My doggie has been on treatment for cushings - Brownie has passed

[frijole]

There probably is but I don't know! I think checking with the university is a good start.

I'd take all those test results (to save time and money) and explain everything to them. And most important, get a real acth test done. I know if they do the other test to diagnose they have to be able to get the acth gel. It is expensive I will warn you. If you can locate where to get it we can save you money because they can reuse the gel and freeze it for future testing. Alot of vets don't know this trick

Do keep us posted ok? We become very attached.

Kim

Buena suerte y abrazos para Brownie!!!

[SoggyDoggy]

Quick question here Kim, If Brownie is having these attacks, looks to be on too high a dose, when Marce takes her to the vet, perhaps the vet giving the cortisol is what has stopped here from having the crisis? Could it be that they have inadvertantly saved her even while not knowing what they are doing? Just wondering. Would the cortisol dose not work the same as a dose of Prednisolone? Being so new to all of this myself, I could be totally off base, but this was the first thing that popped into my head, so I am just wondering.

[Marce]

Thank you so much Kim for all your help, you have no idea how much you have helped me and my Brownie. I will let you guys know how it goes

[Marce]

That's an interesting theory Soggy. Indeed it would make sense.

[frijole]

Quick question here Kim, If Brownie is having these attacks, looks to be on too high a dose, when Marce takes her to the vet, perhaps the vet giving the cortisol is what has stopped here from having the crisis? Could it be that they have inadvertantly saved her even while not knowing what they are doing? Just wondering. Would the cortisol dose not work the same as a dose of Prednisolone? Being so new to all of this myself, I could be totally off base, but this was the first thing that popped into my head, so I am just wondering.

My laptop connection died so I had to switch pc's!

I'm laughing at the irony but you could be right. Not sure of the timing of the lethargy vs the shot etc. I'm also not convinced that the dose is too high until I see an acth test. Normally it'd be obvious before 2 months but it could be that the cortisol has declined over time and therefore the lethargy.

Once a dog is regulated they shouldn't get the shots - better clarify that!

[frijole]

Thank you so much Kim for all your help, you have no idea how much you have helped me and my Brownie. I will let you guys know how it goes

Glad to help. I found this site over 7 years ago when my girl Haley was diagnosed by a clueless vet so I have a soft spot in my heart for those with clueless vets! True story.

[labblab]

Thank you She is. That's a good idea, I'm gonna try some universities. Yep they gave her Cortisol, a few times. They told me it was the lesser of two evils that she could die If the swelling doesn't go down. Is there an alternative way treatment for an allergy attack that I could suggest next time?

Welcome from me, too! I am so glad Kim was here last night to talk with you! She's already given you a ton of good info, so right now I only have this little bit to add. I have a dog who suffers from allergies, too, and she's had one acute episode where her whole head swelled up and she had hives all over her chest. When I rushed her into the vet, she was given a cortisone shot, too, in order to relieve the swelling and inflamation. If a dog's airways swell up from an allergic attack, it's true that it can actually be life-threatening. So in this case, your vets are probably doing the right thing. Even though you don't want to be treating a Cushing's dog with steroids for an extended time period, an emergency injection may be necessary.

I know that epinephrine (adrenaline) injections are also given to halt acute allergic reactions. Many humans who are at risk carry around "epi-pens" in order to have the ability to self-inject in an emergency. But I don't think ephinephrine has the same anti-inflammatory properties that cortisone does. So I guess that's where it becomes a judgement call by the vet as to whether or not the cortisone is the better treatment depending on how your dog is presenting at the time of the attack.

Acute allergic episodes can be very scary, that's for sure. So in that instance, a temporary shot of steroids may really be necessary.

Marianne

[frijole]

Awesome Marianne! I'm glad you found this thread also due to your knowledge of trilostane! Kim

[Marce]

Hi guys, its been a while. Let me tell you of brownies progress. I was not able to find any ACTH stim tests here in Peru so I've been keeping her on a steady dosage 15mg in the morning and 15mg at night. A few days ago month they gave her a biochemistry exam and the results are of very high values indicating liver problems, she also got an echo and it shows a shrinking liver.

2/25/2013 (latest)

AST: 228
ALT: 144
ALP: 590
BUN: 29
UREA: 61

5/21/2012

AST: 80
ALT: 64
ALP: 60
BUN: 14
UREA: 33

2/22/2012 (trilo treatment started)

AST: 39
ALT: 47
ALP: 178
BUN: 20
UREA: 43

It's a marked increase. Her vet gave her a prescription of antioxidants and Ursodeoxycholic acid to help with her liver. He also a tells me I should wean her off of trilostane and keep her of, his logic being that her hepatic health is much more important than her cushings right now, and trilostane could be what is causing these liver problems. I asked him if the cushings itself can hurt her liver, he tells me no, it is a completely separate from her hepatic problems.

But I read online that cushings itself, the high cortisol count, affects the liver directly and can cause elevated enzymes. Could it be that the elevated counts are from the cushings and not from the trilo? What will be more harmful to her? The trilo or the extra cortisol? So I'm at a loss of what to do. I will be following the vet's advice for the time being, hopefully her enzyme levels get better, but now im worried all her cushings symptoms will come back, her hair will fall out, her skin will get oily and rashy and she will start to non-stop scratching like she used to. Any advice regarding cushings treatmemts to a patients with hepatic problems would be super appreciated. I'm really scared for my brownie right now. I have seen her have moments of shakes and shallow breaths, I just hope I didn't catch her high levels too late

EDIT:

Reference ranges:

AST: 1-49
ALT: 1-57
ALP: 10-101
BUN: 9-26
URA: 20-55

[Squirt's Mom]

Hi Marce,

Do you by any chance have the normal values for these levels you posted? That would help us a great deal.

Your vet is wrong about the liver not being affected by Cushing's. It is one of the main organs that is affected. However, liver disease can present with the same signs as Cushing's, including elevated cortisol, yet not be Cushing's. Has Brownie had an abdominal ultrasound? If not, can she get on there in Peru? If she can, I would have one done asap if at all possible to look at the liver. A biopsy may need to be done at the same time.

I can share a little about liver values -

• ALKP (ALP) is important in metabolism and is found in liver cells.
High levels indicate bile duct obstruction, Cushing's, liver disease,
certain cancers and may be due to certain drugs such as steroids or
phenobarbital. Low levels indicate starvation or malnutrition.

• AST is important in the breakdown and elimination of nitrogen.
High levels indicate muscle damage, heart muscle damage, liver
damage, toxin ingestion, inflammation and various metabolic
disorders. Low levels indicate starvation or malnutrition.

• ALT is also important in the metabolism of nitrogen and is most
often associated with the liver. High levels indicate liver damage,
toxin ingestion, Cushing's disease and various metabolic
disorders. Low levels indicate starvation or malnutrition.

• GGT is also important in nitrogen metabolism and is found
within liver cells. High levels indicate bile duct obstruction, liver
disease, pancreatitis, Cushing's and can be caused by high levels
of steroids. Low levels indicate starvation and malnutrition.

As you can see, Cushing's is listed as a cause for all of these values along with other considerations. So Cushing's DOES have an impact on this organ, no question about it.

The flip side is this, tho - if a pup has liver disease, none of the treatments used for Cushing's should be used with that pup. So the first step is to find out why those values are elevated. Is the liver diseased or is something else going on? I would think it highly unlikely that the Trilo is causing these elevations tho if there is liver disease present, it may be aggravating it.

Please let us know what you decide to do about further testing on the liver and especially how Brownie and you are doing, 'k?

Hugs,
Leslie and the gang