Originally Posted by
molly muffin
Her ALP's have been high consistently and we try to balance that using the SO food, that encourages her to drink more water and the crystals not to form. She only had them once, that was enough.
If Molly has cushing’s, it is highly unlikely that prescription or nonprescription food will have any effect on ALP.
2012 June tests
ALP 1003 (5 - 141) (this has actually decreased a bit since March)
ALT 152 (6 - 118) (while this has gone up a bit since March)
In subsequent posts I noted that you are very concerned about the progressive increase in ALT. 152 would be considered a mild elevation, which is the norm for a dog with cushing’s. This doesn’t mean a dog’s liver is being damaged but rather is being overworked from the effects of high cortisol. It also should not be the primary factor in determining whether a dog should start treatment.
Cor1 - Cortisol (base) 172 (30 - 300)
Cor 21 - Cortisol (ACTH) - 1 hour 924
Cor 22 - Cortisol (ACTH) - 2 hour 1014
Lab states, that in a normal animal Cortisol will increase above 250 but not above 600.
The results are consistent with Cushings Disease; Pituitary-Dependent Hyperadrenocorticism
This appears to be an acth stimulation test, probably using an acthar gel, with peak concentration occurings two hours after stimulation, thus the two post blood draws. Here in the states most vets prefer to use cortrosyn as the stimulating agent, with peak concentrations occurring 1 hour after stimulation, requiring only one post blood draw. Regardless of which stimulating agent is used, an acth stimulation test does not differentiate between pituitary and adrenal based disease. Could you please recheck your paperwork to make sure you aren’t missing some text.
okay, so now that is out of the way, my vet, who has been Molly's vet since we brought her home as a rescue baby at 11 months, feels that this has been caught at the very earliest of stages. Her recommendation is to begin treatment with Vetoryl 30 mg. In fact, it is sitting here on my desk right now. It is the monster in the closet, under the bed, or in my case, in front of this computer monitor.
So I asked her why begin treatment now,( actually she has called me once since they told me on Wednesday, to discuss and then we spoke again today, when I went to pick up copies of lab results) and she said, that although it is not clinically necessary to start right now and we can decide when we would want to start medications for the cushings, that her experience is that when treatment is not started, the risk increases greatly for dog to develop diabetes and/or pancreatitis. That she feels and she has had good results with early treatment.
Symptoms are a big components of a diagnosis and a cushing’s savvy vet would not confirm a diagnosis and launch into treatment in the absence of overt symptoms. The primary goal of treatment is not to cure the disease but rather to eliminate clinical signs. If there are no overt clinical signs, there is no need to jump into treatment. As a matter of fact, I would be hesitant to start treatment without validating the ACTH stimulation test and determining which form of the disease Molly has.
I asked also about the Davis study suggesting a lower dose and she said that the Davis study is already out dated compared to more recent studies, from universities around the world.
The UC Davis protocol was established as a result of their extensive experience with Trilostane. Based on the 100’s of threads here, I believe UC Davis protocol is much safer than the dosing recommended by Dechra, the manufacturer of Vetoryl. One of our administrators was actually told by an internal medicine specialist on staff with Dechra that they are verbally recommending to vets that they use the very lowest end of the range for dosing but they have not yet published a revision to packaging inserts.
That she has had good luck with this dose for Molly's size. Starting the medicine she said would be followed up with tests at day 10 - 14 (she suggested day 12) after starting treatment and then based upon how molly is doing, either 4 weeks or sooner if she feels that it is needed.
Proper protocol dictates that an acth stimulation test be done at 10 to 14 days and again at 30 days. I would recommend that if and when you start treatment, your vet should follow proper protocol, especially in the first 30 days of treatment.
I find myself second guessing how well I thought molly was/is. She does lay around more, but has a great time playing when she wants to. She doesn't eat all at once every day, usually she eats maybe half or even less, and then later will finish off (around dinner time). She drinks, but not overly so and we in fact try to encourage her to drink since she had issues with the crystals forming. She does have some times when she doesn't want to jump up or she has to make a running leap for that window seat she loves. And yes, there is the pot belly. (we thought she just really loved those treats a tad bit too much and that is probably still true)
With symptoms being limited to a pot belly, I absolutely would not start treatment until symptoms became apparent. I would, however, want an abdominal ultrasound done to make sure there is not some other problem going on. A very small number of dogs have cushing’s caused by tumors outside the pituitary and adrenal glands that secrete acth, so having a look at internal organs is a really good idea. In these cases the treatment of choice would be to remove the tumor. One of our moderators has a dog who had elevated cortisol but it was later discovered, via an abdominal ultrasound and subsequent surgery, that the cause for the elevated cortisol was a tumor on the spleen. Once removed, cortisol levels fell. Oddly enough, these dogs usually have higher levels of circulating cortisol, like Molly. With just an acth stimulation test and no symptoms, how does your vet know what she is truly dealing with?