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Thread: Daisy - 6yo labrador diagnosed with Cushings (Daisy has passed )

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  1. #1
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    Default Daisy - 6yo labrador diagnosed with Cushings (Daisy has passed )

    Hello, I hope this is the right section to post!

    Daisy our sweet 6yo lab was recently diagnosed with Cushings. My mother in law first brought the increased water drinking to our attention. After two pee accidents inside, I knew something wasn't right and we made a vet appointment right away. The blood panel and urinalysis results showed elevated levels and very dilute urine. (I will post more specific results later.) The vet suspected Cushing's and scheduled us for an ATCH stim test. The result of that test also strongly suggested Cushings and we were referred to a specialist for an ultrasound. The ultrasound should two enlarged adrenal glands so she was diagnosed with pituitary Cushings. Daisy has all the symptoms - increased water intake, ravenous appetite, rear end weakness, more panting than usual, and an enlarged belly. The specialist vet says she's a textbook case of Cushings.

    We have decided to go with the Trilostane for treatment and are just waiting for it to come in to start.

    My husband and I have taken the diagnosis pretty hard. It's become so apparent to us just how much Daisy has slowed down in just the last two months. She just doesn't have the energy or stamina to swim or do agility anymore. She has always been lean and muscular but now her spine is started to show even though she weighs more than she ever has (64lbs vs 55-60lbs). She has eaten 1 1/3 cups twice a day for most of her adult life (currently Earthborn kibble). My mother in law thinks we should feed her more but I'm just not sure. She eats grass constantly whenever she's outside and has started to snatch food off of the coffee table.

    She can't jump onto the bed anymore and almost fell off trying to do it this morning. I just can't believe this has happened so quickly and it makes me worried considering she is only 6 years old which is relatively young for a Labrador. Will her energy and muscle tone improve after starting treatment?

    Thanks for listening
    Ashley, Daisy (yellow lab), Lily (mini dachshund), Thor (black lab)

  2. #2
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    Default Re: Daisy - 6yo labrador diagnosed with Cushings

    Welcome,

    I'll just make a few comments and suggestions to give you a head start and let the other more experienced take over. Gather all of your test results blood work, urine, ACTH, ultrasound, etc., they love numbers here. What I can contribute here is to start out on the lowest dosage possible for your girl, my guess is your vet / IMS is starting her out on 60 mg once a day in the morning with a full breakfast. It sounds like you're doing exactly what needs to be done so far. The next step will be to slow down and get the dosage right which can be frustrating and may take a few months. The point of the exercise is to not over-medicate which isn't good for your girl, your sanity, and it will slow the process because you will have to pause and start over on a lower dosage.

    My girl is a 10 year old Aussie Shepard mix and weighs in at 57 lbs. All dogs react differently to Trilostane, my girl is sensitive and her initial dose of 60 mg was too much and is now taking 35 mg. Please read the short thread titled "Lolita" to get an idea of how we got from 60 mg to 35 mg. I think we will be bumping her up to 40 mg which should be just about perfect. It's very important that you schedule an ACTH Stim Test no later than 14 days after you start the meds and during that time look for ANY major side effects.

    I'm not going to go any further because by the end of the day today you will be inundated with replies and information from people that have years of experience compared to my few months.

    There are a couple of positives you may be overlooking in all of the negatives. You caught it early, you took the proper steps, and it's pituitary and not adrenal so the disease should be easier to control.

    Darrell and Lolita

  3. #3
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    Default Re: Daisy - 6yo labrador diagnosed with Cushings

    He and welcome to you and Daisy,

    Darrell has done an excellent job of reading my mind and saying exactly what I would have had he not beat me to the punch. We do love to see test results so when you have chance, please post them. It's actually a a great idea to keep all of Daisy's test results in a folder. The reason for that is not just because we keep asking you to share results but because cushdogs are more likely than completely healthy dogs to require an after hours trip to an ER. ER vets love it when they have their patients latest up to date medical history in front them. That folder also helps when we pet owners forget some things during the emotional turmoil of our dog's sickness. When you are ready to share the results, we need only see the highs and lows on the blood chemistry and cbc, and please include the normal reference ranges.

    My second cushdog was a shelter rescue with very advanced disease. He was one big infection with bleeding eyes, black stuff oozing from his ears and he had severe muscle wasting due to the catabolic effects of excess cortisol. His hind quarters tremored constantly for the weakness and he would fall over if he attempted to lift his leg to pee. My first cushdog was also diagnosed late but she was much younger, only three years old so her muscle wasting was not so severe. I remember the first time Jojo actually started to skip across the yard. I started to cry because I never thought I would see him do anything but plod along. Muscle wasting is a symptom that does not resolve quickly so patience really is a virtue, especially for a pet owner like you whose dog have been remarkably active and agile. I promise that with effective treatment, this will get much better in time.

    As for the physical changes due to cushing's, muscle wasting and redistribution of fat makes a dog look thin and fragile and it doesn't mean a dog is emaciated and needs more food. I would keep Daisy on her same healthy portions of good feed that is higher in good quality protein and lower in fat. Earthborn is a bit higher in fat than some people are comfortable with but if she's done well on that brand, I personally would not change it. It's actually rated as one of the better kibble. It's actually more important that you remember to give her the Vetoryl with or directly following a full meal. Daisy's appearance will improve but it may not be restored to her former glory. We have seen more than a few cushdogs who returned to agility and did quite well, so hang in there.

    It is in Daisy's best interest that you be an active participant in her care. My best advice, based on my own experience and those of a multitude of members, is never place blind faith in your vet to act in the best interest of your dog. You seem to be a lucky one who has an pretty good vet but many people have not been so lucky. I am including a url below to Dechra's Continuing Education (CE) page for petowners and veterinarians, that will help you understand a great deal more about monitoring treatment. The flowchart is fairly easy to follow so quiz yourself when your vet does the first acth stimulation test at no more than 14 days after starting treatment. See how well you can assess the results. This will help you greatly in being a proactive participant in Daisy's care. The more you learn, the more relaxed you will become. There are a lot worse things that can happen to our dogs and as long as you and your vet do your part, your precious Daisy can live out her life expectancy with a very good quality of life.

    http://www.dechrace.com/pdfs/vetoryl...ngBrochure.pdf

    I'm sorry for the circumstances that brought you here but I'm glad you found us. We're here to help you in any way we can. Be sure to check out our Helpful Resources subforum. There is a whole bunch of reference material on many, many subjects that can help you learn. If you have any questions, don't hesitate to ask.

    Glynda

  4. #4
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    Default Re: Daisy - 6yo labrador diagnosed with Cushings

    Welcome to you and Daisy! Looks like Darrell and Glynda have covered all the topics I can think of this morning, though I don't see your mention of the dosage of Trilostane you're going to start using. I hope it's no more than the current recommendation of 1mg/pound.

    I'm so glad you found us, and am looking forward to learning more about Daisy!

    Shana

  5. #5
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    Thanks for all the replies all. My husband has been the one to take her to all the appointments since his hours are a little more flexible but I do have all the paperwork so I'll post that info as soon as I get home.

    The medication just came in and the dosage is 1mg per lb. We are making an appointment for a stim test for 14 days out.
    Ashley, Daisy (yellow lab), Lily (mini dachshund), Thor (black lab)

  6. #6
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    Default Re: Daisy - 6yo labrador diagnosed with Cushings

    Hi and welcome from me as well!

    I see that you have received a lot of very good information and the only thing I'd like to add is that some members give their cushdog frozen green beans to help with that ravenous hunger, carrots are also another option as long as diabetes is not involved.

    Hugs, Lori

  7. #7
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    Here's everything that was outside the normal range, i put the reference range in parenthesis

    ALP - 1707 (5-160 U/L)
    ALT - 792 (18-121 U/L)
    AST - 58 (16-55 U/L)
    GGT - 101 (0-13 U/L)

    Cholesterol - 347 (131-345 mg/dL)
    Chloride - 106 (108-119 mmol/L)
    Potassium - 3.9 (4.0-5.4 mmol/L)
    NA/K - 38 (28-37)

    Lymphocyte - 811 (1060-4950 uL)
    Eosinophil - 7 (70-1490 uL)

    T4 - .8 (1.0-4.0 ug/dL)

    Pre-ACTH - 12.1 (2-6)
    Post-ACTH - 34.9 (6-18 )
    Last edited by arentspowell; 06-19-2016 at 11:58 AM.
    Ashley, Daisy (yellow lab), Lily (mini dachshund), Thor (black lab)

  8. #8
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    Default Re: Daisy - 6yo labrador diagnosed with Cushings

    Hi to you and Daisy! You have already received outstanding guidance. I did want to mention a couple of things. There are many theories about why dogs eat grass. I personally have found that my dogs have eaten grass when they have an upset stomach. If the latter is the case with Daisy and because trilostane can cause indigestion in some dogs, you may consider giving her some Pepcid AC (original) about 15-20 minutes before the meal after which she will get the trilostane.

    Others who have more experience than I with regard to lab test results will come along to discuss those. In light of all of the liver markers being high, I would be interested to know if the ultrasound report said anything about Daisy's liver.
    Judy H. (Always "Maggie's Mom" & now "Abbie's Mom")
    Riverview, FL

  9. #9
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    Default Re: Daisy - 6yo labrador diagnosed with Cushings

    Judy - I checked the ultrasound report and it doesn't mention anything about the liver. The ultrasound did reveal a gallstone that we weren't aware of that could possibly be pose a problem in the future but isn't cause for too much concern right now. Other than that it just says the bilateral enlargement of the adrenals rules an out adrenal tumor.

    The specialist also noted a grade II systolic heart murmur which I didn't even know she had! Our regular vet may have told us this when she was a puppy but we must have forgotten.

  10. #10
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    4 days into treatment. I was really hoping that the pee accidents would subside There was a huge pee spot on the bed when I went to go to sleep. Had to wash everything - duvet, sheets, and mattress cover. Didn't get any sleep until 2 am when the sheet and mattress cover were finally dry. We never saw her do it and we keep the door to the bedroom closed while we aren't home. Is it possible she peed while laying down on our bed?
    Ashley, Daisy (yellow lab), Lily (mini dachshund), Thor (black lab)

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