Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

Yes, exactly the ACTH dumps that cortisol into their bodies and sometimes for 48 hours or so, it could be less, they eat, drink, pee, run around like crazy. This should go back to normal soon though. Give it a couple days.

Has their been consistent protein in her urine? If so the vet might want to address that with UPC and moving to a lower protein food.

The other option and not very common, is if the cysto's have caused any problems with the bladder. It is quite common to get some blood in the urine when they do a direct draw, but this should go away and the next free catch urines shouldn't show any blood if that is what it was from.

What about crystals or a stone, those can also cause blood in the urine.

Just throwing thoughts out there for consideration.

Abbie sure is adorable.

Sharlene and molly muffin

Thanks for quick reply! I think she is cute, too. :D Effects of ACTH make sense. Abbie hasn't had the "zoomies" (how we describe crazy running around on a beagle forum I participate in) but that may be due to having to give her melatonin this afternoon for thunderstorms anxiety.

I thought that high protein in the urine was a fairly common finding in Cushings dogs so was thinking that was just one more indicator. I feed Abbie prescription Purina DCO mixed with prescription Royal Canin low-fat canned food. It was a very long process to find a food that had the right amount of fiber and the DCO finally worked. Not familiar with UPC abbreviation ...

There haven't been any crystals in the urine but stones are a possibility. We have kind of put that on the back burner until getting through the current tests.

Well, Abbie is officially a Cush pup! :( I will get copy of ACTH and post numbers. Her vet is calling Maggie's IMS tomorrow to see if he can see Abbie next week for an ultrasound. Meanwhile, due to continuing gi issues, will be adding pepcid and going back to twice daily flagyl. The vet is concerned that the Cushings may be irritating Abbie's stomach lining. Abbie's symptoms do seem to be increasing very quickly. She definitely has a pot belly and cries for food two hours before dinner time!

I know it is premature but ... if we end up treating with Lysodren (my vet has treated with both Lysodren and Vetoryl but has more experience with Lysodren), are there guidelines to using a slower loading phase due to already existing gi problems? Would we just use the lower end of the range?

Hi Judy, well, we welcome little Abbie into the fold even though ours is a club that does not recruit members other than honorary ones! :o

I think Abbie's ACTH results may have some bearing on the treatment decision -- how highly elevated her cortisol seems to be at this time. Our staffer Addy's Zoe had pre-existing IBD at the time of diagnosis, so faced some of the same issues as you and Abbie. However, Zoe was not as classically symptomatic with Cushing's. Addy corresponded with NY endocrinological expert Dr. Mark Peterson in addition to her home vets, and this is a recent summary that Addy wrote re: their situation (in reply to a dog without GI issues, however -- Sharlene's Molly).

Quote:

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Originally Posted by addy

Zoe started out without the classic Cushings symptoms, even in her blood work. Dr. Peterson told me not all Cush pups will have the elevations we normally see. Her main problems were skin/coat issues. Dr.Peterson felt her cortisol was too high for a maintenance dose of Lysodren to work and that her IBD would not tolerate the higher Lysodren doses of a load. He opted for starting at a low dose of Trilostane.

I think if it were me, I would ask if a maintenance dose of Lysodren would hurt Molly and how and if her cortisol is not sky high, perhaps a maintenance dose would be enough to bring it down. Dr. Oliver did tell me he had dogs that did respond to a maintenance dose without a load.

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Zoe's GI issues were an ongoing challenge, and I'm hoping Addy will have a chance to stop by at some point to share her experience with you.

Marianne

Hi, Marianne! I just picked up a copy of Abbie's ACTH results. If I did a correct conversion (ug/dl to nmol/l), she is swimming in cortisol!

10/14/14

Cortisol Sample 1: 3.8 ug/dl (reference range 1.0-5.0)
Cortisol Sample 2: 26.0 ug/dl (reference range 8-17 with note that any number above 20 is indicative of HAC)

If I converted correctly, 26.0 ug/dl would equal 717.34 nmol/l. From what I have read most Cushing's pups have above 600 nmol/l in post-ACTH.

If we decided to treat with Lysodren (again premature thinking before ultrasound), I am figuring Abbie's loading dose would be 580 mg., divided and given twice a day. At her last weigh-in she weighed 25.6 lbs.; converting that to 11.6 kg and multiplied by 50 would be 580 mg. of Lysodren. Still looking for literature discussing doing loading with less than 50 mg/kg. although, thankfully, no diarrhea yesterday or today.

Hi Judy,

I am sorry to read about Abbie’s problems. I am glad Marianne provided the text I wrote t and she is right that Zoe’s IBD was on going. She took a small dose of Metronidazoe usually every day as it continued. Here on the forum, part of the problem we have seen with using a lower dose to load is that it can prolong the time to load. Dr. Peterson did tell me I if I went ahead with the load, I could also give Zoe prednisone during the load.
The other thing Dr. Peterson mentioned was that he felt Zoe would be better off on Vetoryl because if she had flare ups we could start and stop the drug. With Lysodren, he said we would not be able to do that without losing the load.

Hang in there

Hi, Addy! Thanks for your input. I was really surprised to read that Dr. Peterson suggested giving Zoe prednisone during the loading phase. I don't think that would work with Abbie as she has an extreme reaction to prednisone with a significant increase in drinking/urinating. Also, since that is her most pronounced Cushing symptom, I would be concerned that I would miss any changes in that area during loading.

The IMS wasn't in today and the staff told my vet that the next available appointment is on 11/3. My vet is going to call back on Monday to speak to the IMS directly and see if he can fit Abbie into his schedule for next week as we really don't want to wait until November for the ultrasound.

Thank goodness I am retired and can work my schedule around letting Abbie out to pee at least every two hours!

I was surprised too at the recommendation, especially after everything I read here, but he did say it was possible to do. I wasn't thrilled with the idea of it.

Zoe's IBD flared even on the low dose of Vetoryl in the beginning. So in the end, it was the better drug her Zoe's IBD though I don't know that I am sure it was the best drug for her Cushings.

It is hard sometimes to have it all work out the way we hope.

Ugh, I hate it when they give you "next appt" that are far out. Same thing happened with me in August/September.

There is someone else I know who did a loading phase of prednisone and lysodren, per Dr. Petersons instructions. They did it and it worked out fine for them. I think everything depends on the dog though and how they react.

Sharlene and molly muffin

I just wanted to say "Hello" and tell you that Abbie is a doll! I have a weak spot for hound dogs. So precious and such a sweet little face! Thank you for rescuing her.

I'm sorry that you are both going thru this. I think the Creator must know who to give these pups to because everyone on this forum is exceptional parents. For you to be given a second Cush pup means you must be a great Mom!

I too am home during the day which is really a blessing because my girl is like Abbie and goes out about every 2 hours as well and unfortunately still does even with medication. I think sometimes its just become habit now. LOL. She's learned how to boss me around very well.

I do remember reading on this forum where small amounts of canned pumpkin can help firm up the bowels. I just can't remember how much to give... and the warning was that too much could cause diarrhea. That may also be something to try and see if it helps Abbie's GI symptoms. Hopefully someone will pop in and give you the exact amount.

Dixie (my doxie Cush Pup), Buttons (beagle, doxie and lord knows what else) and I are rooting for you and Abbie. I'll be following along with the others to see how things are going.