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Thread: My 13 yr old baby has Cushings

  1. #1
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    Default My 13 yr old baby has Cushings

    Hi,

    My pup, Chi, was recently diagnosed with pituitary Cushings via a 2-hour ACTH stimulation test. She has been exhibiting symptoms consistent with Cushings for around 6 months -- excessive hunger and peeing with increasing panting, and also has the pot belly. The vet recommends putting her on 10mg Vetroyl (currently weights 17 lbs - normally weighs 14). I'm a bit nervous because of the potential side effects and would like to get your opinion. Also, should I be requesting prednisone from the vet? Thank you in advance for your help!

    P.S I wanted to attach Chi's bloodwork etc as a PDF but I couldn't figure out how to do it??
    Last edited by eliz; 10-10-2022 at 06:09 PM.

  2. #2
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    Default Re: My 13 yr old baby has Cushings

    Hello, and welcome to you and Chi — we’re so glad you’ve found us! I’m sorry you aren’t able to upload your PDF, but for site security reasons, members currently aren’t permitted to do so. We’ve suffered from some devastating forum hacks over the years, and we’ve been advised that limiting member uploads is one safety step that we can take. Members *are* permitted to create albums and upload photos, however. So if you want to add a photo of any lab reports, that’s one option. However, in honesty, we’re generally only interested in knowing diagnostic Cushing’s test results such as the ACTH, and also any other lab results that are abnormally high or low, along with the printed reference ranges for those values. So even though it’s a bit of a pain, the easiest thing for you to do may be to just type out those specific values in a reply.

    For right now, given Chi’s outward signs of Cushing’s and assuming that her lab results are also consistent with the disease, let’s go ahead and talk about treatment. The Vetoryl dose that your vet is recommending seems very reasonable. For dogs the size of Chi, the most widely accepted current initial dosing protocol is to give a daily total that doesn’t exceed 1 mg. per pound. The starting dose is just a guess for any dog, since there can be wide variation in how each individual dog metabolizes the medication. After beginning treatment, subsequent dosing adjustments are based upon observed symptom resolution as well as monitoring bloodwork. But we’ve learned over the years that it’s much safer for a dog to start at a lower dose and work upward if necessary, rather than vice versa. Hopefully, this strategy also minimizes unwanted side effects. So returning to Chi, the starting dose of 10 mg. seems reasonable to me, and a dosage that I would feel comfortable giving to my own dog.

    As far as the need for keeping prednisone on hand, I think a lot depends on your access to emergency vet care. If a dog is exhibiting acute symptoms of overdose, it’s always preferable to head to a vet ASAP so that they can make the determination as to what is really going on. I never kept prednisone on hand, myself, because I live in a large urban area and both my regular vet and several ER vets are within easy driving distance. However, for pet parents who don’t have easy access to vet care — especially overnight or on weekends — then I think it’s reasonable to keep a small supply of prednisone on hand for use in an emergency. It’s unlikely that you’ll ever actually need it, but it can give you some extra peace of mind if you can’t easily get your dog to a vet in a crisis.

    OK, I’ll go ahead and quit for now. But I’ll leave you with links to a couple of threads on our “Resources” forum that offer a lot of helpful info about treatment with Vetoryl. Once again, welcome, and don’t hesitate to ask further questions.

    https://www.k9cushings.com/forum/sho...TH-Stimulation

    https://www.k9cushings.com/forum/sho...ushingoid-Dogs

    Marianne

  3. #3
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    Default Re: My 13 yr old baby has Cushings

    Hi Marianne,

    Thank you so much for your reply. You're a calming voice in a stormy ocean! Question: before Chi had the ACTH test, she was ravenous pretty much all the time. Since then, I must coax her into eating. Is that a reaction to the test or just a coincidence? I'm now really worried about how she will react to the Vetroyl. I'm enclosing below a list of Chi's bloodwork that came back in the red zone. Also, including the Reference Value number & her separate ACTH test numbers.

    1. BUN 47 ------Reference Value: 9-31 mg/dL
    2. Phosphorus 6.4 ------Reference Value 2.5-6.1
    3. Calcium 12.1 ----Reference Value - 8.4 -11.8
    4. Potassium 5.6 ---4.0 -5.4
    5. Na: K Ratio 26 ---28 - 37
    6. Total Protein 7.8 ---5.5 - 7.5
    7. Albumin 4.0 ----2.7 - 3.9
    8. ALT 267 ---18- 121 U/L
    9. ALP 855 ---5-160 U/L
    10. Cholesterol 391 ---131 - 345 mg/dL
    11. Lipase 342 ----0- 250
    12. MCH 26.2 ----21.9 - 26.1pg
    12. Platelets 739 ---- 143 - 448
    13. Creatine Kinase 263 ---10 - 200 U/L

    Below is the results from the ACTH stimulation test:

    pre -
    Cortrosyn 250 mcg/ml 0.1 ml IV RCV @ 3:36
    post (1-hour)

    In summary, to say that Chi hates going to the vet is an understatement! She panics. But I just want her to have the best life possible for whatever time she has left. FYI -She still has a good life. She hikes every day with me— just not as much a badass as she used to be. Lol. Not sure what I'm really asking except maybe just your thoughts on if moving forward with the Vetroyl is the right thing to do after reviewing the above results and knowing a bit of Chi's history.

    With infinite gratitude,

    Elizabeth

  4. #4
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    Default Re: My 13 yr old baby has Cushings

    Hello again! I’m afraid it will still be later today before I’m able to return and add a more thorough reply. But I wanted to assure you that you’re not being forgotten in the meantime. It’s been a busy couple of days for me, but I will talk to you soon!

  5. #5
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    Default Re: My 13 yr old baby has Cushings

    Thanks for getting back.

    I messed up on the ACTH results. See the correct numbers below.

    Cortisol - Pre = Result 4.0 ug/dL
    Cortisol - Post = Result 28.2 ug/dL

    Look forward to hearing your thoughts.

  6. #6
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    Default Re: My 13 yr old baby has Cushings

    OK, Iím finally back ó Whew! Thanks again for all this additional info, including Chiís ACTH results. The ACTH test is definitely elevated, and yes, thatís certainly consistent with Cushingís when viewed alongside her outward observable symptoms.

    Before commenting on her other lab values, though, let me state that Iím not a vet myself and have no professional training. However, based on my experience following the Cushpups on this forum, here are my thoughts. Certain of her lab abnormalities are also consistent with Cushingís: elevated liver enzymes (ALP and ALT), cholesterol, and platelets. Some of her other values are only slightly out of range, and I donít have any specific knowledge that they would be a concern. The three values that I *do* wonder about are the elevated BUN, phosphorus, and potassium. The latter two are only mildly out of range, and I believe BUN can be elevated on testing simply due to dehydration. However, elevations in all three can be caused by kidney dysfunction, and so the combination of these three abnormalities ó alongside Chiís new inappetance ó would prompt me to question your vet as to whether or not they pose any concern about the current status of her kidneys. You donít list her creatinine (CR) as being high, and thatís another important kidney marker. So thatís good. Also, thereís an additional blood test directly related to kidney function that already may have been included in her testing: the SDMA. If thatís normal, that is also reassuring. But if that test hasnít yet been run, that could give you important info about the status of her kidneys.

    We have been told by other parents that their dogs have temporarily felt ďoffĒ after the ACTH stimulation test, but I wouldnít expect there to be a lasting effect. So if Chiís appetite doesnít pick up, Iíd definitely report that to your vet, and I personally would hesitate to start the Vetoryl until sheís back to normal in that regard. Cushingís is a slowly developing disease, and thereís no harm in holding off on treatment until youíre sure thereís nothing else going on with her. Especially if thereís any newly developing problem with her kidneys, youíd need to be cautious about starting Vetoryl treatment. Since the kidneys are involved in proper metabolization and excretion of the drug, there are specific warnings about using the medication in dogs with genuine kidney impairment.

    And if and when you do start up, Iíd want to make sure your vet checks her basic blood chemistries alongside her cortisol when monitoring blood testing is performed. In addition to lowering cortisol, Vetoryl can also lower the production of another adrenal hormone, aldosterone. Aldosterone helps control the balance of potassium and sodium in the body, and I see that Chiís ďNa:K ratioĒ is already a bit off. So youíd want to make sure that the medication doesnít create further problems in that regard.

    So in summary, I donít mean to worry you unnecessarily about those three abnormalities. They may not mean anything. But if Chi were my own dog, I wouldnít start treatment until I reported her inappetance to the vet, and asked him/her if any further kidney diagnostics might be warranted.

    Marianne

  7. #7
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    Default Re: My 13 yr old baby has Cushings

    Hi Marianne,

    Thank you so much for your detailed response. You're a Godsend!

    Chi has a vet appointment on Thursday to have the SDMA test run. In addition our vet wants to run a Spec cPL to check her pancreas since she has a decrease in her appetite.

    I'll report back after I get the test results.

    Thanks again!

  8. #8
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    Default Re: My 13 yr old baby has Cushings

    I'm relieved to hear that the SDMA is being done, and I think the Spec cPL is also an excellent idea. I wasn't sure whether the elevation in Chi's lipase was enough to warrant concern, but for sure, pancreatitis will affect the appetite. One of my non-Cushing's dogs suffered from a couple of acute pancreatitis attacks during her lifetime and she was definitely ill during those times. So I'm very glad your vet is checking on that further, too.

    You told us how much Chi hates going in to the vet, so I know these visits have to be very stressful for you, too :-(((( Good luck to you both, and we'll surely be anxious to learn the results!

    Marianne

  9. #9
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    Default Re: My 13 yr old baby has Cushings

    Hi Marianne,

    See below from our vet. It seems like Chi does have pancreatitis. Her Spec cPL was elevated at 425 (normal range (0-200). Awaiting our internists response to the below from our vet.

    I'd love to hear your thoughts. I don't know how we can put her on Trilostane at this point. She's having issues eating. OY. I think this approach will change once our internist reviews.


    Follow up - I did receive your note about Chi's pancreas being more prominent on the U/S and her appetite being so so -- so with the elevated spec cPL active pancreatitis is now suspected. Let's await Dr Yau's thoughts on how to proceed.

    Thank you,
    Dr Hsu

    On Sat, Oct 22, 2022 at 3:33 PM <results@vetconnectplus.com> wrote:
    Hello,
    Please find Chi's results from her lab blood test. Her SDMA returned within normal limits after she was fasted - so no active kidney changes are noted.

    Her Spec cPL was elevated at 425 (normal range (0-200). I reviewed her previous labwork and did not find any other spec cPL results to compare this value with. Some of our pets have elevated pancreas enzymes due to chronic inflammation to the pancreas without active clinical illness. I understand that you asked to have her pancreas value checked, so unless Chi's appetite has been poor or she has been vomiting, we can keep this value to monitor and recheck this value in 1-2 months to see if there are changes once she starts on her Trilostane.

    Per Dr Yau and from Chi's latest blood panel - Chi can be started on Trilostane 10mg by mouth once a day in the AM. Recheck blood work (ACTH stim test) should be completed in 2-3 weeks (with the blood draw taken 2 hours after the morning dose).

    Take some time to review these results and let us know how you would like to proceed and if you need the Trilostane filled with AMH or you will be getting this from Veterinary Specialty Group of Glendora. We will forward these results to Dr Yau for her records.

    Thank you,

    Dr. Andrea Hsu
    hello@amhpasadena.com
    (626) 796-3019

  10. #10
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    Default Re: My 13 yr old baby has Cushings

    Iím so glad to know Chiís SDMA came back within normal range so we can eliminate kidney issues from our worries! And like you, Iíll be anxious to see what Dr. Yauís recommendation is at this point. I really do defer to your specialist in terms of the trilostane. Through the years that Iíve been on the forum, weíve had multiple members whose dogs have experienced pancreatitis both before and during treatment, and a possible relationship between Cushingís and pancreatitis has been talked about but not necessarily well understood. However, newer research of which Iím unaware may be offering clearer direction in that regard. Normally, a general rule is to hold off on giving trilostane to a dog who is not eating and is observably unwell. However, if elevated cortisol is fueling the pancreatic inflammation, then perhaps itís advisable to go forward with treatment.

    Inappetence does present problems. The medication is not metabolized as efficiently if not given alongside a meal. And since inappetence can be a symptom of overdosing, your ability to monitor the effects of the dose becomes more limited. However, as I say, your specialist may feel that the possible benefits would outweigh the negatives. Whenever you do begin, the written treatment instructions youíve been given are just what we would be expecting. I would just add one note: on the morning of the monitoring ACTH test, Chi should be fed breakfast alongside her dose of trilostane, just like any other day. (And hopefully, sheíll want to eat her breakfast by then!)

    So please let us know what Dr. Yau suggests. This will be a learning experience for me, as well, and Iíll appreciate the information moving forward.

    Marianne

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