SOS: Frosty the maltese (9) may have Cushing's. Need help!

[FrostyKhoo]

Hi there,

My name is Kirsteen & my maltese (Frosty) aged 9 has been diagnosed with Cushings. We went in for pre-dental bloodwork in September. His ALKP was 529. The vet wasn't too concern at this point thinking it was due to his teeth & recommended a re-test in 2 weeks. The subsequent blood test showed ALKP was 385 u/l.

A bile acid test was then suggested & did. Preprandial 14 umol/L; Postprandial 19umol/L.

Our vet suggested either an ultrasound performed or we could start him on denosyl for a month to see if it would bring down his liver enzymes. We opted to try the denosyl as we had already done a ultrasound in 2014 & nothing was found. His blood test came back showing that the ALP had risen to 619 u/l while his ALT was 64 u/l.

My partner & me decided to have an ultrasound done for him. The sonographer found the nodule in his lymph notes unchanged but his both adrenal glands has enlarged.

A LDSS test was perform on Tuesday & we received a call on Wednesday confirming he has mild form of cushings. Our regular vet was not in that day & the vet on duty wants to start him on lysodren immediately. We have since made an appointment with our regular vet for this Saturday to discuss the next step to take. I will also ask for the LDSS results then.

Frosty is not exhibiting any of the classic Cushing's symptoms. He still drinks & normally. He waits patiently for me to let him out to the backyard in the morning for him to do his "businesses". He still loves to go for walks & gets really disappointed when we go for the shorter route instead of the long ones he loves. His hind legs are slightly weak but he has had that problem since he was a puppy. He regularly has to knock the left one back in place. He weighs approx 5.8kg/12.7 pounds. Only symptoms he seems to be showing is that there a brown spots all over his body. We previously brought him to the vet for this & was told allergic reaction to plants. He does scratch quite alot. I also noticed a bruise on the spot where the blood was drawn during the LDSS.

My question is should we have further testing conducted? We are planning to have a urinalysis done, as I noticed he has been licking his private parts really frequently. Hoping to get some feedback on this matter. All suggestions are welcome.

I am so happy to have found this forum. I need all the help I can get, dealing with a disease I no nothing about. I love him. He is my whole life basically. I can't imagine my life without him. I can't thank everyone on this forum enough. I have been running around like a headless chicken this past 3 months. This forum has been a god send. I now know I'm not alone in this battle & that I have an knowledgable army behind me.

Thank you & sending lotsa love to both the pups & you.

[Harley PoMMom]

Hi Kristeen,

Welcome to you and Frosty! I'm assuming that your avatar is of him and what a cutie pie he is!! I definitely remember that lost and scared feeling when my Harley was diagnosed with Cushing's, trust me the more you learn about Cushing's the less scary it gets.

Yep, we do like to see all test results so when you get them post em right here, ok? Does Frosty have any underlying illness and if so what is it and what medication is he taking? Now, with Frosty not displaying strong Cushing's symptoms I would be less likely to start treatment. You see, the drugs used for Cushing's do not cure the disease instead they help control those bothersome Cushing's symptoms and get that elevated cortisol down to within the therapeutic ranges.

Cush dogs usually have a ravenous appetite which is needed when treating with Lysodren. A loading phase is the first part of the Lysodren protocol, during this phase you are looking for any sign of the dog being loaded. Generally a change in eating is the one noticed most and it could be really subtle sign such as the dog pausing for a sec before eating his meal. If a dog does not have strong symptoms than it is very difficult to judge how the Lysodren is working and this could be serious trouble for that dog. If Lysodren is given too long it can erode more of the adrenal gland than it should which can put a dog in a life threatening situation known as Addison's. The key to facilitating safe and effective treatment is an experienced vet and an educated pet owner, so the best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. With treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span.

I'm including some links to info regarding Cushing's: http://www.k9cushings.com/forum/showthread.php?t=180

http://www.k9cushings.com/forum/showthread.php?t=181

We understand that you are fearful but we will help you and your dear furbaby in any way we can, we will walk this journey with you, ok? I am sorry for the reasons that brought you here but so glad you found us.

Hugs, Lori

[FrostyKhoo]

Hi Harley PoMMom,

Thank you for welcoming me. Sorry for the late reply. I spent the whole night reading up on the other cases on this forum. I get bouts of optimism & also of intense panic & sadness. Yesterday was one of those days, when I really was in no mood to think about it anymore.

Yes, that is Mr.Frosty. Frosty thanks you for your compliment.

We just got back from the vet this morning & our regular vet confirms that Frosty is showing clear positive signs of Cushing's. She recommends starting him on 10 mg Vetoryl.

ENDOCRINOLOGY.

*Cortisol Baseline- 265/L 15-170ml

*Cortisol 4 hr post LDSS 32 nmol/L

*Cortisol 8 hr post LDSS 46 nmol/L


Post time 1: 4 hours
Post time 2: 8 hours

His symptoms are steadily rising ALKP with no rise in ALT. Thin coat & rats tail developing.

He is generally a healthy dog who before a year ago never had to go in to the vet for more than a yearly vaccination & general check. He is not on any medication. He does suffer from luxating patella since he was a pup. Regularly has to knock his left back paw back into place.

An ACTH was perform this morning & results will be back next week.

Please bare with me as I post all of his medical history reports, as I'm still getting the hang of the terminology. Thank you!

[FrostyKhoo]

BLOOD TEST (18 June 2014 08.38)


*HCT 57.7% 37.0-55 HIGH

*HGB 19.2 g/dL 12.0-18.0 HIGH

*EOS ~3.27 x10^9/L 0.50-1.50 HIGH

*ALKP 422 U/L 23-212 HIGH

BLOOD TEST (17 FEBRUARY 2015)


*HCT 60.1%

*HGB 19.3 g/DL

*PLT 565 K/ul

*ALKP 344 u/l

BLOOD TEST (15 SEPTEMBER 2015)


*HCT 57.1% HIGH

*HGB 18.6 g/dL HIGH

*RDW 14.7% LOW

*ALKP 529 U/L

BLOOD TEST (3 OCTOBER 2015)


*HGB 18.6 g/dL HIGH

*ALKP 385 U/L

BLOOD TEST (17 NOVEMBER 2015)

*ALKP 619 U/L

[FrostyKhoo]

BILE ACID TEST (20 OCTOBER 2015)

Preprandial: 14 umol/L

Postprandial: 19 umol/L

<12 umol/L-Normal; consistent with sufficient hepatic function

12-25 umol/L-Equivocal; retest at a later time if hepatic dysfunction is still a concern

>25 umol/L- Consistent with decreased hepatic function.

[LauraA]

Hi Kirsteen and Frosty Just want to welcome you both and say that Cushing's can be controlled and Frosty can happily live out his normal life span. My girl has a luxating patella as well and also a heart murmur and some kidney problems. Despite this she has been doing really well on the Trilostane (which is the same as Vetoryl) for over 2 years. It really has given her back such a good quality of life. She regained a lot of strength in her back legs and happily still does 2 walks a day, her skin has cleared up immensely although in winter she is still prone to rashes, she has never been a big eater even before her diagnosis so her weight has always been about the same. Sure she is old now and has some of the normal old age stuff dogs get as she is 12 1/2, don't we all hehe. So hopefully Frosty will be in that majority that does really well on the drug and once you get through the first couple of weeks on the Vetoryl you will find you will start to stress less about the disease. I remember feeling the same way as you at the beginning and many tears were shed.

It also helps that this forum is filled with some knowledgeable, caring and compassionate people that are more than willing to go that extra step in helping you out. You and Frosty are definitely in the right place.

[FrostyKhoo]

ULTRASOUND REPORT

Today's study is compared to study 24.7.2014 which represents a 16 month re-evaluation period. Steadily rising ALKP with no rise in ALT. Thin coat & rats tail developing.

Measurement Comments
L Kidney 3.59cm Occasional tiny mineralised foci throughout cortex, otherwise unremarkable

L Adrenal 0.61cm (previously 0.45cm) Increased in size. Upper limits of the normal range.

R Adrenal 0.77cm (previously 0.56cm) Increased in size. Mildly smoothly enlarged.

Spleen Normal: No Comments: Subtle hypoechoic nodule previously demonstrated has increased slightly in size from 0.49cm to 0.65cm. Still not associated with any capsular distortion. Spleen remains otherwise unremarkable.

Liver Normal: No Comments: Very mild hyperechoic diffuse parenchymal change demonstrated. No significant focal parenchymal change demonstrated. Capsular margins remain smooth & relatively sharp.

[FrostyKhoo]

Hi Laura,

Thank your for your kind words. Your little ones are adorable!

Frosty will be glad to hear that as he has been having trouble with his hind legs & has been ordered by the vet to be on bed rest for the next week or so. Ageing is such a pain isn't it? haha.

Here's hoping he will be as good as your girl on Trilostane. Is there anything specific that I have to keep any eye on when he first starts on the medication? Frosty still eats & drinks the normal amount. Is the dosage recommended correct as well? How much did she start on with? Sorry for the amount of questions! haha. Just want to be sure my vet is on the ball with the dosage.

I'm very grateful for you & everyone else on this forum. My partner is really grateful as well. He has been reading up on the disease too! Thank you! <3

[LauraA]

10mg is fine to start on, much better to go low and slow than have an overdose My girl is 7kg and is on 30mg once a day. It really is important to do the ACTH Stim test around the 10-14 day mark as this way you can tell if the cortisol is too low. If so then the dose should be reduced, if not then you shouldn't adjust the dose as the cortisol will continue to lower for some time. I know even after 4 months Bulgers kept decreasing on the same dose. Around the 30 day mark you should have another test and then if you need to increase the dose you can.

Thinks to look out for are lethargy, diarrhea, loss of appetite, trouble getting up, vomiting - and I am sure others will jump in with everything else I have missed

Also the tests should be done withing 4-6 hours of taking the meds which should be given with food. That is why it is best to give the meds in the morning with their breakfast. After you get the dose tweaked correctly you can then go to 3-6 monthly testing which is a relief on the wallet.

Questions are great!! Always good to ask And it is such a shock at the start, I didn't know if my girl would make it even though my vet was going she will be fine once we get everything under control lol. She also had protein loss in her urine but luckily after about 5-6 months it all returned to normal since she wasn't pumping all that cortisol around her little body.

With her luxating patella we give her tramadol as NSAIDS are generally a no no for Cushing pups. They are really hard on their livers.

Oh and I see you are another Aussie I am in Perth!

[FrostyKhoo]

Hi Laura.

Awesome, good to hear from another Aussie (even though its not under the best circumstances How's the weather in Perth these days?

I'll be watching him like a hawk when he starts his medication. Will be starting him as soon as his ACTH results return. We also decided to have an urinalysis done, as I noticed he has been licking himself pretty frequently this couple of weeks. Just wanna rule out, him having a UTI too.

Thank you so much for your help. Will be a nervous wreck this couple of weeks but with everyone else's help, it will hopefully be bearable for Frosty.