Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed
Hi everyone, I'm Sharlene and my lovely dog Molly has been diagnosed with Cushings for 5 days now.
I've been reading over the site and I've cried many tears while reading the various posts. Some tears for you and your loving companions, some for Molly, some if I am honest, for myself.
Molly weights 19.2lbs. She has in the past been prone to crystals forming, so she has been on SO dog food for years. She takes Glucosimine because she has a hip joint that isn't grooved really deep enough and she's had some issues with that in the past. In fact, it was a sore leg and a pot belly that causes her to be tested for cushings 2 years ago, results of which were negative, from a DEXA test. Hence the glucosimine. 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.
This morning I went and picked up copies of her lab tests going back 2 years.
I'll post any that were off with the appropriate ranges:
2010 physical
ALP 518 (20 - 150)
everything else within normal ranges
2011 physical
Albumin 46.7 (26 - 44)
Protein 78 (51 - 72)
ALP 764 (5 - 151)
2011 DEXA
Cortisol (Base) 82.2 (20 - 300)
Cortisol (DEXA) - 4 hours 28.7
Cortisol (DEXA) - 8 hours 35.1
Not Cushings
2012 March physical
Albumin 44.1 (26 - 44) (barely out of range)
Protein 76 (51 - 72)
ALP 1121 (5 - 141)
ALT 139 (6 - 118)
At my request we redid the ALP and ALT along with the ACTH test a week ago
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)
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
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. 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. 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.
So, that is where we stand. She didn't say start right now, because as she mentioned we might not have tested at all and it wouldn't have been caught until some other time, when I brought her in for a problem of some sort. True enough I suppose. She thinks it is an opportunity to prevent any further complications and to get her sorted out and on the road to a "maintenance" life, which would hopefully be a long one. She also said, that it is possible that once the cortisol levels go down, that we will see some arthritic issues since she had a spell with joint pain last year. She outlined what we'd use to treat that if it does occur, which would be Glucosomine first, pain meds possibly, laser and finally injections if none of the other options work.
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)
Have I been in denial? Maybe. Yet people on the street can't believe she is 9 years old, thinking her much younger.
Will starting her on the medications sooner rather than later lead to less complications and a better over all life? I don't know that either.
Really, I know a lot and I know nothing. That about sums up the gist of it.
Sharlene and the late great diva - Molly muffin (always missed and never forgotten)