6 y/o cockapoo Bonnie recently diagnosed

[Tina]

Hi Andrea,

You might consider asking your vet about a bile acid test. It is a highly sensitive test that specifically assesses liver function. My pup Jasper had a lot more Cushing's symptoms than Bonnie, including very excessive drinking and peeing, along with the elevated liver values. Our vet had us do a bile acid test to rule out primary liver disease before she considered looking into Cushing's. His test came back normal and he was subsequently diagnosed with Cushing's after additional testing. He had just turned 8 when everything started. As others have said, the diagnostic tests for Cushing's can show a false positive if there is any other illness going on.

My other pup that I just lost did not have Cushing's, but she did have some level of liver disease, and also a gall bladder mucocele that was successfully removed through surgery. Her bile acid test at the time came back very elevated. We did an ultrasound after that.

Also, I didn't see that Bonnie had an LDDS test done? I think it used to be the gold standard for Cushing's diagnosis. Lori, Marianne, Leslie, please correct me if that is not right, I've been out of the loop with the testing protocol for a while!

Tina

[Harley PoMMom]

Looking forward to your update on Bon Bon!!

[BonnieandDre]

Hi everyone, and thanks for checking in.

We just got back from Bonnie's repeat ACTH test. She is responding well to the Vetoryl - her cortisol is now in a good range.

Baseline: 1.3 ug/dl (vs last time it was 9/3)
Post: 3.4 ug/dl (vs last time it was >30) - ref range is 1.8-7.2 for Vetoryl, "maintain current dose if pt is doing well"

Tx/Follow-up:
- Continue with Vetoryl 30mg once daily w/ day - I asked about the risk that cortisol continues to fall in the coming weeks and the risk of Addisonian crisis, and he said that it should be relatively stable now, so he is not concerned about that. I also asked about switching to twice daily and he said not necessary.
- Continue with Denamarin until out of Rx (6 more weeks) - The vet said the liver functioning takes longer to affect, so we'll test her liver enzymes at the 3 month followup
- Continue with probiotic until out of Rx (4 more weeks) - Her bloody poops are better.
- Repeat ACTH test at 3 months
- Monitor for any changes.

Tina, Bonnie didn't have an LDDS test done (in hindsight, I should have done that. I chose to do the ACTH test since it wouldn't require Bonnie staying at the vet all day, and she HATES the hospital. I didn't realize that ACTH doesn't tell me where the tumor was :/ )

Her specialist visit is early April, so I will do an ultrasound at that point. I asked about if the ultrasound is still okay to do once she's on treatment (since Vetoryl could increase size of adrenals), but he said still worth doing while she's on it, to confirm if adrenal tumors are present.

So glad her cortisol levels are better. Is there any reason to suspect it's not Cushing's at this point, given her response to treatment?

Thanks all,
Andrea & Bonnie

[Harley PoMMom]

I do still have my doubts about her Cushing's diagnosis because of that elevated bilirubin.
Cortisol can continue to drift downward during the first 30 days of treatment so do keep an eye out for too low cortisol such as: loss of appetite, lethargy, diarrhea, vomiting, or Bon Bon just not acting herself. If any one of these symptoms is noticed stopping the Vetoryl is required.

How is Bon Bon doing? Is her appetite normal?

You're doing a great job!!

Hugs, Lori

[BonnieandDre]

Yes will definitely keep an eye out!

Her stool sample came back positive for Giardia. We're starting metronidazole for 7 days and Panacur (dewormer).
At least that explains the bloody poops...

Poor Bon, so many meds the last few weeks!
Found a much more reasonable price for Vetoryl at Costco, and an ultrasound at another vet for about half the price! That appt is on 2/28.

[Harley PoMMom]

Poor Bon indeed Did you ask UC Davis what they charged for an ultrasound? If they're competitively priced, you may want them to do it as they are probably more experienced at ultrasounds.

Keep us updated please!!

[BonnieandDre]

I saw an ultrasound price in an full Adrenalectomy quote, and that was ~$500. This was in the context of a much larger operation though, so not sure if applicable.
The appt isn't til April, so would prefer to know sooner rather than later.
The one I'll get on 2/28 is w/ board certified folks so I think should be okay (and cheaper, ~$400) .

[Harley PoMMom]

Hopefully we'll learn more from the ultrasound on the 28th, good luck and keep us updated, please!

Hugs, Lori

[BonnieandDre]

I certainly will!

[labblab]

Although I haven’t had the chance to write much over the last couple of days, I’ve just now been catching up. And I’ll be wishing you good luck on the ultrasound, too! In the meantime, best wishes to both you and sweet Bonnie.

Marianne