Introducting My Dude

[Momofdude]

Hello,

I am very new to cushings and am trying to stay in the loop and find out more.

My dog dude is a 8 year old beagle, We moved In march to a sublease townhouse and started to have an issue with dude peeing in the house. We figured it was him "marking" (which he has never done before) as there was a puppy previously in this house. After a few weeks, I figured there had to be an issue or maybe he was just getting old.

The vet checked his bloodwork, urine and even his hormones and nothing showed. She even mentioned cushings but said nothing really pointed to it being that.

Fast forward to the ending of April and dude was still urinating so we took him back in and the vet said his heavy and odd stomach could indeed be cushings. He was tested the next day via low dose dexamethasone. He was then started on 35Mg of Trilostane.

He had a acth test on tuesday and is continuing on 30Mg of trilostane even though he is still urinating.

[Momofdude]

hello,

we are new to this, Our 8 year old beagle was diagnosed in april as having cushings. He had a low dose dexamethasone test in April and then a ACTH test last tuesday. He is still urinating but it has improved since starting 30Mg of trilostane once daily.

looking forward to advice and similair stories in the future,

[Joan2517]

Hello and welcome. Please post the blood work that led to the diagnosis, highs and lows with the reference ranges so that those who are more knowledgeable than I am can try help you through this.

[Squirt's Mom]

Hi and welcome to you and Dude!

It would help us if you would get the actual results of the tests used to diagnose the Cushing's as well as the last monitoring ACTH since starting treatment. That will help us help you a great deal. ;)

One thing bothers me - Cushing's is a VERY slowly progressing condition and does not show up from one month to the next. There is a rare form of diabetes called diabetes insipidus that has nothing to do with blood sugar but rather with the way the body processes water. It is not uncommon for this condition to be misdiagnosed as Cushing's. If the drinking and peeing are not slowing it mist be worth talking to his vet about this. Other than the peeing and drinking what other signs or changes did you see in your sweet boy before the Cushing's diagnosis?

I'm glad you found us and am sure others will be along soon to chat with you.
Hugs,
Leslie

[DoxieMama]

Welcome to you both! As the others have said, copies of the test results for diagnosis, as well as the follow-up ACTH, will be very helpful to support you. Can you get those? Does he have any other symptoms?

Looking forward to learning more about your dude.

Shana

[Momofdude]

Hi and welcome to you and Dude!

It would help us if you would get the actual results of the tests used to diagnose the Cushing's as well as the last monitoring ACTH since starting treatment. That will help us help you a great deal. ;)

One thing bothers me - Cushing's is a VERY slowly progressing condition and does not show up from one month to the next. There is a rare form of diabetes called diabetes insipidus that has nothing to do with blood sugar but rather with the way the body processes water. It is not uncommon for this condition to be misdiagnosed as Cushing's. If the drinking and peeing are not slowing it mist be worth talking to his vet about this. Other than the peeing and drinking what other signs or changes did you see in your sweet boy before the Cushing's diagnosis?

I'm glad you found us and am sure others will be along soon to chat with you.
Hugs,
Leslie

Hi leslie, We changed vets right after his diagnosis and our current vet looked into that as he said his levels weren't bad. Ill post his results in a moment.
He has rapidly gained weight but i didnt notice any other symptoms so I was leery to believe it was indeed cushings.

[Momofdude]

Dudes Labwork.

June 13.

cortisol -baseline 167 nmol/L HIGH (28-120 nmol/L)
cortisol 4 hr <27.6 nmol/L
cortisol 8 hr postdex 75 nmol/L HIGH - >41nmol/L (consistant with pituitary-dependent)

08/20
Total protein 82 g/L HIGH (50-74g/L)
Albumin 47 g/L HIGH
AST(SGOT) 114 U/L HIGH (15-66 U/L)



glucose 1.4 mmol/L LOW (3.9-7.7mmol/L)
mag nesium 1.4 mmol/L HIGH (0.7-1.3 mmol/L)
potassium 6.2 mmol/L HIGH (3.6-5.5 mmol/L)
sodium/potassium ratio 24 LOW (27-38 ratio)
Precision PSL 157 U/L HIGH (24-140 U/L)
CPK 1139 U/L HIGH (59-895 U/L)

Platelet count 532 /L HIGH (170-400 10/L
platelet estimate increased
Neutrophilis 12.07 L HIGH (2.06-10.60 10/L)

09/12
cortisol sample 1 ACTH 106 nmol/L
cortisol sample 2 ACTH 129 nmol/L

Dude is 40 Pounds,he is on brand name vetoryl and yes daily with meal.

[Harley PoMMom]

Hi and welcome to you and Dude from me as well!

I apologize as I have only a moment to post but I wanted to greet you and let you know that I've now manually approved your membership so now all your posts will be seen right away and don't worry about the validation email that was sent to you from k9cushings.

Thank you for posting those blood work results, but could you edit your post and include the reference ranges to the values you posted? I'm sorry to be asking you to do this but reference ranges can differ between labs. Also, how much does Dude weigh? Is he taking brand-name Vetoryl and is this being given with a meall?

Please know that we will help in any way we can and do not hesitate to ask all the questions that you want.

Hugs, Lori

[Momofdude]

Dude was diagnosed on June 12th via ACTH stim test and was put on TRILOSTANE 35MG GEL CAPS from the ending of june until we switched vets In August who switched him to Vetoryl 30 MG.

Dude is still having some occasional accidents (we discussed uping his dose a bit if it continued) however His levels via ACTH are within normal range.

Anyways my question is can someone give me the run down on your testing . My new vet called last week to tell me dudes medication refill was in and that dude would need to come in monthly for the next 2 months for the ACTH test per medication protocol.

This test cost me $650 on sept 12th. So that would be the cost again for october and november.

Is this normal??

[Squirt's Mom]

MODERATOR NOTE:
I have merged your post about "testing timeline" into Dude's original thread. We like to keep all info about each dog in one thread so it is easier to look back thru the history if needed. Thanks!

[Squirt's Mom]

(Be sure to see reply on the previous page)

Testing for Vetoryl follows this schedule per the manufacturer:


Monitor
The dose of VETORYL Capsules should be titrated according to individual response as determined by
monitoring of clinical signs, physical examination and laboratory test results (ACTH stimulation test and
serum biochemistry, including electrolytes).
Once treatment with VETORYL Capsules has been initiated, samples should be taken for biochemistry
(including electrolytes) and an ACTH stimulation test 10-14 days later, 30 days later, 90 days later and
every 3 months thereafter

Every time the dose is changed that starts all over at the 2 week mark.

[Momofdude]

While cutting dudes nails , I realized that his skin is beginning to act up again. He has had skin issues for the past 5 years, but I thought his medication might make things better :(

[Squirt's Mom]

What were the results of that latest ACTH?

What skin conditions does Duke have?

[Momofdude]

What were the results of that latest ACTH?

What skin conditions does Duke have?


His last ACTH was 106 (26-124nmol/L)
and 129

Says on his paperwork anywhere from 40-250 nmol/L indiates optiomal control

He has had allergies every year , usually worse than the year before. He was on prednisone off and on over the years but we switched to atopical in the beginning of the year and he stopped using it in Feb. Looks like he might need to be put on something again

[molly muffin]

Those numbers are perfect and yes it does seem it might be allergies, as his skin shouldn't be acting up due to high cortisol with those results. $650 seems high to me. I'm in Canada in Ontario and I think my tests were 1/2 that amount, or maybe less. Once control (as you have is obtained) after the 30 day mark, you shouldn't need to retest for 90 days unless a problem comes up.

[Momofdude]

Those numbers are perfect and yes it does seem it might be allergies, as his skin shouldn't be acting up due to high cortisol with those results. $650 seems high to me. I'm in Canada in Ontario and I think my tests were 1/2 that amount, or maybe less. Once control (as you have is obtained) after the 30 day mark, you shouldn't need to retest for 90 days unless a problem comes up.

Im in Aurora. My previous vet was in aurora and we switched to a richmond hill vet as his quotes seemed less expensive but at this rate i should have stayed with the original vet.

[molly muffin]

Well hello neighbor. :) I'm in Mississauga, right on the Toronto/Mississauga border.

Are the splitting the vial for testing? To make it less expensive? They can find out about this from the lab that is used for testing. The vial is the agent used to stimulate the adrenal glands to dump the cortisol for the post portion of the test. This is what the ER vet at Oakville/Mississuaga did to keep cost down for patients and is where my dog was tested. In the end it was cheaper than the vet. So I ended up having the IMS taking care of all of my molly's cushings stuff, which was good when she developed kidney issues, she already had an IMS. So that is a thought too. Call around and find out how much others are charging for ACTH testing.

[Squirt's Mom]

I'm not sure this is available in Canada but there is a great new allergy drug available here called Cytopoint. It worked within hours on my Fox and lasted for about a month. NO side effects!! Ask your vet about it to see if it is up there yet.

https://www.zoetisus.com/products/dogs/cytopoint/

[molly muffin]

YES and it is suppose to be available here as of end of June this year, so your vet should be able to get it. If they can't ask for an IMS. They can usually get drugs via the Guelph University Pharmacy if need be.

[ChulosMom]

Hi there,
I'm also new the forum with a 12-year old pit bull who was diagnosed with cushings and calcinosis cutis in September. Here's his thread/info:
http://www.k9cushings.com/forum/showthread.php?t=8721

When he started trilostane, we were told to come back in 3 weeks for a follow-up ACTH test (which we did yesterday). The vet said that any time his trilostane dosage was changed, there would have to be another test 2-3 weeks later. If he stays on the same dosage, he'll have to have the ACTH test done once a month for two months, then every 3-4 months just to monitor his cortisol levels.

The local vet referred us to NC State Dermatology (they're fantastic but it's a 3.5 hour drive). They charged $340 for an exam, an electrolyte test, the ACTH test, and a month's supply of trilostane (vetoryl). I believe the actual ACTH test was around $180.

Hope this helps!

[Momofdude]

I think Im switching vets again.

Dude is still urinating in the house and my current vet doesn't want to increase his dosage . He said whats a few accidents (dude is having an accident a day sometimes more)


This will be his third doctor since we moved in March , The first had to research the condition (after I spent 1000 dollars with there on call doctor who told me it was NOT cushings since he just started peeing).

I feel bad as it seems like im vet hopping but for some reason I cannot seem to find A vet that I am confident in.

[labblab]

I'm sure sorry that Dude is still having these accident. In fairness to your vet, though, a significant trilostane dosage increase really is not safe for a dog who has tested with a post-ACTH result of 129 nmol/L (converts to approx. 4.7 ug/dL). You could maybe try a slight increase, but you really don't want the cortisol to go a whole lot lower than it is now, and I'm led to speculate that cortisol level, alone, may not be the cause of the accidents.

I apologize for not remembering whether Dude is being dosed once or twice daily. If it is once a day, it might be worth asking to shift to a twice-daily dosing regimen. For some dogs, better symptom relief is gained when the daily total is split into two "half" doses given at 12-hour intervals. Since trilostane generally remains active in the body for less than 24 hours, some dogs exhibit better symptom control when smaller doses are given more frequently. If Dude is already dosed twice daily, then of course this is a moot point.

Unfortunately, however, excessive urination never resolves for some Cushpups. And there may be other reasons for the urination, as well. All in all, though, I'm guessing that no vet will feel comfortable with a significant increase in trilostane dosage unless a new ACTH test shows a higher cortisol level.

Marianne

[Harley PoMMom]

Has his urine been cultured to make sure that an UTI isn't the cause for the accidents?

[molly muffin]

As Marianne said, at 129nmol acth, you don't want to do a big increase in dosage as you risk taking him too low and that would be very bad. That is a good range to be at so now, you want to look at other possibilities for the accidents. UTI as Lori mentioned, bladder control, prostrate issues, anything that might also be causing the accidents and that is what you should talk to your vet about finding out. Hopefully they will be open to that, whether it is your current vet or a new one. I understand that having daily accidents is not something you want to have happening.

[Momofdude]

As Marianne said, at 129nmol acth, you don't want to do a big increase in dosage as you risk taking him too low and that would be very bad. That is a good range to be at so now, you want to look at other possibilities for the accidents. UTI as Lori mentioned, bladder control, prostrate issues, anything that might also be causing the accidents and that is what you should talk to your vet about finding out. Hopefully they will be open to that, whether it is your current vet or a new one. I understand that having daily accidents is not something you want to have happening.


we have had extensive testing as to his bladder , I guess he could have gotten a UTI since starting his medication but hes been peeing the same way since march (he had testing in march and june) Ill bring it up at his testing nov 2nd.

I am just having a hard time accepting that he will have accidents for the rest of his life when hes on a medication that is suppose to help his main/only symptom .

Im in a rental and I just replaced a portion of the floor last week( we only been here since march). I have dog diapers on there way to me but I doubt he will keep them on lol

[Momofdude]

Has his urine been cultured to make sure that an UTI isn't the cause for the accidents?

Originally Yes but I assume he could have developed one since going on medication.

[Squirt's Mom]

I am just having a hard time accepting that he will have accidents for the rest of his life when hes on a medication that is suppose to help his main/only symptom .

Here is the problem - the medication Dude is taking is used to address ONE condition - elevated cortisol. Excessive urination can be caused by many many many many other things that have absolutely nothing to do with cortisol or Cushing's. There is a rare form of diabetes for example called Diabetes Insipidus which causes excess drinking and urination. Kidney or bladder infections cause the same. Liver disease causes the same. Addison's, the opposite of Cushing's, causes the same. On and on and on....none even remotely related to Cushing's. SO you cannot rely on the treatment for Cushing's to address these other conditions if, IF, any of them are also in play. It is VERY possible for a dog to have more than one condition or disease at the same time that share some signs...like excess drinking and peeing. ;)

So since the cortisol level is just about ideal the next thing to start looking OUTSIDE the Cushing's box for the answer to the continuation of these signs. :) We tend to get tunnel vision and think everything we see is due to Cushing's....and sadly our vets get caught up in the same trap sometimes. So we always need to have the ability to look beyond Cushing's when that picture seems to be on track with controlled cortisol as is the case with your Dude. And it's not an easy thing to learn if you are even half as stubborn as me. :rolleyes::o:D

[Joan2517]

We tend to get tunnel vision and think everything we see is due to Cushing's....and sadly our vets get caught up in the same trap sometimes. :rolleyes::o:D[/QUOTE]

Yes, it's called Cushings Syndrome PTSD for owners...very hard to get past!

[lulusmom]

Hi and a belated welcome to you and Dude.

I don't disagree with your vet's hesitance to increase a once daily dose at this point because you don't have a lot of wiggle room. Is Dude on once daily dosing? If yes, as Marianne mentioned previously, Dude could be a dog that could benefit from twice daily dosing. In my not so veterinary professional opinion, I would want a urine test done to see if it is a clinical problem or a behavioral problem. By behavioral, I mean that some dogs with cushing's have been having accidents in the house for so long that they have to relearn their toilet training. If it is a clinical issue and is the result of inadequate control of cortisol throughout the day, urine will be dilute and urine specific gravity will be low. If it is a clinical issue, Dude can't help it and if he is on once daily dosing, then I would highly recommend that you talk to the vet about switching him to twice daily dosing. If urine is dilute, a culture should be done as well.

Glynda

[Momofdude]

Here is the problem - the medication Dude is taking is used to address ONE condition - elevated cortisol. Excessive urination can be caused by many many many many other things that have absolutely nothing to do with cortisol or Cushing's. There is a rare form of diabetes for example called Diabetes Insipidus which causes excess drinking and urination. Kidney or bladder infections cause the same. Liver disease causes the same. Addison's, the opposite of Cushing's, causes the same. On and on and on....none even remotely related to Cushing's. SO you cannot rely on the treatment for Cushing's to address these other conditions if, IF, any of them are also in play. It is VERY possible for a dog to have more than one condition or disease at the same time that share some signs...like excess drinking and peeing. ;)

So since the cortisol level is just about ideal the next thing to start looking OUTSIDE the Cushing's box for the answer to the continuation of these signs. :) We tend to get tunnel vision and think everything we see is due to Cushing's....and sadly our vets get caught up in the same trap sometimes. So we always need to have the ability to look beyond Cushing's when that picture seems to be on track with controlled cortisol as is the case with your Dude. And it's not an easy thing to learn if you are even half as stubborn as me. :rolleyes::o:D

Im pretty darn stubborn LOL.


He was tested for everything , we had urine cultures, detailed urine cultures, blood work, more blook work, more urine. more blood work.

From what we can tell aside from cushings, and allergies there is nothing else medically wrong with him.

[Momofdude]

Hi and a belated welcome to you and Dude.

I don't disagree with your vet's hesitance to increase a once daily dose at this point because you don't have a lot of wiggle room. Is Dude on once daily dosing? If yes, as Marianne mentioned previously, Dude could be a dog that could benefit from twice daily dosing. In my not so veterinary professional opinion, I would want a urine test done to see if it is a clinical problem or a behavioral problem. By behavioral, I mean that some dogs with cushing's have been having accidents in the house for so long that they have to relearn their toilet training. If it is a clinical issue and is the result of inadequate control of cortisol throughout the day, urine will be dilute and urine specific gravity will be low. If it is a clinical issue, Dude can't help it and if he is on once daily dosing, then I would highly recommend that you talk to the vet about switching him to twice daily dosing. If urine is dilute, a culture should be done as well.

Glynda

I would love to say its behavioral as that is what I thought it was intially but Dude has never had an accident since he was a puppy. we have moved numerous times and he has never had any marking issues. Both vets more or less "ruled it out". However I thought at first (from april to june) that maybe he was just getting older. Ill talk to the vet again about possible secondary issues.

[lulusmom]

Thank you for your response. If you haven't had a urine test done in the last several months, I believe that would be a first step in ruling out whether it's a true clinical problem. If it's a clinical problem, then you and your vet might want to consider twice daily dosing. Please let us know what your vet thinks.

Glynda

[Momofdude]

Update on dude:

We met with his new veterinarian who seemed a bit perplexed as to why they jumped to cushings .
She did some urine and asked for a few days to contact her IMS team . She called this afternoon to say that her IMS contact and herself believe that it’s likely dude does not have cushings and that it may be behavioural .

He is to stop his medication and he is having a urine culture (with a needle?) and a ultrasound done on Tuesday in case we are missing something . But she thinks he will need to be retrained with peeing .

I am somewhat confused and slightly upset

[Harley PoMMom]

I am somewhat confused and slightly upset

I surely understand how you feel, trying to figure what is exactly going on with our furbabies can be so frustrating sometimes , if only they could talk!

I'll be anxiously waiting with you for the results of that urine culture, hang in there :)

Lori

[Momofdude]

I surely understand how you feel, trying to figure what is exactly going on with our furbabies can be so frustrating sometimes , if only they could talk!

I'll be anxiously waiting with you for the results of that urine culture, hang in there :)

Lori

His ultrasound showed no issues and his urine was negative . So they are saying it is a behavioural issue