Shelby, 9 y.o. Min Pin just diagnosed - great resource here!

[lyswood]

Hello -

I found this forum last week when our vet was talking about testing our 9 year old Min Pin for Cushing's. What a wealth of information - very helpful!! Still weeding through it all.

Shelby had the low dose dexamethasone test on Friday, which pointed to pituitary-dependent Cushing's. She was tested after her yearly blood panel showed an elevated ALT (570) and a subsequent ultrasound showed enlarged adrenal glands. She does not have any symptoms yet, however, so we are not treating her other than starting her on some milk thistle as a liver protectant, just in case.

This forum will be fabulous as we go down this road - I'm hoping she can go for a few years before needing treatment. I don't like the sound of those drugs, but we'll do what's necessary. For her breed, she's should still have many years left!

We were also told this could be a false positive - the diagnostic testing doesn't seem very solid - but since it's consistent with Cushing's and other obvious causes have been eliminated, that's likely what we're dealing with. At least we know what to watch for.

I'm curious to know if any of you had dogs diagnosed early without symptoms and how long they went before showing the signs. Really hoping our girl can avoid treatment for several years, then of course live a long life while being treated. It seems I'm not completely crazy to think that's possible. We just can't bear the thought of losing her - she's the most amazing little critter!

Thanks again for the great resource -

Malyssa

[molly muffin]

Hello, our vet has been telling us since 2011 that our molly has cushings. She tested negative on the LDDS though consistently (she's had at least 3 so far, all negative) but positive on ACTH and her ultrasound did show mildly enlarged adrenals and liver.

She however, has no symptoms and we aren't pursuing treatment, other than liver supplements and I have her alt/alkp checked about every 3 months and yearly ultrasounds to keep an eye on things. If anything changes then we'll deal with it.

I'm glad you found us too. :)
Sharlene and Molly Muffin

[doxiesrock912]

Given that her adrenal glands are enlarged, this is also a sign of Cushings. Every dog is different and treatment manages the symptoms so waiting until symptoms are bothersome makes perfect sense.

Many dogs aren't diagnosed until symptoms are obvious so you're already ahead of the game :-)

You have time on your side and I would learn as much as you can from the resources on this forum. Feel free to post future test results here as there are several people who are great at interpreting them for you.

The best defense for you and your furlet is knowledge. Too many vets don't know enough about Cushings and you can only benefit from learning as much as you can.

[goldengirl88]

Welcome to the forum. As Valerie said no hurry to treat so you can weigh your options. I will just say one thing make sure your vet is very experienced at treating Cushings, start with a low dose if using Vetoryl or Trilostane no matter what anyone tell you- only 1mg per lb to keep your dog safe. This lets the dogs body adjust to this drug. This will save you time, money and heartache to have experience. Educate yourself as much as possible on here as you are the only advocate for your dog and need to supervise things by knowing proper protocol etc. never put blind faith in anyone including your vet. Make a daily diary of your dog as far as water intake etc. you will need it to refer back to. I am hoping alol goes smoothly for you both. Blessings
Patti

[lyswood]

Thank you for the advice!! I'm kind of the researchin' type, so I am definitely becoming more versed on the topic. Our vet seems very knowledgeable on Cushings, but I will definitely make sure I understand every step and question everything. They're very good at working with their clients and presenting all options and risks, so I'm pretty at ease.

I will start a log of her food and water intake - that's a great idea. Our 22 year old cat shares the same bowl and is quite finicky about his water being fresh, so we replace it often. I'm thinking if we take a few seconds to measure what we put in and measure it before we replace it, that will work. Sounds like the increased drinking will be very obvious. Really hoping that's a few years out.

Thanks again - will be reading a lot this weekend when I have some time to research.

Malyssa

[lyswood]

Hello all -

I joined this forum probably 4 years ago when my Min Pin was first diagnosed with Cushing's. Wonderful support and great information! I haven't been around much - the occasional pop-in to read posts - because she was asymptomatic and we were doing nothing to treat her.

Over the last year she finally started showing symptoms (mostly belly, fur loss, increased water intake and liver levels) and I gave her the first Vetoryl pill a few moments ago. I'm always worried about drugs and hoping she doesn't have any of the bad side effects. I'm comforted to see several of you have dogs on this medicine who are doing well.

I expect to be around the forum much more as we adjust to this new reality, so I wanted to say hello again. :) I'm hoping our girl will be feeling much better soon!

I'm off to poke around...

Malyssa & Shelby

[Squirt's Mom]

Hi Malyssa! Glad to see you again! I have merged your post this morning with Shelby's original thread. We like to keep everything about each dog in their own thread. That way it is easier to look back thru the history...and serves as a sort of diary for you. ;)

[Squirt's Mom]

I also edited the title to include Shelby's name - it will be a bit easier for you to find if you've been gone awhile. :)

Soooo can you tell us how much Shelby weighs now and what dose of Vetoryl is she taking? Once a day or twice? Are you giving it with a meal?

Did she have any testing done like the ACTH or LDDS before starting the Vetoryl?

[molly muffin]

Welcome back! I too had waited for a while before starting my Molly on meds for Cushing's.
As Leslie asked. What dose is Shelby on?

[lyswood]

Thank you for merging the threads =)

Shelby is now 12 and weighs about 9.5 lbs. She did have the ACTH test (I believe) back when she was first diagnosed, but didn't have a repeat before starting the meds. She gets 5 mg once per day in the morning with food. This is Day 3 and so far, so good - she'll get tested again in 10-14 days to see how the dosage is working.

Her liver values are pretty high the last few months, so she's also been on Ursodial, which is slowly bringing them down. They're still quite high - I think ALP is around 3300, down from about 4700. Quite high. Her liver appears normal on US and there are no tumors or anything, so perhaps it's the Cushing's causing this as well. She also has some sludge in her gallbladder.

Overall she's a sassy, spunky gal who knows she's in charge of us, and I'm hoping the meds make her feel even better. She should still have several good years in her - praying that's true.

[Harley PoMMom]

I'm assuming she is on Trilostane for her Cushing's, right? And if so, she's on a great starting dose, the recommendation is 1 mg per pound of a dog's weight so the 5 mg for her 9.5 lbs is appropriate.

With Trilostane it is better absorbed if it is given with a meal, I see from your post that she is getting it with food so I just wanted to make sure you were aware that it should be administered with her meal and not just a snack/treat. ;)

I also see that she will be having her monitoring ACTH test in 10-14 days which is according to protocol. ;) And with Trilostane those ACTH stimulation tests have to be perfomed 4-6 hours post pill.

The ALP should come down once her cortisol is stable but there are some dogs that never have their ALP fall back into the normal reference ranges.

Has the vet mentioned about starting her on medication for the gallbladder sludge?

Glad to hear that she is a spunky gal and I am hoping, too, that she will be even better with treatment.

Hugs, Lori

[lyswood]

Yep - she gets the Vetoryl with her breakfast, or actually just after it in a little ball of bologna or cheese.

She did get a med for the gallbladder for about a week or so, but we haven't done a repeat US to determine if it was effective. Will do that soon - I think our vet wanted to wait until the levels went down on the liver too and take another peek at that at the same time. She did warn us that the levels may not return to normal even with the Cushing's meds. So far the Ursadiol seems to be helping, though.

I'm just happy that so far there are no side effects - I really want her to feel better and stick around for a few more years. She's our whole world - I can't imagine life without her! I work from home and we're together pretty much 24/7. We don't have kids, so you can imagine how spoiled she is. :) She's beyond precious to us. I kept hoping the diagnosis was wrong, but it's nice that there is some treatment and I'm hoping this will keep her in our lives much longer.

[molly muffin]

Awww, I'm sure she is completely spoiled. Ours certainly was. She ran our lives like a fine tuned machine. We called her our little diva as she always let us know exactly what she was thinking.

Hopefully you are going to have many more years together. Just have to get these things sorted out and under control. :)

[lyswood]

Pupdate from the first test after starting Vetoryl:

ACTH Stim test results are almost in the ideal range and things are looking good. After the injection, the cortisol levels should be between 1.5 - 9.1. Shelby's first value was 4.3, which doc said was perfect. The second value was 14.3, which is a little higher than they like to see, but headed toward the right range.

We're staying on the 5 mg dose and will retest in 2 weeks. WHEW!!

No side effects that I've noticed, which is a relief - sometimes reading all that information can be pretty scary. I'm glad they're not raising the dosage, as she seems to be tolerating this one fine.

She does seem to be drinking a little less and have a little less of the pot-bellied appearance but it's probably too early to tell any major changes. Gurgly belly is much less gurgly, which I'm not sure is actually the Cushing's, but it seems to be subsiding from either this med or the Ursodiol.

Malyssa

[Joan2517]

Great update....congrats!

[Harley PoMMom]

I'm glad that her dosage was not increased because a dog's cortisol can continue to drift downward during the first 30 days of treatment....good job, Mom!

[molly muffin]

It can be tough getting the right dose but as Lori mentioned, you don't know for sure how far it will go till after 30 days.

good job!

[lyswood]

We were back in the clinic yesterday - she has some spots on her belly that are dry and flaky, and she wouldn't stop licking the one area. It was very red and irritated. Treating the bacterial skin infection, so for two weeks she has 2 more meds: antibiotic and an anti-itch, plus she's on Benadryl 2x/daily. I was giving her Benadryl when she seemed to need it, but now it's constant. Plus a mousse on her belly every 3 days.

Only day one and it all seems to be helping. I think the belly issue can be a Cushing's thing but am not sure. Doc says it starts with a little pimple and when it ruptures, it causes the dry, flaky patch. When she licks it too much, though, she breaks the skin and causes bacteria to spread, causing the itchy infection.

Seems like she'll be fine after this round of additional meds - wow, that just makes me nervous on top of everything, but she does seem to already be feeling better. She even met another Min Pin yesterday at the clinic - we just don't see very many! I think think will be quite a journey but I'm happy about the results so far...I hope this all helps her.

[molly muffin]

Well cushing dogs do get skin issue but so do other dogs, so the main thing is to get it cleared up. I'm glad the antibiotics and stuff they gave you seems to be helping her. That licking can be a pain as that is their natural reaction and is exactly what they don't need to be doing.

Can try baby tshirts if she still messes with it

[lyswood]

Second stim test Monday and the cortisol levels are right where they should be, though on the lower edge of the range. That, coupled with an increased potassium level, concerns the doc that the meds might be doing too much, so we'll retest in two weeks. I didn't get precise levels this time (didn't directly speak to doc) but can call and ask.

I'm a little nervous that the levels will continue to drop in the two weeks and cause ill effects. Seems like the nasty side effects and danger happens when the levels go down too far. Is that so? Could they plateau now? She's been on 5 mg for about a month and a half. Wondering what others' experiences are at this stage.

Cushing's symptoms seem to be improving. Pot belly is gone and she doesn't drink so much. Aging issues seem to be suddenly appearing, but that happens sometimes. She's still very active - we walk every day and she eats great - she's VERY good about taking her medicine, which is adorable. The belly issue cleared up with some anti-itch meds, Benadryl, an antibiotic and a mousse that we'll continue using because it really helps. These dry patches will likely continue and the mousse strengthens the skin, so there's no harm in keeping her on it.

I'll keep a close eye on her these next two weeks - get a little panicked reading about dogs who suddenly pass because the med did too much, but maybe she's been on it long enough with a slow enough reduction that nothing so serious will happen. Worrisome, still.

[Harley PoMMom]

Could you get the actual ACTH stimulation numbers and post them here? And how high is the potassium? Trilostane can cause the potassium to elevate so it is a good idea that you will be monitoring it.

Unfortunately hypoadrenocorticism can happen at any time, we have had a couple of dogs while on Trilostane for over a period of time that have had their cortisol drop too low even when their dose remained the same which is why owner observation is so very important. Common symptoms of low cortisol are: vomiting, diarrhea, lethargy, loss of appetite, or the dog just not acting right, if any one of these symptoms are noticed stopping the Trilostane is required and an ACTH stimulation test should be performed.

Cushing's sure can be a frustrating and confusing roller coaster ride so please remember you are not alone as we are here to help you and Shelby on this journey.

Hugs, Lori

[molly muffin]

Usually the drop on the same dose is for around 30 days and then they level out. That is normal but never say never.
I'm really curious to know what the ACTH result is and the potassium result as those are key as to what is going on and how she is reacting to the medication.