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Thread: Mia-4 year old poodle recently diagnosed

  1. #1
    Join Date
    Jul 2018
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    El Salvador
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    Default Mia-4 year old poodle recently diagnosed

    Hi everyone. I'm glad that I found this forum to share our stories and support each other. My name is Jonathan and I live in El Salvador, a small country in Central America (you know south of Mexico, neighbors with Guatemala and Honduras).
    This is my story:

    I have 2 poodles, one is a 11 year old male named Clean and the other is a 3 years old female named Mia. Mia will be 4 years old in september and has been recently diagnosed with Cushing. Mia always had thin hair since she was a puppy and she always was hyperactive, she panted more than normal and always seemed to be anxious, but aside from that she didn't have more Cushing symptoms, I don't know if she had the disease since she was a little puppy and it developed gradually. Mia and Clean had a litter of 3 puppies when she was 2 years old but she got spayed after that.

    Earlier this year I noticed that Mia was drinking a lot more water than usual, she gained some weight, started peeing frequently and had a couple of indoor "accidents" and that caught my attention, she also had a few almost bald patches and couldn't jump into the bed and couches anymore, so I took her to the vet and they made a few generic tests and found normal sugar, hemoglobin and other blood levels so the vet said there were no abnormal signs and that the behaviour of Mia could be normal for spayed female dogs.

    After that and in a matter of weeks Mia was hungrier than normal and she even ate things that were not normal for dogs to eat like mint candies and raw tomatoes, she developed a pot belly and a curved back and she lost more hair in her face and stomach, so I searched for those symptoms in the Internet and it was almost obvious that she had Cushing disease. I took her to another vet and told the new vet that I suspected it was Cushing, she said that it was a very rare disease especially in young dogs and that she never had a patient with Cushing that wasn't related to steroid drugs, so the vet made a lot of tests and ruled out diabetes, kidney failure and thyroid issues, the alcaline phosphatase and bilirubin were higher than normal though. After that they made an abdominal ultrasound and found that one of her adrenal glands was smaller than normal and the other one was bigger than normal although no tumors were evident and the other organs were normal. With those tests the vet diagnosed Cushing but unfortunately no labs in my country do the ACTH test for dogs, and we only did total cortisol in blood in a human lab that accepted the sample, indeed the cortisol was higher than normal but I understand it is not the right test.

    Now that we are almost sure it is Cushing, we still don't know if it is pituitary or adrenal in origin and we don't have the technology to know it with certainty though we had started with the treatment, unfortunately in my country there is no Mitotane or Trilostane, so the vet prescribed ketoconazol, the first week 50 mg every 12 hours and now 100 mg every 12 hours. Mia has been 2 weeks now with ketoconazol but her symtomps have not improved yet. I will travel to Mexico in october and I can buy Vetoryl there, so meanwhile we will be using ketoconazol. I also bought lignans online as a complement to the treatment but I still have not received them.

    I wanted to share this with you to know your opinions, do you think we have done the right decisions? any advice on the treatment and caring of Mia?
    Last edited by joalgopa; 07-19-2018 at 05:42 PM. Reason: to correct some grammar errors and added some new information.

  2. #2
    Join Date
    Jan 2016
    Location
    Glen Cove, NY
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    1,565

    Default Re: Mia-3 year old poodle recently diagnosed

    Hello and welcome to you and Mia. Could you post the results of the bloodwork, just the highs and lows, with the reference ranges? Also how much does Mia weigh? Others more knowledgeable than I will want to see those numbers.

    I am on my second dog with Cushing's. Lena, my teacup poodle had adrenal and it looks like Gable, my lab mix has pituitary, although we did not do an ultrasound on him.

    You've come to the right place. This forum has been a godsend for me.
    Joan, mom to my Angel Lena, Doree, Gable, Cooper, Angel Phoenix and now Sibble.

  3. #3
    Join Date
    Jul 2018
    Location
    El Salvador
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    28

    Default Re: Mia-3 year old poodle recently diagnosed

    Thank you Joan2517.

    Mia's most recent weight is 19 pounds.
    Her results were:

    Blood chemistry
    Glucose 118 mg/dL (normal range 60-117)
    Alkaline phosphatase 441 U/l (normal range 10-100)
    SGPT 306 mg/dL (normal range 10-94)
    SGOT 104 U/L (normal range 10-62)
    Total cholesterol 342 mg/dl (normal range 116-317)
    Total bilirubin 8.7 mg/dl (normal range 0.1-0.6)
    Anyway, the sample was hemolyzed so we have to take them again to see if there was some interference.

    Urine test
    Density 1.006 (normal range 1.008-1.012)
    ph 8 (normal 7)
    Few oxalate crystals observed.

    Ultrasound

    Left adrenal gland 0.29 cm (normal 0.54 cm)
    Right adrenal gland 0.76 cm (normal 0.54 cm)

    Cortisol 17 ug/dL (normal range 0.5-5.5)

  4. #4
    Join Date
    Apr 2009
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    Georgia
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    Default Re: Mia-3 year old poodle recently diagnosed

    Hello and welcome to you and little Mia from me, too! I do have some thoughts that I want to share with you, but unfortunately I don’t have the time to do so right now. But I’ll return tomorrow and write in more detail. In the meantime, though, I want you to know that we’re very glad you’ve found us, and we’ll do our best to help you figure out the best path forward for your little girl.

    Marianne

  5. #5
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    Apr 2009
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    Georgia
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    Default Re: Mia-3 year old poodle recently diagnosed

    OK, I’ve finally made it back again, and here are some of my thoughts about Mia’s situation. Certainly, many of her symptoms are consistent with Cushing’s, but there are also some things that raise additional questions. The first is her age: it’s not unheard of, but far less common for dogs to develop Cushing’s when they are very young. Secondly, the fact that her SGPT, SGOT and bilirubin are all elevated make me worry about actual liver damage of some type. We regularly see elevated ALKP levels in Cushpups, but not these other three indicators all together. Why this is additionally worrisome is because I believe ketoconazole can be very hard on the liver. So if Mia already has pre-existing liver damage of some sort, I don’t know that ketoconazole is safe for her to take. Did the ultrasound show anything abnormal about Mia’s liver?

    Also regarding the ultrasound, the appearance of the two adrenal glands does raise questions. As I think you already know, one large and one small adrenal gland is typically associated with an adrenal tumor that is causing overproduction of hormones. And yet, the ultrasound didn’t show the presence of any masses. If there is not a tumor present, I just don’t know what would account for the abnormalities in size. So that is another oddity.

    In terms of Cushing’s diagnostics, there is an alternative blood test to the ACTH. It is the LDDS, or Low Dose Dexamethasone Suppression test. We’ve had some other Central/South American members who have been able to have this test done, so that might be an option for you. One advantage to this test is that, depending on the pattern of the results, we can sometimes determine whether pituitary Cushing’s seems to be the likely diagnosis, as opposed to adrenal Cushing’s. However, a drawback to this test is that it is vulnerable to returning “false positives” in the presence of other nonadrenal illnesses. So I’m back to worrying about the possibility of a primary liver problem, and what effect that might have on the testing.

    You do mention that Mia’s blood sample was hemolyzed, and I don’t know off-hand whether that causes false elevation in those liver values. If so, then I’d definitely want to repeat the testing in order to see whether there are genuine abnormalities present or not. If so, I think those would be one of your primary concerns right now. If not, then Cushing’s is again the main question. If Mia indeed has Cushing’s, then it might be possible for you to obtain some trilostane (the active ingredient in Vetoryl) from a compounding pharmacy here in the U.S. so long as you have a valid prescription. You will know best whether your country allows medications to be imported. If so, you might want to contact this U.S. pharmacy to see whether they could ship the medication to you:

    https://www.diamondbackdrugs.com/

    Also, we are just now learning of a new treatment monitoring plan for trilostane/Vetoryl that involves only testing resting cortisol levels rather than ACTH tests. So that could be a big help to you. We can tell you more about that later on depending on when you may be able to obtain the medication.

    I will close for now, but again, I’m most worried about those liver values. So if you can tell us more about the testing, the ultrasound, and your vet’s thinking about this — that will be very helpful.

    Marianne

  6. #6
    Join Date
    Apr 2009
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    Georgia
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    Default Re: Mia-3 year old poodle recently diagnosed

    P.S. OK, I just checked and see that hemolysis can cause noticeable/significant elevations in SGOT and SGPT levels. So hopefully those elevations are not really present. However, the reverse is true for bilirubin — hemolysis decreases the actual value. So I’m still worried about that high bilirubin, and still wondering about further liver or gallbladder diagnostics. And also worried about the ketoconazole...

  7. #7
    Join Date
    Jul 2018
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    El Salvador
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    Default Re: Mia-3 year old poodle recently diagnosed

    Quote Originally Posted by labblab View Post
    P.S. OK, I just checked and see that hemolysis can cause noticeable/significant elevations in SGOT and SGPT levels. So hopefully those elevations are not really present. However, the reverse is true for bilirubin — hemolysis decreases the actual value. So I’m still worried about that high bilirubin, and still wondering about further liver or gallbladder diagnostics. And also worried about the ketoconazole...
    Thanks for your reply!

    The ultrasound shows that liver is normal but the vet was worried because of those levels too, meanwhile she prescribed Trihepat (which I've just found is milk thistle) to help protecting the liver, I'm not very fond on natural remedies but I hope it helps someway. Mia doesn't show any other signs of liver damage like jaundice, vomiting, diarrhea or loss of appetite, so that's kind of a relief for now. I will let you know what the new tests show as soon as we take them.

    Thanks for the pharmacy recommendation, I will try to buy it from there if i don't find it in Mexico. I also found a few canadian pharmacies where I can buy it online and ships to my country.

  8. #8
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    Jul 2018
    Location
    El Salvador
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    Default Re: Mia-3 year old poodle recently diagnosed

    Hi! I want to give you a quick update on Mia's case.

    We finally get Vetoryl thanks to a cousin that traveled to Spain and a friend that went to Mexico and both of them bought the Vetoryl for me.
    I'm planning to start the treatment this weekend but Mia has been 3 weeks on ketoconazole and the vet said we should wait just 24 hours to change meds but I know that changing from Vetoryl to Lysodren requires a few weeks without any medication, so that made me wonder if I should wait more to change from Ketoconazole to Vetoryl?

    Yesterday I got HMR lignans that I bought on ebay a few weeks ago, I know they are more useful with atypical Cushing's but can I give it to Mia as a complementary medication? do you think it could help?

    By the way, ketoconazol helped her to drink less water though she still drinks more than normal but the other symptoms still persist, I know it has been only a few weeks but hopefully Vetoryl will be more effective.

  9. #9
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    Apr 2009
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    York, PA.
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    Default Re: Mia-3 year old poodle recently diagnosed

    I don't know of any interactions between ketoconazole and Trilostane so waiting only 24 hrs sounds ok to me. What dosage strength is the Vetoryl? With Mia weighing 19 lbs you really don't want to start her at a dose larger than 20 mg and 10 mg would be best especially since the ACTH stimulation test isn't a option in El Salvador.

    As for the HMR lignans, I'd hold off on giving them for right now because if you would start them at the same time and Mia would have a bad reaction it would be tough to judge just what was causing it. Now, down the road when she has been on Vetoryl for a while you could begin them.

    Lori

  10. #10
    Join Date
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    El Salvador
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    Default Re: Mia-3 year old poodle recently diagnosed

    Quote Originally Posted by Harley PoMMom View Post
    I don't know of any interactions between ketoconazole and Trilostane so waiting only 24 hrs sounds ok to me. What dosage strength is the Vetoryl? With Mia weighing 19 lbs you really don't want to start her at a dose larger than 20 mg and 10 mg would be best especially since the ACTH stimulation test isn't a option in El Salvador.

    As for the HMR lignans, I'd hold off on giving them for right now because if you would start them at the same time and Mia would have a bad reaction it would be tough to judge just what was causing it. Now, down the road when she has been on Vetoryl for a while you could begin them.

    Lori
    The vet wants to start with 5 mg twice a day, at least for the first 7 days. From what I've read it may be too little but the vet wants to be sure that Mia will tolerate the low dose before increasing it.

    And you're right about the lignans, I should better wait until the Vetoryl dose is adjusted.

    Thanks for your advice!

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