Recent diagnosis; lab test recheck and dosage change

[labblab]

Thank you so much for giving us all these test results! I apologize that I haven’t yet had the chance to look things over in detail. But I’m having some extensive yard work done this week and my mind is swimming with all the decisions. I’m cringing right now as I see the crew digging trenches through my nest of underground cables — hopefully I’ll still have live internet by the end of the day………………

Anyway, I *will* return, but in the meantime wanted to thank you for giving us this info.

Marianne

[Harley PoMMom]

Some thing's that stick out to me are that his creatinine and phosphorus levels are elevated, these are indicators of kidney issues, I would suggest having a SDMA test done to see how the kidneys are functioning. Also, his WBC (white blood count) is slightly elevated which means that an infection may be brewing, for this I would advise having a urine culture and sensitivity test performed to see if an UTI is present. Cushdogs are prone to UTI's (urinary tract infection) which will cause a dog to urinate and drink more water than normal.

Hugs, Lori

[TheBean]

We finally recieved the Bean's ACTH recheck results from a week ago. Here are numbers and recommendations. As a little wee-tot At just 7 lbs, it's worrisome his trilostane needs increasing again.
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"Test
Results
12.1ug/dL (1-5 reference range) 17.4ug/dL (7.8-19.7referencerange)

Comments: Since his clinical signs are still somewhat present, our internal medicine specialist recommend at these values we go upto10mgtwiceaday. Pleaseletusknowwhenyouneedmoremedications.
Please make a recheck appointment. 8 weeks to recheck ACTH Stimulation to see if further adjustment is needed."
_______
After 2 urinalysis which apparently were too dilute due to his excessive drinking, he was put on clavamox for a suspected silent UTI based on his bloodwork, creatin and bun ratios. They suggested a renal food to supplement, but when inchecked its fat ratios the renal food was over 25% fat on a DM basis. We finally got his stomach woes resuolved by getting rid of high fat so we're still looking at the food issues (vet aware of this).

We've also added lignans once a day (vet okayed) hoping that helps, after changing his diet to a lower fat food (we were shocked to learn the pet food label as to fat content is completely misleading until you do the full math on a dry matter basis).

Is it accurate what i've read that cushings dogs have great difficulty processing fat? Is there a thread listing different foods people have tried with their Cush pups that work well? Is there a thread about experiences people have had with lignans and their cush dogs?

Thank you for your thoughts, comments, ideas, concerns Support groups are great for this type of thing and you all are so knowledgeable it gives me confidence as we work thru his difficulties with Cush.

Ps. Not sure its relevant, but Other meds he is on due to his continuing eye problems and a new injury: metacam liquid for recent eye injury pain (should be finished tomorrow), cyclosporin for dry eye, tobramycin drop for recent eye injury while traveling.

[Squirt's Mom]

Did they run the SDMA? This is a great fairly new test that lets us know much sooner if kidneys are compromised than BUN and CREAT can. If that was not done, I would insist it be done asap so you know the status of the kidneys.

I am also a tad bit concerned about the timing of the ACTH. IF there is a UTI present, that can easily skew the ACTH toward a false positive...meaning those high readings could be due to the UTI and not Cushing's IF the UTI is present. If he has strong signs again then I'd be less concerned but that isn't clear to me from your post. "Somewhat present" is kinda scary. LOL

Also IF he continues treatment for Cushing's, his first test is in 2 weeks, NOT 8 weeks. The testing schedule is very strict for Vetoryl/Trilostane for very good reasons....to lower the risk of the cortisol going too low, which is life-threatening. High cortisol can be lived with for quite some time in most cases but low cortisol is an emergency situation. His first test will be in 2 weeks, the next two weeks later (30 days after starting), the next in 30 days. IF all is well at that point, he will be tested every 90 days. Once the pup is settled it isn't quite so bad to let a little time pass between ACTHs IF the parents are well educated on what to look for but never, never in the beginning of treatment. And this restart is considered the beginning of treatment.

Lignans are part of the treatment combination for Atypical Cushing's in which the cortisol is normal but 2 or more of the intermediate, or sex, hormones are elevated. So it won't help the Cushing's if the cortisol is elevated. The combination is lignans and melatonin. Lignans are high in fiber so watch for diarrhea.

There really isn't a diet for cush pups. What ever they were eating before is fine UNLESS something new like kidney disease, IBD, diabetes, etc. comes along that do require dietary changes. I started home cooking for my first cush pup and have continued to do so for most of my babies since, sick or not. If you would like to try this, I recommend Jody Zesko with Spot On Nutrition. I've used her for my babies in the past with satisfaction.

I don't see any issues with the other meds other than the Metacam (because it's hard on the liver) but that's a short term usage so no biggie. Long term could be a problem but short term is fine.

Hope this helps!
Hugs,
Leslie

[TheBean]

Thank you for this wealth of information. I will inquire about the SDMA. I don't know if this was done. He has finished his 2 weeks of clavamox for the suspected silent UTI and there was improvement after starting it in his overall demeanor and frequency/urgency of urinating. If the are kidneys are compromised is a recommended treatment a change in diet? The vet has susggested incorporating a prescription renal diet food into his feeding regime.
His increased cushings symptoms at the time of the acth test were increased water consumption and urination, increased food obsession, increased anxiety. He also was exhibiting some further weakness in his rear legs with some intermittent minor leg trembling. These symptoms continue although there has been marked improvement in his peeing urgency/frequency which might be? attributable to the clavamox. He's drinking alot, but able to "hold it" better.
I will follow up with the vet on retesting earlier than 8 weeks. They re-tested 3 weeks out after his last vetoryl increase. We have been traveling and are not increasing his dose while we are all on the road.
I guess now we are wondering if he needs an increase in dosage at all if his last stim test results might have been off due to a uti? They tested 2 urine samples but both were "too dilute" and the one they cultured out didnt grow anything. They said there seemend to be an infection somewhere based on his blood test, and the clavamox seemed to make some difference. Is water intake and food obsession and anxiety the right symptoms to look for? Otherwise he's pretty much a happy go lucky kinda guy. Not the sickly miserable fellow he was before we started vetoryl.
Thank you again so much for the advice of this group. It helps us better understand what to do best for the Bean. It is such a relief to be able to talk to people going thru this and who have the experience of having gone thru it. My heartfelt thanks to you all.

[Harley PoMMom]

I would definitely have the SDMA test performed to check kidney function, and if the kidneys are compromised, unfortunately Vetoryl isn't recommended in dogs with renal issues.

A change in diet is very important with renal impairment, blood pressure should be checked too.

Hugs, Lori

[TheBean]

Got it. Very helpful to know. Thnak you.