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Thread: My Milo has Cushing's

  1. #1
    Join Date
    Dec 2022
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    Post My Milo has Cushing's

    Hello lovely people,

    Glad I found this amazing forum. I want to apologize in advance for my bad English.
    Me and my almost 13 year old jack russell Milo are from Bulgaria.
    I will try to briefly tell our story.
    Ever since he was little, my Milo has been very attached to me and doesn't let anyone get close to me. He went through training, but there was not much result. Whatever we've been through with him, he's my boy. He was hardly sick.He was always greedy and very muscular. However, this summer it struck me that he started drinking a lot of water and urinating. He drank 2.5 liters of water per day at a weight of 6.5 kg. He became even more greedy and the muscles of his hind legs began to weaken.
    I took him to the vet and they ran tests on him. What went out of the norm is:

    LYM 0,51 0,83-4,91
    MON 0,12 0,14-1,97
    MCHC 392 300-380
    PLT 562 117-490
    MPV 5,9 8,0-14,1

    ALAT 94,3 8,00-57,0
    PRO 0,15 g/l
    SG 1,010
    His electrolytes were normal.
    After these results, the vet decided to test for Cushing's (LDDS)
    Results they are;

    Pre-dose 11,02 ug/dl
    4H Post – dose 7,32 ug/dl
    8H Post – dose 7,81 ug/dl

    So Milo started taking Vetoryl 5mg morning and night for 20 days now. His appetite hasn't diminished much, but he's always been a glutton. Drinking water decreased to 1.2 l-1.5 l.
    However, it seems to me that his muscles are weakening more. On the tenth day, he was tested for urine and only PRO 0.30 g/l came out.
    I said that on the 30th day they will run urine and electrolytes again. Unfortunately we don't have a test (ACTH) and I don't know how they will monitor cortisol.

    Thank you for listening to me. I am open to any ideas and advice on how to help my treasure.
    Last edited by Sneji; 12-05-2022 at 07:37 AM.

  2. #2
    Join Date
    Apr 2009
    Location
    Georgia
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    Default Re: My Milo has Cushing's

    Hello and welcome to you and Milo! We’re so glad you’ve found us! And you don’t need to apologize for your English at all — it is excellent. There is no way I could write as clearly in another language, myself. You have done such a good job of introducing Milo to us.

    I will come back again later when I have more time to answer your questions. But I wanted to quickly have the chance to at least welcome you to our group here, and to thank you for the information that you’ve already given us. So I will be back to write more soon.

    Marianne

  3. #3
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    Dec 2022
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    Default Re: My Milo has Cushing's

    Thank you very much for the kind welcome Marianne!
    I look forward to your reply.

  4. #4
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    Default Re: My Milo has Cushing's

    OK, here I am back again. Once again, thank you for giving us all this information on Milo. From what you describe as far as his behavior changes and also his lab results, I do understand why your vet tested for Cushing's. I'm assuming that the ALAT lab value corresponds to what we see listed as ALT here in the U.S. That is a liver marker which is often elevated with Cushing's. There is another liver marker that is listed here in the U.S. as ALKP or ALP which is most frequently elevated in dogs with Cushing's. I don't see any number on Milo's lab result that would likely correspond with that value, so I don't know whether that marker was tested by your lab or not. At any rate, in addition to the high ALAT, Milo had elevated platelets and also the specific gravity of his urine was on the low end. Both of those results are consistent with Cushing's.

    The results of the LDDS are also consistent with Cushing's. Sometimes the pattern of the LDDS results will point towards a pituitary tumor as being the cause of Cushing's for a dog with the disease. However, in Milo's case, even though the test results are consistent with the Cushing's diagnosis, the pattern of his results could be caused by either a pituitary or an adrenal tumor. It would take further testing to try to figure that out. Here in the U.S., in this situation, an abdominal ultrasound is the most common next step if an owner wants to know more about the type of tumor. The ultrasound imaging of the adrenal glands will show whether or not a tumor is found there. Owners often ask for an ultrasound if they think they might consider adrenal surgery to remove a tumor if one is present. Removal of an adrenal tumor can provide a total cure of Cushing's. However, here the surgery is very expensive and very risky. So the majority of owners go ahead with medication treatment. Vetoryl is used to treat Cushing's caused by either a pituitary or an adrenal tumor. And the starting dose you are giving Milo seems to be appropriate for his weight. So further diagnostics to distinguish between a pituitary or an adrenal tumor may not be of any interest to you. But I did want to mention the fact that we cannot tell what type of tumor he has based on the LDDS test.

    Finally, to answer your question about Vetoryl monitoring testing, an alternative to giving an ACTH test is for your vet to simply test Milo's resting cortisol level one hour *before* he is scheduled to receive his next dose. Milo's cortisol level was tested three times during the LDDS test, so your vet should not have any trouble with performing that simple blood draw once again at any time. Here is an informational chart that explains how this monitoring test is done:

    https://drive.google.com/file/d/1aQO...ZWjCrdlG4CE7p0

    Take a look at this chart, and let us know if you have any questions about it. Also, here is a link to the thread where this chart is found. In addition to this chart, the thread has a lot of other helpful information about treatment with Vetoryl.

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

    So again, take a look at all this information and do tell us if you have more questions. Before I end this note, I want to mention that it is possible that Milo's hind end issues may be worsening after starting the Vetoryl if he is suffering from any arthritis in his hips or back legs. For the most part, Vetoryl treatment is helpful to dogs with Cushing's. But one way in which the previously high cortisol levels may have been *helping* an older dog is if the high amount of circulating cortisol was easing the inflammatory pain of arthritis. Once the cortisol levels are lowered, the arthritis pain may worsen and an alternative pain-killer may need to be prescribed. That may not be the problem for Milo at all, but I did want to at least mention it.

    OK, I'll end for now, and once again we're so glad you've found us!

    Marianne

  5. #5
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    Dec 2022
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    Default Re: My Milo has Cushing's

    Hello Marianne,
    I am extremely grateful for this comprehensive answer.
    I forgot to mention in the previous post that Milo had an ultrasound. No adrenal tumors were seen. He has an enlarged liver.
    I will ask about an alkaline phosphatase test.
    I gave him a urine test today and the results are:
    PRO 0.15 g/l
    CA <=1.00 mmol/l
    SG 1.015
    CR 8.8 MMOL/L предната урина беше 17,7 mmol/l
    PRO/CR <0.2

    I'm going to run an electrolyte panel tomorrow and we'll do a blood prick cortisol test.
    The vet was worried that he was losing muscle mass on his legs and back so quickly and asked us to reduce the dose to 5 mg, but in the evening. I have no explanation why evening.
    When I get the results tomorrow I will write them immediately.

    Thank you very, very much!

  6. #6
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    Dec 2022
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    Default Re: My Milo has Cushing's

    Hello again,
    Milo had his blood taken today for a cortisol test and it came out at 10.2 ug/dl and his electrolytes are norma.This is 24 hours after the last dose of 5 mg vetoryl.. He has been on only 5 mg in the evening for two days.He lost weight in 20 days with 300 grams (the vet therefore reduced it to 5 mg), I don't know if it is correct.
    Last edited by Sneji; 12-07-2022 at 01:17 PM.

  7. #7
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    Apr 2009
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    Georgia
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    Default Re: My Milo has Cushing's

    Again, Iím sorry for the delay in getting back to you, and especially sorry that Milo is not doing better right now. It is hard to know exactly what is continuing to cause the weight loss and weakness. As youíll see in that monitoring chart that was in my earlier reply, his cortisol level was not too low when it was tested (10 ug/dL). In fact, it was much higher than you would like (ideally less than 5 ug/dL). I know this was two days after his dose was dropped to once a day instead of two. So we donít know what his cortisol level would have been on the higher dose. Still, I doubt that that his cortisol was likely *too* low earlier even when on the higher dose.

    One thing that Iím confused about is why your vet told you to cut back to the single evening dose instead of giving the one dose in the morning. The makers of Vetoryl recommend giving the medication in the morning when only one dose is given each day. This makes sense to me because, in that way, the dog is benefiting the most from the effect of the medication during the day when he is active, instead of at night when he is sleeping. By the time he awakens in the morning, the benefit from the medication may already be wearing off. So I would ask your vet why he has chosen to give Milo his single dose in the evening.

    And truly, given that relatively high cortisol result, it seems possible that Milo actually needs to be on a higher overall dose of the Vetoryl rather than a lower dose. His symptoms may be continuing to worsen because his cortisol remains quite elevated at all times. I surely understand why your vet is being so careful to avoid overdosing with the medication. But given that cortisol test result, it seems possible that Miloís main problem is that his cortisol has not yet been lowered enough to gain control of the Cushingís.

    Is Milo still on the lowered dose, and how is he doing now?
    Marianne

  8. #8
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    Dec 2022
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    Default Re: My Milo has Cushing's

    Hello Marianne,
    After we reduced the dose and he immediately increased his water drinking and urination again (he had reduced them a little - not to the desired level of course). We increased it again to 5 mg in the morning and 5 in the evening and it was immediately felt. I continue to follow it like an eagle and will keep you updated on what happens.
    I do have one question though: When they did the one time blood test for the cortisol test they told me the normal range was 6mg-26mg??(I had it done at another lab because our vet said that this sample wouldn't give us any information about his cortisol?!?)
    I'm getting so confused now.

    Sneji and Mailo

  9. #9
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    Location
    Georgia
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    Default Re: My Milo has Cushing's

    That range of 6 - 26 ug/dL is the normal range that you’d expect to see for a dog who does not have Cushing’s. So that’s the range that is commonly found on laboratory printouts. When a dog with Cushing’s is being treated with Vetoryl, however, you are looking for an entirely different cortisol range. I’ll give you the link to the monitoring chart once again:

    https://drive.google.com/file/d/1aQO...ZWjCrdlG4CE7p0

    Please let me know if you can’t get this chart to load for you, and I’ll try to find a different way to link it for you. But if you can see it, you’ll find that that there are specific instructions about how to give Vetoryl to a dog, depending on the pre-pill cortisol level. If your vet doesn’t know about this, hopefully you can tell him about it, as well.

  10. #10
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    Dec 2022
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    Default Re: My Milo has Cushing's

    Thank you so much Marianne,
    I will look into it very carefully!

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