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Thread: Abby: Just found out my baby Abby has Cushing's

  1. #1
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    Post Abby: Just found out my baby Abby has Cushing's

    We tested Monday our 14 year old shih Tzu and she was positive for Cushings. We had been testing her blood for her liver enzynes as last year she had to eye surgery in both eyes and the pre lab work show ALP to be 2,400 so took her to our regular vet and he thought it may just be stress from all the drugs and surgeries. We tested for a year every three months and no change. So tested for Cushing and she was positive. Dr put her on 2 10mg tables once a day to start, I will tell you I have now look for a compounding pharmacy and found one that was half the price. She got her first meds today so we will see. She does not really have any signs other than her tail hair thinning, hungry all the time which can happen as they age. I measured her water intake based on date for the amount for her body weight and that was normal. Does have accidents but not all the time and sleeps all through the night. So weird but I still decided to treat with meds per vet and asking my self is this the right thing to do.

  2. #2
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    Post Abby: Just found out my baby Abby has Cushing's

    Our baby Abby (14 years old) tested positive for Cushing’s Monday and started Vetroyl today. She weighs 11.8lbs and he started her on 20mg once a day. Seems high and he said he wanted to start her on a low dose. So afraid that is high after some research. My other question is…. she really is not showing any signs other that hair thinning on her tail, hungry all the time. No panting, water consumption is not that big I may measure it a couple of times based on data for her body weight, she sleeps all night long…maybe once a month wakes us up for water and a bathroom trip and sleeps most of the day also. She does have accidents once in a while, winter or rain seems to cause that sometimes. but can sometimes go all day. We both work but have potty pads for both our girls.
    So bottom line am I doing the right with the Vetroyl. Poor girl had back surgery in 2016, but walks just fine now, two eye surgeries last year Cornea graph for a hole in the cornea due to crystalized calcium breaking lose and now this and the constant needles for the test that must be done for the Vetyorl.
    Help I have prayed for peace in my decision to give the meds and am wondering to treat or not to treat. No clinical signs that are a problem.
    I also need to say that her liver enzyme ALP is 2,400 and has stayed there for a year, her ultrasound looks good-she has had three in the last year.

    So, confused HELP

  3. #3
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Hello and welcome to you and little Abby! You’ll see that I’ve moved a reply that you had posted elsewhere to this new thread about Abby. That’s because we like to consolidate information about our members in one single thread. This way, it’s easier to keep track of a dog’s entire medical history, all in one place.

    I apologize that I don’t have the time right now to post a more complete reply of my own, because I do hsve some concerns about the trilostane dose, and even the need to launch into treatment yet. I’ll definitely come back a little later on and write more. But I wanted to at least get you girls started here ;-).

    Once again, welcome, and we’re really glad you’ve found us!
    Marianne

  4. #4
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Thank you for the fast response! I think I will reduce her dose to 10mg I had to get two 30 day supply of 10mg to get the dose the vet wanted. Also wanted to say she had a lot of GI issues and vet said it was a protein intolerance and put her on royal canin hydroloyzed protein and it helped

  5. #5
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Just time again for another quick comment, but I support your reduction of the trilostane dose to 10 mg. Given Abby's weight, that seems to be a much safer starting dose. It may be tomorrow before I can make it back again to add a lengthier post. But I definitely think the lower dose is a better way to start off.

    Marianne

  6. #6
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    OK, I’m finally back again with that lengthier reply that I promised yesterday ;-). As I wrote earlier, I would definitely feel far more comfortable with the 10 mg. daily dose since the currently accepted starting formula is not to exceed 1 mg. per pound. When trilostane was first introduced, higher doses were indeed given. But research and experience has led clinicians to scale down the initial dosing recommendations considerably. Perhaps your vet hasn’t had the opportunity to see the updated literature, so here’s a link to guidance that you may want to print off and share with him.

    https://www.k9cushings.com/forum/sho...=1251#post1251

    However, aside from the dosage, if Abby were my own dog, I would have reservations about treating her right now, at all. Rather than reinventing the wheel, I’m going to recopy a message that I recently posted to another member who was debating treatment for her senior dog. But given Abby’s age and lack of troublesome external symptoms, right now there may be more downside to treatment than upside.

    Given her age, Gidget has now entered her senior years. That being the case, there may be pros-and-cons to Cushing's treatment that you'd want to think over. In my own mind, the decision whether or not to treat any dog depends on a number of factors: age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen. For a younger dog, I would want to provide as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.

    However, since the damage usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly. Instead, my biggest concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I might choose not to treat, especially if my senior dog suffers from inflammatory conditions like arthritis that may actually be soothed by the elevated cortisol level of Cushing's. Treatment also involves frequent vet visits and blood draws, especially at the beginning. So again, if vet visits are really stressful for a senior dog, I'd also factor that into my treatment decision.

    Marianne
    So bottom line, in the absence of bothersome observable symptoms, you may want to discuss in greater detail with your vet what the actual goal of treatment is for a dog of Abby’s age right now. Even in younger dogs, many specialists delay treatment if the only symptom is the lab abnormality of elevated liver enzymes. If you do decide to proceed with treatment now, I’d definitely recommend the lower dose, and you should also be planning to return for monitoring testing within a couple of weeks. But that’s a topic for another reply ;-).

    Marianne

  7. #7
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Hi from me as well!
    Welcome to you and Abby!

    Marianne and I agree - in your shoes, based on Abby's age and in the absence of any real signs I would not treat right now. Rather I would wait and watch. But I have some questions....first what tests were done to diagnose the Cushing's and would you mind sharing those results here? Second, was Abby well when she was tested for Cushing's? Other illnesses can and do cause false positives on the Cushing's tests. Those tests can only tell us IF the cortisol is elevated but not WHY. I've had 2 dogs who returned false positives (one on 4 different tests!) so I am hyper-conscience of this possibility anytime someone mentions other problems going on with their baby.

    I'm glad you found us and look forward to learning more soon!
    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.

  8. #8
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Hello,
    Her ATCH results were 25.5 and have have charted her ALP results from 2018. In 2018 there were 948 per dental work ,in 2019 per eye surgery 1 3,177 (this is when she had her first eye surgery and had we had been treating her with meds for a scratched ccornea, autogenous eye serum, tobramycin/adeqan, dexamethasone sod phod o, ofloxacincyclosporine the eye drops went on for several months until I decided we need an opthalmology vet to look at her and that is when they did corneal graft to heal the hole in the cornea. per eye surgery 2- 2,253>2400 and 2020 >2400 two test.

  9. #9
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Thanks for getting back to us with these test results. I do want to make sure that Abby isn’t still being given any eyedrops or ointments that contain steroids, however, since that can raise ACTH results in just the same way as naturally occurring cortisol. Dexamethasone is an exception — it doesn’t alter ACTH testing results. So that eye treatment would have been OK. But I just want to make sure she isn’t taking anything else that contains steroids now.

    Also, in re-reading what you’d written earlier, I see that Abby has had three ultrasounds this past year and you described them as “normal.” Dogs with Cushing’s most often exhibit irregularities in their adrenal glands. Pituitary Cushing’s typically causes both adrenal glands to enlarge; Cushing’s caused by an adrenal tumor will typically be seen as a growth or a mass on ultrasound. The adrenal glands can be very hard to be seen clearly using standard ultrasound equipment found in many general practice veterinary offices, so referral to a specialty practice using technologically advanced equipment may be needed to get really good views of the adrenals.

    The reason why I’m focusing on this is to “second” what Leslie has written. In the absence of observable symptoms that are typical of Cushing’s, the diagnosis always remains somewhat questionable since other illnesses, systemic stresses, or medications containing steroids can return “false positives” on the diagnostic testing. It’s for this reason that I’m just trying to sort out any additional evidence that supports the validity of assuming that Abby truly has Cushing’s, and that there isn’t some other reason for those elevated ALPs.

    Marianne

  10. #10
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    Default Re: Abby: Just found out my baby Abby has Cushing's

    Her ALP was 948 pre dental work in 2018 and in May of 2019 the eye issues started and was on tobraycin, ofloxacin, an eye serum mixed with her blood, dexamethasone, cyclosporine. So, the first surgery was in July and on these drugs all that time. Her pre surgery ALP was 2253 which could have been all the stress due to the pain in her eyes and maybe meds. For the second surgery in September it increased to 3177. Later teste at her regular vet said >2400. She has been on cyclosporine since may 2019 and noe/poly/dex until January 2020 and back on far a week so so in March. I also have been giving her Milk thistle since the liver enzymes were high.

    Need to add she also was on rimadly, tramadol, for a bit with eyes but I only used them for a short time and has not taken any since eye suygery and one day after dental cleaning in January 2020.

    Only eye drop she is on now is cyclosporine 2% once a day and artificial tears twice a day. I also need to note that they blew out the vein on her neck for the blood test for Cushing’s....that may also be a stressor at the time of the testing. Not really happy about that. They did not say anything about it, I noticed her neck all red and bruised looking and hubby said I bet that is what happened. I emailed pictures last night and asked. I will hear from them tomorrow or I will call. Just as with humans you have to take the medical care into your own hands with your fur baby and ask questions. My fault that I did not research more before the drugs but was shocked as the vet had said he did not think she had Cushing’s due to no real clinical signs when we started this journey a year ago. He said the liver enzymes rise slowly with Cushing’s so weird.

    One other thing she seems to be licking her whoohoo a lot not sure why it looks fine. Going to try and get in with and internal vet, but due to COVID-19 may be hard. She is also on a diet of Royal canin hydrolyzed protien due to GI issues all her life. Went on diet in 2017.
    Last edited by Texas12; 05-10-2020 at 03:51 PM.

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