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Thread: 13 year old dog with "Cushings Light" (words the vet used)

  1. #1
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    Default 13 year old dog with "Cushings Light" (words the vet used)

    Hi, I am Julie and my dog is Jackson. He is most likely a Corgi/English Bull Terrier mix but we don't know for sure. He will be 13 in May.

    A year ago this past December (Dec '17)while getting a pre-op check prior to a dental cleaning he was diagnosed with elevated liver enzymes. I believe his ALP was over 1000. The vet postponed the procedure and we started him on Denamarin. It seemed to me that shortly after starting the supplement he started drinking more water. The vet did not think this was related to the Denamarin so he remained on the supplement and it did bring the enzymes down a bit. In June of this past year Jackson urinated in the house while my husband and I were away. We took him to the vet the next day thinking and praying it was a urinary tract infection and not something more serious. There were no sign of a UTI so they did an ultrasound to check out his organs and I believe at that time the vet saw a few nodes on his liver and said that was not unusual for a dog his age. The vet was leaning towards Cushings at this point so shortly after we had the LDDT completed. This is when she diagnosed him as "Cushings light" saying that his cortisol was elevated but did not stay elevated consistently so she did not want to start him on medication as it could push him to other way towards Addisons. We agreed to monitor him with a specific gravity test on his first AM urine every 4-6 weeks. The past two tests weren't where she would like him to be and he has urinated in the house twice in the past two weeks so we are going to have the LDDT re-done.

    I just reached out to the vet's office today to request all of his lab/test results since December of '17 and will share those once I get them. I guess for now I just need some moral support as I know this is not going to be an easy road ahead.

    Thank you.
    Last edited by jaxr0806; 02-18-2019 at 03:49 PM.

  2. #2
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hello Julie, and welcome to you and Jackson. We will do our very best to answer your questions and, for certain, we’ll be here to offer our support!

    That’ll be great if you can post Jackson’s test results. You don’t need to list every single number — what’s most important for us are any numbers that are abnormally high or low, along with the range of what’s normal for that particular value. Also, in addition to the excessive thirst and urination, are you seeing any other abnormalities with Jackson? Other common Cushing’s symptoms include excessive hunger, bilateral hair loss on the sides and/or haunches, hind-end muscle weakness, seeking out cool spots to lie down, and pot belly. Last but not least, has Jackson had any other significant health issues prior to this?

    It’s true that the medications for Cushing’s must be monitored carefully. But we’ve seen many success stories here, and we’ll definitely be here to coach you every step of the way if Jackson does end up starting treatment! But first things first, so let’s see how these test results turn out.

    In the meantime, once again, welcome!
    Marianne

  3. #3
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi Marianne,

    Jackson has always been very food motivated but there are times now when he is almost frantic around food. I would say he is a little pot bellied and I don’t know if I am noticing hind end weakness per se but sometimes a hind leg will quiver when he lays down. His only other health issue is hypertrophic cardial myopathy. He takes atenolol daily.


    Thank you for welcoming me to the group and I will post his abnormal labs as soon as I get them.

    Julie

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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hello,

    It's been about a month since I've been out here. I was just on the phone with Jackson's vet. He had a follow up LDDS on Monday. She is still hesitant to start him on any meds and consulted with an internist who is leaning the same way. She feels that based on his results we would be walking a very tight line with the medication at this point. Here are his LDDS levels from June 2018 and March 2019

    June 2018 - baseline 1.8, 4 hr 1.9 and 8 hr 2.2
    March 2019 - baseline 3.8, 4 hr 2.5 and 8 hr 2.2 (it shows he is suppressing but not to within the normal range)

    His ALP in June was 1058 and his ALT was 82.

    I expressed to her that I definitely don't want to start him on meds if there is too much risk but I told her that he drinks and pees a lot. She suggested we measure his water intake over a 48 hour period and if it is in the excessive range for his weight we can discuss putting him on a very low dose of Trilostane. I would really like to improve the drinking and peeing as my husband and I both work outside of the home and while Jackson has had a few accidents in the house he really does a great job of "holding it" and I feel horrible about that.

    I know I've seen this info somewhere but I am wondering what Trilostane costs (Jackson weight about 48 lbs.) and if it will provide enough relief from the drinking and urinating to justify the cost if he's not quite ready for meds.

    Thanks!

  5. #5
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Was an UTI ruled out as the cause for the increased drinking and urination? Also, does he have a low urine specific gravity?

    One thing you may want to think about doing is having an ACTH stimulation test performed to see if his body is producing excessive amounts of cortisol. I really would recommend not starting the Trilostane until a diagnosis of Cushing's is confirmed, which the ACTH stimulation test can help do.

    Lori

  6. #6
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hello Julie, and welcome back to you and Jackson. I agree with Lori that it's always helpful to continue to rule out the presence of a UTI when excessive thirst and urination are present. But if there still is no UTI present now, just as there was not one last summer, then I'm very puzzled as to why your vet is minimizing the LDDS result as somehow being borderline or "Cushing's Light." For symptomatic dogs without other known/suspected illnesses, the LDDS is the "gold standard" in terms of canine Cushing's diagnostics. And Jackson has now tested positive twice on that test. Not "sort of" positive -- but positive. That is all the LDDS is designed to do. The result does not tell you how severely compromised a dog may be, or predict how he/she will react to medication — it just tells you whether or not the result is consistent with Cushing's, in general. And Jackson's result, twice, has been positive.

    For some dogs, the LDDS is also able to give another piece of information. Depending upon the pattern of results, a pituitary tumor can be determined to be the likely cause of the Cushing's symptoms. However, in Jackson's case, either a pituitary or adrenal tumor could produce the results we've seen. That being the situation, an abdominal ultrasound probably would be the most helpful next step in terms of diagnostics. For dogs with pituitary tumors, frequently both adrenal glands show enlargement. If there's instead an adrenal tumor, you'd expect to see a lump or thickening one one of the glands, and the other gland may atually be smaller than nornal size. But Jackson has already had an ultrasound, and apparently there were no abnormalities seen related to the adrenal glands? Can you double-check the ultrasound report in order to see how the adrenal glands were actually described? Also, was the ultrasound performed at your regular vet's office? The reason why I ask is because the adrenal glands can be very difficult to see clearly using basic ultrasound equipment. Sometimes it takes high resolution equipment -- such as the equipment found in specialty practices -- to be able to visualize the adrenal glands clearly.

    Additionally, as Lori says, you can certainly request an ACTH stimulation test in order to measure Jackson's actual cortisol reserves. If that test is also positive, that can give additional confidence in the diagnosis. However, one drawback is that the ACTH is more likely than the LDDS to give a "false negative" even if a dog does have Cushing's. It is especially vulnerable to false negatives for dogs who are suffering from an adrenal tumor. However, if nothing else, the ACTH will give you a baseline reading of the dog's circulating cortisol status, and this can be very helpful prior to starting treatment. The ACTH is the test that is given periodically to monitor medication effectiveness, and it can be helpful to know what the cortisol level is before giving the medication.

    In summary, you may indeed wish to pursue a few more diagnostics. But since Jackson exhibits both symptoms and two LDDS results that are consistent with Cushing's, I think it's reasonable to expect that he truly has the disease (and not some "Light" version, whatever that means). If so, the question then shifts to whether or not you want to start treatment. The cost is not insignificant. Current recommendations for trilostane use are to begin dosing at a formula that doesn't exceed 1 mg. per pound. And it's certainly OK to start even lower. The rationale for this is that it is both safer and probably gentler on a dog's system with less risk of unwanted side effects to start at lower doses and work upwards if necessary, rather than vice versa. If you were to start with only a 30 mg. dose of brandname Vetoryl, the cost could be around $50 per month from select veterinary pharmacies. However, compounded versions of trilostane would be even less expensive. The monitoring blood testing must also be factored in. However, that is more frequent at the start of treatment and tapers off once a dog is stabilized on a specific dose.

    Given Jackson's age, your treatment considerations may be largely focused on his quality of life. For younger dogs, you want to halt the progression of systemic damage that uncontrolled high levels of cortisol can cause. But for older dogs, my personal opinion is that you are weighing the discomfort of the symptoms vs. the risk of medication side effects, and the stress that may be associated with the need for frequent vet visits and monitoring tests. And, of course, the costs for the owner. In the case of my own older Cushpup, his Cushing's symptoms made him so uncomfortable (ravenous appetite, excessive thirst/urination, panting, muscle wasting, hot all the time, couldn't climb stairs or tolerate even short walks), that treatment was a no-brainer. But if Jackson doesn't appear to be suffering very much, then you may indeed choose to hold off on treatment for now, or forever. That is really a judgement call that you are the best one of all to be prepared to make. So please do continue to ask us any questions that come to mind as you continue to sort through your options.

    Marianne

  7. #7
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Lori and Marianne - thank you for your replies.

    I hope we didn't jump the gun (based on your suggestions to retest for a UTI, which we did not do) but we started Jackson on Trilostane this morning. After measuring his water intake over a 48 hour period Sat AM to Mon AM (he is 47-48 pounds and drank 170 oz of water) the vet recommended we start him on the Trilostane. He also had another accident in the house on Friday while we were at work. She prescribed 50 mg once a day and it is a liquid suspension formulation that a compounding pharmacist filled for us.

    Marianne - to answer a couple more of your questions...Jackson did have an ultrasound of the adrenal glands at his regular vets office and there was some enlargement but no tumors. As for him suffering, I know most dogs are pretty stoic when it comes to illness so I don't really know how much he is suffering but he does pant and spends a lot more time laying on the hardwood or tile floor than in his bed which I attribute possibly to him being hot. I think I commented in an earlier post that he has always been very food motivated but he is now frantic around food. I timed how long it took him to eat his breakfast the other morning and it was just over 1 minute. We may end up buying one of the slow feeding bowls. The most prevalent symptom is the drinking/urinating. He is up drinking multiple times during the night and I know this because I am a light sleeper and I wake up and hear him. Some times it sounds like he is drinking his entire bowl and then I toss and turn wondering if I should get up and take him out to go to the bathroom. My husband sleeps very soundly and doesn't hear any of this so it impacts me more than him.

    We are committed to giving him the best possible life for as long as we can so we are hopeful that the meds will give some relief from the drinking and urinating, panting and his ravenous/frantic behavior around food.

    We will be monitoring him for any side effects and have an ACTH scheduled in 12 days.

    Julie

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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Julie, thanks so much for updating us. Given Jackson’s total symptom profile and two “positive” LDDS results, I do agree that Cushing’s seems likely and we’ll certainly be wishing you guys good luck with his treatment. The 50 mg. dose sounds good for a 48 pound dog, as does the ACTH testing in 12 days. So I think you’re off to a good start! I know you’ll be watching carefully for any side effects, and with the liquid suspension, you can easily adjust his dose if it ends up being warranted.

    Just a couple of tips... I want to make sure you’ve been instructed to give the trilostane along with breakfast. The medication must be given along with food in order to be metabolized properly. This is also the case on the day of the ACTH test — Jackson should not be fasted on the day of the test, and the testing should take place 4-6 hours after eating/dosing. Here’s a helpful link that summarizes some of this same information:

    https://www.k9cushings.com/forum/sho...l-(trilostane)

    So once again, good luck and please let us know how you are doing!
    Marianne

  9. #9
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Newbie here - trying to figure this all out.

    So I called the vet's office to schedule Jackson's ACTH at 12 days but they won't schedule it on a Saturday so I am thinking of moving it up a day. I would rather get the results earlier than later if there is any chance of him being over-medicated. I was told to drop him off before work and pick him up after work. I said I did not want to leave him there all day and that I was under the impression that if he had breakfast at his usual time of 6AM that he should be done by noon at the latest. The receptionist spoke with a tech who said the first blood draw would be 4-6 hours after he took his meds and then an hour later would be the second blood draw. If they wait until 6 hours to do the first draw then the second draw is 7 hours later - isn't that too late? Also, I thought the draws were supposed to be two hours apart not one hour.

    Please set me straight. Thanks.
    Julie

  10. #10
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hey Julie, It’s me Karen. I know I ‘m knew to all this too but my advice would be to take one for the team and leave Jax at your vet for the day if you can to really obtain an accurate level. With the low dose test, they do administer the stimulant and do a first draw after 4 hours—- then they do another draw after another 4 hours. So yes Jax will have to be there all day. It’s really worth it if you can do it because it will give you and your vet the most accurate reading, especially if it is his first. My only question is, has he reached his fully “loaded” level and now you’re on a maintenance dose? Annie is on Lysodren and I won’t even pretend to know anything about Trilostane.

    Listen to the others here before me. There is a lifetime of experience to learn from. I’m rooting for you because you’re basically a neighbor I haven’t yet met. Blessings. Karen

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