[labblab]

Hello again from me! Like Leslie, I’ll be anxious to hear how Daisy’s bloodwork turned out this week. From our earlier discussion, I’m guessing this will be her first monitoring testing done after the first month of treatment. So it’ll indeed be interesting to see where her cortisol level has landed.

That’s great that you initially were seeing positive results, but it’s true that Daisy’s dosing needs may have shifted during these first 30 days. Most commonly, cortisol levels drift downward during this initial phase. Her new lack of appetite could be caused by a cortisol drop that’s lower than is comfortable for her. Usually an increase in thirst is due to higher rather than lower cortisol. But as Leslie says, low cortisol could be the cause of that, too. So we’ll be anxious to hear how the testing turned out, and whether any dosing changes seem advisable. Do let us know.

Marianne

[Pinkcat]

Hello again from me! Like Leslie, I’ll be anxious to hear how Daisy’s bloodwork turned out this week. From our earlier discussion, I’m guessing this will be her first monitoring testing done after the first month of treatment. So it’ll indeed be interesting to see where her cortisol level has landed.

That’s great that you initially were seeing positive results, but it’s true that Daisy’s dosing needs may have shifted during these first 30 days. Most commonly, cortisol levels drift downward during this initial phase. Her new lack of appetite could be caused by a cortisol drop that’s lower than is comfortable for her. Usually an increase in thirst is due to higher rather than lower cortisol. But as Leslie says, low cortisol could be the cause of that, too. So we’ll be anxious to hear how the testing turned out, and whether any dosing changes seem advisable. Do let us know.

Marianne

Hi so the vet called and said that she needs more vetoryl and that she is upping it to 15mg per day. She starts today. She has asked to see her again in ten days but for us to go earlier if we see any of the following, lack of interest in food, depression, lethargy - unforunately because of the need for a 5 and a 10 capsule this has cost £170 for one months supply - we are insured but have a limit so once she’s settled on a dose for a few month I will move to buying online with prescription from the vet. I don’t have a copy of the results but could get one if you think it useful thanks

[labblab]

It sounds as though your vet is following recommended protocol, but yes, it’s always helpful for us to find out the actual numbers for testing results. So when you return to the vet in ten days, it would be great if you could get a copy of the numbers or at least write them down to relay to us.

My one concern right now is about her appetite — you had said earlier that she was surprisingly picky one day last week. Did that continue, or was that just a one-off?

Marianne

[Squirt's Mom]

It would be helpful if you could you get the actual test results numbers and share them here with us? I know it's difficult to get those in the UK but it can be done. At least sometimes you can get them to tell you the pre and post number along with the lab ranges for the ACTH. For the PVC, which is most commonly used in the UK now, you will probably only have one result number along with ranges. Too often we have seen these results misinterpreted, doses changed as a result, and the dog does not do well. So we like to see those test results if at all possible just to be sure everything is on track. ;)

You're doing a great job, Pink!
Hugs,
Leslie

[Pinkcat]

It would be helpful if you could you get the actual test results numbers and share them here with us? I know it's difficult to get those in the UK but it can be done. At least sometimes you can get them to tell you the pre and post number along with the lab ranges for the ACTH. For the PVC, which is most commonly used in the UK now, you will probably only have one result number along with ranges. Too often we have seen these results misinterpreted, doses changed as a result, and the dog does not do well. So we like to see those test results if at all possible just to be sure everything is on track. ;)

You're doing a great job, Pink!
Hugs,
Leslie

Hi both

Sorry for late reply. The eating thing lasted for a couple of days - I think it was literally because she has been having wet food with her tablets on a morning she wanted it with her tea as well! She barks when her water isn’t cold enough always has 🙈 she seems ok at the minute getting out for plenty of walks - I will do my best to try and get the results from the vets when I go next and let you know thanks again for al your help

[Pinkcat]

Hi both

Sorry for late reply. The eating thing lasted for a couple of days - I think it was literally because she has been having wet food with her tablets on a morning she wanted it with her tea as well! She barks when her water isn’t cold enough always has 🙈 she seems ok at the minute getting out for plenty of walks - I will do my best to try and get the results from the vets when I go next and let you know thanks again for al your help

Hi

I have all daisys blood results but I can’t figure out how to upload can you advise me please thanks

[labblab]

That’s great! One option is to take a digital photo of the paper, and then upload the photo to a personal photo album that you create for yourself here on the forum:

https://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

If that’s not possible, you can just type the relevant results in a reply here. We’ll want to see all results that are marked as being tests of cortisol (such as ACTH, LDDS, or straight cortisol tests). Just type those results as you see them on the page. As far as regular blood work, we only need to see results that are marked as being abnormally high or low, along with the normal range for that particular lab value.

Hope this helps, but just let us know of additional questions.
Marianne

[Pinkcat]

Please see below results:-

10/2/22 - ACTH stimulation
Basal cortisol 229.1 (nmo/l 50 - 250)
Cortisol post ACTH - 404.1

17/2/22 - Low Dose Dexamethasone Supression Test
Basal Cortisol H 298.1 (nmol/l - 50 - 250)
Cortisol 2 - <37.3
Cortisol 3 - 119.5

18/3/22 - Basal Cortisol
Cortisol Basal 196.6 (nmo/l - 50 - 250)

Hope that helps. Personally, Im thinking she seems a bit lethargic today although was very active at the weekend out and about. She is not off food but definitely drinking less. Please let me know if you feel any of the above seems out of sorts. Thanks

[labblab]

Thanks so much for giving us these test results! For the benefit of our U.S. readers, I’m going to convert the results into the units that are most often seen here.

Original diagnostic ACTH done in February
Basal cortisol: 8.3 ug/dL
Post-ACTH: 14.6 ug/dL

Diagnostic LDDS done in February
Basal cortisol: 10.8 ug/dL
Cortisol 2: <1.3
Cortisol 3: 4.3

Current monitoring pre-pill basal cortisol: 7.1 ug/dL

So, the results of the two diagnostic tests do correspond exactly with what your vet originally told you. The initial ACTH was negative for Cushing’s. However, “false negatives” on the ACTH are relatively common. So your vet proceeded to the LDDS, and it was positive for the pituitary form of Cushing’s. Therefore, Vetoryl treatment was begun, and you’re now at the the 30-day mark.

This monitoring cortisol level is indeed higher than is preferred at the 30-day mark (around 5.0 ug/dL), especially if symptoms remain. So the dosage increase does make sense. I’m going to give you a link below that maps out the monitoring protocol for dogs who are having their pre-pill cortisol checked. As you’ll see, to further lower cortisol, two options are given: increasing the once daily dose, or dividing the daily dose to be given 12 hours apart instead of only in the morning. Under your circumstances, simply increasing the once daily dose is indeed an option. However, some dogs do end up with better control if they are switched to twice daily dosing. In that case, if two pills of equal size are not being given, the larger of the two should be dosed in the morning.

Anyway, it sounds as though your vet is right on course for the moment, and we’ll continue to be anxious to hear how things are going. In the meantime, here’s the link to that monitoring flowchart:

https://drive.google.com/file/d/1gqUchP2gvFIyG8udZgNS1bWfppWW6fin/view?fbclid=IwAR2DelBbsQeFErzcG9ZODzfWJnFdlbMmZz49 p8wpQPcumL9Y6RtbrcaKAE8

Marianne

[Pinkcat]

Thanks so much for giving us these test results! For the benefit of our U.S. readers, I’m going to convert the results into the units that are most often seen here.

Original diagnostic ACTH done in February
Basal cortisol: 8.3 ug/dL
Post-ACTH: 14.6 ug/dL

Diagnostic LDDS done in February
Basal cortisol: 10.8 ug/dL
Cortisol 2: <1.3
Cortisol 3: 4.3

Current monitoring pre-pill basal cortisol: 7.1 ug/dL

So, the results of the two diagnostic tests do correspond exactly with what your vet originally told you. The initial ACTH was negative for Cushing’s. However, “false negatives” on the ACTH are relatively common. So your vet proceeded to the LDDS, and it was positive for the pituitary form of Cushing’s. Therefore, Vetoryl treatment was begun, and you’re now at the the 30-day mark.

This monitoring cortisol level is indeed higher than is preferred at the 30-day mark (around 5.0 ug/dL), especially if symptoms remain. So the dosage increase does make sense. I’m going to give you a link below that maps out the monitoring protocol for dogs who are having their pre-pill cortisol checked. As you’ll see, to further lower cortisol, two options are given: increasing the once daily dose, or dividing the daily dose to be given 12 hours apart instead of only in the morning. Under your circumstances, simply increasing the once daily dose is indeed an option. However, some dogs do end up with better control if they are switched to twice daily dosing. In that case, if two pills of equal size are not being given, the larger of the two should be dosed in the morning.

Anyway, it sounds as though your vet is right on course for the moment, and we’ll continue to be anxious to hear how things are going. In the meantime, here’s the link to that monitoring flowchart:

https://drive.google.com/file/d/1gqUchP2gvFIyG8udZgNS1bWfppWW6fin/view?fbclid=IwAR2DelBbsQeFErzcG9ZODzfWJnFdlbMmZz49 p8wpQPcumL9Y6RtbrcaKAE8

Marianne

Hi

Thank you so much for this - it’s very good to know the vet is on track. As I felt daisy is a bit lethargic I ve popped into vets today to ask about the morning and evening dose they are going to phone me tomorrow but next check up is next Wednesday anyway thanks so much again

[labblab]

Hmmm…if Daisy’s lethargy persists, my worry would be that the 5 mg. increase is too much for her to handle, regardless of whether she gets it in the morning alongside the other capsule or later on in the evening on its own. The 5 mg. represents a full 50% increase, and that may be more than she can comfortably handle. It’s too bad the 5mg. is the smallest capsule that Vetoryl comes in, because for smaller dogs, you don’t have a lot of incremental dosing options unless you shift to a compounded product (and I don’t know whether that’s even available in the U.K.).

I’m very glad you’ve contacted the vet to let them know how she’s doing, though. They may suggest just cutting back to the 10 mg. again for the time being. Let’s see what they say.

Marianne

[LauraA]

Being in the UK it can be difficult to get lower doses. However if your Vet contacts either BOVA UK or Summit Veterinary Pharmaceuticals UK, then he/she can order liquid trilostane (which is the active ingredient in Vetoryl) for you. Just in case you do need to consider a lower dose :) It is always nice to have options.

[labblab]

Laura, thanks so much for that info! I’ll definitely make a note of that to pass on to other U.K. members.

And Pinkcat, in terms of the capsules you already have on hand, one other option occurs to me that you might discuss with the vet. And that would be to try giving one 5 mg. capsule both morning and evening. In that way, her daily total wouldn’t exceed the 10 mg. total, but she may benefit from better cortisol control by receiving a fresh dose every 12 hours without getting the bigger whammy all at once…


Marianne

[Pinkcat]

Hi all - hope everyone is well
Just thought I would check in as it’s been a few months now. Daisy has settled on 15 mg per day separate as u suggested thank u and all of her fur has grown back and she looks good. She is however seeming to be at the vets every other week has had kennel cough, anal gland blockage, now this week off her food for three days and ended up admitted on fluids and now we have found a crusty sore in the fur on her tail which we now think was the pain she was yelping when touched about and not anal glands. We are back at the vets tonight to have it checked but just wondering if this is common with cushings ? She’s becoming more and more chilled but I’m not convinced it’s chilled wondering if she can’t be bothered being her usual barky self �� how do we stop thinking everytime she is Ill she’s deteriorating �� thank u

[labblab]

Welcome back! I’m so sorry, though, that Daisy is continuing to have so many problems. Can you tell us more about her hospitalization and what the vet thinks caused it? For dogs taking Vetoryl, the first thing we worry about when we hear of inappetance, lethargy, or need for hydration is low cortisol. Has that been ruled out, and was there something else amiss that resulted in her need for fluids?

In terms of her sore, Cushpups do seem to be more vulnerable to skin infections, especially if the cortisol levels are running higher. Have you seen any other sores, or just that one place on her tail?

Marianne

[Pinkcat]

Welcome back! I’m so sorry, though, that Daisy is continuing to have so many problems. Can you tell us more about her hospitalization and what the vet thinks caused it? For dogs taking Vetoryl, the first thing we worry about when we hear of inappetance, lethargy, or need for hydration is low cortisol. Has that been ruled out, and was there something else amiss that resulted in her need for fluids?

In terms of her sore, Cushpups do seem to be more vulnerable to skin infections, especially if the cortisol levels are running higher. Have you seen any other sores, or just that one place on her tail?

Marianne

Hi marianne, when I went back to the vets for check up after fluids Friday they were a little bit puzzled because the obvious thing would be vetoryl levels but there was a couple of things thrown in to complicate it ie a temperature of nearly 41 and slow filling on gums when pressed, we had also just taken her away in the campervan for a quiet weekend to practise before we take her on holiday in a few weeks, she was stressed on the way there only just over an hour drive but better on way home, the lethargy lost appetite etc did seem to start from the Sunday evening. The vets thought that maybe the stress of the weekend has affected things so prescribed some steroid to try and level things out - since I don’t know if it’s a coincidence but her nose is back at the treat door again but she isn’t realy playing just laying around but is managing a walk if taken and it has been hot in the U.K. this weekend - at a loss but I guess that testing bloods needs doing in case - the vet also suggested maybe prescribing us some steroid to take away in case she is realy stressed - we were debating taking her but she ll be as stressed left with dog nanny for two weeks 🤷*♀️ Thanks for coming back to me

[labblab]

Yes, given your description of her behavior, I do suspect that her cortisol level had dropped too low. And especially if she was stressed and her body was not able to produce an adequate amount of cortisol in response, that could make her ill. The fact that she’s doing better on the supplemental steroid really does point in that direction.

I assume she’s off the Vetoryl right now? It would not make sense to be giving her both the Vetoryl and the steroid at the same time since they directly conflict with each other (lowering the steroid level and raising the steroid level simultaneously). I do think a check of her bloodwork before your trip, ideally including cortisol level, is in order. However, you need to be aware that if she’s taking supplemental steroid at the time of the test, it will skew the cortisol level upwards, just like natural cortisol. So she would need to be off the steroid for a few days in order to measure her genuine natural cortisol production. I realize the timing of all this may be difficult with your trip coming up, and the most important thing is keeping her as comfortable as possible. I agree that it most likely will be best to take her with you so that you can see exactly how she’s doing. For right now, let’s see whether she continues to normalize while taking the steroid, since that is a an important indicator as to whether low cortisol was the original problem. And I do think that checking her bloodwork at some point before your trip will be important.

Marianne

[Pinkcat]

Yes, given your description of her behavior, I do suspect that her cortisol level had dropped too low. And especially if she was stressed and her body was not able to produce an adequate amount of cortisol in response, that could make her ill. The fact that she’s doing better on the supplemental steroid really does point in that direction.

I assume she’s off the Vetoryl right now? It would not make sense to be giving her both the Vetoryl and the steroid at the same time since they directly conflict with each other (lowering the steroid level and raising the steroid level simultaneously). I do think a check of her bloodwork before your trip, ideally including cortisol level, is in order. However, you need to be aware that if she’s taking supplemental steroid at the time of the test, it will skew the cortisol level upwards, just like natural cortisol. So she would need to be off the steroid for a few days in order to measure her genuine natural cortisol production. I realize the timing of all this may be difficult with your trip coming up, and the most important thing is keeping her as comfortable as possible. I agree that it most likely will be best to take her with you so that you can see exactly how she’s doing. For right now, let’s see whether she continues to normalize while taking the steroid, since that is a an important indicator as to whether low cortisol was the original problem. And I do think that checking her bloodwork at some point before your trip will be important.

Marianne

Hi

Yes on steroid her appetite and drinking has increased although she still seems lethargic but could be the heat. We aren’t used to it ha ha ! But unfortunately she has been on vetoryl and steroid over the weekend but I haven’t given steroid today just vetoryl thinking that it would skew the bloods. All other bloods have been done and show ok apart from
White cell count which they prescribed antibiotics for. I’m going to ask for cortisol levels to be checked but could it be that the weekend away just skewed them because she was happy as Larry before that ? Also vets have suggested us taking some steroid tablets away with us so that when she gets stressed we can have it to hand to help her out but I’m
Not sure I fully understand how this would work given what you have just said thank you xx

[labblab]

I don’t understand why the vet would tell you to give Daisy *both* Vetoryl and a supplemental steroid. If she is suffering from low cortisol requiring steroid supplementation, this would mean that her Vetoryl dose is now too high. If so, the Vetoryl needs to be discontinued altogether for a time, and then restarted at a lower dose once her natural cortisol production has rebounded. In other words, the supplemental steroid is usually meant to be a bridge during the time period when she is off the Vetoryl and her natural cortisol production needs to rebuild. Once that has happened, the steroid can be stopped and the Vetoryl restarted at a lower dose. The time it takes for a dog to rebound from Vetoryl overdosing can vary greatly, though, from a few days to weeks.

But this all depends upon whether her Vetoryl dose is truly too high and low cortisol is really the culprit. This can only be known for sure by testing. However, for safety’s sake, whenever low cortisol is suspected, the Vetoryl should be halted until the testing can be performed. The temporary reemergence of Cushing’s symptoms in the absence of Vetoryl can be frustrating. But the dangers of low cortisol caused by Vetoryl overdosing can be life threatening. So of the two choices, temporarily halting the Vetoryl is far safer. Again, I am not a vet myself. But I am puzzled by your vet’s recommendation here.

Marianne

[Pinkcat]

I don’t understand why the vet would tell you to give Daisy *both* Vetoryl and a supplemental steroid. If she is suffering from low cortisol requiring steroid supplementation, this would mean that her Vetoryl dose is now too high. If so, the Vetoryl needs to be discontinued altogether for a time, and then restarted at a lower dose once her natural cortisol production has rebounded. In other words, the supplemental steroid is usually meant to be a bridge during the time period when she is off the Vetoryl and her natural cortisol production needs to rebuild. Once that has happened, the steroid can be stopped and the Vetoryl restarted at a lower dose. The time it takes for a dog to rebound from Vetoryl overdosing can vary greatly, though, from a few days to weeks.

But this all depends upon whether her Vetoryl dose is truly too high and low cortisol is really the culprit. This can only be known for sure by testing. However, for safety’s sake, whenever low cortisol is suspected, the Vetoryl should be halted until the testing can be performed. The temporary reemergence of Cushing’s symptoms in the absence of Vetoryl can be frustrating. But the dangers of low cortisol caused by Vetoryl overdosing can be life threatening. So of the two choices, temporarily halting the Vetoryl is far safer. Again, I am not a vet myself. But I am puzzled by your vet’s recommendation here.

Marianne
Hi
I ve just got back from checkup, they have agreed that I stop steroid (I did this morning anyway and seen an improvement in daisy already picking up toys again etc until we had to go back to vets) she’s finishing antibiotics and they are going to discuss her and see when she’s good to get tested again. I ve taken on board what you have said and will watch closely for signs of low cortisol but I’m starting to think that the stress of going away has just increased her cortisol too much and made her have all of these symptoms rather than dosage being wrong as she was fine before we went - is that possible ? And if so the key is how do we keep her cortisol levels down on our travelling days during holiday is it feasible to just give 10 or 5 mg those days ? I have to ring them back to get instructions what to do while we are away on Thursday

[labblab]

Well, the most important thing is that Daisy is feeling better. Since her illness came on so suddenly, perhaps cortisol isn’t the issue at all and she truly had developed an infection of some sort that the antibiotics have helped. I still doubt that *high* cortisol was the problem since dehydration, loss of appetite and lethargy are more symptomatic of low cortisol. But again, perhaps it was an infection and not her cortisol level at all. And if she’s doing better again while still taking her Vetoryl, then I’ll try to stop worrying! Especially if you’re given some steroid to take along with you, just in case problems should develop again.

I do hope you all are able to have a good, relaxing vacation — the whole family definitely deserves it. Best wishes and, of course, do keep us updated.

Marianne