Cushing questions my Codyboy just diagnosed

[Codyboy]

Hello to you all, Codyboy and I are new to your forum. I've never joined a forum before and I hope I am doing this right. I have a few questions on this cushing's disease that my 12yr old Shilo shepherd was diagnosed with last week. My vet wants to start him on 120 mg vetporyl 1x a day to start the 44-88 pound doasage. CODYS symptoms started with the constant panting, excessive drinking and urinating, hind weakness and wasting and now bowel control, I had him checked with the orthopedic and was told he had a lot of arthritis thruout his lumbar spine and hind knees so they ruled out degenerative myopathy , I still want to get the blood test to def rule this out. That being said with Cody's symptoms and being dionosed with cushing's , when I start him on this medication will it relieve any of these symptoms and how long does it take. I would like your advice with what your fur baby has gone thru and if things got better after medication. Thank you all .
Cortisol-pre. 4.9. Reference 1.0-6.0 ug/dl
Cortisol-4hr 4.6. Reference
Cortisol-8hr. 2.6

[labblab]

Hello and welcome to you and Cody! I have only a moment to post, so apologize that I only have time to discuss one thing right now. But I'm hoping to catch you before you buy the 120 mg. capsules. In years past, initial dosage recommendations were higher. However, the most recent recommendation made by the maker of Vetoryl (which is a revision to their dosing chart) and most specialized clinicians is not to exceed an initial formula of 1 mg. per pound. I'll come back later and give you some specific citations.

Can you tell us exactly how much Cody weighs? From the range you are giving, I'm guessing that the 60 mg. capsule may be a better fit. There are a couple of reasons for this that involve both safety and also financial considerations -- you cannot split capsules, so especially when starting out, it is better to combine smaller capsules than to start with a large capsule that can no longer be used if a decrease is warranted.

So once again, welcome, and stay tuned!
Marianne

[Codyboy]

Thank you I was thinking this was to high of a dose. Cody weighs 84lbs haven't started any medication yet it was on back order

[lulusmom]

Hello and welcome from me too.

In addition to the information Marianne has already mentioned, I would like to know if an abdominal ultrasound or other test was done to determine which form of cushing's Cody has...pituitary or adrenal? Sometimes the results of the LDDS test can tell us if a dog has pituitary dependent disease but unfortunately, Cody's does not so a differentiation test would be necessary to make that determination. The law of averages say it's most likely pituitary but you can't be sure. If my dog had an adrenal tumor, I would definitely want to know as these tumors are often malignant and survival time is greatly diminished. You cannot make that differentiation after treatment has started so if this has not been done yet and your finances allow, you may want to consider an abdominal ultrasound. I would definitely be interested in imaging given the bowel issue, which is not a symptom commonly associated with cushing's.

With the exception of the excessive drinking and peeing, all of the other symptoms you mention can be attributed to arthritis in Cody's lumbar spine and knees. Was a urinalysis, including a urine culture done to determine if the excessive drinking and peeing is due to cushing's and to rule out a urinary tract infection? Your vet should have done a full senior screening before the LDDS and it would be helpful if you could please share the results of the blood chemistry and complete blood count (CBC). You need only post the high and low values, and please include the normal reference ranges. Also can you share the results of the urinalysis? We would be most interested in seeing the urine specific gravity (USG).

With respect to your question about how quickly you can expect to see improvements, the answer is dependent upon whether the initial dose is adequate. My cushdogs responded in the first week with vast improvement in symptoms but I was fortunate that both stabilized rather quickly on the initial dose. As Marianne mentioned, the 120 mg prescribed by your vet is too high. Recommended started dose is now 1 mg per lb of body weight. This is particularly important to note for bigger dogs as a study found that:

Dogs weighing more than 66 lb (30 kg) required less trilostane to control their clinical signs. The results did not achieve statistical significance, but a trend suggested that as body weight increased, the relative amount of trilostane needed to control signs decreased. The researchers also found that only 11% of dogs required more than 3 mg/kg/dose to control their disease—the manufacturer's recommended initial dose is 3 to 6 mg/kg once daily.

For clarification, trilostane is the active ingredient in Vetoryl. You may want to share this information with your vet. The abstract can be found at https://www.ncbi.nlm.nih.gov/pubmed/22708554. You may also want to share an article from July, 2014 in Vet Times (in the UK) announcing the new lower recommended starting dose. That can be found at https://www.vettimes.co.uk/news/new-...e-for-vetoryl/

Before you start treatment, I highly recommend that you make sure that you and your vet follow proper treatment and treatment monitoring protocol. I've two of Dechra's brochures below, one for pet owners, which includes important Do's and Don'ts and the other includes a treatment monitoring chart which will help you understand a bit more about the acth stimulation test. Please let us know if you have any questions. I know this is overwhelming and that your head will be spinning for a while. This is completely normal and the more you learn, the more relaxed you will become.

VETORYLTreatmentMonitoringBrochure.pdf

VetorylClientBrochure5mg.pdf

Reading your intro brought back memories of when I showed up on our predecessor site many years ago to reach out for help with my second cushdog. Marianne was there to welcome me and was a major contributor to my continuing education. My first cushdog was diagnosed three years before that and I thought I knew what I was doing but I quickly discovered how ignorant I was. LOL I had never been part of a forum before and was never really technically savvy so it took me a while to figure things out. I promise that you'll get the hang of it. If I can do it, anybody can do it.

Glynda

[Codyboy]

Just a quick note Cody did have his ultrasound the same day and showed normal size Adreanals and have a full blood work up. His wbc was a bit up 16.98 ( 5.5 - 16.9) neutrophil - 14. (2-12) on ultrasound he had an enlarged spleen with nodules seen inside, biopsy reveled them to be myelolipoma tissue benign yea. Cody had surgery on 10/17/16 to remove his spleen and did recover well. now I have to work on this Cushing diagnose. My vet did give me a printout on the ACTH protocol and constant maitence while on this medication.

[labblab]

Hi, me again! I'm so glad Glynda was able to give you so much more thorough a welcome! Just a couple more quick comments from me...

First, you'll see that I've moved your thread here to our main discussion forum. This way, our members are more apt to see your thread and have the opportunity to write to you.

Secondly, here's the link that I mentioned earlier re: revised initial dosing recommendations. It may duplicate some of the references that Glynda has already provided, but I'll go ahead and give you the chance to take a look.

http://www.k9cushings.com/forum/show...=1251#post1251

Marianne

[DoxieMama]

Welcome from me, too. I'm not an expert by any stretch, but am curious if Cody's symptoms may have been from the arthritis and spleen issues rather than Cushing's. If his spleen was only just removed on the 17th, then an ACTH test done a week later, wouldn't that have effected the results? I'd want to be sure that he is fully recovered from that surgery before testing for the next thing.

Just a thought!

Shana

[Squirt's Mom]

I'm also wondering about the normal appearance of the adrenal glands on the ultrasound. Typically we see at least one of those glands enlarged...tho with Cushing's ya just never know so I guess normal adrenals could be feasible!

[lulusmom]

Thank you for your response. Normal size adrenal glands are possible with cushing's but that's not the norm. Nor are the results of the CBC. Do you have copies of the blood chemistry? I would be very interested to see results of liver enzymes ALT, ALKP and GGT as well as cholesterol and triglycerides. These are all commonly elevated in dogs with cushing's. Was a urinalysis done by your vet to make certain that Cody's drinking and peeing are clinical manifestations of cushing's? The clinical terms for this is polyuria (excessive urination) and polydipsia (excessiving drinking). As I mentioned all of the other symptoms you listed can be attributed to arthritis so in the absence of the normal organ abnormalities on imaging and no urine tests, I am concerned with the accuracy of a cushing's diagnosis. Does Cody have a voracious appetite and I mean a hunger that makes him beg constantly, finishes his food in seconds and leaves the dish looking like it's right out of the dishwasher? Does he have any loss or thinning of coat. Any problem with the skin and/or any changes in skin pigmentation?

[lulusmom]

I also forgot to mention that Leslie's beloved Squirt was misdiagnosed with cushing's. As I recall, it was her spleen which caused false positive results on the LDDS and/or ACTH stimulation test. Like Cody, she had her spleen removed. This was another red flag for me. I hope Leslie will come back and share her experience.