Bichon Cushings plus other?/Keo has passed

[sjbichon]

Hello everyone. Found this online community by web surfing on Cushings subject. Our pet buddy Keo (8yr old Bichon) has been showing signs of Cushings (excessive water drinking/peeing/appetite - but no potbelly/skin/fur symptoms at this time). Vet did ACTH stim and found posititive, but not as high as expected. Had xray which showed slightly enlarged liver. Went in for u/s and found enlarged ad glands (both) and liver. Dx right now is pit based Cushings. The docs are pretty sure but think might be masked/masking possible other issue(s). His blood work shows high in following: ALT 644U/L, ALKP 543U/L, GGT 58U/L, CHOL 520mg/dl, BASO 0.20K/uL, PDW 19.7fL and low in EOS 0.01K/uL. All else in normal range. So something's happening with the liver, which may be Cushing's related, or not. He had previous episode of heavy water drinking and elevated liver in Dec2013. At that time vet gave him Convenia injection for possible UTI and daily oral Denamarin for a month. That solved the symptoms almost immediately. Prior to that he had a week's dose of Prednisone for skin sores which might have contributed to condition then and now(?) - my own conjecture. Diet for past few months has been dry Taste of the Wild Pacific Stream (salmon and sweet potatotes). Wondering if we should try Denamarin again and see what happens before Cushing's treatment (seems to be pretty toxic/risky stuff). Thanks in advance for any feedback or suggestions.

[Squirt's Mom]

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[Harley PoMMom]

Hi and welcome to you and Keo!

I have manually approved your membership so please just ignore the email confirmation request from us.

I am sorry for the circumstances that brought you here but so glad you found us.

Cushing's usually causes high elevations in the ALP and moderate elevations in the ALT, so there might be something going on with Keo's liver. Has the vet mentioned performing a bile acid test to see how well the liver is functioning?

I see from your post that Keo was on prednisone, was the ACTH stimulation test done while he was on this medication?

Regarding Keo's skin sores, was a biopsy or skin scraping performed to help in diagnosing what the sores are/were?

Cushing's progresses at a snail's pace so one does have time to get a confirmed diagnosis for Cushing's. It is also a treatable disease but success does depend on keen owner observation along with a vet/IMS that is experienced with treating Cushing's and knowledgeable about the proper protocols for Cushing's.

We will help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[sjbichon]

Hi Lori, thanks for the reply. The ACTH was just a couple days ago as well as ultrasound. The prednisone was back in early Dec (3mos ago). The vet didnt think it would affect test now. I dont remember if any tests of the wounds were done. He was taking Denamarin Dec-Jan. The onset of high water drinking has only been in last 2 weeks so thats one reason we're concerned something other than Cushings. Planning to talk more with internist and his usual vet this week. Thanks.

[Harley PoMMom]

Since the prednisone was given 3 months ago, there wouldn't of been any interference with the ACTH stim test. Could you get a copy of the ACTH stim test and post the results here?

Do let us know what the internist and vet have to say...Thanks!

Hugs, Lori

[sjbichon]

If Cushings is a slow progressing disease we were surprised at the rate of change. A month ago Keo was an energetic dog. Today he only wants short walks. Is onset and change that quick?

[doxiesrock912]

No, I would say that something else is going on as well.

[sjbichon]

Talked with internist today. She said evidence was high for Cushings but had 3 other concerns:
(1) CHOL was high indicating fats in blood and wants to do a fasting blood test;
(2) U/S showed gall bladder "sludge" and wants to redo U/S in a few months after starting on Ursodiol;
(3) Wants to do thyroid test (T4) of blood as may have 2 hormone problem

We asked her to add to fasting blood test: bile acid test (adds wait and 2nd blood sample) and heartworm (she said this was unlikely) and urine test for infection.

As far as a liver problem she thinks treating for Cushings may improve it or may need biopsy later.

She said starting Denamarin would be ok as well as applying Keo's normal Paradyne flea/heartworm treatment.

She said onset of symptoms different dog-to-dog. Some show little, some show more, some slow, some faster.

Keo will go in tomorrow morning for these tests so has to starve overnight (poor puppy).

Getting ACTH results and will post soon.

Thanks.

[molly muffin]

Usually by the time symptoms start to show up, they have had cushings for awhile. Often cushings is first suspected when the vet notices the liver enzymes starting to go up.
For things to progress so fast, I'm inclined to think, either, this has been going on for awhile or there are other factors to consider, either in addition to cushings or alternatively to cushings.
That is why it is best to rule out other possibilities and treat anything else going on, before saying definitively that it is cushings.

Sharlene and Molly muffin

[sjbichon]

Keo's ACTH test results show

Sample 1 3.7ug/dL (ref range 1.0-5.0)
Sample 2 22.4 ug/dL (ref range 8.0-17.0)
Test reports says greater than 20ug/dL are consistent with HAC.

Interestingly his blood work from early Dec 2013 (3 months ago) showed elevated liver enzymes (ALT, ALKP, GGT) but nothing like last week's. His CHOL at that time was in range, but way high now.

I guess we'll see what tomorrow's blood work shows.

[molly muffin]

The gall bladder sludge has been shown to cause quite an elevation in ALKP and other liver enzymes. Just one of the things I've noticed on the forum here. I'm not sure what the effect would be on cholesterol, but you might want to recheck general blood work, after being on the Ursodiol for awhile.

It might not make a bit of difference in whether or not cushings is a factor, but I would hope it would help to bring down some of the other values as the sludge goes away.

I agree with doing a fasting blood test to check the chol and also to check the T4, a thyroid panel. That too can have the same symptoms as cushings, so needs to be ruled out. Was it low on the general blood work and if so how low?

I am an advocate as having as much of the big picture as possible when it comes to our pups.

Welcome to the forum.

Sharlene and Molly Muffin

[sjbichon]

Hi everyone, lots of interesting discussions and information going on.

But I need some help - lots of questions.

Well...we got the results of the some tests run to rule out Cushing's and it looks like definitely Cushing's. Bile acid neg, heartworm neg, T4 neg, only waiting on urine culture, but likely not a cause of liver enzyme and ACTH stim results.

Keo's energy level and zest for things he use to like, such as walks and chasing squirrels from the backyard, are less.

Next step is to discuss treatment. The internal med vet recommends low dose Trilostane. Keo's already taking Denamarin and Ursodiol. I've heard Trilostane is generally preferred over Lysodren for "milder" cases. But both can cause adrenal gland damage and risk of Addison's. I've also heard Anipryl and ketoconazole are other choices but may be less effective. Keo has PDH version. In all these treatments, I read that these meds treat the symptoms but Cushings progresses anyway and eventually cause other health problems which is what actually ends life. Anyone have some info on how these treatments help prolong life and quality of life?

I've also read that there's some "natural" treatments using herbs or other supplements like melatonin or lignans, possibly acupuncture. There's even some formulated supplements like Cushex or Adrenal Harmony Gold. Can anyone provide information or comment how effective are these?

Should I change diets? The vet says no change is needed. Keo's currently getting Taste of the Wild Pacific Stream dry food (salmon/sweet potato main ingredients) along with a daily helping of unsalted cooked oatmeal.

Really searching to see what is best course to take now so Keo has a happy life for as long as possible. Not ready to let him go anytime soon.

Thanks in advance for any inputs.

Kirby and Keo

[StarDeb55]

Here's a late welcome to both of you! Please DO NOT waste your money on any of the so-called natural remedies you find on the internet. They do nothing to lower the elevated cortisol which is what is causing the pup all of the problems. Anipryl is only effective in about 15% of cases. For it to be effective, the mass in the pit gland must be in a specific location, the pars intermedia. Ketoconazole isn't terribly effective, & it has a huge drawback of being harsh on the liver.

The point of treatment is to ease the symptoms that have become problematic for the owner & have degraded the pup's quality of life. What I can tell you about how treatment improves quality of life includes a number of things. Our babies literally feel that they are starving every second of the day. You can feed them, they finish their meal, & then look at you like, "I'm still starving. Can I please have something else?" They will "surf" the floors & countertops looking for the smallest crumb to eat. The muscle wasting that can be found in the pup's back end will limit movement, but with treatment, those muscles will eventually strengthen, allowing the pup to resume more normal activity. There are many other things that I can discuss, but other members will offer what they have seen with their pups.

I can't offer any opinion on trilostane as I used lysodren with both of my pups. If I ever have to treat another of my pups for Cushing's, I would definitely stick with the lysodren because it's the drug I know, & am comfortable using.

The elevated cortisol levels over the long haul, & I mean years, will cause organ damage that can lead to kidney failure, liver problems,& other issues. Cushing's suppresses the immune system, so our pups can be very prone to infections that may be difficult to treat.

I think this gives you the general idea of the benefits of treatment. I di want to let you know that my 1st boy was diagnosed at about 7 yrs. old, was treated for nearly 8 years. He had a great quality of life. He passed at 15 from causes unrelated to his cushing's.

Debbie

[sjbichon]

Thanks Debbie. Your experience is encouraging. This like stepping into the void you didn't know was there and then drinking from a fire hose to figure out what's what. We like the internal med vet and Keo's normal vet. I guess we need to rely on their best judgement as they have the range of experience in treating many dogs. Hopefully it all works out.

[sjbichon]

Keo's now been taking Denamarin and Ursodiol for the last 3 days. His symptoms (high water drinking/urinating and lower energy) appear to be lessening. Even went on his normal walk distance. He's still hungry all the time. Should the symptoms not reduce if Cushing's is pumping out cortisol?

[Renee]

I've been using vetoryl on my pug, so I can only speak about my experience with it, not lysodren.

Your vet is correct to suggest a low dose of vetoryl to start. No more than 1mg per 1lb. My pug is between 18-20 pounds, depending, so we started at 20mg, split into 10am/10pm. She started treatment in December, and since then, her dose has been increased to 20am and 10pm.

I noticed a small burst of a change in the first few days, then a slide back, then a significant difference at about day 10. The water intake and constant urination dropped off. She still is not able to jump up onto chairs and stools like she used to. We are still working on resolving other symptoms, especially the dreaded CC.

I think cushings sounds so scary that most people initially think it is a death sentence. The reality is, once you get confident and start controlling the symptoms, you will realize that it really is not a death sentence, just something you manage.

Did your vet confirm PDH from an ultrasound or LDDS?

[molly muffin]

Some problems can be caused by the sludge and if this is being taken care of then you will notice some decrease in symptoms if this was the root of the cause of the high cortisol and not cushings.

You haven't started any treatment for cushings yet right?

Sharlene and molly Muffin

[sjbichon]

Keo has not started any Cushing's treatment. We have appointment on Monday to discuss this with internal med vet. Right now he's only taking Denamarin and Ursodiol. Should I wait another week and see how his outward symptoms change?

[lulusmom]

Cushing's progresses at a snail's pace so waiting to treat is not a problem. The goal of treatment is to remedy problematic symptoms that are usually a bigger problem for the pet owner than the dog so in my not so professional opinion, waiting to see if symptoms get better would be just fine.

[sjbichon]

Hi Renee, thanks for the reply. Keo is diagnosed with PDH as a result of ultrasound showing both adrenals enlarged. One is larger than the other so maybe some ADH also. All the best,

Kirby & Keo

[sjbichon]

Hi Lulusmom, we saw the internal med vet today. She said based on all the symptoms and the test results she's confident Keo has Cushing's. She wants to start him on low dosage of 10mg Trilostane 1x per day and do ACHT monitoring.

[sjbichon]

Keo's now developed weakness in his hind legs.

[molly muffin]

Did you get Keo started on the Trilostane? Rear leg weakness is another one of those cushing signs.

Sharlene and Molly muffin

[sjbichon]

Hi Sharlene, yes got the trilostane today. We reported the leg weakness and the vet (not the one he's been seeing) wanted to take a look. But when we got there it seemed to have disappeared and he was walking and moving fine. The vet thought it might be myotonia which is coming and going. She was more concerned if it might have been a clot. Keo was fine coming home and actually ran to the door and jumped over the threshold like he used to. A few hours later the stiff walk returned.

[molly muffin]

It might be arthritis in the joint too, which shows up more as cortisol fluctuates. If so, then as the cortisol comes down with the trilostane, then it is possible that this might show up more often. They can get an xray of it to check for arthritis perhaps? or it could be something else as the vet mentioned.

Sharlene and molly muffin

[sjbichon]

Hi all. OK gave Keo his 1st 10mg dose of Trilostane this morning. 4 hrs later he seems fine, no side effects. Worried about Trilostane side effects and possible hypoad/adrenal necrosis I've read about suddenly occurring at any time. Keeping an eye on him.

[goldengirl88]

Sounds like you are being very vigilant and that is great. I think it is a little early to worry about adrenal necrosis in your case. You will make yourself crazy with worry sometimes thinking about all that can go wrong, so try to just concentrate on getting thru the first few weeks of managing the trilostane dosing. It will get better, and it does get easier as you learn all about this disease. If you manage things well you and your dog will benefit, so try to put the worry away for awhile and use this time to become better educated on all of this as it will help you more than anything. You are the only advocate for your dog. I say this to you as I am also a worrier and it does take it's toll on you. Blessings
Patti

[sjbichon]

Hi everyone. Well Keo's been on Trilostane for 4 days now (10mg every 12 hrs for 7kg/15lb dog). So far no sign of GI problems or "hypo" reaction. Seems to have picked up some energy although at night after dinner takes a nap then wakes up looking confused. Previously he only took short walks and seemed to have some loss in night vision. Last night he took longer walk at normal pace and seemed to know where he was. So far so good. Scheduled to have 1st ACTH check this Friday. Hoping it all goes well and and this works. Thanks for all your good, positive thoughts.

[goldengirl88]

Glad to hear things are going well. Just a comment on you saying your dog has lost some of his sight. Cushing's dogs can get calcium deposits and sometimes lipid deposits on their eyes. A vet is not able to see these, so you may want to think about a trip to the opthalmologist. My Tipper has them and she sees the eye Dr. every few months. Hope all continues to go well, you are doing great!
Blessings
Patti

[sjbichon]

Thanks. I'll ask the IM vet about it.

[Harley PoMMom]

So gald to hear that Keo's is doing well on his treatment, will be looking for those ACTH stim results. ;) and wishing you both the best of luck for great numbers.

Hugs, Lori

[sjbichon]

Hi all. Good news I think. After 8 days on Trilostane Keo's ACTH stim results are 2.7ug/dL pre and 4.9ug/dL post. This seems to be on low side. The results reference is

2-6 pre
6-18 post normal
18-22 post equivocal
>22 post HAC
<2 post hypo
1-5 post pre and post desired on Lysodren

The IM vet said his numbers are what she would expect later not now so she is changing him to 5mg/dose 12hrs. He is on 10mg/dose 12hrs. We had to get this compounded from 10mg capsules. Keo's energy is up and hind leg weakness is alot better. Still drinks and pees alot but not like before. Overall he seems to be feeling better. Thanks for the encouragement. Hoping he continues to progess well.

[Harley PoMMom]

Hi all. Good news I think. After 8 days on Trilostane Keo's ACTH stim results are 2.7ug/dL pre and 4.9ug/dL post. This seems to be on low side.



Actually those stim results are really good! According to Dechra, the makers of Vetoryl, the therapeutic ranges for a dog being treated with Trilostane are 1.5 ug/dl - 5.4 ug/dl, a post as high as 9.1 ug/dl is acceptable if the clinical signs are controlled. Information can be found here: Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

Hugs, Lori

[sjbichon]

Yes it's interesting that the post ACTH stim levels among vets and manufacturer seem to have differences when I "googled" it. I took it to mean that it's not a precise science as of yet, but that so long as it's "in range" that is good (have to trust the knowledge and experience of Keo's vet for this). You also have to be careful about nmol/L vs ug/dL conversions.

I also didn't realize that "compounded" vs Vetoryl trilostane can mean different things. To be clear we are "repackaging" the 10mg Vetoryl to 5mg capsules per advice of the IM vet. Will start reduced dosage tonight.

[Junior's Mom]

The results seem to differ between vets and manufacture because your vet is looking at normal ranges for a dog not on medication. The ranges are different for a medicated animal. Your dogs results were perfect. If the dose is cut in half, the cortisol will rise, and you may see an increase in symptoms.

[molly muffin]

There is no difference between what the manufacturer recommends for a treated dog. There is only a difference between a non treatment dog, a dog on vertroyl/trilostane and a dog on lysodren. Two different medications and non treatment.

There is no interpretation difference either, as it is simply what is stated. While vertroyl was approved in I think it was 2009 for use in the USA, it has been in use in Europe for much, much longer. Lysodren has been in use for a very long time too.
There is some preferences amongst specialist as to where they like to see their treated dogs on vetroyl at, but the recommendations are the same.
We have seen so many vets use the untreated range as a treatment range and get things completely off by doing so. Most labs give the ranges at the bottom for treatment. If the vet reads through them, they would know what they should be looking for.

To do a conversion from nmol to ug you divide by 27.59 to get the ug.

Hope that helps
Sharlene and molly muffin

[dana67]

Hello! I am new to this site too. Our story was just posted last night (Sharing Maggie's story)....she had elevated liver enzymes (up and down) for over a year before diagnosis. Her main symptoms were panting (not tolerating the summer heat well), restlessness, and major water drinking--no skin issues. She had decreased her exercise gradually (she is 12 ) so I figured the belly she appeared to be gaining was due more to that. She has always had a voracious appetite but it did get a little more obvious (and still is). I was super nervous about her going on the medication but we started 30 mg and she did very well. We did not pursue all of the other diagnostic tests, primarily due to the cost where we live (Nova Scotia, Canada) but the vet was fairly confident based on the various blood tests that her diagnosis was accurate. Empirically, it would seem true as well, since her symptoms have subsided with the medication and her overall well being has improved.

[sjbichon]

Wow thanks for all the info. The vet said she was surprised at the level got there so quickly and wanted to make sure we didn't overshoot. We will do another ACTH stim test and probably adjust as she thinks it will probably be somewhere in between 5-10mg. Will be on lookout for increase in symptoms.

[molly muffin]

post can be up to 9.0 if symptoms are controlled, otherwise you'll want to bring that post down a bit.

Remember, that cortisol can continue to drop on the same dose even up to a month or more.

Sharlene and Molly Muffin

[sjbichon]

I did read that the effect of Trilostane on cortisol suppression can continue even after stopping. I think that's why the vet wanted to reduce now since Keo's change was dramatic in only a short time. He had ACTH stim of 23ug/dL a couple weeks ago before starting Vetoryl. Thanks for the advice.

[molly muffin]

It is always better to start slow and adjust as needed.

Sharlene and Molly muffin

[doxiesrock912]

Yes, we found that out. Daisy started at 10mg twice a day which she couldn't tolerate. Over time, we've worked up to 15mg twice a day, but we had to go lower at first so that her system had time to adjust.

[goldengirl88]

Starting slow and inching you way up is how I manage Tipper. I do not want to give her 1 mg more than is needed to control this cortisol. She has done well this way, without any scary emergencies. Blessings
Patti

[sjbichon]

Hi all. Update on Keo. After a week on 5mg/12hrs his ACTH stim showed increase (need to go get results) and some symptoms like rear leg weakness became more noticeable. He still has PD/PU but less than before starting Vetoryl. His vet wanted to go back to 10mg/12hrs but we wanted to be a bit more cautious so he will go to 8mg/12hrs. Another stim test in 2 weeks. So far no GI or Addisonian symptoms after 3 1/2 weeks on Trilo. Also need to reduce his calorie intake as he has gained 1lb from a month ago. Anyone got food suggestions on this (Keo is on grainfree diet due to possible allergy sensitivity)? Thanks.

[goldengirl88]

Fromm makes a lot of grain free dry food, and is a top quality food you can get on Amazon. I am glad you went conservative to the 8 mg. I don't want to give my Tipper any more than is absolutely necessary. Blessings
Patti

[sjbichon]

Keo's ACTH stim showed elevated levels after 8mg/12hrs dosage for week and a half. Now going to 10mg/12hrs and retest in 2 weeks. PD/PU had decreased but appetite and rear leg control was still there though less also. But he now is able to jump up on sofa without alot of effort. While at vet he redid U/S after a month on Ursodiol for gallbladder sludge. The sludge has reduced but gallbladder walls show inflammation. Vet put him on Clavamox in case of infection due to backup of bile. Vet said gallbladder disease is associated with Cushing's and will be watched but currently not a serious situation. She wants to get Cushings under control first. Keo is feeling better than a month ago when we joined this forum and has had no adverse reactions, paws crossed. Thanks for all your support.

[goldengirl88]

Wonderful news that Keo is doing better. Hoping he improves every day. You feel so much better when your baby is doing well! Have a blessed Easter.
Patti

[molly muffin]

Hope the 10mg/12 hr works for Keo.
Good call on antibiotic just in case in the gall bladder.

Crossing fingers
Sharlene and molly muffin

[Harley PoMMom]

Keo's ACTH stim showed elevated levels after 8mg/12hrs dosage for week and a half.

Could get a copy of those ACTH stim results and post them here? Thanks!

Hugs, Lori

[doxiesrock912]

We also have worries with the gallbladder and are using Urisidol.
I'm glad that Keo is improving!

[goldengirl88]

My Tipper has gallbladder issues also, so she is on the ursidiol. I know someone on here had looked it up one time and said it can make them itchy, maybe it was Sharlene?? not sure. If your baby gets itchy it could be that, my Tipper never had an issue with it so far. Blessings
Patti

[sjbichon]

Hi all. Been awhile since I posted. Keo has been on 10mg 2x/day for 15 weeks now and just had a ACTH stim test. He does not show classic Cushing's symptoms and vet says his level is good (need to go get the report). He will continue the dosage and get next ACTH in 90 days at end of October. Overall it's been 20 weeks since we started treatment with Trilostane and so far so good. He continues to take Ursodiol and Denamarin. Will get his gall bladder checked at next visit. During this time he hurt his back and it's taken 8 weeks for him to feel himself again (kept him with limited mobility and using Tramadol - stopped Denamarin during this time). Vet says his back leg muscle tone is improved. During all this time Keo was a champ, never complained and always had his happy disposition except when he wasn't feeling well. All the staff at the vet love him. So glad he's part of our family. Will post again if anything changes. Thanks again for all the best wishes. And to those going thru difficult times figuring out what's happening, I sincerely hope it works out well for you.
- Keo and Kirby

[Harley PoMMom]

Hi Kirby,

Thanks for coming back and updating us, I am so happy Keo is doing so well on his Trilostane! And, yes, if you would get copies of his ACTH stim results that would be great!

Hugs, Lori

[molly muffin]

Great to hear that Kirby is doing well. My molly hurt her back this past winter and it wasn't fun trying to keep her from running and jumping on everything. We bought one of those doggie play pen things and I worked from home till she was better.

Yep, you have to keep an eye on those gall bladders and make sure that the medication is still working and nothing building up.

Glad his levels are good!

Sharlene and molly muffin

[sjbichon]

Keo's ACTH stim results on 7/31/14 were: Pre 0.9, Post 2.3. His previous on 5/30/14 was Pre 1.6, Post 3.4.

[addy]

That puts us back to the discussion of low pre cortisol readings.

That low pre would bother me and the post is just a tad above 2ug/dl. Different endocrinologists will have different opinions on that. Some will say no problem, Dr. Peterson believes neither should go under 2.

We had some discussion that Dechra ( manufacturer of name brand Vetoryl (Trilosstane) did not want to see any pre number that low.

I'm sure Marianne will stop by with the latest suggestions on that acth test. What does your vet say? Any new symptoms? How is control of old symptoms?

[Harley PoMMom]

Those numbers are starting to get on the low side, so you may want to keep an eagle out for symptoms of his cortisol dropping too low such as: vomiting, diarrhea, inappetence, or Keo just not acting himself, if any one of these symptoms are seen his Trilostane might have to be stopped and a call to the vets would be needed.

Hugs, Lori

[sjbichon]

8/22/14 update: 2 weeks after the ACTH stim Keo vomited a couple times in 2 days. Called the vet and they said to stop trilostane. A couple days later an ACTH stim was done showing pre 2.4 and post 10 ug/dl results. Vet says he does not have Addison's and this would be normal for dogs without Cushing's. He currently is not showing any of the classic Cushing's symptoms. Vet thinks the Cushing's will reoccur, but for now we should monitor his condition. May do further cortisol or ACTH later. Vet said she saw one case in her practice that Cushing's resolved itself after treatment. Keo's bloodwork and ultrasound shows things are ok. Ultrasound did see a small cyst on the spleen which vet will monitor with more ultrasound later (hopefully not a problem needing splenectomy). So some good news that will hopefully continue.

[Harley PoMMom]

8/22/14 update: 2 weeks after the ACTH stim Keo vomited a couple times in 2 days. Called the vet and they said to stop trilostane. A couple days later an ACTH stim was done showing pre 2.4 and post 10 ug/dl results. Vet says he does not have Addison's and this would be normal for dogs without Cushing's.

Just for my clarifcation, those stim results were when Keo was off the Trilostane, correct? If so, I believe not resuming treatment is the right thing to do and only revisiting starting treatment when strong symptoms return.

Hugs, Lori

[sjbichon]

Yes, he was off Trilostane for more than 36 hours when the ACTH stim was done. The vet thinks probably Cushing's will return and to observe him for signs. Hoping that he's one of those cases where it got cured. Next thing to deal with is the spleen cyst - possibly need to remove spleen. Thanks for all your good wishes.

[sjbichon]

Update. 2 weeks after going off Trilo Cushings symptoms have reappeared (constant hunger, drinking, peeing, lack of energy except for food, loss of muscle tone). Did ACTH stim today, learn results tomorrow.

[Harley PoMMom]

We will be anxiously waiting with you for those ACTH stim results! Has the vet mentioned what dose he wants to restart Keo's Trilostane at?

[steiny]

Hi to you and Keo!

Just wanted you to know I'm a Bichon owner also and Steiny was recently diagnosed with Cushings this past year. I haven't corresponded with any other Bichon owners on this site and felt an immediate connection to you. Have you had previous dogs? This is my husband and my first dog and we are in our 60's so going through this aging and disease process has been new and hard on us. Steiny was just recently re-started on Vetoryl 10 mg/day as he had problems previously on too high of a dose. So far, so good! We are enjoying all his good days!

I have one quick question for you, we recently started him on ursodiol and was wondering what dosage Keo is on as our dogs are similar in weight? Thanks and looking forward to following Keo's continued progress! Do you have a picture of Keo you can post?

[steiny]

Sorry about the duplicate post!

[sjbichon]

Hi Steiny's owners. Keo is on 1/4 of 250mg ursodiol per day. He's also taking 225mg denamarin per day. He is 16lbs and was on 10mg 2x/day trilo but showed adverse reaction after about 3 months at that dosage. Glad to meet another Cushings Bichon.

[Squirt's Mom]

If either of you are in the TENN area and would like to foster a Bichon, give me a holler! :D

[sjbichon]

Keo's ACTH came back: pre 10 post 18 ug/dl. Vet says while this is not super high for cushings since he has symptoms we should restart trilo at 5mg (was 10mg) 2x/day with ACTH retest in 10 days. She said Keo might be a case of longer term reaction to trilo.

[steiny]

I sure hope Keo does better on the lower dosage and you can get his symptoms under better control. Steiny is on 10mg of vetoryl once per day and so far he's doing much better this time around. The best part is that he no longer wakes us up at 4:30 in the morning wanting to eat!

Thank you for your response regarding the ursodiol. Steiny is on 1/2 tablet of 250 mg. It's higher than what Keo is on but he doesn't seem to have any side effects. Have you seen an improvement in Keo's liver enyzme tests since being on the ursodiol? How long did it take?

[sjbichon]

Hi everyone. Some update on Keo. He is now on 9th week of 5mg trilo 2x/day after experiencing low cortisol, stopping 10mg 2x/day and waiting for Cushings symptoms to return back in August. Latest ACHT results on 10/31 showed pre 0.6 ug/dL and post 6.2 ug/dL. Blood work also showed near normal ALP and ALK. So things look good right now.

An ultrasound done in August also revealed a 7mm nodule on his spleen. It has not changed since and he is having splenectomy this Friday 11/7. Vet does not think it's cancer but doing it anyway as it could result in future rupture and to be sure. Hope it all goes well. I've seen on other posts dogs with Cushings also having spleen problems. Is this a related issue?

[doxiesrock912]

High cortisol from uncontrolled Cushings can affect many organs, Daisy Mae was also on Urisidol but for gallbladder "sludge". Dogs with Cushings are also prone to infections such as UTIs when it is not controlled. So it is great that you are alert to symptom changes :)

Trilo can definitely remain in a dog's system because throughout the course of a day Cortisol naturally rises and falls adding to the complexity of determining the right dosage.

Stay vigilant, and it sounds like your vet is careful and knowledgeable which is awesome.

[sjbichon]

Yes Keo is also taking Ursodiol for gallbladder sludge and Denamarin for liver function. Pre surgery he is now taking 8000IU 2x/day Vit A which is supposed to help healing especially with Cushings.

[molly muffin]

Once the tumor on the spleen is removed, you may see that there is no longer an issue with cortisol.
That is what happened with Leslie's Squirt.

Hoping for a speedy recovery!

hugs

[sjbichon]

Our vet told us that Cushings treatment can sometimes result in resolution of the disease with no further treatment needed. This is what she was checking after Keo's episode in August...but Cushings did return. Does anyone know how spleen removal would affect adrenal system to resolve Cushings? I havent seen that written up anywhere but will certainly ask my vet.

[molly muffin]

Sometimes, as in the case of Squirt, the tumor was the background cause of the cortisol being elevated. Once that tumor was removed, the cortisol levels returned to normal and no further treatment at that time for cushings was needed.
I don't remember how many cushings tests it was that Squirt tested positive on, 3, I think.
So what I mean, is that sometimes, the spleen tumors can cause the cortisol to go up, causing false positives on cushings tests.
There is always a warning with the cushing tests, that if there is another chronic problem, false positives may be seen.
It is just something to keep an eye out for.

hugs

[labblab]

If Keo truly has Cushing's, removing the spleen would have no relationship to the disease. I think what Sharlene was referring to is that other illnesses or diseases can also increase cortisol which can result in the mistaken diagnosis of Cushing's when it is not really present. With Leslie's Squirt, once the tumor in the spleen was removed, Squirt's cortisol ended up returning to normal. So it seems as though Squirt never really had conventional Cushing's at that point -- it was the tumor in the spleen that was elevating her cortisol.

Marianne

Edited to say that Sharlene and I were obviously posting at the same time!

[molly muffin]

Yes Marianne, that is exactly what I meant. :)

[sjbichon]

Thank you for the clarification. That makes sense. I have read that underlying illness can result in same symptoms and test results. When Keo was diagnosed for Cushings it was based on symptoms, ACTH, blood work and ultrasound showing both adrenals enlarged leading to PDH. Your good thoughts for Keo on his surgery appreciated.

[Squirt's Mom]

Yes, Marianne has it right. Squirt had the LDDS, HDDS, ACTH, UTK panel and 2 ultrasounds. All were positive for PDH until the tumor and half her spleen were removed. Her intermediates remained elevated after that however and she was treated for Atypical for several years before becoming true Cushionoid, requiring the addition of a maintenance dose of Lysodren.

Prayers and healing white light flying your way!
Hugs,
Leslie and the gang

[sjbichon]

Anyone know of complications of removing spleen for Cushings dogs? Choice of waiting along with risk of later rupture or cancer vs surgery now and whatever risks come with it.

[sjbichon]

Bad news this week. Keo's spleen pathology came back as cancer (spindle cell sarcoma). We have oncology appointment next week. This is killing me.

[doxiesrock912]

Awww :(

Depending on where it is and what organs are affected, this can be surgically removed. Crossing my fingers. Hugs

[molly muffin]

Leslie's fur baby squirt had her spleen removed. So she has been through this it too had a tumor on it.

Let us know what the vets say

Hugs

[sjbichon]

Met with oncologist. Said report says Keo has low-moderate grade sarcoma. She did lung xray which showed no growths. She is optimistic splenectomy was curative as tumor was small (7mm). Recommends to do xray and ultrasound monitoring, but thinks chemo not necessary and can get complicated with Cushings treatment. Says 15-20% this might have spread or recur. Not much known about splenic spindle cell (fibro) sarcoma. So looks like we just have to wait and pray Keo is clear.

[Squirt's Mom]

So Keo had the spleen and tumor removed?

[sjbichon]

Yes. His spleen was removed and the "nodule" was on the spleen. No indication it spread to adjacent organs but only time will tell. Apparently chemo is not very effective on this type. But vet is "cautiously optimistic" in the report. Keo gets ACTH stim next week to see how he is doing with Cushings. Life is complicated. Thanks for your continuing support.

[Squirt's Mom]

Ok, good to know this is behind you both! I hope he does well from here on out. We were lucky - Squirt's tumor was not cancerous. She lived another 5 1/2 -6 years with half a spleen and did just fine.

[judymaggie]

Fingers crossed that Keo continues to do well post-surgery! It is so much better to remove the spleen before the possibility of leaking increases.

[Trish]

Well if the vet is optimistic it was curative then I am too!! That's great news and I know the worry of "have they got it all" very well :rolleyes: but sounds like they have Keo on a good surveillance programme! I did that with my dog's liver cancer, his first op was 3 years ago now, they found a recurrence on scan 1 year ago and that was also successfully removed... so my motto is if you find it, deal with it then move on and enjoy the happy times :) So pleased Keo has recovered so well, they always amaze me with their resilience following these big surgeries.

And as far as those numbers go I say a big pfffffft to those... Flynn had a mean survival time of 15mths from his adrenalectomy and we are 4 days shy of making 24 months... 2 years wheeeeeeee (I am celebrating already)!! So I am just going to keep giving any estimations a big middle finger and hope for the best.... our dogs are warm fluffy balls of love not a number :D

[sjbichon]

Thank you for the encouraging words. Keo's ACTH stim came back pre 1.1 and post 4.5 (ug/dL). Vet is happy with this and will continue 5mg 2x/day Trilo. Recheck in 8 weeks unless something changes.

[molly muffin]

Sending best wishes to you and keo this holiday season.

[sjbichon]

Hello all. Hope all is well out there. Update on Keo. He was doing well since spleen removal surgery in mid-Nov. Toward end of Jan he started having less energy and vomited 3 mornings in a row. Had a couple days in which his stool had spot of blood on it. His primary vet checked him and did stool test which came back with no problems (possibly irritated glands). Did an ACTH stim with result of pre 0.4 and post 3.1 ug/dL. Vet specialist reduced his trilo from 2x to 1x per day based on low pre result (he was already at half of original dosage since Sept following an Aug episode of low cortisol but at that time Cushing's symptoms reappeared after stopping trilo completely). That was 9 days ago. So far no increase in hunger, water drinking or urination. His energy is back up. ACTH recheck in couple weeks.

[Squirt's Mom]

Good to hear from you and good to hear Keo is continuing to do well post-surgery. Curious about the Vetoryl and the signs he's displaying. I can't help but think back to Squirt and the fact that her spleen tumor caused all her tests to be false-positives with the cortisol returning to normal after the surgery. We didn't treat at that point as a result.

Keep an eye on your baby boy; sounds like that decrease in dose is just what he needed since he is perking up. Let us know how he is doing!

[Cris]

Hi SJBichon.. I've been following your posts regarding Keo and I'm glad to hear that the spleenectomy was a success. My 14 year old maltipoo (Casey) had an emergency spleenectomy last November. I had noticed a little odd behavior in her, somewhat aloof, disoriented; but I actually thought it was symptoms of CCD (Canine Cognitive Dysfunction). I acted on instinct, and took her to the vet, immediately, to have her checked. There was small mass (tumor) on her spleen which had ruptured and she was bleeding internally. An emergency spleenectomy was performed. The tumor was analyzed and it came back negative. The vet did say that her liver looked at little odd in shape and in color. Two weeks later, she was vomiting and we found that she had pancreatitis. A couple of weeks ago, I found her laying on the floor, shaking and crying loudly. I took her to the vet and the x-ray revealed nothing. They were going to do blood work on her…. and I heard my self say "Would you please check for Cushing's Disease". Cushing's was on my mind, because my 15 year old Bichon was diagnosed with it, early January. Well, the initial tests "suggested" Cushing's. Yesterday, an LCCD test was performed on her and we are waiting for the results. I'm not sure if the spleen issue and Cushing's are related… but I couldn't help but identify with your recent post.

[sjbichon]

Update. 3 months after spleen removal bad news. Ultrasound recheck found mass on liver. Fine needle aspirate being done. :-(

[molly muffin]

Oh son of a gun. :( okay, Trish's Flynn has had 2 liver surgeries, so lets see whats what here.

[sjbichon]

Got needle aspirate results. Likely carcinoma, less likely sarcoma so not related to spleen cancer found earlier. Oncologist says only way to know for sure is surgery and see if can be removed and test tissue. Prognosis only guess until then. Concerned it grew so fast since no sign when spleen was removed. Recommend surgery sooner than later. More $$ but how can I say no? Anxious and fearful.

[Squirt's Mom]

Oh me, I can only imagine what it felt like to hear that news. :( Please let us know how Keo is doing, and you, as things move along.

[sjbichon]

Update 3/30/15- liver growth is benign adenoma. Yayyy! Problem is couldn't get all of it and oncologist is concerned since it appeared in 3 months between ultrasounds that it could grow back fast causing pressure on organs or bleeding. Recommends metronomic chemo with Chlorambucil. Not known if it works on adenoma. Ive drug is toxic to humans and could cause other bad effects including other malignant cancers. Im hesitant to do this but do I just hope adenoma doesnt return quickly? Any suggestions anyone?

[molly muffin]

Eeek Well Yay for benign!

I don't know anything about chlorambucil. Would he be open to monitoring by ultrasound instead? Is there any other less toxic type of chemo they could use?

[sjbichon]

Jan 2016 update on Keo Keo. Bad news. Keo has passed. He was doing fine since surgery in Feb. Was stable on Vetoryl. In last month he started getting weak with increased apetite and drinking but ACTH showed no increase. Went to vet today and xray showed fluid around his heart. We were shocked. He was so weak and not being able to be himself and vet said could have cardiac arrest. So today I said goodbye to my best friend who brought tons of joy into my life. I will miss Keo alot.

[judymaggie]

Kirby--I am so sorry to learn of Keo's passing. He was obviously a big part of your life and you both triumphed over some tough times. Take care of yourself during this difficult time.

[labblab]

Oh Kirby, I, too am so sorry about Keo! Thank you so much for returning to tell us what has happened, though. This way, we can all join you in honoring Keo, always. And if you ever want to write some more to us or to share more memories of your precious boy, we will always be here for you.

Sending my sincere sympathy to you across the miles,
Marianne

[molly muffin]

I am so very sorry to hear this news. My sincerest condolences.

[My sweet Ginger]

I'm so sorry for your loss. My deepest sympathy to you and your family. RIP sweet Keo.