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Thread: New here - suspect Cushing's in 4.5 yr old beagle mix

  1. #11
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    I'm sorry, I also meant to ask - what are your thoughts about prognosis? We've seen very scary stuff online about 2 year life expectancy... is that true? Will this shorten her life? She is only 5.5 yrs.... just wondering long term impacts?

  2. #12
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    Please forget that 2 year life expectancy, Cushing's is a treatable disease and with treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span. However, for the treatment to work safely and successfully it requires an educated pet owner along with an experienced vet as adverse side effects are mostly only seen when the proper protocols are not followed.

    One remark I do want to address, cortisol levels can only be checked with an ACTH stimulation test, so if the vet is stating that her level is low judging solely from those LDDS test results, that's a mistake.

    How much does Joni weigh? And what dose of Trilostane is being prescribed?

    I'm providing a link to a thread with cost saving ideas: https://www.k9cushings.com/forum/sho...ushingoid-Dogs

    Hugs, Lori

  3. #13
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    Hi Shelton,

    Welcome to you and Joni!

    I wanted to talk to you about that 2-year myth....yes, myth. That is exactly what that claim is. Maybe, MAYBE, many years ago that was seen as fact but today it certainly is not and because of changes in the Cushing’s world that 2-year survival claim qualifies as a myth.

    Years ago most dogs were not seen as family nor kept inside. They were working animals and seen more as livestock. As a result when a dog got sick it was the norm to let them go on as long as they could then simply put them down when they could no longer do their job. Very rarely were they treated for any diseases. But today that is not the case. Our babies are part of our family and most of them live inside with us. So when we see them changing we take them to the vet just as we would take a human child to the doctor. And, just like with our human children, when we are told our furbabies have a disease, we treat that disease if at all possible.

    Even tho most cush pups are diagnosed when older with most of their lifespan behind them more often than not they still outlive that 2-year claim. This is due to several reasons. For one thing, that fact that most of our babies live with us, sharing our spaces which allows us to notice quickly when they aren’t their usual selves. Even those working dogs who do live outside are held in higher esteem today than they used to be and we are more apt to treat them than our ancestors were. In addition, there have been advances in the diagnosing and treatment of Cushing’s. For another we, as parents, demand more from their vets and ourselves. We demand their vets keep up with the advancements in Cushing’s and we demand of ourselves that we learn all we can to help our babies live their best life possible with the disease. For these reasons that 2-year myth has been busted to smithereens. Barring one of the rare complications with Cushing’s, most cush pups live out their normal lifespan and beyond simply because of the attention and care they receive from their loving and attentive parents who want to the best thing for their furbabies.

    Unfortunately, there are some factors that can make that myth a fact. The two most dangerous things for a dog with Cushing’s are 1) a vet who doesn’t understand the disease nor the treatments used to manage it, who don’t keep up with advances, who won’t listen when confronted with their mistakes or advances they may have missed, and who refuse to follow specific protocols for the drugs they prescribe; and 2) parents who won’t take the time to learn about the disease, the drugs used to treat it and the signs associated with low cortisol, who blindly follow anything the vet says even when what they are saying and doing is not correct, and who will not listen when they are presented with sound, scientific proof that their baby is not being properly cared for by their vet. In these cases, that 2-year lifespan might be sadly generous.

    You are here, asking questions, trying to learn how to best help your sweet girl so that puts you in the category of those parents who do go that extra mile. Just try to put what you are reading on the web away and don't think on it any more.

    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. #14
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    Thank you Leslie and Lori for the resources and also candor about prognosis! It definitely makes us feel better! I am wondering - the complications you mention, and I've read that sometimes the tumors can be more aggressive - how do you know if this is the case or not with your dog? I asked our vet about Joni's outlook. She said it was largely dependent on her response to the medication overtime, and repeat testing. Regarding her weight - she is overweight just now, and is just over 50lb. At her healthy weight she is closer to 43lb. The vet said the typical starting dose was 1 (mg? I forget the unit) per lb, and that Joni would be started using that. Rechecked in 10 days, then on day 30, then at 3 months, then at 6 months. She said the 10 day or 30 day checks demonstrated an adjustment to the dose was needed, then the process would repeat (10 day after adjustment, day 30, 3 month etc). Regarding the ACTH - I am unsure if they performed that test or not. I will ask. I did ask for the results of the LDDS intending to share here, but I didn't ask / didn't know to ask about ACTH. We go this afternoon to pick up the trilostane and start her (I guess today or tomorrow? Unsure if it's given morning or night, with / without food?).

    Is there any reason to be concerned that given Joni's younger age she might have a more aggressive / complicated form? Does concurrent hypothyroidism (which was also early onset - diagnosed at approx 2 years of age) raise any flags?

    Thank you for the resources regarding the meds. My thought at the moment is to use the vet's own pharmacy until we get her dose right / stable, and then maybe look to source it on a longer term maintenance basis through a cheaper supplier, assuming that makes sense.

    Thanks again!

  5. #15
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    The pituitary form of Cushing's is from a tumor on the pituitary gland, usually benign, however a small percentage, around 15%, do grow to be a macroadenoma. The only way to visualize the pituitary tumor is with a computed tomography (CT) or magnetic resonance imaging (MRI).

    I do want you to be aware that studies have found that dogs weighing over 40 pounds are sensitive to Trilostane and therefore need smaller doses than the 1 mg per pound that is recommended. If this were me, I would not start Joni on a dose higher than 20 mg. Also, it is vital that the medication be given with a meal so that it is properly absorbed, generally it is administered in the morning with a meal.

    The monitoring tests for Cushing's are the ACTH stimulation and this test is conducted 4-6 hours after the dose of Trilostane is given with a meal. For the first 30 days of treatment no upward adjustments to the Trilostane dose should be carried out because cortisol can continue to drift downward during the first 30 days of treatment.

    If you have any more questions, please do not hesitate to ask them!

    Hugs, Lori

  6. #16
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    That is interesting about the dose - thank you! I am sometimes bad at learning things verbally, so when the vet relayed on the phone, I might have gotten it wrong. I can't recall the number she said Joni would start at - so I will look at this when we pick it up at the vet's office, and if it's 1mg to pound (ie - 50 mg), I'll ask if maybe we should start a bit more conservatively.

    Regarding the macroadenoma - how would we know without doing CT / MRI? And when would that be warranted / suggested? Will her symptoms just get worse even with the medication? Also, is it concerning that her ALP was on an upward trajectory? Like getting worse by 100 points within less than a month?

  7. #17
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    Default Re: New here - suspect Cushing's in 4.5 yr old beagle mix

    As Lori said, studies have shown that dogs weighing over 40lbs should start on no more than 0.05mg per pound per day with a max dose of 30mg a day. I will give you some links on this so you can share with her vet. I also want to caution you about the dose increases....that should not happen until the 30 day test. This is because the cortisol usually continues to drop for the first 30 days on the same dose. By increasing at that 2 week mark the dog is put at higher risk of an overdose. So don't let the vet talk you into increasing her dose until that 30 day test. Then if the cortisol is still high and her signs are not improving a small increase of no more than 25% is warranted.

    As far as I know, age has no bearing on prognosis so I wouldn't worry about that. I would keep a close eye on all the signs for the thyroid once treatment starts just to be sure that med dose doesn't need to be lowered. The endocrine system is tricky and seems to interconnected so if one thing goes whacky others will and as one thing is brought back to a more normal range other conditions need to be reassessed. So just watch. And there is a condition called Sick Euthyroid Symdrome in dogs that is connected to Cushing's and once the cortisol is under control that disappears. But that is something I would want to talk to her vet about to see if that is a possibility since she was diagnosed with thyroid issues earlier.

    As for complications, the macros Lori mentioned are probably the most heartbreaking. Two other conditions come to mind that can occur and those are a skin condition called Calcinosis cutis and a muscle disease called Pseudomyotonia. But as we said, these are rare. Most cush pups have nothing more than the usual signs associated with elevated cortisol and live life pretty darn normally. So don't worry about these extreme possibilities. Just focus on getting Joni settled in on the right dose and loving every day with her.

    Here are the links on large dogs and smaller doses:

    https://pubmed.ncbi.nlm.nih.gov/22708554/

    https://onlinelibrary.wiley.com/doi/...6.2012.00956.x

    And one written by one of the Admins here:
    https://drive.google.com/file/d/155a...gpCjmRdUz/view


    A link on Pseudomyotonia:

    https://endocrinevet.blogspot.com/20...-cushings.html


    And a link on CC:

    https://drive.google.com/file/d/0B5R...ttcnlaX1k/view

    Hope that helps!
    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.

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