Lena, Teacup Poodle w/ adrenal tumor - Lena is now an angel

My teacup poodle, Lena was just diagnosed Dec. 7. She is only 6lbs. Has all the classic symptoms which snuck up on us as she is going to be 15 in March and we attributed them all to her age. She started on 10mg of Vetoryl and it seemed to work within a few days, but the symptoms are all returning. We increased to 20mg and now it is up to 30. Testing again this coming weekend. I am heartbroken! She has been my baby since the first day I saw her. She has an adrenal tumor, which is inoperable. Does anyone have any suggestions on diet?

Hello Joan, and welcome to you and little Lena. I have only a moment to post, but I wanted you to know that I've moved your post in order to create a thread that is your very own. This way, it will be much easier for our members to reply to you directly. ;)

We're very glad you've found us!
Marianne

Thank you, Marianne...I wasn't sure where to go. I am crying all the time and just want to hear from others who might help me get through this.

Hi Joan, Welcome to you and Lena.

30 mg. is a boatload of Vetoryl for a 6 lb. baby. Please post the results of all of her ACTH tests. I am concerned about such a high dosage.

Thanks,
Kathy

Oh, God....now I'm nervous! The vet said it was okay to go that high. She's only been on 30 since 1/21. I just called them and asked them to fax me the test results. How do I post them after I get them? I knew it...I thought it was too high!

DO NOT PANIC JOAN!!!!! ;). BREATHE!!!!!! We just want to check a few things. Starting recommendations for Vetoryl is 1mg. per pound. Cortisol can (and often does continue to drop) the first 30 days of treatment. Lena has just been diagnosed. Her Vetoryl has already been raised twice. This is a red flag waving wildly to me. We ask a bunch of questions for clarification. TRY NOT TO PANIC!!!

Kathy

They haven't sent it yet...how do I get it to you when they do? If they don't send it to me by tonight, should I not give her the pill in the morning?

Hi again, Joan. I'm so glad Kathy's had the chance to greet you, and now I'm back again, too, to talk some more. First of all, as Kathy has said, please don't panic and please do not alter Lena's dosing at this point. We are just in the process of learning more about her situation and her testing history. One of the things we do know is that dogs who suffer from adrenal tumors may end up needing higher doses of the Cushing's medication in order to control the symptoms caused by adrenal overproduction. So this dose is not necessarily the wrong dose for Lena -- that answer will depend upon a combination of her behavior and also the monitoring testing.

When you get the test results, this is what we are looking for. ACTH stimulation tests are performed to monitor Vetoryl treatment, and what these tests consist of are two different values: a test of baseline cortisol taken before the administration of a stimulating agent, and then a second cortisol measurement taken one hour later. So in terms of the lab report, it will look like a baseline or "pre" cortisol reading, and then a second or "post" reading. It looks as though Lena has been taking the Vetoryl for almost two months now along with a couple of dosage increases. So if you can give us the dates and results for any ACTH tests, that will be great.

Also, can you tell us more about the diagnosis of the adrenal tumor? I'm assuming she has had some abdominal imaging performed. Is the reason why the tumor has been deemed inoperable based upon her age, or upon factors associated with the tumor size/location itself?

In terms of Cushing's symptoms, can you also tell us more about little Lena is outwardly doing?

Thanks so much for this additional information,
Marianne

Hi, Joan & Lena! When you do get the ACTH results, the easiest way to give us the info is to type it in a post here in your thread as you won't be able to attach any documents. When I post ACTH results, I just type:

1/26/2016
Pre 3.4 ug/dL (or nmol/l which is more common if you live outside the U.S.)
Post 7.8

If Lena is on any other medications/supplements other than Vetoryl, we would appreciate your letting us know what they are and why they were prescribed.

With regard to diet, most Cushing's dogs do well on low protein/low fat food but we can talk more about that later.

Again, as Kathy wisely advised, TAKE A DEEP BREATH!

I just sent a whole message that didn't get sent...

She had an ultrasound and it showed a sizeable tumor on her right adrenal gland over the kidney and vena cava. Then they did the low dextrose test, which showed adrenal Cushing's.

She has had symptoms for about a year, I think. They didn't happen all at once, but crept up. The panting, not wanting to cuddle anymore, peeing in the house, slipping on the wood floors, not climbing stairs anymore, drinking a lot of water, eating like crazy; the potbelly, warts, an eye infection, her tail didn't poof after grooming anymore; she was always hot, when she used to love to lounge around on the deck and soak up the sun. Some I went to the vet for, but the rest I thought was just her age.

The Vetoryl seemed to work right away, but then she started drinking and peeing again within 2 weeks. The belly is getting bigger and she seems to be breathing harder. I have put her on kind of a diet, same food, just less.

Everyone keeps saying she seems fine, but I know her better and she's not. I don't know what to do!

Joan, take a look at this thread for hints to keep you from losing your replies before they get posted:

http://www.k9cushings.com/forum/showthread.php?t=1329

I am so very sorry that I scared you with my post earler. :o I only had a minute, as it was in the middle of my work day. Chaos can (and often does ) erupt without warning. So again, my post was too short and didn't provide enough of an explanation. I am very sorry about that!:o

Please do not withold Lena's pill. As Marianne said, we are just beginning to gather the information needed to sort out Lena's particular circumstances. Every fur baby has different needs and often different dosages.

I do believe you when you say that you know there is something wrong although others say that Lena is fine. A mother always knows. ;)

Hang in there, enjoy your sweet girl and remember to BREATHE!!

Kathy

I just want to say hello and welcome. Adrenal tumors can be real buggers to get control of.
So let's see the ACTH testing results and the dates and dosage she was on at each test and go from there.
Deep breaths. Knowledge is key with Cushing's and the more you learn the better equipped you will be to make decisions on her behalf.

I can't tell you all how happy I am to have found this site! I finally feel like I am not alone. Thank you so much for all these posts.

This seems strange, but when I got home from work tonight, Lena seems better. She's more alert and even playful...maybe she senses my relief and I don't seem so sad to her.

That is very good o hear. Hopefully the improvements continue and no need for worries.

I forgot to mention she also has high blood pressure. I just saw the picture of Ginger and her dry nose...another trip to the vet where they gave me cream for it and never mentioned high blood pressure.

You do want to have the BP monitored periodically and especially if you know it is high. Is she on any medication for high blood pressure?

What about the cream??? Is it by chance a steroid??? That could definitely make Lena's cortisol go wonky. :o

She is...something that starts with an A..I don't have the bottle in front of me.

It's called Dermoscent and its a bio balm. But I just realized that her eye drops have steroids in them.

Again, I posted a whole long thread with her blood work last night on a different computer and lost it. When I get to work I'll try again. I forgot to click the "remember me".

Quote:

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Originally Posted by Joan2517

It's called Dermoscent and its a bio balm. But I just realized that her eye drops have steroids in them.

---

Joan, for how long has she been getting the eyedrops and for what reason?

Also, another thing you might try in order to avoid retyping lost replies is to compose them elsewhere, like in a word processing program, and then copying/pasting them into a reply here. That way, you'll still have the original even if the reply here goes astray.

Here are all of her tests beginning with the first one:

First test 12/10/15:
Cortisol Serial 3 (DEX)
Cortisol Sample 1: 10.0
Cortisol Sample 2 Dex: 2.6
Cortisol Sample 3 Dex: 7.3
10mg started 12/11


Second test 12/31/15:
Cortisol Sample 1: 10.4 (HIGH)
Cortisol Sample 2: 30.9 (HIGH)
20mg started 1/4 (10 in morning and 10 at night)

Third test 1/16/16:
Cortisol Sample 1: 5.5 (HIGH)
Cortisol Sample 2: 20.4 (HIGH)
30mg started 1/21

Next bloodwork to be done this Saturday or Sunday

She is on Amlodipine for High Blood Pressure 1/4 of 2.5mg 1x daily, discovered during first test (200)
and and has been using eye drops Neomycin and Polymyxin B Sulfates Dexamethasone Ophthalmic Suspension USP (I only just started this again the other day) they were because her left eye started pussing up. I'm on the second bottle prescribed Oct. 6...don't remember the first date, maybe August or September.

That is what I just did...worked like a charm! Thanks!

So it is coming down. I just want you to be aware of one thing, cortisol will drop on the same dose for 30 days normally. I see you increased 10mg after 2 weeks but I do not think you should increase until after the 30 day mark next time to see where she actually levels out at. That is my thought and just a note to be safe, as she hasn't actually leveled even on 20mg. Because it was still high, the increase probably was fine, but it is something you need to be aware of.
Here is the manufacturer print out, which has an easy to read flow chart on it:

http://www.dechra.us/Admin/Public/Do...US-046-TEC.pdf

I also have a jpeg in my photo albumn on the forum here if you would like to see just the flow chart: http://www.k9cushings.com/forum/albu...pictureid=8043

My molly also takes amoldipine for her high blood pressure :)

Thank you for this information. So, I'm thinking that even if my vet wants to raise it again, that I should just let him know I would like to wait until she has been on 30mg for 30 days. He checked with an endocrinologist before raising it to this dosage, so he is concerned about how small she is. I think I might have made them nervous when I asked for the results of the test!

I should ask them what her blood pressure is when they do the test this weekend. Does the Vetoryl make their breath smell different?

I think since I cut down on her food, she feels better. Her tummy doesn't seem so big and I think she is more comfortable. She was a little more playful when I got home today. Is it normal for their bellies to feel hot?

I have a million questions!

How long has Molly been on Vetoryl?

Joan--just a quick question. Are you giving Lena the 30 mg all together or are you still dosing twice a day? If twice a day, it is recommended that the higher dose be given in the morning so that the ACTH tests will reflect the increase.

My Abbie also is on medication for high blood pressure (amlodipine and telmisartan). I am able to get the amlodipine free at a grocery store pharmacy so you might check on that where you are. Also, when my vet checks Abbie's blood pressure, I leave her at the vet for a while. A tech sits quietly with her and takes six different readings over an hour. The lowest and highest readings are thrown out and then the remaining readings are averaged.

Don't ever hesitate to ask for copies of everything! You are paying for their services and you are entitled to copies.

Hi Judy,

I will try the grocery store, thanks. I give her the 30mg all at once in the morning. It doesn't come in 20mg and a box of 10mg is $80, a box of 30mg is $85. The vet said he could special order 15mg, but I don't want to special order anything until we get the dose right.

I also don't like leaving her at the vet's office. I feel it is too stressful for her. In the past when I called to see how she was, I could hear her barking in the background, she doesn't like being in a cage. When she goes for the ACHT test, I sit in the waiting room with her for the 2 hours...she either sits in my lap or on the bench next to me and she naps while I read. I'm sure they think I'm a nutcase there, but I don't care. Right now I am. I'm on overdrive with all of this and whatever I can do to make her more comfortable, that's what I will do.

I feel so guilty that I waited this long, if I had only known that all of those little things that were bothering me meant something.

Hi again, Joan. I just want to assure you that you have plenty of company on the "guilt train." :o :o

In retrospect, I now believe my own Cushpup was suffering from observable symptoms for probably two years prior to diagnosis. But taken in isolation, none of them made any particular sense to me since I was totally unfamiliar with the disease. So I didn't even know to mention some of the subtle changes to my vet, and then after I did, it still took a trip to a specialist to confirm the diagnosis. Cushing's is such an insidious, tough disease to diagnose.

Anyway, moving on...! :)

Thanks so much for typing out all the test results. And yes, it now makes much more sense as to why Lena's dose has been increased, and it will be very interesting to see how this upcoming monitoring ACTH turns out. There is one thing, though, that I want to mention about Lena's diagnostic LDDS test.

Quote:

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First test 12/10/15:
Cortisol Serial 3 (DEX)
Cortisol Sample 1: 10.0
Cortisol Sample 2 Dex: 2.6
Cortisol Sample 3 Dex: 7.3
10mg started 12/11

---

Taken alone, this test result actually would be thought to be consistent with the pituitary form of Cushing's rather than the adrenal form. This is because Lena exhibited cortisol suppression at the four-hour mark, such that her Sample 2 result was less than 50% of her initial baseline reading. However, through the benefit of the imaging, we know that she does indeed have an adrenal tumor. Plus, another of our members just reminded us of a 2006 paper in which a leading Cushing's researcher noted that some dogs with adrenal tumors do indeed exhibit that suppression pattern. So, more than anything else, I am just offering this as additional information. I suppose it is remotely possible that Lena might have both a pituitary and adrenal tumor, but even if so, I don't believe that would alter her treatment regimen. So basically, I just wanted to make note of her interesting test result.

Bottom line, I'll definitely be watching for those new test results. And I am certainly wishing you two well!

Marianne

Thank you, Marianne...I like knowing what I'm looking at because I haven't got a clue what any of it means.

I too, noticed so many symptoms, but they were vague and just seemed to go with old age, or disappeared before they really registered. So it was almost like I was imagining them. But I have had a feeling for a while now, which is why I always had the vet check them out. I am relieved that I know, but also heartbroken that I know. I kind of feel like my vet should have put all this together, but maybe not.

Lena loves treats, but now I'm afraid to give her any. Any suggestions? She loves fruit: mango, apples, bananas strawberries, blueberries and lychee nuts. Are these okay to give her? What about yogurt? She loves that...

Before all these symptoms escalated in December, I had gotten them these treats that had apple, banana and one had carrots and she loved them. Now she won't eat them at all...she'll still eat ice cream, cookies, cake, and she still begs for people food and will kill for the cat food.

I'm feeling so sad today after reading about poor little Tammy last night. My heart aches for Brianna. I'm wondering if I am doing the right thing by keeping Lena on the Vetoryl. I'm getting her blood work done tomorrow.

She took a tumble down the basement stairs last night. I don't know if she slipped or forgot they were there. I feed our cat next to the stairs, so she might have backed up while scrounging for food. I know she didn't go down on purpose, she hasn't been able to do stairs for so long that I've forgotten the last time that she could. I heard the noise and thought one of the bigger dogs had chased the cat down and there she was at the bottom. She was standing, and shaking, but didn't seem hurt. I felt around to see if anything was broken and she kissed me and got down to look for more food. I can tell you that my adrenaline was pumping!

Then I read about Tammy and just cried and cried. Everything is happening so fast. A few months ago she was still my little precious and now sometimes she seems like a stranger to me. She doesn't want to sit with me anymore and when she looks at me, I feel like she is wondering why she feels so bad and I'm not making her feel better...and I don't know how to make her feel better. I'm putting my trust in my vet, but wonder....

I'm just depressed and putting my feelings out there. Now I have to leave her and go to work and act professional, when all I really want to do is stay home and take care of her.

Be kind to yourself. It's perfectly normal to have these doubts. It's a sad reality that there are a lot of losses around here, but there are so many positive stories too.

During the beginning of treatment, I asked myself all the time if my girl would ever be herself again. She had cushings for a few years before diagnosis and we have had some ups and downs since her diagnosis in Dec 2013. All that said, I firmly believe she would not be here, nor would she have any quality of life, if I had elected not to treat her.

Get through this tough part and once you have her cushings managed correctly, you'll find your new normal. She may not be exactly the dog she was before, but she will still be your girl and she will still have quality of life.

Thank you, Renee. Your kind words are making me cry, but more out of relief than sadness. Since her diagnosis, even though I knew something wasn't right for about a year, I have been kicking myself for not insisting on more tests, but for what I had no idea. I never heard of Cushing's until one of my vets said something about her potbelly back in May I think, but after blood work came back there was nothing showing that might be of concern. If only I had looked it up then, I would have known. She had so many of the symptoms that I never even thought to mention to my vet.

Of course, now every time I see one of the other dogs drinking too much I think CUSHING'S!!

Joan

Oh Joan, I over-analyze water consumption ALL THE TIME.

If my girl drinks too much, I worry her cortisol is spiking. If she doesn't drink enough, I worry she's dropping too low. If any of my other pugs drink too much, I immediately start wondering if they are developing cushings too, lol. This disease, it will mess with your head! Best way to fight the paranoia is to get yourself educated. Then you can talk yourself down when you get too worked up.

Hi Sharlene and Marianne,

I am noticing that you always say that in the ACHT test that it is checked 1 hour after the first one. My vet does it two hours after. Does this make any kind of difference? I'm just wondering....

Thanks,
Joan

Do you know what stimulating agent was used for the ACTH test? The timing of the post number is dependent on the stimulating agent used. When Cortrosyn is used, one hour after it is injected the post blood draw has to be taken; when acthar gel is used that post blood draw is taken 2 hours after the injection. I would definitely ask the vet which stimulating agent they are using.

Hugs, Lori

Thanks, I am never able to talk myself down...that is why I love that I have found all of you...LOL!

um, gosh molly has been on trilostane for over a year now. She was a bugger to diagnose though as she tested negative on like 3 LDDS tests. However, 5% of dogs do, molly is just in that 5%. How do we know this, subsequent ACTH testing, showed high cortisol consistently, then she developed the other problems, and we still don't know which came first, the chicken or the egg, but she got high BP (welcome to amoldipine), protein loss in her urine (hello Benazepril), scaring of her eyes from retinal bleeds from the high BP (uh oh, shake hands with eye drops and ocu-glo) so, as you can see, diagnosis can be difficult with cushings, and results of high cortisol, no matter what the cause of the increase, can be daunting. But we carry on. My girl is happy, she has great days and some off days, she doesn't seem to care too much that she has problems seeing, it just is our life.

I'm sooooo glad she is okay after the stair tumble. Okay, first off, get gates for the stairs. Yes, we had to do that with my molly too, she can't see and took a tumble once too, end of that for the little miss independent. So, now I have gates to all the stairs down and she doesn't bother to try to go up stairs any longer, since she's learned that her hand servants will pick her up and carry her. All she has to do is make a noise so we come see what she wants and she puts a paw on the step and waits, because she is after all the diva of the house.

I'll post a picture to show you the window seat creation. http://www.k9cushings.com/forum/albu...pictureid=7186