What is the best treatment for my Chloe, 9 yr old Rat Terrier/Fox Terrier mix [Archive] - Canine Cushing's Information and Support Forums

kimbodaisy4

08-11-2009, 11:55 PM

My Chloe

She is a 9 year old Rat Terrier/Fox Terrier mix just got diagnosed with Cushing's Disease today. I can't remember if the vet said it was a tumor from the adrenal gland or the pituitary, but odds are it's pituitary. She will call me back tomorrow to tell me and we will discuss options of treatment on Friday.

I am sooo sad. She is my everything. Can you guys help me decide on the healthiest, happiest, cost efficient, least invasive treatment for her? She is about 16lbs, doesn't have much hair loss or pot belly. Not too sure how far along in the disease she is. All I know is that the lysodren treatment doesn't sit well with me because of all the possible complications/side effects.

I would like to be proven wrong about it, or given other advice. Does anyone know about holistic approaches...I just need help. Please help me, all of you know best because it's happend to your loved one.

Thank you so much,
Kim

frijole

08-12-2009, 12:02 AM

Hi Kim! My name is Kim! :p

I am going to make your day. It is not a death sentence and your dog will be just fine. You just have some "learning" to do. And you are on top of things by researching and reading already so good for you!

My dog has been using lysodren for 3 yrs now and she is 15 1/2! I was afraid of lysodren also but it isn't really a big deal - you just need a vet that has experience and that clearly explains to you how to dose Chloe.

Sorry but holistic cures (the miracle drops) just don't exist or we'd all be using them. There are different types of cushings including atypical cushings which IS treated usually with melatonin and lignons.

There is no reason usually to rush the treatment. You want to make sure you have done all necessary testing (normally more than one or two!) and that should determine which drug you use. I'll save that for later as it is overwhelming at first.

Tell us about Chloe, her symptoms, the tests that were done and the results if you have them. We will help you through this and seriously - you will be fine. Glad you found us!

Kim

Go here for our resources section to read - great stuff:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

StarDeb55

08-12-2009, 12:18 AM

Kim, I would like to give you & Chloe a big welcome! I'm sorry for your need to be here, but glad that you have found us. First of all, let me warn you that we tend to play "20 questions" with new members. All of the questions & your answers just help us to get a better handle on what has been going on with Chloe, so we can give you the best advice we can from the group's collective experience. So here goes.

Can you tell us about Chloe's symptoms that led you to take her to the vet? Some of the symptoms may include a voracious appetite, pot belly, excessive drinking & urination, skin/coat issues, muscle weakness/wasting,especially in the rear end. Do you have copies of all of Chloe's test results, so that you can post the numbers for us? If you don't have copies, I would strongly recommend that you ask your vet for them. Most of us do keep files on our pups at home because you never know when you might need them, especially if you end up at a strange vet. Do you know what type of tests your vet has done to make the Cushing's diagnosis? Did your vet rule out such issues a diabetes & thyroid? This is very important because the symptoms for these 2 problems are very similar to Cushing's. Did your vet do any basic labwork such as a senior wellness panel or super chemistry panel? Could you post only the abnormals on the general labs? Does Chloe have any other health issues or is she taking any medication, or supplements

When it comes to treatment, I hate to disappoint you but there is no herbal or holistic treatment that really works. The goal is to lower the high levels of cortisol produced by the adrenal glands to a more healthy level, & right now the only to drugs that can do that are lysodren & trilostane. I really can't talk much about trilo, as we like to call it in the group. I have now treated 2 pups quite successfully with lysodren. My 1st Cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15 years old. Harley is 14 years old, was diagnosed with both regular & Atypical Cushing's about 16 months ago. He has been treated with lysodren from the start & is doing well. Both drugs are very powerful drugs, but they are life-saving drugs for our pups. No matter which drug you & your vet choose to treat with, it is IMPERATIVE that your vet follow the standard protocols for loading, dosage, & monitoring of the drug. When things go bad with a a pup who has just started treatment, it is most usually do to an inexperienced vet who is not following these standard protocols, is "flying by the seat of their pants", & the pup pays the price.

The best thing you can do to help Chloe is to become an educated, knowledgeable owner as you are her only voice & advocate. Along those lines, you may want to take a look at the important information section of the forum where there is a huge number of links that will lead you to most any information you want to know about Cushing's.

I'm sure some of the trilo parents will be around to offer you their input. Please keep us posted as to how you proceed. We are here to help in any way we can.

Debbie

PS- I see Kim & I were typing at the same time, so sorry for any duplication.

Harley PoMMom

08-12-2009, 12:21 AM

Hi Kim,

I just want to welcome you and Chloe to our cush-family, I am so sorry for the circumstances that brought you here...but so glad that you found this forum.

These people are amazing...very knowledgeable about cushings. They have years of collective experience with this disease...you have definitely come to the right place.

Just remember you are not alone...we are here and we will help you.

Hugs.
Lori

kimbodaisy4

08-12-2009, 12:23 AM

First of all thank you so much, your quick response brought tears to my eyes and I feel like a weight has been lifted off of me for knowing that I have this resource.

Chloe's Symptoms are:

Excessive water intake
Excessive urination
Lack of appetite (atypical i think)
Bit of hair loss on sides of tummy not alot
Darkened skin on her belly
Saggy/Wrinkly appearance to her skin (not potbelly)
Diarreah recent (for about 3 days now getting slightly better)
Excessive Panting
Laying on the floor instead of the couch (NOT LIKE HER)
Tired all the time
Bladder infection (now treated)

She initially went to the vet for her excess in water/urination. Found out she had a bladder infection and was treated with antibiotics, but when the water drinking hadn't stopped..they tested her urine and thought maybe she had diabetes. Tested her blood, and turned out it was not diabetes. They were confused for a while because she had glucose in her urine and not in her blood. Then she thought maybe Cushing's so we did that ATHC test or whatever it's called and I was a little overwhelmed today when she told me all of this information...so I can't really remember what the details were about her test results but she is going to call me back tomorrow. She did confirm Cushing's Disease.

What types of questions should I ask my vet on Friday?

THANK YOU SOO MUCH KIM!!!

kimbodaisy4

08-12-2009, 12:29 AM

Debbie, thank you for responding to me, this all really helps me feel so much better.

I posted her symptoms already...and I will see about getting all of her test result paperwork and as soon as I get it, I will post!

So, I should get her tested for a thyroid problem before treating for Cushing's? We have ruled out Diabetes.

Chloe is not on any medications or supplements.
She did take antibiotics recently for her bladder infection, and was on predisone for about one week this summer due to skin allergies. I took her off of it as soon as possible due to the negative side effects and hope that it didn't cause this.

Thankyouthankyou...
Kim

StarDeb55

08-12-2009, 12:31 AM

Is the ACTH the only test that was done to diagnose? It's a really bad idea to try to make the diagnosis based on a single test result as Cushing's is one of the most frustrating/difficult disease to diagnose as there is no single test that is 100% sensitive or specific? Most Cush savy vets like to confirm a positive ACTH with a second test usually an abdominal ultrasound to get a good look at the adrenal glands.

When it comes to symptoms, Chloe's do point toward Cushing's. Don't worry about the lack of appetite as not all of our pups have read the "book" on what type of symptoms they're suppose to have. Harley is another one who absolutely doesn't have a big appetite. In fact, his pickiness frequently makes me nuts. Chloe is laying on the floor as she is looking for cool places to rest, this is very common. Also, frequent infections that can be difficult to treat are quite common as Cushing's suppresses the immune system. My Harley fought a non-healing corneal ulcer for nearly a year before we got it under control.

Kim, there is no huge rush to treat. Cushing's is a very slowly progressing disease. It's more important that you take a little time, educate yourself, & make absolutely sure that you have a confirmed diagnosis before you begin treatment.

By the way, is your vet just you regular vet or are you seeing an internal medicine specialist?

Debbie

kimbodaisy4

08-12-2009, 12:31 AM

Lori,

Thank you so much for your added support. Chloe is very loved and I know we will get through this with all of your help in this support group. Right now she is sleeping on the floor dreaming and moving her little feet like she's running. How cute. :)

Can't express my gratitude.
Kim

kimbodaisy4

08-12-2009, 12:36 AM

Debbie,

Now that you have said that I feel like my vet is rushing me. The ACTH test is the only one that has been done. She wanted to order medication today on the phone and I felt like that was too soon as I knew almost nothing about the disease. Do you think I should consider going somewhere else, if she were experienced she would have known to do more testing....? I don't want to have her treated by a doctor who doesn't know absolutly the best for her..

Thanks,
Kim

StarDeb55

08-12-2009, 12:36 AM

Kim, if the prednisone was only for a brief period of time, that shouldn't be a problem. Was any of the testing that has been completed, done while Chloe was on prednisone? You were very wise to stop the prednisone ASAP as there is a 3rd type of Cushing's called iatrogenic which is induced by long-term use of prednisone or other steroids.

If you haven't had her thyroid checked, then absolutely, I would have that done. There is a thyroid problem that is associated with Cushing's called sick euthyroid syndrome which will resolve with the Cushing's being treated. I'm telling you this because you need to ask you vet to also run a free T4 because if Chloe does have Cushing's, there is a possibility the routine thyroid tests may come back low. The free T4 is the only to determine if Cushing's is causing the thyroid problem.

Debbie

PS- I'm sort of the resident lab expert as I have worked as medical lab tech for 29 years, so I can help you understand all of the "numbers".

kimbodaisy4

08-12-2009, 12:38 AM

Debbie,

The vet is my regular vet, not a specialist in Cushing's. Is there a huge cost difference for a specialist as opposed to the regular vet? I know that my ACTH test was only $80...which from what I've read might be pretty cheap.

I know that there isn't a cost for love of my dog, I love her dearly but I'm a poor college student. Would love to do the best for her, but can't break the bank.

Thanks, Kim

kimbodaisy4

08-12-2009, 12:42 AM

Debbie,

No, she was not tested while on predisone..
I will get as many numbers as I can when I meet with her.

I'm happy to know that this is a slow progressing disease and that I have time to get all of this information correct. And thank you for informing me!

Kim

StarDeb55

08-12-2009, 12:46 AM

Please don't feel that I'm knocking your vet, but we have seen vets try to make the diagnosis time & time again in this group based on only one test. IMHO, the best investment you can make is an abdominal ultrasound. Chloe's adrenal glands can be checked, & if they're enlarged, that would confirm the ACTH result. You also can get a look at all of Chloe's abdominal organs to get a better idea of her overall health.

If your vet has minimal experience treating Cushing's, I would then suggest you ask for a referral to an internal medicine specialist as they are the vets who are the experts in this area. I use my regular vet as he is pretty Cush savy, treated Barkley successfully for years, so I had no problem taking Harley to him. If you're comfortable talking with your vet, why don't you have a "heart to heart", & ask how much experience they have with Cushing's, would they have any problem with listening to your input on how you would like to proceed, & would they have a problem with working with you to insure that Chloe gets the best care possible. I would also ask how much experience they have in using the 2 drugs of choice. The most successful treatment happens when the vet & owner are working as a "team" on the pup's behalf. If your vet is resistant to any of this, then, I would say you need a referral to a specialist.

Debbie

StarDeb55

08-12-2009, 12:53 AM

Kim, all of us understand the financial burden of treating. This is why I haven't taken a vacation in 5 years. Looking at $$, you may want to consider lysodren as your first choice. Once you would get Chloe stabilized on lysodren, the costs go way down. The testing to monitor the medication would only have to be done quarterly, & maybe only twice a year. Also, once stabilized with lyso, you would only be giving meds 2-3x per week, trilo has to be given daily.

Yes, $80 is dirt cheap for an ACTH. With finances being a concern, I would ask about the abdominal ultrasound. If you opt for that, make sure that it is done on a high resolution machine so that the adrenals are clearly visualized. I'm a huge advocate of an ultrasound as we discovered that Harley had a pre-existing gall bladder problem which includes a dilated common bile duct. Harley was very ill about a year ago, at the vet's on IV fluid for 2 days, with what turned out to be a gall bladder attack. If he had not had the ultrasound, we never would have known.

I'm going to have to bag it for the night as I have to be at work at 5 AM. I will check in tomorrow afternoon. Please don't hesitate to keep asking questions tonight as we have some "night owls" who are around & usually available.

Debbie

Debbie

kimbodaisy4

08-12-2009, 12:57 AM

Thanks to all of you I feel like I can get off the computer and maybe sleep a little now...I feel at ease. I can't even express my happiness about this website and for all of you!

Next steps:
Get test results on paper
Post them on here, get advice..
Seek out a Cushing's specialist
Get Chloe an appt. for an ultrasound

Let me know if there are any other questions I should be asking or what other steps I should be taking. I'll be happy to someday share my story and advice with a newbee on here...to pay it back. :)

Sleep well and enjoy snuggling with your doggies.
Kim

kimbodaisy4

08-12-2009, 11:48 AM

Hello all,

I called around and the best estimate I got for an abdominal ultrasound was for $220 (that's my original vet too so that's cool). I'm going to make an appointment to get that done. After getting that done,

I should know what form of Cushing's Disease she has right??? And would not need any further testing??
Then from there we can discuss treatment..

I'll keep you posted.
Thanks!
Kim

Harley PoMMom

08-12-2009, 12:37 PM

Hi Kim,

When it comes to getting an ultrasound done you want to make sure that it is done on a high resolution machine, many regular GP's don't have this type of machine, I know my regular GP doesn't, I have to take my Harley to the Univ. of Penn. to get his ultrasounds done. This is a very important test to have done, and it must be done and read properly.

Your Chloe is just a little girl...16 lbs? right? well her adrenals are small and that is why a high resolution machine is so valuable here. On my Harley's U/S it showed that his right adrenal had a 7.3 mm nodule at the caudal pole. 7.3 mm is so small, about the size of the end of a pencil eraser (before you start using it!).

This is just my opinion, tho.

Best of luck to you both.
Hugs.
Lori

SaxLady

08-12-2009, 02:04 PM

Hi Kim!
I totally agree with Lori. The ultrasound MUST be done on a high resolution machine. That is how they found my doxie Katrina's adrenal tumor. Katrina is a tiny girl, only weighing 9 3/4 pounds. There was a thread on here the last couple of days giving the specifications for a high resolution machine. You might want to enter keywords in search to find it. I don't know how to do the quote thing, otherwise I would bring it up.
Hugs,
Candy

gpgscott

08-12-2009, 03:05 PM

Hi Kim,

Welcome to you and Chloe.

I would not rush into an U/S. Although U/S is a good diagnostic tool and you should probably have one at some point it needs to be done as has been mentioned on suitable equipment and even more importantly by a Dr. specifically skilled in imaging adrenals, this skill is usually only found in the office of an IMS (internal medcine specialist)

I think the first bloodwork should be a full adrenal panel from UTK (University of Tennessee@Knoxville). If you were only charged $80.00 (which is real low) for an ACTH this test should be about $260.00 and will tell you about all six adrenal hormones all of which can cause Cushing's. I gotta say I suspect you did not have an ACTH but if you could post the results that would clear up the question. I also am suspect of her being cleared of diabetes as I know in humans glucose in urine is a serious marker, have her kidney values been assesed?

We see many people and pups put through the diagnostic wringer. If she has Cushing's there is usually plently of time for a methodical diagnostic process which will minimize stress for both you and Chloe.

Please let us know the results of what has been done as soon as possible.

Best to you both. Scott

Harley PoMMom

08-12-2009, 03:34 PM

Hi Kim,

I guess I'm gonna eat my words here. :o I called The Univ. of Penn. Radiology dept. and talked to a Radiologist, I asked him about their U/S machine and he said their U/S machine is not a "high resolution machine" per se but a top of the line GE Voluson U/S machine.

When I asked him why my regular GP's U/S machine wouldn't pick up Harley's nodule, he explained that their GE U/S machine came with all "the bells and the whistles" and they could dial it in.

So Scotts explanation is probably more apt,
done on suitable equipment and even more importantly by a Dr. specifically skilled in imaging adrenals, this skill is usually only found in the office of an IMS (internal medcine specialist)

Hugs.
Lori

k9diabetes

08-13-2009, 12:42 PM

Hi Kim,

I am a satellite member of this forum as I had a dog with diabetes but not Cushings. A handful of dogs wind up with both...

I'm concerned about the diagnosis as well because all the symptoms you described are far more in line with diabetes than they are with Cushings. The two diseases share many symptoms but in particular the fact that she doesn't want to eat is more common with diabetics than with Cush pups and the fact that she apparently had glucose in her urine and a UTI.

So I want to chime in that I would not treat for Cushings until a lot more is known about what's going on with Chloe.

Definitely get a copy of all of Chloe's test results and post them here - her value on the blood tests, etc., and the reference range provided.

Is Chloe spayed?

Diabetes in an unspayed dog can come and go with heat cycles.

Very anxious to see the results of Chloe's tests as that will answer many of our questions.

Natalie

StarDeb55

08-13-2009, 12:59 PM

Kim, after Scott mentioned his concerns about glucose being found in the urine, I went back & re-read everything you have posted so far, as the glucose in the urine was bugging me, too. I know of no other reason for glucose to be found in the urine EXCEPT diabetes. This is the reason why I asked Natalie to take a look as she is our diabetes guru. Now, I'm not real sure about a Cushing's diagnosis, either. So, as soon as you get those results, please post them.

Debbie

kimbodaisy4

08-13-2009, 07:28 PM

She was tested for diabetes and it was negative. They were confused about that too, that she had glucose in her urine but not in her blood. This is why we did further testing and she said that it was Cushing's. Chloe is not spayed btw.

StarDeb55

08-13-2009, 08:38 PM

Kim, I think it would be a good idea to run the possibility of diabetes by your vet, again, especially in light of Chloe not being spayed.

Debbie

Harley PoMMom

08-13-2009, 09:01 PM

Kim,

Here is something else I found that you might want to check out.

Fanconi Syndrome in Dogs

Fanconi syndrome is a disorder in which the proximal renal tubules of the kidney do not properly reabsorb electrolytes and nutrients back into the body, but instead "spill" them in the urine.Symptoms include excessive drinking (polydipsia), excessive urination (polyuria), and glucose in the urine (glucosuria.)

http://www.caninegeneticdiseases.net/Fanconi/basicFAN.htm

Hugs.
Lori

AlisonandMia

08-13-2009, 09:03 PM

There is one thing that I know of that can cause glucose to show up in the urine but normal blood glucose and that is something called Fanconi Syndrome. This is usually genetic but recently there have been outbreaks of something that looks very like Fanconi Syndrome that has been traced to certain imported treats, particularly chicken jerky treats from China. It seems that whatever causes this has something to do with the treats being irradiated before being brought into the country. Has Chloe had any treats of this sort recently?

The other thing is, with the blood that was tested for glucose levels, was that done in house by your vet or was the sample sent out to a lab for testing. I'm guessing the vet tested it then and there but if it was sent out it is possible that the glucose level was actually higher than showed up on the testing. This is because the living cells within a blood sample will keep on using the glucose within the sample as fuel and so by the time it arrives at the lab and is tested the glucose can show up as being lower than it actually was when the sample was drawn.

Alison

I see that Lori has beaten me to it!

Here's a link to some info about Fanconi Syndrome in dogs: http://www.carolonpets.com/blog/pet-news/jerky-treats-causing-fanconi-syndrome-in-dogs/

k9diabetes

08-13-2009, 09:11 PM

When was she last in heat?

Female dogs can have high blood sugar only while in their heat cycle and the blood sugar goes back to normal once the heat cycle is over.

Have you seen improvement in the drinking and urinating since that test was done?

I know we will know a lot more when you have the test results to post... sometimes it is hard to wait though! ;)

Natalie

StarDeb55

08-13-2009, 09:48 PM

Alison, what you said is basically correct about glucose being used as fuel by the RBC's but there is a big BUT, in your explanation. Most human Dr.'s offices & vet offices centrifuge down (spin down) whole blood collections, separate the serum, freeze & send the serum. As long as the sample were centrifuged, this wouldn't be a factor.

Debbie

PS- Most any analyzer that would measure blood glucose requires serum or plasma as a sample, so the whole blood would have been centrifuged, eventually.

kimbodaisy4

08-16-2009, 08:45 PM

Chloe is going in to have her ultrasound tomorrow morning. I will have them print out all the lab tests and information of tests done and I will post them here probably on Tuesday night after work. Thank you guys and I will ask her all about that other syndrome...

Kim

MiniSchnauzerMom

08-17-2009, 12:48 AM

Kim,

Just wanted to wish you good luck with Chloe's ultrasound tomorrow. Will be watching for your update.

Louise

kimbodaisy4

08-18-2009, 12:10 AM

I got a huge packet of test results and all of it looks like gibberish to me. I will try my best to re-write them.

7/16/09
Hemogram (MWVCLT)
Red Blood Cell Count 6.26 x10^6/uL
Hemoglobin 14.2 g/dL
Hematocrit 43%
Mean Corpuscular Volume 68.8 fL
Mean Corpuscular Hemoglobin 22.7 pg
Mean Corpuscular Hgb Conc. 33.0 g/dL
Red Cell Distribution Width 16.9%
Platelet Count * x10^3/uL
White Blood Cell Count 10.4 x10^3/uL
Seg. Neutrophil Absolute # 7.07 x10^3/uL
Band Neutrophil Absolute # 0.00 x10^3/uL
Lymphocyte Absolute # 2.18 x10^3/uL
Act Lymphocyte Absolute # 0.00 x10^3/uL
Monocyte Absolute # .52 x10^3/uL
Eosinophil Absolute # .62 x10^3/uL
Basophil Absolute # 0
Other Absolute # 0
Blast Absolute # 0
Promyelocyte # 0
Myelocyte # 0
Metamyelocyte# 0

Differential (MWVDIF)
Segmented Neutrophils 68%
Lymphocytes 21%
Monocytes 5%
Eosinophils 6%
Nucleated Red Blood Cells 1 /100WBC

Animal Profile 1
Glucose 220 mg/dL (HIGH)
AST(GOT) 36 U/L
ALT(GPT) 72 U/L
Alk.Ptase 103 U/L
Total Bilirubin 0.1 mg/mL
Cholesterol 214 mg/dL
Total Protein 6 g/dL
Albumin 3.2 g/dL
Globulin 2.8 g/dL
Urea N 6 mg/dL (LOW)
Creatinine .7 mg/dL
Phosphorous 4.9 mg/dL
Calcium 9.9 mg/dL
Sodium 144 mmol/L
Potassium 4.9 mmol/L
Chloride 107 mmol/L
Bicarbonate 15 mmol/L (LOW)
Anion Gap 27 mmol/L (HIGH)
GGT <3 U/L
A/G Ratio 1.1

RUA Dip
SP-TY Free Catch
Color Yellow
Turb Clear
Gluc Negative
Bilirubin Negative
Keto Negative
Sp-Gr <=1.005 (LOW)
Bld Negative
pH 9.0 (HIGH)
Prot Negative
Uro Norm
Vol 10mL

Notes:
Platelets are clumped but count appears to be 175-450 thousand
No significant poikilocytosis or polychromasia seen
The specimen is moderatly hemolyzed. Lipemia and hemolysis may skew serum chemistry results.

7/27/09
RUA Dip (MDVDIP)
SP-TY Free Catch
Color Yellow
Turb Clear
Gluc >=1000 mg/dL (this was circled) (ABNORMAL)
Bilirubin Negative
Keto Negative
Sp-Gr 1.015 (LOW)
Bld Negative
pH 6.0
Prot Negative
Uro Norm
Vol 10 mL

RUA-Micro (MDVMICR)
Sp-TY Free Catch
Hyl Rare
Fine None Seen
Coarse 0-2 LPF (ABNORMAL)
Renal Epi Casts None Seen
WBC 0-2 HPF
RBC None Seen
Renal Epi Cells None Seen
Squam 0-2 HPF
Mucus 1+
Bacti None Seen
Vol 10 mL
Amorphous 1+

7/29/09
Glucose (MDVGLU) 131 mg/dL

8/6/09
RUA Dip (MDVDIP)
SP-TY Free Catch
Color Yellow
Turb Clear
Gluc Negative
Bilirubin Negative
Keto Negative
Sp-Gr 1.020
Bld Negative
pH 6.5
Prot Negative
Uro Norm
Vol <5mL

RUA-Micro (MDVMICR)
Sp-TY Free Catch
Hyl Rare
Fine None Seen
Coarse None Seen
Renal Epi Casts None Seen
WBC 0-2 HPF
RBC Rare
Renal Epi Cells None Seen
Squam 3-5 HPF (ABNORMAL)
Mucus None Seen
Bacti 1+ (ABNORMAL)
Vol <5mL
Amorphous 1+

Notes:
Rare Calcium oxalate crystals present
Droplets resembling fat seen per HPF

Amorphous = Amorphous urates, no clinical significance

8/10/09
2Hr Cortisol 34.2 ug/dL
Cortisol Baseline 16.1 ug/dL (HIGH) Normal Range (1.0-5.0)
Notes:
Normal Values for the ACTH stimulation test: baseline cortisol of 1 to 5 ug/dL in dogs and post-ACTH cortisol of 10-20 ug/uL in dogs (in 1 or 2 post ACTH samples)
Cortisol conversion factor is: Cortisol ug/dL x27.6=nmol/L

8/17/09
Ultrasonographic Findings (Handwritten sorry if it's not 100% correct spelling put a ? next to spelling i can't decipher)

(Abnormal)RT Adrenal mildly enlarged, plump, hypoechorc? R=16.8x5.8x5.4mm
LT Adrenal Upper Limits normal L=17.2x4.3x4.7mm
(Abnormal)RT Kidney 44.9mm
(Abnormal)LT Kidney 42.7mm both have slight nuneral? stippleng within the parenchyma? no pelvic dilation
(Abnormal)Uterus both horns mildly dilated c anechoic? fluid and irregular/slightly nodular mucosal wall
Ovaries Normal
Everything else normal
Diagnosis:
Right Adrenal Gland hyperplasia DDx stress vs. pituitary induced
Uterine fluid present DDx nuncometra?, pyometra, hydrometra,c probable endometrial? hyperplasia
Bilateral benign nephrocalciosis?

OK. Sooo if someone could just let me know what the heck all that means...that would be awesome. I have an appointment to get her spayed after the results of the ultrasound. That will be happening next Friday. She is saying that Chloe has pituitary cushings.

Sorry if alot of that information you didn't actually need or care about but I didn't want to leave something out. PLEASE READ OVER THIS and let me know what you guys think.. thanks you all!!

Phew that took a long time. Hope this helps.
Kim
Chloe got her belly shaved and I feel so bad :) She looks so silly but I'm happy to get results from this and feel it was worth it.

StarDeb55

08-18-2009, 12:23 AM

Kim, the most glaring thing I see is the blood glucose from 7/16 at 220 is most definitely elevated. I don't know who told you that the blood glucose is normal, but it's not. I'm more suspicious than ever that this may be diabetes, but I would like to get Natalie's take on it. In light of Natalie's comments about unspayed females only demonstrating symptoms during their heat cycles, IMHO, I think you should wait on doing any Cushing's treatment to see how the spay goes & see if some of these symptoms subside. You need to wait, anyway, until Chloe has recovered from the procedure as you absolutely DO NOT want to use either of the 2 drugs with a dog who is under the weather no matter what the reason is.

The other thing that makes me suspicious of a Cushing's diagnosis is the fact that Chloe's liver function tests are all perfectly normal. One of the first abnormal test results that usually clues a vet into the possibility of Cushing's is an elevated alkaline phosphatase. The alk phos can elevate into the thousands with Cushing's. With the possibility of a pyometra, this may explain Chloe's elevated ACTH results. Any stress or illness will frequently elevate the ACTH. Frankly, I would hold off on doing anything further along the Cushing's road until after Chloe is spayed.

The good news is that all of Chloe's other lab results are nice & normal, including her kidney function tests which are the BUN & creatinine.

Thanks for posting all of this. If you have any further questions about the results, please ask. Again, let's see what Natalie has to say.

Debbie

AlisonandMia

08-18-2009, 12:41 AM

I agree with Deb - that high ACTH stim test result and the adrenal enlargement seen on ultrasound may be a result of long-term stress caused by illness, in this case possibly pyometra. It could also be caused by pituitary Cushing's but only time will tell. We've seen quite a few dogs here that have tested positive for Cushing's because of another condition that skewed the tests results.

The downside of treating a dog that doesn't have Cushing's with either trilostane or Lysodren is much, much greater than leaving the disease untreated until you can be sure beyond reasonable doubt that it is really what is going on.

That blood glucose is definitely well and truly elevated (from memory the high end of the normal range is 130 according to most labs) although it is not as high as in most diabetics at diagnosis (often 400+) - which may be why you were told it didn't indicate diabetes. It does look like diabetes is a possibility - but I'll leave it to Natalie to comment on that. When did Chloe last come into heat?

Alison

k9diabetes

08-18-2009, 01:31 AM

Hi Kim,

The test results are interesting... there was high blood glucose on July 16th and high urine glucose on the 27th. So she did in fact have high blood sugar on the 16th and must also have had high blood sugar on the 27th.

Blood sugar over about 140 is abnormal. Any glucose in the urine suggests there has been significantly higher glucose at some point in the day.

Say her blood sugar had been 300 in the morning and then started dropping, going down to 170. The whole time the blood sugar was above 180, glucose would have spilled into the urine. So you take test the urine in the afternoon and find some hours worth of accumulated glucose. But by now the blood sugar has dropped below the renal threshold to 170 so it shows no glucose. Urine is a cumulative collection while blood glucose varies moment to moment pretty much instantaneously. The urine would reflect blood sugar earlier in the day.

Dilute urine also suggests that she may be thirsty and drinking excess water - as much a sign of diabetes as Cushings.

7/16/09
Blood panel
Glucose 220 mg/dL (HIGH)
Urinalysis
Gluc Negative
Sp-Gr <=1.005 (LOW) - dilute urine

7/27/09
Urinalysis
Gluc >=1000 mg/dL (this was circled) (ABNORMAL)
Sp-Gr 1.015 (LOW) - again dilute

7/29/09
Blood panel
Glucose (MDVGLU) 131 mg/dL

8/6/09
Urinalysis
Gluc Negative
Sp-Gr 1.020

In cats it's possible for "vet stress" to send the blood sugar above normal but that's not something they generally consider in dogs. And you wouldn't see the high urine glucose if it was just vet stress.

I believe that she may have hormone induced diabetes, somewhat mildly. In which case it's distinctly possible that the spay will resolve the blood/urine glucose and excess thirst. As her hormone levels fluctuate, so does the presence of the diabetes.

Did you notice her being in heat around July 16?

I completely agree that I wouldn't do anything about treating Cushings until she's through the spay and healed up. There's no need to rush to treat the Cushings and enough questions that it's worth waiting to see what the spay does.

Some dogs have quite severe diabetes when they are in heat - needing a full dose of insulin while in heat and none when not in heat. If this is hormone induced diabetes, it looks fairly mild at this point so might resolve with the spay. Time will tell.

Natalie

Squirt's Mom

08-18-2009, 01:57 PM

Hi Kim,

I have been following along with Chloe's thread but haven't posted before. After seeing her lab results, I want to share with you my Squirt's story.

Squirt had the LDDS, HDDS, ultrasound, and ACTH during her diagnostic phase starting in 3/08 and all tests said she had PDH - pituitary dependent hyperadrenocortisim. I wanted to be sure I had covered all the bases before starting any treatment so she had the UTK panel done which came back a positive for Atypical, too. On the results from UTK they suggested another ultrasound - it had been four months since the first one but I did it anyway.

This time they told me she had a splenic tumor and it had to come out. :eek::eek: So last Sept. she had the tumor and part of her spleen removed. Since 3/08, her post cortisol levels ranged from 18+ to 32+ ug/dl and her liver enzyme levels (ALKP and ALT) were high as well. After the tumor was removed, her cortisol went down to 14.2 ug/dl and has remained normal ever since.

Her docs now say that the initial diagnosis of PDH is "highly questionable" as her cortisol continues to be normal. Her liver values have come down as well although they do remain a bit high. So it appears that the tumor was the cause of the positive results on all her tests for Cushing's except the UTK/Atypical results. This form of Cushing's is all she is being treated for with melatonin and lignans.

If I had started treatment with Lyso or Trilo, she could easily have suffered some damage to her adrenals that may have been irreversible.

I agree whole-heartedly with the others....take your time about addressing the possibility of Cushing's. Have her spayed, give her plenty of time to recoup, then watch her for the signs. I do not have experience in diabetes but I do know the two conditions mimic each other with the same signs often.

Cushing's is a slow progressing condition and, as you can see from Squirt's story, even when all the tests come back positive for Cushing's there can be a non-adrenal cause for those results. Cortisol is one of the "fight or flight" hormones - a stress hormone. Any time the body is under any type of stress, including physiological, cortisol is being released as part of the normal functioning of the body. Removing the stressor (in Squirt's case, the splenic tumor) can sometimes allow the body to return to normal without treatment by any of the Cushing's meds. In other words, the stressor can cause false positives on the tests.

Please take your time with the Cushing's...her labs do not support a diagnosis based on the liver values. The other things Debbie and Natalie mentioned are much more pressing, as is getting her spayed asap which you are doing. :cool:

Hang in there!
Hugs,
Leslie and Squirt

gpgscott

08-18-2009, 05:32 PM

Hi Kim,

I agree with the others. There is way too much going on here for me. If this was my dog Cushing's would be the last item on the list until after the spay and either cessation of the excess glucose or a clear understanding of what is causing it.

Scott

kimbodaisy4

08-18-2009, 09:40 PM

Chloe indeed was in heat around mid July. If that answers anyone's questions..

Thank you all, after she is all healed from her spay, what would be the first testing I should get done to re-test for previous symptoms?
Urine? Blood? Both? What specific things should be tested at that time and what should my questions be?

Thank you all and I hope hope hope that the spay would solve all of her problems. If not, one step at a time and I am so happy to have all of you who do not even know us but seem to care more than anyone I've talked to in person. Chloe and I are very thankful. :)

Kim

StarDeb55

08-18-2009, 09:45 PM

Let's see what Natalie has to say, but IMO, at a minimum, you would need a basic chem panel that includes a blood glucose, & another urine to see if Chloe is still spilling glucose in the urine.

Debbie

gpgscott

08-18-2009, 09:57 PM

Thank you all, after she is all healed from her spay, what would be the first testing I should get done to re-test for previous symptoms?
Urine? Blood? Both? What specific things should be tested at that time and what should my questions be?

Kim, we appreciate you as a member.

I think after the spay and an appropriate healing you don't concern yourself with previous symptoms. I would view it as a clean slate and diagnose as appropriate to whatever presents itself at that time.

Please continue to post as you go through this issue.

Best to you both. Scott

k9diabetes

08-20-2009, 02:42 AM

Chloe indeed was in heat around mid July. If that answers anyone's questions..

I think there's a very good chance that the spay will resolve the glucose issues and potentially side effects that go with it, such as excess drinking and urinating.

You can buy urine test strips and test her at home actually.

http://www.walgreens.com/store/product.jsp?CATID=100133&navAction=jump&navCount=1&id=prod4852

If you find glucose in her urine after the spay, then you've got plain old permanent diabetes. But with such a mild elevation in her blood sugar, I think there's a good chance that won't happen.

It does concern me, however, that no one treating Chloe seems to have mentioned this as a possibility to you. I hope they thought of it but just forgot to tell you!

Natalie

kimbodaisy4

08-28-2009, 12:31 PM

Her spay is today and I will know how she is around 12:30pm---my poor old gal! I'll keep you guys posted!

Squirt's Mom

08-28-2009, 12:59 PM

Hi Kim,

A nerve-wracking day ahead, huh? geez, do I understand! For what it's worth, spays are as common as tonsillectomies and something in which vets are well trained. Nine is still fairly young - Squirt went under at 9 and then again at age 10, and came out of anesthesia just fine. So try to keep the faith and we will do the same. Please let us know when you hear from the docs!

Scott's advise below is very, very good and something I would take to heart if I were you:

I think after the spay and an appropriate healing you don't concern yourself with previous symptoms. I would view it as a clean slate and diagnose as appropriate to whatever presents itself at that time.

When Chloe comes home, look at her as a perfectly healthy pup...until and unless you see something "off". Then start at step one to figure out what the problem is.

We are here if you need us anytime, ok?
Hugs,
Leslie and the girls

BestBuddy

08-28-2009, 07:26 PM

Hi Kim,
We adopted Phoebe at age 10 and had her spayed. I think the anesthetic knocked her a bit but she had no complications and is still rocking on at nearly 18yo now!
Jenny

kimbodaisy4

08-28-2009, 07:44 PM

Chloe just came home and is doing really well, she is groggy and tired and on pain medication. The doc said that she seems to be recovering like a 6 month old puppy! That was good to hear. Thank you guys I'll let you know what happens from here. They said there was a milky fluid in her uterus upon inspection, and they are sending it in for a culture..to see if its a bad bacteria or something...so I'll post about that too!

LOVE YOU GUYS!!!
Kim
I will have to post pictures of Chloe for you guys! She's so adorable.

Squirt's Mom

08-28-2009, 07:48 PM

Hey Kim,

So glad to hear that Chloe is home and doing so well! "Like a 6 month old puppy" sounds like music to my ears! :D I hope the recovery is short-lived and uneventful, and that the path on the fluids provides an answer for her recent troubles....and that that's the end of that! :cool:

Oh, and do post some pics...I just love seeing our babies here!

Hugs,
Leslie and the girls

StarDeb55

08-28-2009, 07:48 PM

I'm glad to hear that the spay went well for Chloe. In all likelihood with that "milky fluid", probably does indicate a pyometra. Please post the culture report when you get it, because IMO, Chloe will probably have to be put on antibiotics.

Debbie

kimbodaisy4

08-28-2009, 08:43 PM

I have a question. Chloe seems to be doing this odd behavior ever since she got home and it's probably normal but I would like to know maybe a reason why she is doing it...

Her behavior..

She keeps laying on the floor with her front legs laying down and her head laying down and her back legs standing, she will even start to fall asleep in this position, I wonder if something is painful or if there is gas or something....does this behavior seem normal for after surgery or is that something I should worry about?

Kim

StarDeb55

08-28-2009, 08:53 PM

Kim, I don't think it's anything to worry about, especially since Chloe appears to be able to fall asleep. This actually used to be one of my other dogs favorite sleeping positions. She may be a little uncomfortable to sleep in the position she normally does, & she has worked this out on her own to minimize any discomfort.

Debbie

kimbodaisy4

08-28-2009, 09:10 PM

Okay yeah she is sleeping so thats good I bet that it's just more comfortable for her that way! Well I made a photo album of Chloe if anyone wants to look at it! :)

k9diabetes

08-30-2009, 08:22 PM

Just checking to see how you and Chloe are today.

Natalie

kimbodaisy4

08-31-2009, 03:39 PM

Chloe and I are doing great today. She just took her last dose of pain medication and shouldn't need it anymore. She did so well from her spay, pooped that night even without crying or anything. Was eating food that same day and drinking water. She hasn't been scratching or licking her incision and it looks really great not red or seepy or anything. I am so proud of her. The results came back from the culture of the white fluid from her uterus and she told me that it was not actually infected, so I'm not sure if removing her uterus actually was the problem. Could that extra cortisol be from her uterus even though it wasn't infected?? Or would that be the only reason?

She is scheduled for an ACTH test on the Sept.9th same day as her stitches are removed. I'll let you know how that goes.

Thanks for asking how we are doing, it makes me so happy to know people think/care about our situation. :)

Kim

Squirt's Mom

08-31-2009, 04:15 PM

Hi Kim,

So nice to hear that Chloe is doing well! It sounds like the incision is healing nicely...always good to see! And good that it wasn't an infection but am still curious about what the fluid they found was and what it could mean. :confused:

I think I would still have her spayed anyway. If she's not breeding, it may cause problems on down the road...but many dogs do just fine keeping their "works" ;) their whole lives. To my simple mind, that is just one more area that could cause her to suffer and since it's not being used, take it out. But that's just me! I had rather have an all manual vehicle for the same reason....all that electronic stuff is much more apt to go wrong and more expensive to fix...I'm an old fuddy duddy tho. :p

Hugs,
Leslie and the girls

gpgscott

08-31-2009, 05:10 PM

She is scheduled for an ACTH test on the Sept.9th same day as her stitches are removed. I'll let you know how that goes.

Thanks for asking how we are doing, it makes me so happy to know people think/care about our situation. :)

Kim

Hi Kim,

Very glad Chloe is doing well (we had actually named Hermes Chloe until we figured out the whole gender thing with HIM!:eek:)

No Dr. here, but I would be very concerned about doing the stim so close to any sort of surgery.

Scott

StarDeb55

08-31-2009, 09:17 PM

Kim, the fluid that was found in the uterus after the spay could probably be considered an effusion. An effusion can occur in any body cavity with a build up of fluid in that cavity. The fluid build-up can be caused by either something systemic factors in that part of the body. For instance, a heart valve that is not working correctly leads to a build up of fluid in the lungs. The other reason is some type of alteration in local factors that influence the formation & absorption of fluid in that area of the body. An example of this type would be a build up of fluid in the lung when a person has pneumonia. This is really good that no infection was found, so I'm sure that the spay should resolve whatever was causing this fluid build-up.

I agree with Scott that having an ACTH on the same day that Chloe's sutures a removed probably isn't such a great idea. IMHO, I would wait at least a week after that before I scheduled any diagnostic testing for anything. Frankly, before starting testing for Cushing's, I would repeat the basic bloodwork to see if Chloe's glucose has dropped back to normal range. If it has, then I would simply watch her. If you see a return of symptoms, then start the Cushing's diagnostic testing as if you were on a clean slate. If it comes to this, the first thing I would have done is a urine cortisol:creatinine ratio which is a very good screening test. If it's negative, you are not dealing with cortisol based Cushing's, positive simply means that Cushing's is a possibility, further testing required.

Debbie