Cushings in the Performance Dog

[Lisa Beever]

Hi all!

Dachshund Penny was diagnosed with Cushing's today. We had the blood test done last week and I took her to my sports vet today for a sonigram. (We were referred to a more skilled vet for this work.) No tumor on the adrenal gland. Slightly inflammed gallbladder with a liver that looks like that of a Cushing's dog. I have an appointmnent with my GP vet to start treatment, probably trilo.

Penny competes in agility and obedience trials. I have not been able to find anything regarding Cushing's and the performance dog. Last month, she took a first in Obedience Open A and another couple points toward her agility championship at our national specialty. She's not what you would call sick but has slowed down over the course of the last couple years. A year ago, I reduced her agility runs to one per trial day. We trial one weekend per month and train twice per month.

My sports vet thinks that treatment will make her stronger, protect her ligaments better and grow her fur thicker (each new coat is like velvet and then she loses it). She recommends that as long as Penny enjoys competing and we don't overdo it, she should be fine.

Does anybody else have experience and advise about Cushing's in the performance dog?

-Lisa

[mytil]

Hi Lisa and Penny,

Welcome to our site. I will start off with the usual questions if you don't mind.

What was the type of blood test performed and the results. How old is Penny? Can you let us know what symptoms prompted your vet to test for Cushing's?

Cushing's can be difficult to diagnose as its symptoms mimic other conditions such as diabetes, liver and thyroid conditions.

I have no direct experience with performance dogs who are diagnosed with Cushing's but I do know that with diagnosed Cushing's and proper treatment, the muscle wasting is abated and it is the over all health of the dog that needs to be considered when making the decision to continue on any rigorous tasks; especially with conditions such as Cushing's or other conditions such as diabetes etc..

Here is a great link that describes what Cushing's is and what happens to the body - http://www.k9cushings.com/forum/showthread.php?t=180

Keep us posted
Terry

[Lisa Beever]

Hi Terry!

Here are the answers to your questions:

What was the type of blood test performed and the results.
Cortisol suppression test: baseline 4.4 ug/L, 4 hours 5.7 ug/L, 8 hours 6.7 ug/L. (ALT, ALKP GGT LIPA high; TT4 AMKL low; all else including GLUC normal). All three vets (GP, sports and radiologist/oncologist)that I have consulted with have no doubt it is Cushings. All three carefully reviewed each others' work. All three recommended Trilostane. She began treatment today.

How old is Penny? 10 years old

Can you let us know what symptoms prompted your vet to test for Cushing's? I asked my vet for the test. A friend who breeds dachshunds suggested it after she asked about her hair loss. I did so after reading more and seeing pot belly and thirst (in comparison to my 1 yo dachshund) as additional symptoms.

Penny still loves agility and performing. I think the physical activity and conditioning has helped to keep her stronger than otherwise. It probably continues to do so. A few months ago, we attended a conditioning class. Our work on a peanut has increased some of her strength even with untreated Cushings.

Penny likes jumpers with weaves less than standard agility so we've only done standard for the past year or so. I always have listened to her. She has pretty good judgement regarding what she does or doesn't want to do and informs me. As an example, she whimpers to bring me back to the bedroom to help her down from the bed when she sleeps in. This year, AKC has dropped the height and slope of the A-frame for her size class so that is better too.

I will keep you posted on both her Cushings life and performance life.

-Lisa

[lulusmom]

Hi Lisa and welcome to you and Penny.

I don't believe I've ever seen a dachshund compete in agility so that is really awesome. I'm sure you are very proud of your girl. I know I would be. :D To answer your question about cushing's affect on agility, excess cortisol chews through protein, affects the body's metabolic functions and left untreated, can greatly affect a dog's ability to perform. Exercise intolerance is very common as is severe muscle wasting due to the catabolic effects of excess steroids. With treatment, there is every reason to believe that Penny can kick butt and take names. :D

The blood abnormalities you mention are definitely ones we see with cushing's and the LDDS test results show no suppression at all, which is suggestive of an adrenal tumor as opposed to pituitary based disease. That coupled with the fact that Dachshunds are a breed that seem to be predisposed more than most to adrenal tumors, your vets, and most certainly the oncologist, should have recommended an abdominal ultrasound to check the adrenal glands for suspected tumor(s), as well as check surrounding internal organs. I'm always concerned about possible hypertension, especially if a dog has a functional adrenal tumor. Adrenal tumors can cause really high blood pressure so please talk to your vet about this and makes absolutely certain that this addressed.

The first choice of treatment for an adrenal tumor is surgery, which can be a total cure. If surgery is not an option, then Trilostane is the best second choice.

I'm glad you found us and we'll look forward to hearing more about your precious Penny.

Glynda

[Lisa Beever]

Hi Glynda!

Yes, it was the radiologist/oncologist that performed the sonigram and he was certain that it was not due to an adrenal tumor. He also checked the other internal organs and wrote a thorough report for my other vets. Penny is in good hands.

You may think I am imagining things but four hours after her first trilstane, I noticed that her fur was softer and less bristley. The velvet, that had been coming in with her summer coat and on her chest where there had been hair loss, felt more robust. This velvet had been coming in with each coat change but lost after a few weeks each time.

Also, she slept in my arms for the first time in several months, as she used to do. She also seemed generally happier this morning and eager to work on her conditioning peanut. No side-effects to the Trilostane so far.

I am really thrilled with her progress in such a short time.

On the agility front, here is a link to a Cushings dachshund running agility: http://www.youtube.com/watch?v=xy43AbW6ENM. You may notice the hair loss on the back of her thighs and her belly.

-Lisa

[Lisa Beever]

I reread my last post and it wasn't clear. The Cushings/agility dachshund on http://www.youtube.com/watch?v=xy43AbW6ENM is Penny.

-Lisa

[lulusmom]

Hi Lisa,

I absolutely loved the video and wow, am impressed with little Penny. She was awesome and if that was you with her, I'm impressed with your agility too. :D

Way to go, Penny!!!!!

So you did have an ultrasound done. Any chance you can get a copy of the findings and post them here?

Glynda

[Lisa Beever]

Hi Glynda!

Thank you for asking for the sonogram results. I asked the vet for it and it is now in my records.

On 5/23/2012 Penny Beever was presented for an abdominal untrasound examination.

Sonogram:

Peritoneal Cavity: No evidence of free fluid in the abdomen.
Liver: Mildly enlarged with smooth margins and uniformly hyperechoic parenchyma compared to the spleen. Normal perfusion based on color flow Doppler evaluation.
Gall bladder: Increased wall thickness with evidence of echogenic debris in the luman.
Spleen: Normal size, shape, echogenicity and perfusion. No macroscopic evidence of metastasis.
Kidneys: normal size, shape and echogenicity. Normal perfusion based on color flow Doppler evaluation.
Adrenal Glands: The left adrenal is moderately enlarged (>2.2 cm x 1 cm). The right adrenal was difficult to measure but is enlarged.
Pancreas: No significant changes.
Stomach: No significant changes.
Small Intestines: No significant changes.
Lymph nodes: No significant changes.
Urinary Bladder: Normal wall thickness. No evidence of echogenic debris.

Impressions:

Impression: These changes are consistant with pituitary dependent Cushing's Disease. There was no macroscopic evidence of malignant neoplasia noted at this time.

...

David Herring, DVM, DACVR

----------------------

And yes, that was me running Penny in the video. It was a good run just last December. -Lisa

[lulusmom]

Hi Lisa.

Thank you for sharing the ultrasound findings with us. It's good to know what form of cushing's you are dealing with and the ultrasound definitely gives you the answer to that question.

I'm glad to hear that Penny is responding so well to the Trilostane. Most dogs do respond rather quickly and cortisol can drop like rock in the first couple of days. Some dogs can feel kinda crappy in the first few days due to cortisol withdrawal but it appears that Penny is doing just fine on the dose your vet has prescribed. Can you tell me how much Penny weighs and what dose of Trilostane your vet prescribed? Did your vet instruct you to have an acth stimulation test done no later than 14 days after starting treatment? On the day of the test make sure that Penny has her dose in the morning with food and have her to the vet 3 to 5 hours after dosing. The test should be completed no later than six hours after dosing to insure that cortisol measurements are obtained during Trilostane's peak concentrations.

Glynda

[Lisa Beever]

Hi Glynda!

Can you tell me how much Penny weighs and what dose of Trilostane your vet prescribed?
She last weighed 18.4 lb and is on 30 mg.

Did your vet instruct you to have an acth stimulation test done no later than 14 days after starting treatment?
No, he asked me to bring her back in 3-4 weeks. I received a 30 day supply of Trilostane.

On the day of the test make sure that Penny has her dose in the morning with food and have her to the vet 3 to 5 hours after dosing.
He said it would be done with Penny fasting. No comment about the medication.

The test should be completed no later than six hours after dosing to insure that cortisol measurements are obtained during Trilostane's peak concentrations.

I will follow up appropriately,
Lisa

[lulusmom]

Alrighty, Lisa, looks like we need to help your vet with a little continuing education. :D I'm providing a link below to Dechra's treatment monitoring protocol . Dechra is the manufacturer of Vetoryl (Trilsotane). Please take a look at it yourself so that you have a better understanding of the drug and make sure you share it with your vet. Dechra recommends a small meal on the day of testing as Vetoryl is more readily absorbed with food. If you fast Penny, you won't get an accurate reading of cortisol levels and believe me, acth stimulation tests aren't cheap so you don't want to waste your hard earned money.

If your vet has any questions, there are vets on staff at Dechra who are willing to answer any questions or help with test interpretations.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

[Lisa Beever]

OK. I have forwarded my link to my GP vet and inquired regarding prcedure.

-Lisa

[Lisa Beever]

So, Penny has been on Trilostane for a week now. I find it remarkable the rate of her improvement. Fur growing in on her neck and less sway in her back.

I took Penny to obedience training this evening. Her drop on recall included a gallop (rather than a trot) and her drop look like a border collie, keen and eager. Heeling great, including a full-out run on the fast pace. Penny was recruited for the club's team at the Dog Obedience Compeition of Florida as an "awesome obedience dog". That was based on untreated Penny. I have to give Penny much credit for achieving what she has as an untreated cushings dog. She's shared food with my puppy. She's competed successfully, including a first placement in Open A obedience at the Dachshund Club of America show last month.

I reviewed Trilostane's label info. I have set a ACTH stimulation test for 14 days after treatment was initiated. Food with the pill and 4-6 hours after the pill.

Thank you, Lisa

[Chancie]

Good going Penny:D

[lulusmom]

That's a great update and good for you for making sure proper treatment monitoring protocol is going to be followed. Give yourself a big pat on the back for being an excellent advocate for Penny.

[Lisa Beever]

Penny was diagnosed and started treatment (trilostane) nearly 3 weeks ago. Last week she was tested and her results were 3 µg/dL. She showed improvement on the medication right away and I see additional improvement almost daily.

Last weekend, Penny won her Companion Dog Excellent (CDX) title from AKC. It is an advanced competitive obedience title, which includes retrieving a dumbbell over jump, going over a broad jump, a 3-minute out of sight sit-stay, 5-minute out of sight down-stay and heeling. She also competed in rally-obedience. She kept a gruelling schedule of 9 competitive events in 1 1/2 days. She qualified in all six rally events and qualified in 1 obedience event with 1 small error in each of the other 2 events. There were only 2 qualifying dogs (seeking a CDX title)the whole weeked, of any breed.

Penny was called a great working dog by judges and other exhibitors. As a dachshund, her work is striking. The fact she had the loss of strength with the Cushings makes her a wonder.

-Lisa

[Chancie]

Congrats Penny!

[Lisa Beever]

Two weeks after earning a Companion Dog Excellent (CDX) obedience title, Penny won her Master Agility Championship (MACH) title. She is the first dachshund in Florida (and one of the first couple dozen ever) to MACH. This is all after 4 weeks on trilostane and her Cushings diagnosis. Trilostane has been wonderful for Penny! I have my young dog back again.

Her MACH run can be viewed at http://youtu.be/ijO1Ocj5vTo. You can see some rudimentary hopping through the weave poles. I hadn't seen her hopping in a long time and certainly after AKC lengthed the distance between poles! This suggests that her legs are strengthening. Her belly looks better and her fuzz in growing in the bald spots. She is drinking less. This has been the smallest amount she has taken in many months of trialing. (Though she is a good dog and emptied her bladder every time I took her out to the grass).

I am planning more titles with Penny.

-Lisa

Moderator's Note: I have merged your update on Penny into Penny's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[mytil]

That is amazing Lisa! The first cushpup doxey to win the title I would say :D. Thank you for including the video.

Big congrats smoochies to Penny.
Terry

[Lisa Beever]

:)Hi all!

I thought I'd check in again. Penny is still doing great. Her pot belly is gone, her fur is thick and luxurious, she plays with the 1 yo puppy, and is fully her young self again.Trilostane has been a miracle drug for her. People joke that they would like to get rid of their baldness and pot belly so easily.

Since Penny got her agility championship, I haven't trialed with her much, but she's done very well and enjoys it when I do take her. She still enjoys training agility and obedience.

A month ago, I took her to a coursing ability test and she earned a CA title. The judges were amused at how loaded for bear she was whenever she saw the lure. She earned the title in 3 out of 3 runs.

Next weekend, I am planning to take her to an earthdog test because she is really getting her dog on! Good dog Penny!

-Lisa

[mytil]

Hey Lisa,

Glad you checked in. You go Penny girl....sounds like she is feeling so much better, and I am sure you are too!!!!!

Terry

[Boriss McCall]

I am so happy for you & Penny! She is trucking along.:D

[molly muffin]

wow, Penny is doing really excellent, but on the Trilostane and in her competitive carreer! I bet she's looking beautiful now too with the coat all nice and full.

Sharlene