Cairo, 8 year old staffordshire bull terrier just diagnosed

Hi all,

Our staffy has just been diagnosed with Cushing's - just got told yesterday so he's not been started on treatment yet as his vet will discuss it with us tomorrow when she's back in.

I don't know if this is something that's been steadily brewing for a long time or not but we've always joked about him liking to eat - he'd eat till he burst if he was allowed.

We lost his "brother from another mother" two years ago and after Neo's death was when we really noticed a change in Cairo. He seemed to be very anxious out on walks, stressing, panting and would only go as far as it took for him to toilet then he wanted to go home again. We just thought he was grieving for losing his buddy.

In the last few months, he gained a lot of weight - he went up to 28kg which is heavy for a stafford. He's a big boy and his ideal weight would be about 23 - 24kg so I guess it's not a huge weight gain. Despite cutting his food and treats down, he didn't lose any weight.

Then we noticed he started developing some bald spots and the skin round his bum looked dark and just not right. Then the tip of his tail when bald - that rang alarm bells for me and I initially thought that it was his thyroid - which would explain his weight gain, lethargy and anxiety.

The vet ran some bloodwork (I don't have any results for this) and said that his thyroid hormone was low but his TSH was normal which basically ruled out his thyroid, so he had a low dose dex suppression test on Friday. We just got the results yesterday that he has pituitary hyperplasia.

I'd have taken a thyroid problem over this any day but now I need to make sure he's getting the best care and treatment possible.

We'll be speaking to his vet tomorrow to see what the next step is regarding medication, etc but I really wanted to know if there is anything I should be asking her?

What's the best medication for him (Lysodren isn't licenced here in the UK). Are there any alternative therapies that can be tried? Should there be any dietary changes to help him?

Is there anything else I should be asking the vet?

I'm really devastated about this. It's bad at any time but it's exactly a month short of the two year anniversary of Neo's death and it just feels like we're away to go through another devastating time (Neo's illness came suddenly and was very upsetting).

So glad I found this forum and hope that I can find out as much as possible to help my boy.

Alison

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Hi Alison,

Your membership approval has now been finalized so your posts will now be publicly visible just as soon as you write them.

Cushing's is one the most difficult endocrine diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing it and other non-adrenal illnesses can create false positive results on all tests for Cushing's.

If you could round up copies of all tests that were done on Cairo and post any abnormalities that are listed, that would be great. We would also be interested in all results from any Cushing's tests...Thanks!

Having a vet/IMS that is Cushing's savvy is a real plus, so if this were me I would ask the vet if they are knowledgeable about Cushing's, the treatment protocols for Cushing's, and ask how many Cushingoid dogs they have treated. I would also want to know if when they treat with Trilostane/Vetoryl do they go by Dechra's or UC Davis treatment recommendations. These are just some of my own thoughts and I am sure others will be along to share theirs.

Does Cairo take any other herbs/supplements/medicines? Any other health issues?

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

Love and hugs, Lori

Thank you for the welcome.

I'll ask them for copies of his tests tomorrow - he's not had loads of tests done - just for his thyroid and then the low dose dex suppression test.

The vet we normally see is really good with him and she's been patient at explaining things as well - I do trust her (which is more than I can say for my own doctor!!). I'll ask all the relevant questions. I believe they'll be using Vetoryl but I'll ask which treatment protocol they'll be using. Will she or should she be familiar with the two protocols with being in the UK?

Cairo isn't on any other meds - apart from a short course of Noriclav two weeks ago for an ear infection. He's always been so healthy (or I thought he was) which is why this has come as such a shock.

I have Addison's myself and I'm fairly up on that but Cushing's is freaking me out because all I can think of is "tumour".

Hi Alison and welcome to you and your Staffy :)

I am so glad you found your way over here. Their is an abundance of information here and many members to help and share experiences.:)

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Originally Posted by Alison

I believe they'll be using Vetoryl but I'll ask which treatment protocol they'll be using. Will she or should she be familiar with the two protocols with being in the UK?

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Yes, I think that she would of read about both of these two treatment protocols. The biggest difference between Dechra and UC Davis is the initial starting dose: UC Davis -

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The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

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This article can be found: Comparing therapies for canine hyperadrenocorticism

Dechra's -

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The starting dose for the
treatment of hyperadrenocorticism in dogs is 1.0-3.0 mg/lb (2.2-6.7 mg/kg) once a day based on body weight and capsule size.

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Link to Dechra info: http://www.dechra-us.com/files/dechr...ts/Vetoryl.pdf

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Originally Posted by Alison

I have Addison's myself and I'm fairly up on that but Cushing's is freaking me out because all I can think of is "tumour".

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So sorry to hear that you have Addison's, then you know Cushing's is the exact opposite of Addison's. Most dogs (85%) have PDH (pituitary-dependent hyperadrenocorticism) in which there is a small and usually small growing tumor of the pituitary gland; the other 15% have ADH (adrenal dependent hyperadrenocorticism) and have a tumor of the adrenal gland/s.

If a dog has ADH, then a cure is possible with surgery.

One thing I want you to know is that Cushing’s is a treatable disease. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Love and hugs, Lori

I'm not sure if the vet will phone me or my mum so I've given her the list of questions to ask as well. I said to her it might be better to phone first thing and just ask if we can pop in and speak to her and that way we can pick up any meds he needs at the same time (and ask for his lab results.)

The vet did say that Cushings wasn't life threatening the way Addison's is and that we didn't use Lysodren here as it wasn't licenced here plus the Vetoryl was reversible if the dose was too high where as the Lysodren isn't. We'll get more info tomorrow though and I'm doing a mountain of reading - I need to know as much as possible because Cairo can't speak for himself so he needs me (even though he's in the huff with me for all the poking and prodding he's had over the past few days).

Way to go with the mountain of reading. Good luck and the people here are wonderful. I will be on the lookout for more details from your journey.
Angela

Hi Alison, glad you found your way over to the forum. :)

Welcome. :)

I replied over on the Facebook page, but I'll say it here too. Knowledge is key. The more you know about cushings and treatment and testing protocols, the better things will go. You are one step ahead just because you know about the opposite. So, that is the biggest risk, you don't want the cortisol to go too low that you get into an Addison crisi, which is not actually get Addison, but falling into that low zone. It is one reason that when you start the vetoryl, you want to have a pred rescue does on hand, just in case. You'll probably never need it, which is great, most don't.
It is why we always recommend starting at the low end and working up as needed. The body seems better able to tolerate it too, when the dose is started at the low end of the scale.

Welcome to the forum
Sharlene and molly muffin

Just a quickie.

The vet's just phoned. She says he's definitely got Cushing's but he's not had it long. I'm getting to pick up a copy of his lab results so I can post them later.

He's to be started on 120mg Vetoryl (he's 28kg).

Alison:
Welcome to the group. Sorry your baby is having troubles. I know you had an LDDS test right? There are other tests that are done also, ACTH, Urine, and Ultra Sound are all used to get a confirmation of the Cushings and what type you are dealing with. Since these are powerful drugs used on Cushings I personally would want more confirmation that my dog has it, and what type.I use Vetoryl, and I can tell you the single most important thing with using it is to start on a low dose. It gives your dogs body time to adjust to the drug. Some vets start these dogs on a high dose and they have problems. If you want to minimize the risk to your dog start low. Just be vigilant about watching him and you will do fine. As far as diet goes I was told by a nutritionist that they need a low density, medium protein diet. Keep a daily doggie diary on your dog . You will need it to refer back to. Make sure your vet has experience treating Cushings as it will save you time, money and heartache. Hope all goes well. Blessings
Patti

Alison, DO NOT START ON THAT DOSE. It is way too high, and you are just asking for trouble. The 2 different recommendations are much lower than that. Either 1mg/kg, which would be 28mg for your dog, or 1mg/lb, which would be 60mg. You are much better starting with the lower one. It may take more dose adjustments, starting low and working your way up, but it is much better for your dog. Don't worry about arguing with your vet, you are the only one who can speak for your pet.

Oh heck. We're just back from the vet. She says she's starting him on a dose that's in the middle of the Dechra recommendations - 3mg per kg. She's booked him for an ACTH stim test on 17th September.

I've got his lab results - just away to scan them and work out how to post them up.

You only need to post the abnormal high/low results and the full LDDS or ACTH result which is a couple numbers with the ranges for each. Easier to just type those out. We see better results with starting on the low end of the scale and working up usually. So 60mg for starting.

Sharlene and Molly muffin

Those are OLD recommendations from Dechra. Unfortunately a lot of vets do not keep up with new studies, and many of the products inserts still seem to be old. Dechra recommends 1-3mg per pound now. UC Davis, 1mg/kg. Tell your vet NO.
My dog has been on vetoryl for about 5 weeks now. He weighs 50lbs (22.68kg). I started him on 20mg, twice a day. I believe the twice a day makes more sense. He has done very well, no problems at all. After his first acth test, which MUST be done 10-14 days after starting, and every time there is a dosage change, I increased his dose to 25mg twice a day, as his cortisol levels were still to high.
Don't worry, you will be fine as long as you follow protocol. If your vet won't listen, then find a new one. There is no rush to treat.

I've got his lab results now

http://i41.photobucket.com/albums/e2...b-results1.jpg

http://i41.photobucket.com/albums/e2...b-results2.jpg

http://i41.photobucket.com/albums/e2...b-results3.jpg

Alison, I'll tell you how I look at it, and I'm sure the many on here with much more knowledge than me, will correct me if I'm wrong.
Your dogs cortisol levels didn't go to the levels they are now overnight, they built up over time. Many systems are dependant on cortisol. The body has been trying to adjust all along to the levels increasing. A large dose will cause a big drop in the cortisol quickly. So not only is there the sudden shock to the system due to the change, but they could get too low, causing an addisons crisis.
Like with many other things we take, weaning them slowly off the cortisol levels their body has been used to, is much easier on the system, and a much safer way to go.

Dechra protocol ..

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Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range.

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It seems to many of us here that the larger dogs seem to need less trilo per kg than the smaller dogs do.

Please be sure your vet gives you some rescue predisone to keep on hand for any emergency.

Within a week or so, you may notice less thirst and ravenous appetite, but of he refuses to drink or eat and seems lethargic... stop the trilo and call the vet immediately.

I am sure you will do just fine :) but in any case you have lots of friends here that will be around to help and just listen if need be. :)

I've had a good read of Dechra's leaflet for Vetoryl and it certainly says that for his weight, the starting dose should be 120mg.

Read the adverse reactions though and that's scared the pants off me.

Is there really any serious risk to this medication? Or are they just covering all basis for every possibility? I don't want to kill him with medication. My mum's scared to give him it and I'll admit that I'm a bit scared too.

As with any medication human or canine, their is always possible side effects. In most cases of concern is when a pup goes too low on the cortisol. Resulting in lethargy, loss of appetite, not willing to drink water and diarrhea. Many times this results in a trip to the ER for testing and fluids.

This is why many of us recommend starting on the lower dosage and working up if necessary. It may take a bit longer to get control, but we feel it is a better and safer method.

Like I mentioned before, it does seem the larger dogs need less trilo per Kg than the smaller dogs.

I am trying to read the test below and am having trouble seeing the numbers. Did the vet do an ACTH test to baseline Cairo?

I'm going to jump in here and give my 2 cents worth. My dog was 65 lbs. We started him once a day at 58 mg and over a period of time there was no change ( 3 weeks) . We bumped it up to 68 mg and again no change for awhile then suddenly we had a couple of good ones. Peeing and thirst were the main issues. Then there was some weakness in his back end so the dose got reduced to 65 mg, still once a day. My dog crashed and at the time I had no idea about prednisone as the vet never mentioned it. He was literally minutes away from being euthanized and the vet said it was time.
Well "mah boy" is still here cause I brought him home and paid no attention to this vet. She also as a sidenote did NOT do the ACTH test at the proper times, again I found out later all thanks to this forum.
I have been to 5 different vets which include a teaching veterinary college and an IMS. All vets have had different comments and diagnosis. My point is that being an average size dog the dose my dog got was too much for him. Please do NOT give a large dose to your dog. Start out at the 1mg and build up if need be. I was told just last week that it can literally take months for a dog to respond to treatment. Every dog is different.
I come here now for all my advice and this is coming from someone that has no faith AT ALL in forums, until I came to this one. They know what they are talking about.
My dog is still a mystery, after now 4 months of problems and I'm no expert at all on here, however I've learned a few things, and I almost had my dog put down until I listened to what was being said to me here.
Hope this helps you in your decision about the dosage.

Alison:
Please start him on a lower dose and work up from there. We are all here to help you, and make sure nothing happens to your baby. The people on here have a lot of experience with this, more than most vets do, so please trust in them. Blessings
Patti

Lord, now I'm worried.

She didn't do an ACTH stim test - just the LDDS test. He's to get the Stim test on 17th September after 2 weeks on the meds. Boy were they expensive.

I'll try and type out his lab reports as they appear in the hope they make sense.

Oh and we weren't given any prednisolone but I do have 1mg, 2.5mg and 5mg tablets in the house, along with hydrocortisone (the joys of a family with Addison's and ulcerative colitis!!) Are human prednisolone OK to use if necessary?

Here are the lab results - hope I've typed them out correctly. There are three pages:

Page 1

SNAPshot Dx

CORT 83nmol/L

8 hour post low dose dex
...Both 4 and 8 hour <27.6nmol/L - Normal
...Both 4 and 8 hour = 27.6 - 41.4 nmol/L - Inconclusive, consider repeating in 6-8 weeks
...Both 4 and 8 hour > 41.4 nmol/L and >50% of baseline -
.......Consistent with Cushing's syndrome; consider HDDST to rule out adrenal tumour
4 hour <41.4nmol/L or <50% of baseline and 8 hour >41.4nmol/L and >50% of baseline -
.......Consistent with PDH
4 hour <41.4nmol/L or <50% of baseline and 8 hour >41.4nmol/L and <50% of baseline -
.......Consistent with PDH
4 hour >41.4nmol/L or >50% of baseline and 8 hour >41.4nmol/L and <50% of baseline -
.......Consistent with PDH


Page 2

SNAPshot Dx

CORT 101 nmol/L
baseline cortisol


Page 3

SNAPshot Dx

CORT <14 nmol/L
4 hour post low dose dex
Await 8 hour post result for interpretive comments

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Originally Posted by Alison

Oh and we weren't given any prednisolone but I do have 1mg, 2.5mg and 5mg tablets in the house, along with hydrocortisone (the joys of a family with Addison's and ulcerative colitis!!) Are human prednisolone OK to use if necessary?

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I believe that would be ok. The standard rescue dose of pred is 0.25mg/kg.

So for Cairo's weight of 28kg, from my calculations the rescue dose would be 7 mg.

If I am reading those LDDS results correctly they are :

• Baseline = 101 nmol/L

• 4 hour = <14 nmol/L

• 8 hour = 83 nmol/L

Converted to ug/dl, which is the units we are used to seeing:

• Baseline = 3.66 ug/dl

• 4 hour = <0.51 ug/dl

• 8 hour = 3.01 ug/dl

Most times the cut off value is 1.4 ug/dl, so I believe those LDDS test results are indicative for PDH. However, I am in agreement with the others that the starting dose for Cairo is too high.

UC Davis protocol advises a starting dose of 1mg/kg which in Cairo's case would be 28mg. Dechra verbally recommends starting at the low end of their dosing scale which is 1mg/lb, so for Cairo's weight in lbs that would be 61.6lbs and a starting dose of 60mg.

We have seen dogs that do well with no adverse side effects when started at an initial low dose. If Cairo was my dog I would start him at 30mg...just my 2 cents worth. ;)

Love and hugs, Lori

I did say to the vet that the dose was higher than I'd thought he'd be on but she said that it was smack bang in the middle of the recommended treatment regime and was fine for him.

I'm terrified I kill him!

Would giving him 120mg every second day work? There's no way of splitting the capsules and I don't think the vet would agree to reducing the dose if she believes him to be on the right dose.

Trilostane only remains in the system for about 12 hours. a little less or a little more. Part of the reason that twice a day dosing is seen more and more. Every other day would cause a roller coaster ride.

You are Cairo only voice and advocate. I would at least ask if we could start at a lower dose as you are not comfortable starting so high.

as Lori indicated...

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UC Davis protocol advises a starting dose of 1mg/kg which in Cairo's case would be 28mg. Dechra verbally recommends starting at the low end of their dosing scale which is 1mg/lb, so for Cairo's weight in lbs that would be 61.6lbs and a starting dose of 60mg.

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You may want to print out the links and send them to your vet. UC Davis is world renown in the treatment of canine cushings and testing, monitoring protocol.

I'll speak to the vet tomorrow. The last thing I want to do is cause him more problems.

Just spoken to someone else who is in the UK and her dog (roughly same weight) was started on 120mg too but he was reduced down to 30mg daily. Sounds like over here they do start them on the higher end of the scale. :rolleyes:

That's why Veterinary medicine is still called a practice.... just don't practice on my dog..right? LOL

You are his only voice and advocate... You will be fine :) after all the vet works for you.

I'm always terrified about questioning the medical profession - human or animal - cos they're meant to be the experts!

I think if you calmly tell him your concerns, and your stress level, he will be glad to accommodate you and give Cairo a lower dose.

You will be okay :)

A few of us had had discussions and disagreement with our vets. If my vet wasn't willing to work with me, he was fired and another vet was found. I finally found a vet that would have open discussions and worked with me and my concerns. We all learned from the experience.

Ha ha .. I remember one time he was a little upset and said " I went to vet school for this !!!" the discussion was about an ear medicine that side effects were loss of hearing... anyway he excused himself, went and looked it up then came back an apologized LOL I loved this vet because he was willing to listen and discuss.. BTW, he stopped using that ear med on the local police station canines :-)

It was this group right here that helped me research it... there is not much that gets past this group of members right here :D

If you are torn between the advice you are getting from your vet and the advice you are getting from the folks on this forum, listen to these folks! I did, and I'm so glad I did!

My vet wanted my dog fasted before the first ACTH after she had been on Vetoryl for two weeks. I'm so glad I posted full information, because the people here picked right up on it and warned me that the test has to administered after the dog is given their Vetoryl dose with food - as it is always to be given. Testing a fasted dog means the test will be invalid, and basing dosage on such a test could result in an overdose, because the food is needed for the Vetoryl/trilostane to be fully effective. Without the food, the Vetoryl isn't fully absorbed, therefore the dog's cortisol is not fully controlled, and the test will read higher levels of cortisol which could lead to an unneeded increase in dosage.

I had a discussion with my vet, who thank goodness was willing to work with me and learn something, but I had to go over a stubborn and rude technician first. And it helped that, thanks to the people here, I had the reference information printed out as well as website addresses that they could check, not just my own opinion.

If you make it clear that you are just concerned for your beloved Cairo, not trying to be a confrontational know-it-all, you should be able to convince your vet to start at a much lower dose. The only risk to the lower dose is that you may need additional ACTH tests and several dosage increases before you arrive at optimum control - and you might not (my dog was started low and stayed low). High doses risk going into an Addisonian crisis and even possible death.

Your vet may be comfortable with that risk, but if you aren't, you really need to be brave and speak up.

Calmly expressing your concerns should in no way be threatening to a good vet. They should understand that you have fears that need to be addressed and that it doesn't hurt to take a more cautious road when the owner has concerns.
So many of us have been down this path and it can be hard having that first discussion, but after you've had one, you'll find the next 100 to be a piece of cake. :)

Sharlene and Molly Muffin

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I'm always terrified about questioning the medical profession - human

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or animal - cos they're meant to be the experts!

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As my husband always says- just because they went to school doesn't mean they got an "A". There are a lot of "D" vets and doctors out there.;);););)

You must be the voice for your pup and that means never blindly following doctor's orders and it also means asking questions when you have them and it can also mean saying "NO".:):)

No worries, we will get you ready!!!:):)

Addy's husband is so right! Not all health professionals (animal or human) are created equal! You can only hope they will listen to your concerns and work with you so you can feel confident and comfortable with the choices made.
I grew up with parents who would never think of questioning a doctor and didn't, so I understand how you feel. Sometimes it's intimidating to even ask a question, but a good doctor/vet will welcome your concerns and answer your questions...if they don't , it's time for a new one! ;)

Barbara

I've not had a chance to speak to our vet yet as she's on days off and I wanted to speak to her, but I contacted Dechra and this is the reply I got:

Thank you for your enquiry regarding Vetoryl. Please be reassured that the dose of Vetoryl prescribed by your veterinary surgeon for your dog is consistent with the recommended dose range on the Vetoryl datasheet. We are unable to discuss the details of individual cases with animal owners so if you have any concerns regarding the treatment of your dog with Vetoryl, we would advise you to discuss these with your veterinary surgeon. If your veterinary surgeon would like to contact us to discuss the case further they would be very welcome to do so.

I hope this helps you with your enquiry.

Wow this is strange - not like what we have seen before.... are you by chance located outside of the US? That might explain it. Thanks Kim

Allison:
Are you located in the US?

Yeah, I'm in the UK