Six Year Old Daschund -- Rolo -- cushings--(Passed away 17 August 2012)

Our dog Rolo was recently diagnosed with Cushings Disease. Rolo is a purebred Mini Wirehaired Daschund.

https://lh4.googleusercontent.com/-i...100_1313-1.jpg

This started back in the summer when we noticed that he had begun to drink and urinate a lot. We took him into our vet and after blood testing and an ultrasound concluded he has Cushings.

An interesting point in this is that we had a sr. wellness blood panel done on him in May, and there were no glaring abnormalities showing then. In July, we noticed the onset of symptoms and a followup panel led our vet down the road of Cushings. She always cautioned that while he was displaying some of the signs/symptoms (to include the pot-bellied look) he was not displaying all of the symptoms. She then proceeded to order the ultrasound and then a panel that was supposed to be the definitive test for Cushings. Based on those results, we began a regime of 10mg 2x daily of Vetaryl.

Since then we eventually upped his dose to 15 mg 2x daily, however, after a few weeks, he developed pancreatitis and we withheld the vetaryl while treating the pancreatitis. After getting him over the pancreatitis, we resumed the vetaryl (doing 10mg 1 x daily and 15mg 1x daily). However, after about 2 weeks, he begin to exhibit lethargy and extreme dullness (understood as a possible side-effect of the Vetaryl). We again withheld the Vetaryl since the only remaining sympton of the Cushings was the pot-bellied. After about 2 weeks off of the Vetaryl, the heaving drinking and the urinating began, feeling we were again headed for dehydration, we resumed the Vetaryl at 10mg 2x daily. We finally stabilized his drinking and urinating again and decided we would leave him on that dosage until early 2011 then have his Cortisol levels tested.

One of the concerns our vet expressed after the pancreatitis is that his "liver levels" remained elevated, something not seen before the pancreatits.

Last night, he appeared extremely dull and listless and would simply lay in his bed not reacting to us at all. For the first time, he refused food. We called our vet at 7:30 pm and she met us at her office. She examined him and he was exhibiting symptoms of a respiratory infection -- swollen lymph nodes in the throat, wheezy sounds by stethoscope (although you could also detect them by putting your ear to his back and listening). No fever, but she decided to treat as respiratory, however without steroids.

After the pancreatitis and because of the elevated liver levels still showing up, our vet prescribed Amoxicillin and he took his last does on the December 20. She told us the Amoxicillin is not really as effective in treating the respiratory and may have only suppressed the respiratory infection and when Amoxicillin was terminated, it finally allowed the RI to more completely exhibit.

I asked my vet for all of Rolo's blood work, I need to swing by and pick it up. She did give me the blood work from last night. I noticed in some other threads, that some of the levels of interest are:

(Numbers in Parens () are from 6 December testing)
bilirubin -- TBIL - 0.4 mg/dL [no Ref Range] --(0.4)
creatinine -- 0.5 mg/dL [with a Ref Range of 0.5 - 1.8] --(0.4)
creatine kinase -- I don't see it on the blood report
albumin -- 3.0 g/dl [with a Ref Range of 2.3 - 4.0]-- (3.2)

A few other out of range readings:

ALT 679 U/L [Ref Range10-100] (673)
ALKP 716 U/L [Ref Range of 23-212] -- (433)
GGT 300 U/L [Ref Range of 0 - 7] -- (166)

AMYL 460 U/L [Ref Range of 500 - 1500] -- (No previous)
CHOL >520 mg/dL [Ref Range of 110-320] -- (>520)
EOS 0.1 u/L [Ref Range of .1 - 1.49] -- (.22)

Hi and welcome to you and Rolo!

Rolo is such a beatiful boy! I am so sorry for the circumstances that brought you here but very glad you found us.

I was wondering if you could tell us more about your boy, such as his weight, and besides the Vetoryl, is he on any other medicines/herbs/supplements?

How was his pancreatitis confirmed? Did he have a cPL test done? The cPL test result is specific for the lipase enzyme for the pancreas.

Another question I have is, was the testing that was done for Cushing's performed while Rolo was having pancreatitis? The reason I ask this is because all Cushing tests can create false positives when a non-adrenal illness is present.

According to Dechra's Product Insert; an ACTH stimulation test should be done 10-14 days after any dose adjustment. Also for the ACTH test to be accurate for monitoring it must be done 4-6 hours after the dose of Vetoryl. Were these protocols followed? Could you post all test/s that were done, this would help us to provide you with more meaningful feedback.

Pancreatitis is a serious illness but it can be managed. My boy, Harley, had pancreatitis too. Liver enzymes will usually be elevated when a dog has pancreatitis, even the high cortisol from Cushing's will elevate the liver enzymes.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

Quote:

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Originally Posted by Harley PoMMom

Hi and welcome to you and Rolo!

Rolo is such a beatiful boy! I am so sorry for the circumstances that brought you here but very glad you found us.

I was wondering if you could tell us more about your boy, such as his weight, and besides the Vetoryl, is he on any other medicines/herbs/supplements?

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He started off only on the Vetaryl, he was on that for probably 2 months before the pancreatitis hit. Following the pancreatitis he has been on Denamarin as a liver supplement. For the respiratory infection, she put him on Tramadol (pain), zeniquin (antibiotic) and tomorrow he starts actigall (gall bladder).

Quote:

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Originally Posted by Harley PoMMom

How was his pancreatitis confirmed? Did he have a cPL test done? The cPL test result is specific for the lipase enzyme for the pancreas.

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Yes, the cPL test confirmed the pancreatitis.

Quote:

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Originally Posted by Harley PoMMom

Another question I have is, was the testing that was done for Cushing's performed while Rolo was having pancreatitis? The reason I ask this is because all Cushing tests can create false positives when a non-adrenal illness is present.

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He had two rounds of the testing to confirm the Cushings prior to the pancreatitis. The second round of testing was because there was just some inconsistencies and we wanted to rebaseline him with confirmation.

Quote:

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Originally Posted by Harley PoMMom

According to Dechra's Product Insert; an ACTH stimulation test should be done 10-14 days after any dose adjustment. Also for the ACTH test to be accurate for monitoring it must be done 4-6 hours after the dose of Vetoryl. Were these protocols followed? Could you post all test/s that were done, this would help us to provide you with more meaningful feedback.

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Yes, these protocols were followed. That was exactly the way she told us to go with the testing. He was tested after 10 days, dose adjusted, then again a month later. It was right after the last test that he developed the pancreatitis.

Quote:

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Originally Posted by Harley PoMMom

Pancreatitis is a serious illness but it can be managed. My boy, Harley, had pancreatitis too. Liver enzymes will usually be elevated when a dog has pancreatitis, even the high cortisol from Cushing's will elevate the liver enzymes.

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The elevated liver enzymes were never mentioned until the onset of the pancreatitis. We have had quite a bit of blood work done on him and she has it ready for me to pick up. I will be doing that soonest.

Quote:

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Originally Posted by Harley PoMMom

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

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Thanks for the welcome. Our vet has been super and we have discussed a referral to an IMS. She has really worked well with us in walking through the learning. She really sits and goes over the test results with us and walks us through the options.

Tomorrow he has a sonogram because of her concern for his liver (this will be second one). While the clinic is closed, she has said she will call us with the results. She has also offered to set up a telephone consult with one of the Dechra vets she has spoken to about Rolo, as well as helping with working the consult to the IMS.

Welcome
I am glad you came to us for your Rolo. I have a 13 year od dachie, Apollo who has been dealing with many of the same issues as Rolo, the pancreatiis, taking 10mg Vetroyl, he weighs 10.7 lbs. Ask us all the questions you want. We are hear to support and help in any way we can.
Hugs Sonja and Apollo

Rolo weighs 24 pounds. He always hovered around 18. Looking back his weight gain may have been an earliest symptom. Over the past year he has jumped to the 24. At one point, he was slightly over 25.

In October, we put him on Nutro Ultra Weight Management. He had been on Eukaneuba for Doxies his whole life. We just bought another bag of the Eukaneuba to switch him back. We are just trying to eliminate any of the variables that may have contributed to any of his troubles. The pancreatitis came on a few weeks after switching.

A tough Christmas for Rolo. On Wednesday he was diagnosed with a respiratory infection. His lymph nodes were swollen in his throat making it difficult for him to open his mouth/eat. Vet administered fluids, gave us Tramadol for pain and zeniquin for the respiratory infection.

He had a followup sonogram on Friday am, little sludge in his gall bladder. Main concern was his liver and though enlarged (normal for Cushings), no remarkable findings.

Called vet yesterday because Rolo was still not eating more that a mouthful since RI. She finally decided we needed to add prednisone to fight the inflammation in throat. Gave him first dose and we noticed a little bounce. He even ate and drank some.

Today, he seemed to just hang in. Can get him to eat a little, but not much. This is the first time he has refused food in his life. He will show just a brief uptick, then seem to just bottom out again.

Hi Bgoods and welcome to you and Rolo! :)

He is a handsome boy for sure!

Is Rolo still taking the Trilostane (Vetoryl)? If so, please stop now or tell the vet to stop it if she is still giving it. It sounds as if his cortisol could have dropped too low. Prednisone is the antidote for this. It sounds like you vet has a fairly good grasp on this but I wanted to make sure you know the Trilo needs to be stopped and pred given. Regardless, it is never wise to give treatment meds for Cushing's while a pup is sick. The meds are stopped til they are recovered, then restarted.

Have his electrolytes been checked? If not, that needs to be done asap.

I am looking forward to seeing those test results from when he was diagnosed. My Squirt had five Cushing's tests - LDDS, HDDS, ACTH, UTK panel, and two ultrasounds. After the second ultrasound they told me about a tumor on her spleen. Once it was removed, her cortisol returned to normal and has remained within range ever since. I share this to illustrate how a non-adrenal illness can cause false positives on these tests. Cortisol is one of the body's natural responses to stress of any kind and these tests cannot tell why the cortisol is present in such high levels.

On his ultrasound, what did they say about his adrenal glands? Were they visible?

How is he feeling this morning? Is the RI any better? Is he eating?

I know you are worried but please know you are not alone. We are here anytime you need to talk, even if it's just to vent your fears and concerns. We have broad shoulders and soft arms to go with our loving hearts.

Hope to hear from you soon and learn that he is doing better.
Hugs,
Leslie and the gang

We had stopped the trilo on 22 December when he was first diagnosed with the respiratory infection. We did resume it on 24 December with a pm dose when the prednisone was also started. Not going to dose him with the trilo this am and we are dropping the prednisone back to 1/2 tablet (2.5 mg final dose).

His electrolytes were checked on 22 December and were normal. His electrolytes have been monitored pretty closely by our vet (she always mentions them after a blood test). I think she says she checks the to make sure we aren't edging him toward Addison's.

Thanks for the info on non-adrenals! Since the beginning our vet has cautioned that we may have something lurking under the Cushings. She says Rolo only read about half the book on Cushings. That is why we did the whole retest/rebaseline. The sonogram last week was concentrating on the liver. I think they said one of the adrenals was enlarged as was the liver. Our vet has been out of town and we have been on the phone daily with her (she demanded we call and always calls back if we leave any messages), so we have not sat and gone over the results completely. We will do that this week.

This morning he is eating and drinking some. He got up a few times last night to drink, no urinating. We have him on Eukanuba wet right now. Usually, we do a combo of the wet and dry but he has been very hesitant about anything that has to be chewed since 22 December. His lymph nodes still feel slightly enlarged, but better than Saturday.

It's been a long journey so far. Luckily, I have been able to work from home and monitor him. I have also spent way too much time reading about Cushings, but it has helped understand what our vet is saying.

Hope everyone had a wonderful Christmas with family and friends, even the non-furry ones!

The last couple of days have been especially hard on Rolo. Our vet returned from her time with family and friends and I met with her on Tuesday. Rolo was not eating almost anything but a tiny bite here or there. She administered fluids and we tried some different antibiotics. He seemed to pick up, the Tuesday night while he was eating some turkey from my hand, I watched him literally pass out. He was out for a few hours, woke up and within minutes crashed again.

Yesterday, I did get him to eat a little more if I hand fed him. We made the decision to take him to UT Knoxville and we have an appointment on Tuesday morning. Today, he has eaten a little better, even eating some dry food tonight. Hopefully, the UT visit will give us a better grasp and plan for his care.

I've been following your story and just wanted to let you know I'm sending best wishes and prayers for Rolo. It is great that he is at UT and in great care. Do keep us posted ok? Kim