Cushings or Not ?

Hello Doctors , Opinion please - My boy has had absolutely No symptoms of Cushings .. He is 13 yrs old with moderate pulmonary Hypertension . This has been confirmed by a Cardiologist that took an echocardiogram . On a routine bloodwork with a new Vet ( our regular vet could not schedule any new appts at the time due to loss of staff ) the ALP was 569. New Vet said he has Cushing's ... LDD was done and the  ""  lab report said he could have Cushing's however , if he has other illness that might factor into it , and NOT to treat without symptoms.  ( I was not aware of this at the time )  .."" his resting was 8.9 , 4 hr was 0.7 and 8 hr was 4.2... ,  He was placed on Vetroyl , it nearly killed him .  He rapidly went downhill , both physically and cognitively.  His  hind legs gave out , urinated in house , loss of appetite , and a horrible cough began . cognitively he was confused , spaced out  , did not understand things said to him.  On the Tenth day of vetroyl , I took him to the vets , and I took him off Vetroyl . I told them this medication was making him deathly ill . They said his bloodwork showed WBC elevated and started him on antibiotic . This was on a Thursday.   He had a seizure that night and again Sun.  Its taken him over a month to recover .  My former Vet was able to see him ,  and I had  a UCCR test done - those results were only 24 , the lab report said he likely did not have Cushing's and other causes of clinical signs is recommended . But, he never had any clinical signs . What is your opinion ? I've been told LDD rules it in and UCCR rules it out .  I don't believe he actually had Cushing's based on the information I have learned since then .  I just want another opinion.   Ive been told an elevated ALP does not mean Cushings .   Ive been told an LDD  could indicate Cushings , but, not necessarily and it has a lot of false positives .  Ive been told the UCCR is over 90% accurate ....  My boy has pretty much recovered .  He is healthy again physically and cognitively he is about at 90%.  In your opinion , do you think he had a too large dosage , which was 30 mg daily for a 24 lb dog , or he simply never had Cushing's ? Thank you for any input . 1 Comment Like Comment

Hello - let me tell your story back to you.  Your vet got some results that they interpreted to mean that your dog had Cushings.  They treated for Cushings but the patient turned out not to have Cushings- indeed it sounds as though they might have had an Addisonian crisis (the 'opposite' of Cushings happened in their body) when treatment for Cushings was given.  This can be extremely serious.  Your dog was consequently taken off the Cushings treatment, has done very well and your vet says that they don't think it was Cushings.  Your dog is now doing brilliantly.

Having reached that point, it sounds as though taking your dog off Vetoryl and doing the second test was the correct course of action.   Cushings is a chronic diseases - so in my understanding, once it is diagnosed, dogs do not tend to recover but live with the disease pretty well, given the correct drugs.  The starting dosage for Cushings is usually given in the datasheet inside the vetoryl packet and is given in mg per kilo, which means, that that number of mgs need to be given per kilo that the dog weighs. I wonder where these questions are leading?

The manufacterer suggests a starting dose for Vetoryl, although there will be exceptions.  This is 1- 3 mg per pound.   ie no more than (3 x 2⁴) miligrammes in a 24 pound dog. However, from a linguistic point of view,  any dose of a drug that is too much for that dog at that time may be considered an overdose.  I think that this is the crux of what you are asking.

Please note that I meant to write 24 up there, not 2⁴ which maths buffs will know to be something completely different.  With apologies.

So no more than 3 x 24 mg in a 24 pound dog

Dear Liz,  Thank you so much for the input .  Once this happened , the vet who was seeing us was removed from the case ,  and the owner , also a vet took over my dogs care . I did not ask for this , actually I liked the original vet very much . She was young , a very sweet person , and  you can tell how much she loves animals .  The owner was very vague about my questions which prompted me to research into Cushings , how its diagnosed , what lab results  mean , use of  Vetroyl ,  etc.  , and led me to believe my dog may have been  misdiagnosed .   Its my understanding that Cushings is one of the more difficult diseases to diagnose , but, my boy had absolutely no symptoms of Cushings .  The ALP was 569 on a routine blood test .  With a 13 yr old dog with known pulmonary hypertension , that should have been considered .  The LDD test has an average of 50% false positives , and my boy was super stressed . He tried to run away when they called us to go back . Accidents and mistakes can and do happen . I understand that completely.   However,  I want the truth  , my dog got deathly ill , and had to be hospitalized .  Can you explain exactly what addisonian crisis is from  your professional point of view  ?  The owner knew he was sick and hospitalized ,  but, when I asked if my boy even had Cushing's ,  the owner only said "  he didn't know , and the treatment can be worse than the disease ".    My boy was not sick, he never had any symptoms.   Im just trying to educate myself .   If he actually has Cushings , I would not treat him until he is sick and has symptoms , and then I would want information about holistic treatments . He can not tolerate Vetroyl . If he does not have Cushings  , I feel I as his pet mom , I have a right to know .  I was told that the UCCR ruled out him even having Cushings .  The test result was 24 , and the lab form said anything <34 meant it is highly unlikely the dog has Cushings .  My boy sees a neurologist on Monday, and I will ask more questions then . After he had the seizures , he was put on Keppra ,  and I want to find out if  the Vetroyl  can cause a stroke or what happened , and if not ,   he can be safely taken off Keppra .   He currently takes Keppra, Sednifil and Hydrocodone .   Oh, when he was on Vetroyl , it was a 30 mg capsule once daily and he weighs 24 lbs.  Lastly , do you know if Vetroyl can cause WBC to elevate ?  Prior to starting his WBC was normal , then it elevated and he took several courses of antibiotics .  He is fine now .  I just dont know or understand much .  I thought WBC meant infection but, I have read certain medications can also cause the WBC to elevate . Thank you so much for your time , knowledge and opinion .

Hello.  I was not very clear and waffled a lot in my answer;  let me try again.  It sounds to me as though you need to ask your own vet or a second opinion vet explicitly whether your dog has Cushings - yes or no.  If I understand correctly, I think that your vets have now found out that this patient doesnt have Cushings.  If that is the case, you may want to know whether the Vetoryl was incorrectly given on the basis of a false positive test, and whether this meant that the collapse was therefore preventable.  The neurologist is better placed than me to explain whether the Keppra can now be reduced and if so, how quickly that should be done. I do think that you are right to be asking these questions and wish you all the best in getting to the bottom of the matter.   The RCVS have an independent investigative procedure which can be helpful if necessary.