12-Year Old Maltipoo (75% toy poodle; 25% maltese) just diagnosed

[lisaaloha3]

My 12-year-old toy poodle/maltese mix, Coco, was just diagnosed with Cushing's 5 days ago and began 10mg of Vetoryl 4 days ago. She's 15.8 lbs. I proactively asked my vet to test her after one of her liver enzymes came back slightly elevated. Previously, I had taken her to the vet for excessive drinking and panting awhile back and they had not thought to test her for Cushing's at the time. But I had her scheduled for a dental and, instead of doing that, I asked for ACTH testing. My hunch was correct. It was only after her diagnosis that I realized she actually had more symptoms that I thought. She had a bit of a pot belly, she has moles all over her body (which are common in poodles) that would get infected, and she had a pretty large appetite. Coco was already on a low-fat diet following a bout of pancreatitis. Unrelated to her Cushing's, Coco also has luxating Patellas, she tore an ACL two years ago, and she has a habit of chewing on metal that causes chipped teeth. That's my Coco!

I don't have her numbers from the ACTH testing as I didn't think to ask for them. Although it's early, my guess is they'll have to raise the dosage a bit. She still pants a bit excessively (although this is hard to judge--we live in Texas and it's hot outside, but she pants enough in the air conditioning for me to believe it's the Cushing's). I don't know if she's still drinking excessively. Again, it's hard to judge because of the heat. She may be drinking a bit more than my other dog of the same size who doesn't have Cushing's. It's only been 4 days so she still has the pot belly; she has no current skin infections. Her fur is still fine and skin are fine otherwise.

One thing I have noticed is a reduced appetite. She still has an appetite, but she's pickier. Specifically, she's not down with her dry dog food. She's supposed to get 1 cup of dry food per day. I mix it with a bit of low fat wet food. She gets baby carrots for snacks. She gets fed 3 times a day, although I'm going to try to switch it back to 2 times a day. What she's been doing--and this isn't necessarily new, it's just a bit worse now--is she'll eat all the wet food, including sucking on the dry food that has wet food on it and then spitting out the kibble. She'll also eat her baby carrot. But she may or may not eat any dry food. This morning, I sat with her and she did eat most of her dry food. This afternoon she ate some of it; this evening she ate a bit of it. But later this evening when I fed her some more wet food she scarfed that right up. So clearly she didn't lose her appetite--she just wants only the tasty morsels and nothing else. She also eats figs that drop from a tree in my front courtyard. I'm not sure how to feel about the reduced appetite--there really could be a number of reasons for it unrelated to the Vetoryl--but I'll probably call into the vet tomorrow to ask whether I should switch her to all-wet for the time being (even though I shudder at the expense of that).

I should add that she's not lethargic at all. She was so not lethargic that she decided to eat the paper wrapper of two tampons today while I was on the treadmill. Thankfully, the paper is very thin and it disintegrates in water, so I don't think it's going to get stuck anywhere. She also decided to run around the front yard barking at the guy doing lawn work next door, and pushed a pot out of the way so she could attempt to chew on the metal at the base of one of the outer doors. I put a stop to that.

Anyway, just wanted to say hi. I'm new to this.

[Joan2517]

Hi and welcome to you and Coco. Please see if you can get the numbers from the ACTH test and any other blood work with just the Highs and Lows along with the reference range and post them here. She should have another ACTH test done at the 14 day mark to check the numbers and make sure her cortisol has not dropped too low. Also, no increases in the dose until the 30 day mark as the cortisol can continue to drop for 30 days. Any change in dosage will need another check after 14 days.

My teacup poodle, Lena, got very picky with food after beginning Vetoryl and I had to get very creative so that she would eat as the medication must be given with a full meal. My other cushdog, Gable, never had any issue with eating, and I don't even think he knew he was being medicated.

[labblab]

Hello and welcome from me, too! Joan has already done a great job of greeting you, so I will leave this first note at a simple “hello.” But we’re really glad you’ve joined us, and we will all look forward to learning more about Coco’s diagnostic history and ongoing treatment response.

Best wishes,
Marianne

[lisaaloha3]

Hey all -- sorry for the delayed response. I wanted to wait until I was able to get the labwork from her first ACTH test. She just had her second (2 week) test today, so I don't have those numbers yet. As I mentioned, she's on a low dose of Vetoryl (10mg), and it's only been two weeks, so I'm not expecting a huge change. But we'll see.

Her first ACTH test:

Cortisol - Baseline 3.2 ug/dl

Cortisol - 4hr post dex 0.8 ug/dl

Cortisol - 8hr post dex 3.8 ug/dl

Usually we get the lab work results the next day, so unless they decide not to call on a Saturday, the vet should call tomorrow. I'll ask for the results of the 2 week test.

As for her appetite, she's still not thrilled with her dry food, but is eating her wet food and any treats (baby carrots) just fine. I've noticed she's more apt to eat the dry food in her morning (6am) meal, so I'm going to be feeding more of daily allotment of food in the morning than in the afternoon/evening. It could really just be that it's super hot outside and she's less active. Or she's simply bored of her dry food, but as she's on a prescription diet there's not much I can do at the moment.

Her other symptoms seem pretty much the same. Perhaps she's panting less. She mostly does this in the late afternoons now.

I kind of mentioned this earlier, but she's become quite destructive. She's taken to trying to eat paper (toilet paper is a favorite, but she attempted to eat a book cover the other day). She used to do this as a puppy. I've looked it up and this isn't uncommon amongst older dogs. I would try to exercise her outside more but the temps have been over 100 degrees every day for the last month, so that's a no go. She does play some outside, but wants to go inside after about 10 minutes. At least she's still active!

[lisaaloha3]

By the way, thank you for the warm welcome and I'm glad I found this community!

[lisaaloha3]

I noticed that others were giving y'all some additional diagnostic results. I have those from the time in which she took the ACTH test, so I thought I would share. I'll only give you the ones that are out of range:

MCHC: 32.5 g/dL (reference value (RV) 32.6-39.2 g/dL) (2022: 34.9; 2020: 34.4)
Eosinophils: 0.022 K/uL (RV 0.07-1.49 K/uL) (2022: 0.11; 2020: 0.343)
Platelets: 466 K/ul (RV 143-448 K/ul) (2022: 405 K/ul; 2020: 434)
ALP: 181 U/L (RV 5-160 U/L) (2022: 177; 2020: 76)
GGT: 29 U/L (RV 0-13 U/L) (2022: 5; 2020: 5) -- This is what made me decide to ask for the ACTH test -- the last straw of sorts.
Cholesterol: 391 mg/dL (RV 131-345 mg/dL) (2022: 287; 2020: 245) (this was fasted; notably, this is after several months on a low-fat diet she wasn't on in 2022 and prior)

All other labs are normal. Interestingly, her urine has improved since 2020/2022. It was dark yellow/cloudy in both those years, with crystals found in 2022. This year the urine was yellow and clear with no crystals.

Coco also gets a Cytopoint injection every month for allergies and takes Dasuquin prescription for arthritis, which she has in her back legs.

[labblab]

Welcome back again, and thanks so much for all this additional information! The general lab abnormalities that you posted are indeed consistent with Cushing’s, as is the specific diagnostic blood test. I do want to clarify that the diagnostic test results you posted appear to be from a LDDS (Low Dose Dexamethasone Suppression Test) as opposed to an ACTH. This is totally reasonable since the LDDS is actually favored by many clinicians in terms of initial diagnostics. Coco’s results on the test you’ve given above are again consistent with Cushing’s, and specifically the form of the disease that is caused by a pituitary tumor.

Turning to treatment monitoring, the ACTH is the test of choice for that, so I’m assuming those are the results we are now awaiting. When that test is given in the U.S., typically there are just two numbers to report: a baseline cortisol level and then a stimulated cortisol level taken one hour later.

So we’ll be anxious to learn those numbers once you have them in hand. Once again, thanks so much for reporting back, and we’ll be awaiting your next update!

Marianne

[lisaaloha3]

Thanks for the response! I'm very new to this, so thank you for the information. Yes, I do believe the test I'm waiting on now is ACTH since it was a shorter test (just around 2 hours instead of 8 hours). Looks like the lab doesn't work on the weekends, so hopefully I'll get the results on Monday.

[labblab]

We all understand — and remember! — how overwhelming all this new information can seem when starting out on the Cushing’s journey. But you are doing a great job of educating yourself and advocating for Coco!

Continuing best wishes to you both,
Marianne

[lisaaloha3]

Hi all! Sorry for the late update. It's been a crazy week and this is the first I'm able to get on my personal computer. I got back Coco's ACTH results on Tuesday.

Interestingly (to me), my vet there are two different ranges for the results that could be deemed "normal." The clinical recommended range post-ACTH testing is 1.5 to 6 ug/dL. The manufacturer's recommended range is 1.5 to 9 ug/dL. My vet would like Coco to be in the clinical range, but she is currently in the manufacturer's range.

Pre: 2.9 ug/dL
Post: 8.6 ug/dL

So my vet would like her post-ACTH level to be lower. She's of course still on the 10mg of Vetoryl for now. She's supposed to get another ACTH test done this coming Tuesday. That's not quite the 4 week mark, so I'm going to call Monday to see if we shouldn't schedule it for Friday (which would be the actual 4 week mark on Vetoryl).

She still does pant a little more than I would like. She has lost 0.8 pounds (gone from 15.8 pounds to 15), which is expected. Her poochy stomach looks less poochy. She is still not loving her dry food, but she does eat most of it over the course of a day. She appears to have more energy. And she's had no skin infections since starting Vetoryl, which isn't necessarily because of the medicine, but hey, it's good nonetheless.

[labblab]

It’s so good to hear back from you, and especially with what sounds like a good report overall! I think you’re on the right track and will be hoping for continued improvement as time goes on. Since Coco’s symptoms are not yet as well controlled as you’d like, if her cortisol has not come down more at this next testing, your vet’s recommendation to lower her cortisol further makes sense to me. She is right that many specialized clinicians prefer a post-ACTH result that is around 5-6 ug/dL. And in honesty, even Dechra (Vetoryl manufacturer) recommends aiming for a post-ACTH level lower than 9 ug/dL if a dog appears to be generally well but Cushing’s symptoms haven’t resolved as much as hoped. Here’s a link to one of their treatment and monitoring publications. It’s lengthy, but if you scroll to the very bottom, you’ll find a flowchart that illustrates their treatment recommendations.

https://dechra-us.com/Files/Files/SupportMaterialDownloads/us/01TB-VET50030-0720TechBrochureFinal.pdf

So once again, I think you guys are doing great with hopefully more improvement to come :-))).

Marianne

[lisaaloha3]

Hi all!

I got back the results of Coco’s 4-week ACTH test and the doctor was very pleased.

Pre: 3.0 ug/dL
Post: 5.5 ug/dL

Coco is down to 14.8 pounds, so about a pound down from when she started Vetoryl. This is well within her typical weight (closer than the 15.8 pounds was). She’s still being a bit picky with her dry food, but the vet doesn’t appear concerned at this time. Coco has a lot of energy (almost too much, as mentioned before), so I think her Cushing’s affected her more than I initially thought. In reality, she’s still a feisty girl. I believe her drinking, panting and peeing are better controlled at normal levels. So looks like we’re staying at 10mg for the time being. She’s getting checked again at the 12 week mark (Oct 11), but I’ll keep you apprised if any changes occur.

[labblab]

This is a great report!!!! Kudos to Coco, you, and your vet! It’s a lift to us all to read such good news :-))))))))))). Thanks for reporting back, and we’ll be hoping for continued success!

Marianne

[WILLOWSMAMA]

Hello, just wanted to say hi 👋🏻. My beautiful Maltipoo, Willow is 11 & has cushings (diagnosed August 22).
IÂ’m new here too so thought IÂ’d say hello & IÂ’m sending a supportive hug your way.
IÂ’ll help any way I can 😊

[labblab]

Hello, just wanted to say hi ����. My beautiful Maltipoo, Willow is 11 & has cushings (diagnosed August 22).
IÂ’m new here too so thought IÂ’d say hello & IÂ’m sending a supportive hug your way.
I’ll help any way I can ��
Hello and welcome, Willowsmama! I’m sure Lisaaloha will appreciate your very kind reply :-). If you’d like to do so, I also encourage you to go ahead and start a new thread of your very own here on the forum in which you can tell us more about the specifics of Willow’s Cushing’s journey. If you need some guidance in starting a thread, just let us know. We all learn so much from each others’ experiences! Either way, though, we’re very glad you’ve joined our family.

Once again, welcome!
Marianne