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Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 11:34
by Elcy
Hi All,

We have been through so much the last 6 weeks I am not sure where to start. Walter, GSD mix, was diagnosed with Cushing's Disease and we began Vetoryl treatment about 6 weeks ago. It's not unusual that once chronically high cortisol is supressed with treatment for masked conditions to suddenly appear due to the lack of steroids, and he has become visibly sick with pancreatitis. His test levels were quite acute and we are amazed that he was not exhibiting more severe symptoms, our clues was elevated liver enzymes, Coprophagia(last 6 months), and bouts of mushy/smelly orange poop. It was my observation that lamb tails for lunch made elicited the bad poop (lamb tails have large chunks of fat on them) that prompted us to test for pancreatitis. I don't have his exact test results yet, I will post them when I get them.

I suspect that this has been going on for quite some time because Walter has been losing weight steadily, he's down from 96 to 84 lbs despite a hearty appetite and us increasing his meal size; this tells me he isn't absorbing what he's eating and that the chronic pancreatitis may have developed into EPI.

Has anyone else dealt with a dual diagnosis of Cushing's and EPI? If so, any suggestions for me?

I have immediately removed higher fat meats from his diet, he is and has been fed a whole prey raw ground diet for his entire life. I suspect that the enzymes in the meat may have helped "save" him from getting much sicker than he has been. I also have ordered raw pancreas to add to his food, and in the meantime started with freeze dried pancreas mixed in and allowed to sit for ~40 minutes prior to feeding. Wonderlabs b-12 has been ordered and should be here tomorrow.

We have an appointment tomorrow for an abdominal ultrasound to rule out any tumors or cancer.

I am looking for any other suggestions on nutrition, tests, or general care. It's been a rough couple of weeks for us, in addition to trying to figure out what's been making Walter so sick we just lost his brother two weeks ago, so on top of everything we are dealing with the recovery from that loss.

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 11:59
by Olesia711
Hi Walter's person,

Thanks for writing in. Although i did not deal with EPI + Cushings in the same dog.... i did have two dogs at the same time
1. one with EPI + Diabetes+IMHA+Low Thyroid + Incontinence (get the picture???!!!)
2. another with Cushings

With the Cushings and EPI the diet is very manageable. Most important thing with the Cushings part is to NOT feed any hi protein foods....just stay away from organ meats. So basically, middle of the road protein levels.

With the EPI part (and this sounds like secondary EPI in other words triggered from another condition/situation vs. primary EPI. Most likely, as your vet suspected from chronic pancreatitis which segued in EPI (end stage pancreatitis). With this type of EPI, it is indeed better to limit the fat intake.

VERY glad to hear that your dog is on Cushing meds. However... if the Vetoryl doesn't do a good enough job of controlling the Cushings, be sure to ask your vet if your dog would benefit from Mitodane (Lysodren)... BTW... these drugs are super expensive...i found it to be a HUGE savings by going to a small pharmacy and ordering the entire bottle of pills (for example i paid $500 for a Lysodren- -that i gave 3 pills a week)... this saved me over $300 for the same amount of pills sold to me via script from the vet for monthly or 3 month refills. just saying.........worth checking into.

The elevated liver enzymes should come down now that you are giving enzymes and on Cushing drugs..... but they will have to periodically monitor the Vetoryl..... or any Cushings drugs for that matter.... just a fact of life.

Also....if your dog starts losing hair from the Cushings, talk to your vet about giving Melatonin twice a day.... AND..... not sure exactly which type of Cushings you have BUT also ask the vet if it would be beneficial to give SDGs (flax Seed Hull LIGNANS). To this day i swear these lignans gave my dog multiple years with Cushings.... My Rico lived for 11 years AFTER being diagnosed with Cushings.... and passed away 2 years ago at the ripe old age of 16 .

My EPI gal (with all that she had going on) once i got the right balance of treatment for each condition, she was a very VERY lively happy pup that lived to 15 years old .(she just passed away this February)

... just sharing this to let you know that sometimes things do not turn out as bleak as you think they are going to........

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 12:22
by Elcy
Hi Olesia, thank you for the quick response!

One of the clues that we had a secondary condition to Cushing's was that Walter's ALT and ALP tripled in value 6 weeks after starting the Vetoryl, obviously that was very alarming and we suspect he was in the midst of a more acute pancreatic attack at the time. 5 days later we tested again and the liver values have begun to go down, again I will post more data once the vet emails all of the test results to me.

His Cushing's is of the pituitary variety. Despite his cortisol levels being in optimal range (via ACTH stimulation test) we are dialing back on the Vetoryl for a bit, he became very lethargic the last few weeks probably due to not feeling well from the pancreatitis. We figure picking a happy medium with the cortisol and tempering the pancreatitis symptoms right now is best for him.

From your experience do the melatonin and HMR Lignans interfere with monitoring of the Vetoryl? I don't want to throw more variables into the mix until we get him stabilized with both conditions.

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 12:30
by Olesia711
i honestly don't know if the Melatonin or Lignans will interfere with the testing.... maybe the melatonin, but i cannot imagine that the Lignans will.
But please ask your vet first if the above supplements will help your dog with his Cushings....

Yea, you have got to be careful with those Cushing drugs... they had to test my dog 3 times before they got the right dosage.... (Lysodren) but it sure helped.

I do have a question for you.... does your vet think your dog had an Acute pancreatitis attack .... or has your dog had chronic pancreatitis (whether you knew it or not) and this was a final flare up that segued into EPI?

The reason why i am asking is because even with chronic pancreatitis or CP flareups ...a lot of vets prescribe a lesser amount of enzymes to help the pancreas do its job. Simply put.... with Pancreatitis..the pancreas is so inflamed that the pancreas stops digesting the nutrients and this is where a little bit of enzymes help (sometimes just temporary) .
With EPI the pancreas has atrophied so there is not much there for the pancreas to digest the nutrients (permanent)

BUT..... if your vet thinks this was an acute pancreatitic attack, be sure to ask him if it is okay to give the enzymes right now or should you wait a bit.

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 13:08
by Elcy
We just got the pancreatitis test back yesterday and are waiting on a few other test results to come in regarding the liver function, so we haven't yet gone in depth on chronic vs. acute.

Would the ultrasound show pancreas atrophy due to EPI? I know it will show inflammation.

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 13:34
by Olesia711
the gold standard to test for EPI is via the TLI blood test.... my understanding is that an Ultrasound, CT, and or MRI's only show increase/decrease in the size of the pancreas's body, head or tail, etc..... BUT.... they techincally cannot be depended upon to show pathologic changes .......

SO... i am assuming they can "guess" tht this might be EPI with a ultrasound, but cannot be sure until a TLI blood test is done.

Usually they do and ultrasound, MRI or CT to help them see if they should do more specific individual testing (like the TLI test for EPI)....

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 14:39
by Elcy
OK, I'll see how things go with the ultrasound but will likely schedule the TLI blood test so I can be fully informed. Thanks again for all of the good info!

Re: Any experience with EPI and Cushing's?

Posted: 24 Jun 2020, 23:59
by Olesia711
Good Luck and Please keep us posted.

Oh... when scheduling the TLI.... you need to "food" fast the dog for at least 12 hours prior to the test.... so many folks schedule the blood draw first thing in the morning. sure not to draw blood on a Thursday or Friday, cause by the time it gets shipped it then may get stuck sitting in a lab over the weekend before getting tested and that will skew the accuracy of the test.

And since you are getting the TLI done, might as well draw enough blood and test the B12 (Cobalamin & Folate blood) test... cause if this is EPI, over 82 % of all EPI dogs need B12 supplementation..... so best to find out right at the beginning.

Re: Any experience with EPI and Cushing's?

Posted: 26 Jun 2020, 23:24
by Madelon
Hi there and welcome to our EPI family. I'm so glad Olesia is helping you as she is the expert on all things EPI, diabetes, cushings and a whole host of other doggie issues. Just know that there are a lot of us out there thinking of you and your pup :)