REMY diagnosed last week
Hello Again, I used to be here as “Amanda’s Mom”. She had an adrenal tumor which was successfully removed and she lived another year of so before passing away from CHF. This time it appears to be the pituitary form. We adopted Remy four years ago. He is just now turning 11, a rescued Bichon and came from a backyard breeder after the man passed away. His teeth were beyond deplorable and he was never socialized. Even four years later he has only bonded with my husband and remains afraid of pretty much everything. I have wondered if the stress he lives with might even contribute to his Cushings. Remy always had high liver enzymes and we had an extensive work up in Feb 2018 including a liver biopsy, cortisol levels, bile tests, copper storage disease and liver shunt testing. The internist felt since he wasn’t having any clinical symptoms it was likely some chronic form of inflammation. Treated with prednisone for awhile then eventually discontinued. Never reached ‘normal’ liver enzymes levels. He was always a picky eater, a grazer and not at all food motivated. We would throw so much food away as it would sit all day untouched. In December I noticed he was actually looking for his food and eating it all up. Sometimes he’s looking to see if Angel has left him anything in her bowl. He isn’t ravenous, but definitely eating like most normal hungry dogs do. He has developed a pot belly and I feel his coat is a bit thinner. It was always horrific to get a clipper thru and I noticed at his last grooming it doesn’t seem as thick. He seeks out cool places such as the tile floors but he’s always done that. At night even with our bedroom chilled to around 66 and a fan over him he puffs and pants much of the night. He is sluggish and not at all active but he’s always been that way. He refuses to take walks or show any signs of being interested in activity. Favorite thing is a car ride or to go to bed. We have not had any increased drinking or peeing (yet!). But I felt there were enough changes to warrant asking about Cushings when he had his semi annual senior blood work. The vet ran a comprehensive panel plus urinalysis 2/7/20.
Liver Enzymes were more elevated than ever ALT 714, ALP 772, AST 58, GGT 60, TP 7.6, Cholesterol 443, Glucose 143, platelets 617, T4 1.8, urine protein 1+. He also did another ultrasound and both adrenal glands seemed slightly enlarged. The liver is also somewhat enlarged and hyperechoic (as it has been for several years).
ACTH performed 2/14/20, precortisol 7.8 and post cortisol 24. PIcked up trilostane yesterday with recommend dose 20 mg. Per day either as one dose or two 10 mg doses. Remy is right at 18 pounds. Do you think the two doses is preferable? As long as he’s eating we’re fine. But if he reverts to the old grazing and picky behavior that may complicate things.
I feel he is early stage with mild symptoms so I certainly don’t want to overdo the trilostane. You are a very smart group so I welcome your suggestions. My past experience with Cushings was 23 years ago and more recently Amanda a few years ago but removal of her Adrenal tumor effected a cure and she never did have any clinical symptoms. Remy’s liver situation has always been a concern but the internist felt until he actually exhibited clinical symptoms of something we were throwing money away to continue testing.
We have one other dog, our 14 year old rescue toy poodle Angel. She also has highly increased liver enzymes and TP and pretty much always has. She is missing a lobe to her liver and she is on chemo for Transitional Cell Carcinoma. We are just about at the one year mark and on our second chemo protocol but so far so good. Just started seeing some blood in her urine once in a while but as of 3 weeks ago there was no progression of her disease. We caught it exceptionally early and she has done well with no ill effects from the chemo. I know that isn’t going to last however so I am figuring out the next steps for her as well as for Remy.
I am aware of the team at Washington State University who has been successful with pituitary tumor surgery and it wouldn’t be out of the question but there are many factors including his ever present liver inflammation, his age and the risks of this yet rare surgery. Needless to say, life is consumed with my furry kid’s issues and I welcome your suggestions, comments, etc. Thanks so much to everyone here!! Claire
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. I often wonder if the fear he lives with might contribute to overproduction of cortisol simply because he is so nervous. It’s like he’s always ‘on guard’ and fearful that someone or something is going to harm him. So sad but I really don’t want to try any more drugs since they run the risk of increasing is already elevated liver enzymes. 
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