Hello everyone, new to the group and thanks for having me! Appreciate how y’all love details, (me too!) so here goes just about everything. Hope it’s not overwhelming TMI.

I’m retired in my “not so golden” years in Sweet Home Alabama. I’m just a good ole plain country folk with a brain. My fur child is Patch. He’s white with black patches (like a catahoula leopard), long haired American Bulldog mix with a bushy tail. (Yes there is such a breed). Age 12, neutered after I got him and weighs 64 ½ pounds. He’s my companion buddy. Rescued him in 2008 when he was about age 10-12 months old. He was abused and had a back leg injury that never properly healed, but he gets around fine. He’s just so laid back and easy going with a happy disposition in spite of everything. Patch always fear pants from Tstorms. Has arthritis in left shoulder and bad left back leg. He takes many safe natural supplements and vitamins, wet no grain canned and home cookin when I’m not exhausted.

I’ve been dealing with does he or doesn’t he have Cushing’s for 3 years now. Since 2017, chief complaints: pot belly, unusual panting (other than fear panting from Tstorms) and very restless at night. Up and down constantly. Daytime not so bad. I’ve been to (5) GP vets, a Cardio Vet, (2) Radiologists, (2) Vet Colleges, (2) IMS’s and a Vet Dental Specialist. Met a few very arrogant Vet’s on this journey. Different Labs have been used in testing. Question whether scorings can cause inconsistent readings.

HISTORY
3/2011 – 1/2013 – GP Vet - prednisone tablets given (4) treatments
Mar. 2017 – GP Vet – 1st and only ear infection. Given unknown allergy injection
June 2017 – GP Vet – 1st and only urine infection. Given antibiotics
Oct. 2017- GP Vet xrays showed an enlarged heart.
Nov. 2017- 1st Cardio Vet visit - echo cardiogram, diagnosed Patch with mild enlarged heart and mild aortic stenosis. (can’t take Vetmedin)
Dec 2017 – CBC – hemocrit 63%, ionized calcium 1.46 mmo/L, PTH measured at low end of normal 0.7 pg/mL. IDEXX Lab testing.
Feb. 2018 - 1st. ACTH test -1st Vet Univ (Neg.) suspected pre cushing’s. Started Melatonin and lignans.
Aug. 2018 - 1st IMS - Said asthma/bronchitis. Chastised melatonin and lignans. Lenticular (nuclear) sclerosis in both eyes. CBC- ALP 384, Chol 254. No ultrasound report or findings. Was a horrible experience overall.
Lab testing unknown.
April 2019 – 2nd visit Cardio Vet – Echo, CBC, T4 - ALP 1144 u/L, ALT 193 u/L, platelets 771, triglycerides 457 ug/L, T4 normal at 2.2 ug/dL ZNLabs testing.

THINGS GO DOWNHILL:
Nov. 2019 - GP Vet - upper molar tooth extraction. (turned out a botched job, no CBC done prior)
Dec. 2019 – GP Vet- CBC, T4, Urine - showed High BP, now on Benazepril 20mg. Suspected polycythemia. Wanted to do blood letting. Refused he wasn’t experienced. CBC platelet 673,000 u/L, ALT 161 u/L, ALP 519 u/L
T4 – 1.1 ug/dL normal. IDEXX testing.
Jan. 2020 - 2nd ACTH test (neg.) 2nd Vet Univ. - Ultrasound. Belly shaved bald. Left adrenal gland, 2.1cm. Right ok. Confirmed polycythemia, now on Clopidogrel (plavix) 75mg, ½ dose daily. Still suspect of cushing’s.
Ultrasound mentioned a splenic nodule, no measurement given. They wanted an LDDST done. Urine Protein 185.9 mg/dL Lab unknown.
Feb. 2020 – 3rd visit Cardio Vet - Echo and CBC. No pulmonary hypertension. Polycythemia not from heart. No murmur. CBC showed CO2 Low at 15 nEq/L, ALT high at 193 u/L Choles 280 mg/dL, Triclyc high at 457
mg/dL, others high, no ALP shown. ZNLabs testing.
Feb. 2020 – Vet Dental Specialist – major gum surgery after complications from Nov 2019 tooth extraction. Took 2 months to recover. Had adverse reaction to med’s and anesthesia. Traumatized Patch (and me).

ENTER COVID - NEAR IMPOSSIBLE TO VISIT ANY VET. (expenditures growing!)

July 2020 – 2nd IMS visit - went prepared with all Patch’s records in a notebook binder along with all disc copies of his xrays. He suggested melatonin for helping Patch’s belly fur regrowth, that was overkill shaved bald for the Jan. 2020 ultrasound. It’s only peach fuzz still, 7 months later. I cautioned him about the BP med interaction. He balked at any of the other supplements I give Patch. Had UPC ratio and free catch urine test. Urine Protein scored 273.6mg/dL, Creatinine 106.3mg/dL = ration of 2.6. Benazepril dosage increased to hopefully lower his protein at 20mg 2x daily. BP stabilized, systolic 120. Antech Accession Lab

IMS had a 2nd opinion radiologist review the Jan 2020 ultrasound (without my knowledge or consent. I refused full payment, but offered up a 50/50 split. Seems they wanted all or nothing and gave me a full refund instead. Didn’t appreciate them trying to take control out of my hands). This radiologist report stated Patch had primarily hypoechoic but also mildly heterogeneous small mass of the left adrenal gland, likely of the caudal pole (approximately 2.84 cm x 2.36 cm) and mildly heterogeneous spleen with a hypoechoic nodule, likely of the body (0.96 cm x 0.65 cm). Irregular, mildly heterogeneous area also likely within the splenic body (1.10 cm). Small, heterogeneous mass of the spleen that bulges the capsule (1.96 cm x 1.75 cm). Smaller right adrenal gland, measuring 0.43 cm in height at its caudal pole. Mildly heterogeneous liver with at least one, hypoechoic nodule (0.41 cm). (So much more info than original report!)

Aug 7, 2020 – New Radiologist visit - ultrasound. Report: Left adrenal gland: Cranial pole expanded by a rounded, heterogeneous mass measuring approximately 3.3 x 2.8 cm (this is increased compared to the reported prior measurement of 2.1 cm). The caudal pole measured approximately 0.56 cm. Right adrenal gland: Normal (0.46 cm). Spleen: Ill-defined, approximately 2.3 x 1.0 cm, hypoechoic nodule. Mildly heterogeneous nodule measuring 2.14 x 1.55 cm expanding the splenic tail. (Everything else internally appeared normal.)

IMS believes Patch has atypical Cushing’s or at least ADH, not sure if cancer. Patch’s adrenal gland/hormones are so out of whack. Originally wanted Patch on mitotane, changed mind and now wants Patch to start 90mg Trilostane (Vetoryl) twice daily. When questioned what made him change his mind he said “sleep.” He thinks when he sleeps he stated. (Just when I thought I’d heard it all.)

Seeing the posting 07-15-2020, by cken, “Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?” and responses about the proper mg dosage was a timely huge wake up call for me! THANK YOU! (Patch’s weight is 64 ½ pounds). 180 mg a day IMO is excessive to say the least. Checked all your posted links for info, esp. Dechras site.. feel the 1 mg per pound (2014/15 dosage recommendation) is the way to go. Not sure if 30 mg 2x a day is appropriate or one 60 mg dose in the morning with food of course or to go with initially 0.5 mg/kg even if cost is more. (Feldman study I believe) With Patch’s history of not tolerating most med’s., naturally I’m cautious. Rather be a bit under mg than over and safer than sorry.

CONTINUE TO PART 2
Donna