Newly Diagnosed - Pinkie has passed

[pinkie]

My 8 1/2 year old Maltese was diagnosed with Cushing's in April. Her water intake is approximately 1 cup/day and urination does not seemed to have increased.

The LDDS test results were: pre 3 reference range 1.0 - 6.0 ug/dL; post 4-hour 2; and post 8- hour 2.

I am only listing abnormal lab test results: ALP - 408 reference range 5 - 160 U/L; cholesterol - 444 reference range 131-345 mg/dL; chloride - 99 reference range 108-119 mmol/L; sodium - 139 reference range 142-152 mmol/L; auto platelet - 723 reference range 143-448 K/uL; T4 - .9 reference range 1.0-4.0 ug/DL; Free T4 - .5 reference range 0.6-3.7 ng/dL; Free T4 - 6.4 reference range 7.7-47.6 pmol/L; UA blood - tracehigh. The vet also indicated that her urine was very diluted.

She is currently on thyroid medication and the following supplements: milk thistle, turmeric, cushex s and m.

It seems that her symptoms have become worse this past week to include panting and severe lethargy. She also feels very warm and her heart rate is very high after exercise.

I am not sure if the increased symptoms are due to worsening Cushing's. Should I stop the supplements and try medication at this point? On-line research indicates that medication can be very toxic. Also, should I schedule a HDDS test to rule out adrenal tumor?

Any information would be greatly appreciated with this confounding disease.

[DoxieMama]

Hello and welcome! Thanks for providing the abnormal test results. Do you have the reference ranges so you can add those in? You should be able to edit your post above to include them. Not all labs use the same reference ranges so it can be helpful to see exactly what they're comparing to. I'm sure others will be by to welcome you and provide feedback on the information you've provided... but don't be surprised if they ask more questions! The more details we have, the better support we can provide.

Shana

[kanga]

Sorry about what happen to your baby I want you to know that you are always in my thought's! I know there's a lot of member here who can give you good advice and good information about the problem that you facing right now. I pray for her god is good don't loss hope.

[molly muffin]

Unfortunately cushex doesn't actually lower cortisol, it basically can help with the symptoms sometimes and usually those who try it end up on medication.

Milk thistle for the liver is fine and I've hard good things about tumeric but can't say much as I haven't tried it.

You could try vetroyl at no more than 1mg/1lb to start.

If I was going to do another test, I would probably opt for an ultrasound as it gives you a lot of bang for the buck, can tell you if there is an adrenal tumor and can also rule out sludge in the gall bladder. I've seen several maltese end up with sludge is why I mention it .

[pinkie]

Thank you for the information. I am so glad I found this forum for support and to research information.

I understand Vetroyl is very toxic and can cause more issues. I will discuss the ultrasound and Vetroyl with my vet and next steps to relieve symptoms since there is no cure.

[lulusmom]

I agree with Sharlene that an abdominal ultrasound would be a superior differentiating test and money well spent. It not only can differentiate based on the adrenal abnormalities, it can give the vet a really good look at the surrounding organs, including the gall bladder already mentioned, to make sure there are no non-adrenal problems that can be contributing to symptoms and lab abnormalities. Cushing's is one of the most misdiagnosed canine diseases so the more differential diagnoses a vet can rule out, the better.

Vetoryl is a very serious drug but if prescribed and monitored by an experienced vet who follows proper protocol, side effects can be greatly reduced and most often avoided completely. Of course, your participation in watching for signs of low cortisol is mandatory. The more you learn about the disease and the treatment, the more confident you will become in assuming an even more proactive participation in your pup's veterinary care.

In preparation for starting treatment, I highly recommend that you review Dechra's Vetoryl Diagnosing, Treating and Monitoring brochure. I've provided a link below and suggest that you make certain your vet already has this information. If s/he does not, please make sure you provide him/her with the url or printed copy. You would be surprised by how many gp vets fail to follow protocol. Speaking of which, please make sure your vet follows the latest starting dose recommendations by the manufacturer which is 1 mg per pound of body weight (2.2mg/kg) per day and always give the capsule with food.

http://www.dechrace.com/pdfs/vetoryl...ngBrochure.pdf

I see in your first post you mentioned that your pup is now experiencing increased heart rate after exercise. It is not uncommon for the heart rate to go up when exercising but if what you are seeing is not normal for your dog, it could be that the dose of thyroid supplementation is too high. Increased heart rate is definitely a symptom of hyperthyroidism as is excessive drinking and peeing so if both of these symptoms have increased after starting thyroid supplementation, you may need to cut back on the dose. Please make sure you tell your vet about this because persistent increased heart rate can be serious. How much does your pup weigh and what dose of thyroxine is she getting?

Glynda

[pinkie]

Pinkie normally weighs 8.5 pounds, but she now weighs 8.2 pounds. She is on thyroxine 0.1 mg 1/2 tab every 12 hours.

Also, should I also schedule an ACTH test before starting Vetoryl since I recall reading that ACTH confirms Cushing's? I understand routine ACTH will be required after medication. Is ACTH necessary if LDDS is indicative of Cushing's? The ultrasound has been scheduled for next week.

Thank you everyone for your answers and support!

[Harley PoMMom]

1 cup of water is a normal amount for a 8.2 lb dog, does she have any other symptoms of Cushing's such as: ravenous appetite, skin/hair issues, pot-bellied appearance, exercise intolerance, and difficulty or unable to go up steps or jump on furniture?

An ACTH stimulation test is not required as a diagnostic test but since there isn't one test that can accurately identify Cushing's multiple tests are recommended to validate the diagnosis of Cushing's, and as the others have suggested, an ultrasound would be a very good option.

Hugs, Lori

[pinkie]

Thank you for the response.

She is exhibiting the following symptoms: constant panting; severe itching around mouth area where she scratches until it bleeds; exercise intolerance; feels very warm; hesitant to go up steps; and severe lethargy. Her appetite is normal since she was always food driven from when she was a pup.

The vet said to continue normal activities, but I temporarily stopped activities that may tire her out such as walks and hospital visits.

I will wait for ultrasound results for next steps. I am encouraged to read success stories regarding Vetoryl.

[dsbailey]

Is ACTH necessary if LDDS is indicative of Cushing's?

You should get an accurate diagnosis from the ultrasound and lots of useful information to move forward with.

I'm going to approach your question from a different angle. If money wasn't an issue and my dog didn't mind getting blood drawn then I would have liked to have had an ACTH test done prior to starting meds for baseline purposes. It's not necessary but may be helpful if you start having problems finding the proper dosage. With that said and in hindsight I'd not do it because my girl has gone from enjoying her vet visits to fearing them. Getting stuck in the neck with a needle 20 ish times in the past few months would make me a little vet shy too.

On a side note if you're girl is having persistent UTI's then getting a cystocentesis (needle inserted directly into the bladder) urine culture at the same time as the ultrasound may save you time, money, and mutual stress. This is the best method for a pristine urine sample.

Darrell and Lolita