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Thread: Vet thinks my boy has Cushing's. I'm very worried.

  1. #21
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    Aug 2018
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Hi Leslie,

    Thank you for your perspective, and thank's for the quote from John O'Donohue. Very helpful.

    It's good to hear that it was nothing I might have done that would have caused Kobe to develop this malady. He is such a comfort as our canine companions always are, so you can't help but wonder if our troubles weigh on them. It's only been over the last several months that he'd gone from his happy-go-lucky self to being so lethargic and disinterested in the things he's normally likes to do, preferring now to just lay around and sleep. And of course eat and drink (and drink some more) and potty.

    I'm the same with Kobe as you are when we go out for walks. He's pretty much the boss, and decides which way we're going to go, and gets to stop as often as he likes to sniff whatever he likes. Sometimes just wanting to stand in one spot for 5 minutes only sniffing the air. I can only imagine what the neighbor's think when I'm heading in one direction and Kobe decides "Nope. We're going this way." Stops me and makes me go in the direction he wants to go. LOL Now they know who wear's the fur in that house.

    And Joan, you're right, our dogs are so good at sensing our emotions, and wanting to make us feel better when we're down or upset.

    So.... today was the day to get Kobe's 8-hour test results from the vet.

    But... before that, this morning, after Kobe was let back in from his morning business, we noticed that his jowls were VERY swollen (as well as some swelling around and above his left eye). When I felt them, they weren't all soft and fleshy as they normally are but felt very thick and firm. It was clear he was having an allergic reaction to something, but didn't otherwise seem in distress. We've been having an issue with wasps trying to build nests around the deck, and I can only imagine that Kobe had a run in with one of them. I immediately called the vet, and she said to give him four Benadryl tablets (Kobe is 94 lbs), and if the swelling hadn't gone down in 30 minutes to an hour, or it seemed like he was having any breathing issues, to bring him in for a steroid shot.

    Well after an hour with the Benadryl it seemed like the swelling might have dissipated a little bit, but not much. So, since I was waiting on his test results, I figured I'd best take him in, and could consult with the vet directly since the test results were expected to arrive soon anyhow. She examined him and agreed it appeared to be the aftermath of an encounter with a bee or wasp. I decided that it would be best for him to get the steroid shot to get the swelling down sooner and the vet said it wouldn't interfere with what she also informed me WAS a positive test result for Cushing's disease (and the fact that he already has too much cortisol floating around in his blood). Fortunately Kobe is always very good about getting shots. Barely seems to notice when they are given.

    As for Kobe's Cushing's diagnosis, here are the test results from his LDDS test.

    Cortisol Sample 1 .... 2.4 .......... (Ref 1.0 - 5.0)
    Cortisol Sample 2 .... 2.0 (HIGH) (Ref 0.0 - 1.4)
    Cortisol Sample 3 .... 2.1 (HIGH) (Ref 0.0 - 1.4)

    Diagnosis : Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8 hours post-dex.

    So now I'm told that Kobe will need an appointment with an Internist to have an ultra-sound done in order to determine if it is Pituitary Dependent or an Adrenal Tumor, which apparently is important to know.

    They want to start him on 60mg of Vetoryl (trilostane), and then test him after 2 weeks to see his response. Isn't 2 weeks too early? I thought it was 30 days to retest. I didn't want to question the vet at the time. Since it's $300 I don't want to have to do have to test too often (I honestly don't know why these things need to cost so much ).

    As you said, it's not like he needs to go on the medication immediately. Once I'm comfortable that I'm doing the right thing, I can proceed. I just want to do this in the smartest healthiest (and ideally most cost-effective) way possible. The vet referred me also to an online pharmacy which can supply the Vetoryl at substantially cheaper prices. She said they have it for $65 for a 30 day supply, as opposed to $100 through the clinic since they need to special order it. I simply need to have the online pharmacy Allivet send them the prescription for them to authorize).

    So I may wait until after Kobe has had his ultrasound and I know more about where we're at before ordering that.

    The vet said they do have some other patients with Cushing's, so it would seem they are familiar with treating it. And interestingly enough the vet ALSO has a dog with Cushing's, and has been on Vetoryl since February (only 10 mg as she's a little dog). The vet said her pup has responded well to it, though has recently started drinking more water again, so she is getting retested to see if her dose needs adjusting, though it could simply be the warm weather.

    Anyhow, right now Kobe is sleeping like a baby comfortably having wedged himself between pillows on the bed, making him look supremely comfortable. Heh.
    Glen, Kobe's dad.

    (pronounced Kobay)

  2. #22
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    Aug 2018
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Hi friends,

    Just wanted to give an update on Kobe, who just turned 6 last Friday! By the way, I just realized I hadn't mentioned how his name is pronounced, since just about everybody pronounces it incorrectly. His name is pronounced Kobay (like the Japanese city and its famous beef). I think I'll edit my original post to make note of it.

    So I just received Kobe's medication from Allivet. He'll be on 60 mg of Vetoryl once daily starting tomorrow (Wednesday). Then he is scheduled for his follow-up ACTH two weeks later on the 26th. Kobe is 94 lbs (a good 10 lbs overweight, though the vet would like him to lose at least 5 lbs). So his starting Vetoryl dose is below the typical starting dose. I'm happy this is what the vet decided, since I'd rather start lower. Especially since Kobe's symptoms have dissipated slightly since his infections were taken care of. I still of course worry about false positives on his tests, and maybe this medication isn't right for him. Hopefully that is something which will be evident with his follow up blood work.

    As for Kobe's symptoms. Though he hasn't started medication yet, he isn't panting quite as much as he had been. Though even minor amounts of exercise will get him panting. His drinking seems somewhat less than it had been. I've been monitoring it over the last few days and I believe the volume is still likely excessive for his weight (see below).

    He has since had two more accidents in the house, despite my ensuring he is put out regularly even if he isn't asking to go out. And on occasion when he's been put out, despite not asking, he's let pee out rushing across the deck and down the stairs before getting to the grass (sometimes nearly tripping down the stairs). He also peed in the driveway after getting out of the car, being unable or unwilling to walk over to the grass first. One of his accidents in the house was a surprise to me. Because he had just been put out 30 minutes before and peed a small lake's worth. So it was surprising to me that after getting a snack of some plain ground beef I'd been frying up for tacos, and presumably having a drink, downstairs where his food and water dish are, I came down to find he'd peed on the rug. Perhaps he was overly excited for getting the ground beef, which is a rare treat. But I was surprised he had anything left in his bladder!

    He is more reluctant to go up and down the stairs (maybe due to muscle weakness as I've read), so perhaps he just didn't want to come upstairs to let anyone know he needed to go out.

    He is still very lethargic and sleeps nearly all day, and is reluctant to go on walks. Usually wanting to come back home right away, though sometimes he will stay out and walk longer. And he is hungrier than usual. Begging for food or treats more often.

    He has been slightly more of his friendly self when greeting other people or dogs, though nowhere near his typical self.

    So.. I guess he's still exhibiting typical Cushing's symptoms, even though they seem less to me than they'd initially been. I'd feel better if these tests were more definitive about his actually having it.

    Here is Kobe's water consumption. Again he's 94 lbs ( 42.6 kg)

    9/ 4/2018 3500 mL
    9/ 5/2018 3800 mL
    9/ 6/2018 3600 mL
    9/ 7/2018 3000 mL
    9/ 8/2018 3500 mL
    9/ 9/2018 4200 mL
    9/10/2018 3800 mL


    Presumably this is too high. Though I'm not sure if this is VERY excessive or not. As I'd mentioned previously, Kobe had always been a big drinker. His current water consumption is more than usual for him, though I can't say it's currently A LOT more than usual. Prior to his antibiotics for what was an infection on his paws and his penis (perhaps also a UTI), I'm certain he was drinking even more!

    He will still empty his water dish at least a couple of times a day (which I've taken to not filling all the way up). I will fill it back up right away. Sometimes he'll continue to drink, but other times he won't. Perhaps if I'd put more water in his dish initially he'd continue to drink that until empty, yet chooses not to if he empties a half full dish and then I fill it up half way again.

    In any case. I will keep you all posted on Kobe's progress with his starting of Vetoryl tomorrow. He also gets his ultrasound on the 19th.
    Glen, Kobe's dad.

    (pronounced Kobay)

  3. #23
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Good to hear from you! I had to convert ml to oz so I could see for myself how much water would be considered normal. At 1oz per lb, Kobe would consume 2779.91ml of water so he is a bit over what would be the high end of normal water consumption for dogs (1/2 - 1 oz/lb). Whether this is excessive for a normally heavy drinker would be hard to determine unless you were keeping up with his consumption prior to the Cushing's signs appearing...but for general purposes he is drinking more than a 94lb dog normally would.

    Good luck with the ultrasound and I hope it shows nothing more than abnormal adrenal glands which is what we expect with a cush pup. Let us know what the comments on the US are when you know.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  4. #24
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Thank you Leslie,

    I'm wondering if anyone knows, since I start Kobe's Vetoryl tommorow the 12th, and he doesn't have his ultrasound until the 19th, would his adrenal glands appear normal by then, given that he'll have been on the medication for a week? Or would they still be expected to be abnormal despite taking the medication?
    Glen, Kobe's dad.

    (pronounced Kobay)

  5. #25
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Glen, if Kobe were my dog, I would not start the Vetoryl treatment until after the ultrasound next week. Ironically, Vetoryl treatment can actually increase the size of the adrenal glands rather than lessen them, thus kind of muddying the water in terms of diagnostic imaging. I don’t know whether this effect occurs as rapidly as within just one week’s time. But still, since you’ve had lingering questions about the accuracy of the Cushing’s diagnosis, I’d want to see the ultrasound results before starting treatment and before any new variables are introduced. Even if Kobe truly has Cushing’s, waiting one more week to start treatment is no biggie.

    If you’ve already given him today’s first dose, that should also be no big deal. But as I say, if he were mine I would give no more medication until after the imaging has been done.

    Marianne

  6. #26
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    I agree with Marianne about the ultrasound. In fact, I wouldn't even have paid for the drug until after the ultrasound. It would have sat right where the vet put it until after the US proved nothing else could be causing his issues. IF you have started the Vetoryl already, I would not give any more until after the US.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  7. #27
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Oh okay. Thanks.

    My first inclination was to wait until after the Ultra-sound (indeed to even purchase the medication). But then after it turned out that it would be a couple weeks to get him in for that and given that Kobe had another accident in the house and is still acting very lethargic I figured I'd start him on it.

    Well... I did give him his first dose this morning. Just a few hours ago. So far... no change. Ha!

    But I'll wait till after his ultra sound to give him any further medication. Thanks for the advice.
    Glen, Kobe's dad.

    (pronounced Kobay)

  8. #28
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Today Kobe is especially tired. He normally runs upstairs and to the door when the kids get off the bus to greet them. Tail a wagging, though he hasn't run around like a maniac in several months.

    But today, when they got home, he just stayed downstairs in his kennel (which he goes to when he doesn't want to be bothered, and has a nice soft bed and some stuffed toys in it).

    By-the-way,he's now laying on the floor barking in his sleep as I type this.

    Anyhow, yesterday although he only had his first and only dose of Vetoryl (I didn't give it to him today and will wait until after his ultrasound to continue), he actually seemed a little bit more chipper and energetic than he had been. We even walked a good distance to get ice cream, which is often a good motivator to him to push through with a longer walk these days.

    Now today he's EXTRA tired. I'm wondering if this has anything to do with his dose of Vetoryl yesterday and rebound from not getting any today. I know lethargy on Vetoryl is a bad sign (though how can you tell if the dog is already lethargic, I guess just being extra tired), but he hasn't had any today. And yesterday he seemed to perk up just a bit on his first and only dose. I suppose I won't know until he's back on the medication and has taken it for a few days.

    I imagine Vetoryl is quite bad to take if he does't in fact have Cushings. What sort of signs would I expect to see if that's the case? And presumably this would be evident on his ACTH he gets 2 weeks after starting.
    Glen, Kobe's dad.

    (pronounced Kobay)

  9. #29
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Glen, I’m doubting that the one dose of Vetoryl would prompt a dramatic behavioral shift within a single day’s time. So it may just be coincidental that he was more active yesterday, and more quiet today. But you’re right that you’ll be better able to evaluate the medication’s true effect when Kobe has been taking it consistently for multiple days. Having said that, I did see noticeable improvement in my own dog’s excessive thirst/urination after only 2-3 days of treatment, so you never know — maybe the Vetoryl did help him to feel better yesterday.

    If and when you do start regular treatment, effects of overdosing can include such things as loss of appetite, vomiting, diarrhea, and lethargy. I don’t think that Kobe’s tiredness today — 48 hours after dosing — is likely due to overdosing, though. So hopefully he’ll be back to feeling perkier again tomorrow. Do let us know.

    Marianne

  10. #30
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    Default Re: Vet thinks my boy has Cushing's. I'm very worried.

    Thank Marianne.

    Yeah, I figured it may just be my hopeful imagination that he showed improvement on a single dose. Though he's definitely been sleepier today. That could be due to taking a longer walk yesterday. It's strange to me that I'm hoping that once Kobe's had his ultra sound that they do find it's Cushing's, simply because I'm worried that they'll find out it's something worse, untreatable, and/or fatal. Of course I'd be thrilled if they said it was something other than Cushings and was easily curable or operable with a high success rate.

    On another note though. While he had no medicine today he's actually drank less water today! He greedily ate his dry food breakfast and some treats afterwards. Had a bit of cheese during the day (which he'll NEVER turn down). Before dinner he happily scarfed down some more of his favorite treats (chicken wrapped sweet potato). But when I put his dinner out (more dry kibble) he didn't touch it. Later I gave him a small dish of plain cooked ground beef we had left over from tonight's dinner, and he ate it with gusto. Yet he still hasn't touched his dry kibble!

    This is actually more like him. Since before his Cushing's symptoms started he wouldn't want to eat his dry food unless I mixed in some wet with it. I'm not going to mix any in now to see if he'll eat it, since he needs to lose some weight anyhow. Though I suspect if I offered up some more chicken wrapped sweet potato, he'd gobble it right up. I will give him some treats before bed, just to make sure he's not losing his appetite. If he turned those down I'd be suspicious.

    Meanwhile he sleeps and sleeps.

    Thanks for the info on what to look out for once he starts regular treatment. I'll be keeping a close eye out for those things when he does.
    Glen, Kobe's dad.

    (pronounced Kobay)

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