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Thread: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

  1. #1
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    Default Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Hello everyone, I’ve spent countless hours poring over this forum, reading all the heart-warming and heart-breaking posts, looking for hope for my pup. I finally thought I’d post my situation to get all your helpful feedback. It’s long, so thank you in advance for reading!

    My Wrigley was diagnosed in January of this year with Cushing's Disease. He is a 10 year old male Yorkie with no past health issues. He has been on Trilostane (7.5mg) twice a day, as he weighs 15lbs. He is also taking some herbal supplements – just finished up Gracious Power and switching to Four Marvels (more on why later).

    In Aug 2013, Wrigley was scheduled for his first professional dental cleaning, which required blood work and an exam to ensure he was fit for general anesthesia. His ALP value came back at 1108 (extremely elevated), but everything else was normal. We proceeded with the dental work, but pursued the investigation into his high ALP. His liver was fine, a urinalysis showed no Cushing’s at the time, his lab work was good, and he was clinically good. We also had an ultrasound done, and everything was normal. His vet recommended monitoring the ALP value and checking it every 6 months.

    In Apr 2014, his ALP was 477 (significantly lower, but still on the higher end) with no modifications whatsoever to his lifestyle. In Oct 2014, his ALP was 900 (back up), but again no changes. We continued to check every 6 months, and his ALP consistently hovered at the elevated level (1100, 800, etc.), but he showed no signs or other reasons to be concerned. Fast forward to Jan 2018, and I noticed a few days that he drank a ton of water. This combined with the high ALP prompted my vet to run another test for Cushing’s, and it came back positive.

    At the same time, she did a urinalysis and found Wrigley also has protein losing nephropathy (PLN). We did an ultrasound, which came back normal, so we started on Trilostane, and his follow-on ACTH stim test put his values all in the normal range. Other than the elevated ALP, those few days of high water intake, and the PLN, Wrigley has zero other signs of disease (normal appetite, normal water intake, no pot belly). We have not yet started treatment for the PLN, as I first wanted to see a holistic vet. He first put us on Gracious Power herbs, but I did not see any difference, although, without other symptoms, I wasn’t sure how to judge their effectiveness. For me, the real test would be his next blood panel/ACTH stim.

    Two weeks ago, Wrigley had his first accident in the house. At first, it was just pee and every few days, but now, he has pooped three times in the house, and there are accidents daily. In addition, about a week ago, he fell off a bed while sleeping, which he has never done before. He appeared to be dreaming, letting out little yelps and “running” while lying on his side. So I am not sure if his dreaming caused his fall or what. (I asked the vet about a possible seizure, but she didn’t think so.) Since then, his right hind leg is weak. He walks crooked now (favoring his left hind leg), and he has trouble going up and down things, and he is pacing a lot. So was his leg always weak and the fall injured it more, or did the fall cause the weakness? The vet said his knees and back seem fine, but she senses perhaps some arthritis. She prescribed a light painkiller for 5 days to see if it was just some soreness, but we are on day 2, and if anything, the leg seems worse, and I still don’t understand the pacing.

    We go back tomorrow for a follow-on ACTH stim, urinanlysis, and blood panel to see if that will tell us anything more. The holistic vet switched us to Four Marvels herbs based on the recent developments, which we start tomorrow. The regular vet wants to start us on Benazepril, I think, to treat the PLN, but it seems like a lot to me. The recent onset of the accidents and hind leg weakness came on so quickly, which seems strange to me. I thought Cushing’s was a slow developing disease, and he has been on the Trilostane for a few months now, so I don’t think it’s that. Part of me wonders if there is a neurological issue because he just doesn’t seem like himself on top of it all. He's only 10, and prior to all of this, he didn't seem old at all.

  2. #2
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Hello, and welcome to you and Wrigley! Gosh, you’ve done a great job of telling us what’s been going on with your little guy. There is a lot to think over, and I want to take some more time rereading things before adding a more complete reply. But in the meantime, I want to tell you we’re so glad you’ve joined the forum, and we’ll surely do our best to try to help sort things out.

    So stay tuned...!
    Marianne

  3. #3
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Hi and welcome to you and Wrigley from me as well!

    Thank you for giving us a detailed history on your boy, we really appreciate it, however, I still have some questions

    Could you get a copy of the test/s that were used to diagnose the Cushing's and post those results? Also, could you post his monitoring ACTH stimulation test results too? Is he getting his Trilostane with a meal and are those ACTH monitoring tests being performed 4-6 hours post Trilostane? Was Wrigley tested for any tick-borne diseases? Lyme disease can cause lameness and PLN. Has an urine culture been done to rule out an UTI as an UTI will cause a dog to drink/urinate more and thus have accidents. Has his blood pressure been checked? High blood pressure is very hard on the kidneys and that elevated cortisol can cause blood pressure to rise. What pain medication is he taking?

    I am sorry for all these questions but your answers will help us provide you with better feedback...thanks! Please know we will help in any way we can and if you have any questions do not hesitate to ask them.

    Lori

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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Thanks Marianne and Lori! I've read your other posts, and you are both so incredibly helpful (as is this whole forum!) so I look forward to learning more! Lori, I couldn't help but notice you're in York. I grew up in Gettysburg!

    Sorry for the delay, as Wrigley was stung by a bee today and went into severe anaphylactic shock. This is at least the third time he was stung by a bee, and he never had a reaction before. I saw him get stung and was able to pull out the stinger. A few minutes later, he vomited and started spinning in circles. I got him to the vet, where they treated him for several anaphylaxis. (They said had I waited any longer, he wouldn’t have made it - *TEARS*) So he is at a hospital staying overnight to be monitored, as while he is stabilized, there is a possibility for relapse. When it rains, it pours, I guess…

    To address the questions, regarding the test results, please see below. Yes, he is getting Trilostane with breakfast and dinner. Yes, the ACTH stims are being done 4-6 hours after his morning pills. Yes, he was tested for heartworm, lyme, e.canis, and anaplasma, all negative as shown below. Urinalyses show no UTI or kidney issues, just the PLN. Blood pressure is good. He is taking Gabapentin for pain meds for 5 days (we started Saturday).

    01-15-18: Hind left leg, size 3 cuff BP: 120, 150, 152. Heartworm: neg, Lyme: neg, E. Canis: neg, Anaplasma: neg
    PRE DEXAMETHAS 8.6 H 1.0 6.0 ug/dL
    POST 4 HR DEX 1.4 ug/dL
    POST 8 HR DEX 1.8 ug/dL
    UPC in house 2.70
    02-02-18 PRE-ACTH CORTIS 4.8 ug/dL, POST ACTH CORTI 8.2 ug/dL
    03-21-18 PRE-ACTH CORTIS 3.5 ug/dL, POST ACTH CORTI 3.8 ug/dL
    04-03-18 UPC at external lab 2.3, UPC in house .98
    04-24-18 UPC in house 1.8
    05-02-18 Abdominal Ultrasound: Liver is a bit enlarged, but is consistent with a dog with Cushing's. Also, dog has medullary rim sign in kidneys- can be seen with PLN.
    07-10-18 ACTH STIM came back normal, but I don’t have the exact results, as the reports above were sent to me before the 7/10 results were finalized. Also conducted renal profile (normal) and urinalysis (normal, no UTI or kidney disease, just the PLN).

  5. #5
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Just wanted to add a quick update: Wrigley is still in the hospital, but has completely stabilized. His vitals and everything are good, so the docs are pretty confident the anaphylaxis was isolated to the bee sting. The good thing is the hospital is the same one we were referred to for the neurologist. He did a consult and agreed there is something intracranial going on, so they are prepping him currently for an MRI. As much as I don't want him to undergo the anesthesia, the neurologist assured me it was even safer than the anesthesia for dental procedures, and the benefits far outweigh the risks. Since he is already under for the MRI, they will also do a spinal fluid sample. Fingers crossed these tests help us figure out what's going on with my Wrigley bear!

  6. #6
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    I am so relieved to hear that Wrigley has stabilized ~Whew~ that had to be so awful for you and him. Wishing you both the best of luck with the MRI and hoping you do find an answer to what is going on with sweet Wrigley.

    Hugs, Lori

  7. #7
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Gosh, I’m surely wishing you the best with the MRI, too! I was actually going to write to you earlier today about the possibility of an enlarging pituitary tumor being the source of some of these newer problems for Wrigley. His LDDS result is consistent with the pituitary form of Cushing’s, and sometimes the typically small pituitary tumors do enlarge and place pressure elsewhere in the brain. The MRI will be able to rule this possibility in or out, so it should be a very valuable diagnostic in that regard, as well as others. We’ll be really anxious to hear what you find out!

    Comforting hugs to you and gentle pats to Wrigley,
    Marianne

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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    Post-MRI update: Wrigley actually had both an MRI and they collected spinal fluid. They saw some abnormalities on the MRI and said there was inflammation, but they didn't know what was causing the inflammation, which is why they drew spinal fluid. We are pending those results, and the neurologist is out of town until Tuesday. So Wrigley was able to come home with us last night, and this morning started several new medications (Prednisone, Prilosec, and Doxycycline) to treat the inflammation. We also started the Benazepril for his protein losing nephropathy. I asked the doc about any risks with these medication combinations, and he said it was fine to take all of them together.

    I also inquired about whether the inflammation was related to the Cushing's, and the neurologist didn't think so, but of course wants to wait until the final spinal fluid results get in.

    Thanks!

  9. #9
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    I’m surely glad to hear that the MRI is behind you, and we’ll be so anxious to learn the final results. I’m just so sorry little Wrigley is having any problems at all. One quick question...I’m assuming they’ve told you to withhold his trilostane for the time being? Since they’re giving him the prednisone to aid in easing the inflammation, I’m figuring they want to halt the steroid-lowering effect of the trilostane, at least temporarily. But I just wanted to check on that.

    Please do continue to let us know how your little guy is doing,
    Marianne

  10. #10
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    Default Re: Wrigley (Yorkie/M/10yo) – Recent Cushing's Diagnosis

    They did not tell me to withhold Trilostane. I had asked the neurologist if it was ok to take all these meds together, and he said it was fine, but maybe I should be asking our normal vet. He is on the neurologist's meds for five days, but I will put in a call to our regular vet to ask about the Prednisone and Trilostane. THANK YOU.

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