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View Full Version : Teddy, 10 y old havanese - advice re Diet/Supplements to treat Cushings?



caz
10-14-2009, 09:44 PM
My vet suspects my 10 y old havanese has cushings disease and will be running tests on Friday to confirm.

I have read the side effects of (mitotane, lysodren, trilostane) the drugs and find them scary. In reviewing the articles listed some state that medication is only recommended if the dog's quality of life if poor. Teddy is not showing signs of decline, so I was just wondering if anyone had any thoughts on alternative therapies such as diet/supplements.

If I delay medication and try alternative therapies first, would that put him at risk?

Any advise would be appreciated!
Thanks
caz

Harley PoMMom
10-14-2009, 10:57 PM
Hi Caz,

Welcome to you and Teddy from me and my boy Harley! :) Now I'm going to warn ya we ask alot of questions, ok? So are ya ready? :p:eek::D

What symptoms is Teddy displaying that the vet is suspecting Cushings? How much does Teddy weigh? What other tests did Teddy have done and could you post the abnormal values here with their units. Remember to get copies of all tests done on Teddy and put them in a file for yourself to keep. Is Teddy on any other medications or supplements? Does Teddy have any other health issues? I know this is alot of questions to throw at you at one time, but the more we know about your Teddy the better we will be able to help you help Teddy.

Cushings is a slow progressing disease, and it can be a complicated one to diagnose, but don't worry we are here to help you any way we can.

Hugs.
Lori

Roxee's Dad
10-14-2009, 11:14 PM
Hi Caz,
I would like to welcome both you & Teddy. I'm certainly sorry to hear that Teddy is facing a Cushing's diagnosis, but I'm very glad you found us.

What symptoms have led you or your vet to proceed with a cushing's diagnosis?


I have read the side effects of (mitotane, lysodren, trilostane) the drugs and find them scary. In reviewing the articles listed some state that medication is only recommended if the dog's quality of life if poor. Teddy is not showing signs of decline, so I was just wondering if anyone had any thoughts on alternative therapies such as diet/supplements.

These drugs are powerful and can be dangerous if not used according to proven protocol. Many a cush pup has had their life saved and quality of life returned when using these drugs according to protocol and with diligent and proper monitoring.

Regarding natural treatment. If your pup is dx with atypical cushings then there is a natural treatment route that will lower some of the intermediate hormones. If your pup is dx's with adrenal or pituitary cushing's then Trilo or Lyso may be the preferred treatment.

Depending why you or your vet suspect cushing's you may want to consider a full adrenal panel performed by the Univ. of TN, Knoxville. Here is a quick link:

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info_07.pdf

(see #3 on the above document link for the explanation of the UTenn Lab adrenal function tests, and specifically, #3g for an explanation of the ACTH stimulation test plus a full adrenal "panel", which includes cortisol and other adrenal hormones)

You may want to also discuss this with your vet.

Otherwise in regards to natural treatment I will add quoted text from Lulu's Mom:


I am the member that wrote to PetAlive, as well as other companies claiming to have natural remedies that are effective in treating cushing's. None of these companies have done any testing to prove their claims. PetAlive ignored my very direct question about testing and provided a list of wonderful things their natural remedy would do for my dogs. They also mentioned that it is safe to use with conventional treatment. Well duh, the point of my email to them was to ask them to provide supporting documentation that their product's efficacy would allow a pet owner to avoid conventional treatment. It is pretty disturbing that these people get away with such blatant fraudulent advertising.

Pet owners with cushdogs, especially those new to the disease, are overwhelmed and very vulnerable which makes them huge targets for these unscrupulous companies. I would suggest that any member that is contemplating treating with anything other than conventional treatment, to do their own research and ask questions of any company that claims to have an effective treatment for cushing's. It is only effective if clinical trials have been done to prove its effiicacy by way of acth stimulation tests, low dose dexamethasone suppression test, urine cortisol:creatinine ratio, etc.

Glynda


So, this is alot of information to absorb, and there is so much more useful information in our "Resources" section. :eek: Please read, learn and ask as many questions as you want. The more you learn, the better you can speak up for Teddy and ensure he receives the proper treatment. :)

PS: we do like pictures :)

StarDeb55
10-14-2009, 11:19 PM
Caz, I would, also, like to welcome you & Teddy! Unfortunately, there are no natural/homeopathic remedies for Cushing's. The items you find on the internet such as Cushex drops are huge ripoffs. The folks who promote these items simply want to line their pockets with your money. The elevated cortisol produced by the adrenal glands in Cushing's disease is what causes the damage to the pup's internal organs over the long haul. The cortisol levels must be lowered to stop/slow this damage, & the only 2 drugs that are effective are lysodren & trilostane. Believe me, if there were effective natural treatments, most of us in this group would have our pups on these things in a split second.

Please disregard the articles you have read that appear to indicate you only use these drugs if your pup's quality of life is poor. Most of our pups are troubled & suffering from a variety of symptoms before starting treatment that include a voracious appetite, drinking gallons of water, peeing buckets, muscle wasting especially in the rear end, & skin/coat issues, among others. The other worrisome issue with Cushing's is that it suppresses the pup's immune system where they can suffer from repeated infections that can be difficult to treat. As Lori has asked, could you please fill us in on what symptoms Teddy may have that led you to go to the vet?

Let me say off the top that I am not a Trilostane parent. The good news is that I have now successfully treated 2 pups with lysodren. My first Cushpup, Barkley, was treated with lysodren for nearly 8 years, crossing the bridge at 15 from a medical problem not related to Cushing's. My Harley has been treated with lysodren for 18 months, & is doing well. There is no argument that both medications are serious drugs, but they are life-saving drugs for our pups. We have seen it time & again on these boards that a pup gets into trouble with either drug, when you have an inexperienced vet who does not use the standard loading/dosage protocols for either drug, & the pup pays the price. This is why it is extremely important that you become a knowledgeable owner as you are Teddy's only voice & advocate. On those lines, I would like to suggest that you take a look at our important information & resource section of the forum where you will find a large number of links that will lead you to just about any information you might need concerning Cushing's.

Lastly, Cushing's is about the most difficult, frustrating disease to diagnose in our canine companions as there is no single test that is 100% sensitive or specific. You want to take your time, learn everything you can, & make sure you get a confirmed diagnosis prior to beginning treatment. Cushing's is very slowly progressing, taking months to years to do it's long term damage.

We are here to help in anyway can. Please let us know more.

Debbie

PS- I see John was posting at the same time that I was, so my apologies for any duplication.

Squirt's Mom
10-15-2009, 12:41 PM
Hi Caz and welcome to and Teddy! :)

I am one who found Lyso to be terrifying at first but after much reading and listening I know have no fear of Lyso at all. (Trilo is another story!) They are both life-saving meds and should not be feared in and of themselves. It is the failure to follow protocol in diagnosing the disease, administering the meds, and monitoring them that cause the problems, not the meds themselves.

I use some things to help Squirt deal with the effects of Cushing's and the treatments she is on for her condition would be considered "natural", or non-pharmaceutical, and she is doing great. She is being treated for her Atypical Cushing's with melatonin and flax lignans. She also takes Burdock, milk thistle and Astragalus plus cold pressed Salmon oil, glucosamine/condroitin w/msm, and SAMe. I fully support the use of individual herbs to help our babies and am not completely convinced pharmaceuticals are the only way to treat Cushing's but am a bit troubled by the pre-mixed things out there...especially those like Cushex, Supraglan, etc. These things have no scientific backing regardless of what their websites say. While they may help some pups, they do not address the cortisol or other hormones that are the cause of Cushing's and some of the ingredients are downright counter-indicated for cush pups. So be extra cautious when considering the things you find on the web like these products.

I think what you may have been reading as "poor quality of life" may be related to the severity and number of cush signs present. Some pups are caught early on in the disease and show very few signs and those are quite mild. At this stage, most vets will not start a pup on Lyso or Trilo as the signs are heavily relied on for diagnosing and monitoring the treatment. If no signs are readily readable, then treatment would be more difficult and an overdose more likely. So if Teddy is not displaying quite a few signs and those are not troublesome for him or you, then the use of Lyso or Trilo is not called for at this time. The presence of signs and evidence of "decline" are two different things, tho. Once decline is seen, then it is past time for treatment and needs to be started asap. Decline would be inability to get up due to hind leg weakness, difficulty breathing, many infections, organ failure, no joy, etc. So if you could tell us what you and the vet are seeing that indicate Cushing's (signs) that would help us help you figure some things out.

You and Teddy are at the beginning and that is a great place to start here! We will be with you every step of the way. Please read as much as you can, ask any questions you may have and we will do our best to help you understand.

I am glad you found us and hope to learn more in the near future!

Hang in there!
Hugs,
Leslie and the girls

Franklin'sMum
10-16-2009, 02:11 AM
Hi Caz and Teddy. I'm no expert at all, but since Cushing's is an endocrine disorder (which then affects the immune system) I have been advised to try and boost Franklin's immune system.
Franklin is a 4 and a half y.o. maltese, and along with the Trilostane , I give him gingko biloba (good for brain function), selenium, coenzyme q10 (heart health), taurine (also heart health), vetalogica canine multi and immune complex, vitamin e, flaxseed oil (omega 3+6+9) and spirulina (full of nutrients and anti- oxidants). I also changed his diet to cut out/ lower his intake of artificial colours, flavours and preservatives.
None of the above things treat Cushing's. But by boosting the immune system, the furbabies have more chance to fight off infections.
Reducing or eliminating artificial nasties from their food means that the chemicals aren't interfering with or suppressing the pup's natural defences.
Hope that helps, Jane and Franklin
________
Toys Cam (http://www.girlcamfriend.com/webcam/girls-with-toys/)

caz
10-16-2009, 07:24 AM
Thank you for your help. I appreciate it. What kind of diet is he on as the Hills diet has alot of preservatives.

caz
10-16-2009, 11:09 AM
Hi Caz and welcome to and Teddy! :)

I am one who found Lyso to be terrifying at first but after much reading and listening I know have no fear of Lyso at all. (Trilo is another story!) They are both life-saving meds and should not be feared in and of themselves. It is the failure to follow protocol in diagnosing the disease, administering the meds, and monitoring them that cause the problems, not the meds themselves.

I use some things to help Squirt deal with the effects of Cushing's and the treatments she is on for her condition would be considered "natural", or non-pharmaceutical, and she is doing great. She is being treated for her Atypical Cushing's with melatonin and flax lignans. She also takes Burdock, milk thistle and Astragalus plus cold pressed Salmon oil, glucosamine/condroitin w/msm, and SAMe. I fully support the use of individual herbs to help our babies and am not completely convinced pharmaceuticals are the only way to treat Cushing's but am a bit troubled by the pre-mixed things out there...especially those like Cushex, Supraglan, etc. These things have no scientific backing regardless of what their websites say. While they may help some pups, they do not address the cortisol or other hormones that are the cause of Cushing's and some of the ingredients are downright counter-indicated for cush pups. So be extra cautious when considering the things you find on the web like these products.

I think what you may have been reading as "poor quality of life" may be related to the severity and number of cush signs present. Some pups are caught early on in the disease and show very few signs and those are quite mild. At this stage, most vets will not start a pup on Lyso or Trilo as the signs are heavily relied on for diagnosing and monitoring the treatment. If no signs are readily readable, then treatment would be more difficult and an overdose more likely. So if Teddy is not displaying quite a few signs and those are not troublesome for him or you, then the use of Lyso or Trilo is not called for at this time. The presence of signs and evidence of "decline" are two different things, tho. Once decline is seen, then it is past time for treatment and needs to be started asap. Decline would be inability to get up due to hind leg weakness, difficulty breathing, many infections, organ failure, no joy, etc. So if you could tell us what you and the vet are seeing that indicate Cushing's (signs) that would help us help you figure some things out.

You and Teddy are at the beginning and that is a great place to start here! We will be with you every step of the way. Please read as much as you can, ask any questions you may have and we will do our best to help you understand.

I am glad you found us and hope to learn more in the near future!

Hang in there!
Hugs,
Leslie and the girls

I want to thank everyone- you have brought me so much comfort. I truly appreciateb all of your advise- this means so much to me.

Christine

Casey's Mom
10-16-2009, 12:54 PM
Christine I too have a Havanese - she is not my cushings dog but she is a little dolly - Desi. There is another Havanese on this site named Serena.

Don't be afraid of the drugs, I too was afraid of Lysodren but my dog Casey is doing so well on it that I have learned with the help of the people on this site how to help her and she is much better.

Hang in there and you will be able to help your pup as well,

caz
10-16-2009, 02:38 PM
I saw Serena- I'd love to see a pic of Desi- the havanese is such a sensitive loving dog-- oh heck they all are!!
Thank you all so much, I'm just waiting now for the LDDS test results, I felt bad leaving him there- he knows how to work me- he stood up on his hind legs on the door window crying as I left the vets-- she called me 5 minutes later to say he was playing with her 5 month old pup-- little bugger!
I have requested his file so I will update you on all of his numbers. My friend will let me know of specialists in the Toronto area but if anyone else knows of specialists in Ontario, Michigan or Buffalo I can travel.
I would love to see pictures of your pups- I'm so glad I found you all, thank you thank you thank you!!
Oh gotta go, my dads waiting for me outside!
!

gpgscott
10-16-2009, 04:17 PM
Don't be afraid of the drugs

Christine, Welcome,

This sentance speaks worlds.

The drugs, properly administered are life altering, in a good way.

You first need to be certain that they are needed and then choose the right one. There are preferences which may be expressed by experts. You have to choose the right one, and we can help you inform your choice.

Thanks for asking us.

Looking forward to hearing more.

Scott

acushdogsmom
10-16-2009, 07:59 PM
My friend will let me know of specialists in the Toronto area but if anyone else knows of specialists in Ontario ...We've had several folks here in the past who took their dogs to see one of the Internal Medicine Specialists at the VEC SOUTH in Toronto ( 920 Yonge St. - (416) 920-2002 )

Here's a link to their webpage that talks a bit about the four Internal Medicine Specialists who work there:

http://www.vectoronto.com/staff_internal_medicine.php

(Here's the link to their main page http://www.vectoronto.com/ )

I think that the folks we had here who took their dogs to the VEC used Dr. Mason and Dr. Norris at VEC South, although one may have used Dr. Finora, I'm not sure. I do remember that they were very happy with the expert care that their dogs got there. The Internists at VEC South are probably all very good and very knowledgeable about diagnosing and successfully treating Canine Cushings. (I think I also remember that they may have tended to prefer treating Canine Cushing's with Vetoryl/trilostane rather than Lysodren)

Also, although we haven't had an update from him very recently, we have a member here who not very long ago took his dog Lulu to see Dr. Mason at VEC. And I think he was pleased with Dr. Mason. Here's a link to Lulu and Bomi's thread:

http://www.k9cushings.com/forum/showthread.php?t=1140

caz
10-16-2009, 09:31 PM
Thank you thank you thank you ALL of you!! I cant tell you how much your postings have provided me with support these last few days- Teddy means the world to me, as I know you all understand.

I will definitely check out the Toronto Vet Clinic you mentioned!!!


I went to Teddy's vet today and unfortunately the vet was in an emergency situation, so I am still waiting to hear back, she did not provide me with his lab results. I do have his history though. Here it goes:

Mar 6/08
all results within normal range for ALT.

Jan 2/09
weight 16 lbs
while vet stated results were normal I found from reviewing the report the following HIGH results:
ALKP = 290 (23-212 normal)
HGB = 20.8 (12-18 normal)
MCH = 32.72 (18.5-30 normal)
MCHC = out of reportable range??
allergic to various grasses, trees, weeds, chicken, carrots, corn, oatmeal, barley and tomato pomace
titer test for rabbies 1:400 (in humans 1:5 is acceptable, thus Teddy was well vaccinated/over vaccinated through the years for rabbies- hence I didnt give him his vaccine in 2009)
put on Hills Salmon and potato diet

May 2/09
weight 16 lbs
put on hydroxyzine due to licking paws, dry flacky skin at the rear end, dull coat
heart rate 108

June 5/09
weight 15.6 lbs
otomax for ear infection
heart rate 100

June 12
weight 16.8??? (my mom was babysitting him while I was in Africa- not sure what was happening there)

July 2/09
weight 17.2 lbs (mom still had Teddy)
vets in house results were as follows
ALPK = 380 (0-140 normal)
ALT = 158 (10-120 normal)
Vet put Teddy on Hepatosupport
NOTE the IDEXX results should the following
ALP = 282 (24-141 normal)
ALT = 140 (5-95 normal)
GGT = 7 (0-6 normal)

Oct 9/09
weight = 18.1 lbs
heart rate 145 ??
ECG showed no arrhythmia or conduction disturbance, heart murmur grade 2.
cardiopet proBNP = 1593 pmol/L

vets inhouse tests results
ALKP = 915 (0-140 normal) NOT IDEXX results not provided
ALT = 58 (10-120 normal)
GLU = 6.3 (was 5.8 in July)


Results from Oct 16 have not been provided yet, waiting for the vet to call.

Please let me know if you need any additional information!

Thank you thank you thank you for your help!
CHristine * Teddy

AlisonandMia
10-16-2009, 09:37 PM
Hi and welcome from me too.:)

Just one question (ok 3:p) - how are his allergies going? Has he had them all his life? If an allergic dog develops Cushing's the allergies will often improve because the high cortisol levels "treat" the allergies just a steroid shots or pills would. So allergies suddenly getting better can be a sign of Cushing's.

Has your little guy ever had steroid shots or steroid pills for allergies?

Alison

Casey's Mom
10-17-2009, 01:06 AM
Hi Christine, there are some pictures of Desi on my profile page. She is only 4 and a lot of fun. Loves to play with her toys and I often babysit two other Havanese one of which is her dad -so right now I have three Havanese and Casey ! Luckily I have a fenced yard so they all go zooming out there chasing squirrels while Casey sleeps under the tree oblivious to it all until its time to eat or go for a walk.

Glad to see your are getting some good advice and will be able to help you pup.

Franklin'sMum
10-17-2009, 10:25 AM
Thank you for your help. I appreciate it. [What kind of diet is he on as the Hills diet has alot of preservatives.]
Hi everyone, in answer to your question about Franklin's diet, keep in mind that we are in Australia, so the brands will be different. But here goes : Pedigree Natural wet (Mars Petcare), Nature's Gift wet and dry (Nature's Gift), Optimum wet and dry(Mars Petcare), Fish for Dogs wet(Safcol Australia), Snappy Tom wet cat food (Safcol Australia), Fancy Feast wet cat food (Purina), Lucky Dog dry (Purina), 4 Legs kind of a meatball (4 Legs) . He does eat preservatives and flavours (Schmackos) but they also contain anti-oxidants, so I figure that's something. It's weird that Hills in Canada has preservatives, because Hills in Australia uses tocopheryls (vit. e) and citric acids (vit. c) these days.
Franklin also chows down on Pedigree dentastix, and the same type of thing but it's green (I've thrown out the packaging), Lucky Dog bikkies, lamb necks, lamb shanks, beef bones and people food.
Wow! That was a long answer, hey? Anyways, we hope that everybody is doing well.
Jane
________
Lovely Wendie (http://www.lovelywendie99.com/)

caz
10-17-2009, 03:54 PM
Australia- wow! My friends and husbands' brother live in Australia. My friends in Victoria and my husbands' brother in Turramurra. What a small world.

I spoke with the vet today, Teddy's results came in and confirmed that Teddy does have cushings (in the pituitary gland).

Here are his results from the LDD test:

cortisol (0hr) = 188 (normal 15-120) nmol/L
cortisol (4hr) = 11 (normal 0-10) nmol/L
cortisol (8hr) = 139 (normal 0-10) nmol/L

The vet has informed me that he uses trilostane and L-deprenyl (anipryl) on his patients. (I guess Canada has just approved trilstane in April 2009?).

The vet stated that he has 60 patients with cushings disease.

He stated that he generally starts at lower doses and works his way up depending on how the dog is responding. He says that he is more family with anipryl than trilostane given its just been approved.

I am tending towards anipryl, given he is not showing alot of the symptoms and the vet stated that from his results it is still a mild condition. Any thoughts? comments?

I have his complete file now and will go to the VEC SOUTH animal hospital and request Dr Mason (thank you so much for that info!!!) I am also going to see a homeopath/naturopath regarding Teddy's diet to ensure his immune system and digestion is well supported.

Teddy has had allergies since a puppy (I didnt realize that ear infections were a sign of allergies until this January when his allergies started to get worse). Teddy's previous vet did like steriods and I am haunted by the fact that I gave them to him on occasion when he had a flare up with his ears.

I just wanted to thank you all once again from the bottom of my heart for your encouragement and support, I would have taken the diagnosis as well had it not been for your emails. Thank you thank you thank you.

Christine and Teddy
PS- how wonderful Ellen, Casey and Desi a house full of dogs!! I can't imagine anything better!! I will check out your pictures!!

acushdogsmom
10-17-2009, 05:34 PM
Yup, those Low Dose Dex results are consistent with a diagnosis of Pituitary Cushing's.
I am tending towards anipryl, given he is not showing alot of the symptoms and the vet stated that from his results it is still a mild condition. Any thoughts? comments?

In spite of the initial "hype" about Anipryl when it was first introduced onto the market as a canine Cushing's treatment, it's been known for a long time now that Anipryl doesn't work to control cortisol production the way they thought it was going to, although it might help a very small percentage of pups with some of the clinical symptoms or if their Pituitary tumour happens to be located in a particular area of the Pituitary gland (pars intermedia). In Cushing's dogs, however, it is very important to not only try to resolve symptoms that we can see, but also to lower the cortisol production because it is the cortisol that causes so many secondary conditions, many of which are life threatening:

Medical complications associated with untreated Cushings Disease :
http://www.k9cushings.com/forum/showthread.php?t=195

So if your Vet thinks Anipryl is a good Cushing's treatment, that may be a red flag. Your Teddy would probably be much better off in the hands of an Internal Med Specialist. There have been (and still are) plenty of dogs out there being successfully treated with Lysodren for years and years (mine was treated and did wonderfully on Lysodren for more than 6 years) - in the hands of a Vet who knows how to use it, Lysodren is a life-saving treatment for Canine Cushing's. Vets who haven't had much success with using Lysodren or who are afraid of it or who haven't kept up with the Veterinary literature (ie who don't know that Anipryl is not a very good choice for treating Pituitary Cushing's) are the ones who will tend to use Anipryl.

I've heard that the Specialists at the VEC do tend to prefer Trilostane (Vetoryl) over Lysodren and I'm pretty sure that they also know that Anipryl is not a very effective treatment. Before trilostane was available I believe they were using Lysodren, not Anipryl, to treat their Cushing's patients.

Vetoryl is considered to be a safe and effective treatment for Canine Cushing's and some feel that it may be easier to work with than Lysodren is. But dogs can have bad reactions to trilostane too, and I wouldn't feel very comfortable if the Vet who is controlling the dosage and monitoring of the dog is not familiar with how to dose and monitor it correctly. Anything that has an effect also has potential for side effects or for unusual reactions - so if I was in your shoes, I'd rather have my dog being treated by a Specialist who has treated hundreds or maybe even thousands of cases and who knows all the little subtle ins and outs of dosing and monitoring, than by a GP Vet who has just started to use trilostane. And I'm very sure that the Specialists at VEC were using Vetoryl (trilostane) to treat Cushing's dogs before the drug was actually approved for sale in Canada. They were importing it (with special government permission) from the UK for the past few years, until it did become available in Canada.

Just my opinion, though. You don't have to do what I would do. :)

Here's a link to just one study (there are others) from the veterinary literature about the inefficacy of Anipryl (also known as selegiline):

http://www.k9cushings.com/forum/showthread.php?t=224


Conclusions: Selegiline was confirmed as a safe drug with no important side effects in dogs but was not effective for treating canine PDH at the dose used in this study.

Due to the availability of other more reliable treatments, it cannot be recommended for treating this disease in dogs.

In some dogs, selegiline may have an effect in increasing the activity levels and general alertness, possibly reflecting dopaminergic effects on the brain unrelated to treatment of PDH.

It is conceivable that dogs with known pars intermedia tumours could respond better to selegiline, but premortem identification of tumour location in animals is not possible at present with imaging modalities available.

Here's a quote from an article written by Dr. Edward Feldman, DVM, DACVIM - Department of Medicine and Epidemiology, University of California School of Veterinary Medicine, Davis, CA, USA - who is one of the authors of the Textbook of Veterinary Internal Medicine and very highly regarded in the field of veterinary endocrinology:


MEDICAL THERAPY USING L-DEPRENYL (ANIPRYL):

Use of this drug is based on the theory that pituitary Cushing's is caused by a pituitary deficiency of dopamine. This drug is a dopamine agonist (it increases secretion of dopamine). This is not a new theory. It was heavily investigated in humans in the late 1960s and early 1970s. The idea of such treatment was abandoned because less than 20% of people responded to such treatment.

In objective studies on dogs with naturally occurring Cushing's, use of Anipryl caused no change in low dose dexamethasone test results, no change in ACTH stimulation test results, no change in urine cortisol to creatinine ratios, no change in urine volume and no change in urine concentration. These studies were carried out in more than 10 dogs treated at recommended doses for more than a year. In similar studies completed at the University of California, the drug was not of benefit to more than 90% of treated dogs.

We do not recommend use of this drug.

And here's another link and a quote from a recent article called Hyperadrenocorticism: Treating Dogs, by Cassandra G. Brown, DVM and Thomas K. Graves, DVM, PhD, DACVIM - University of Illinois at Urbana-Champaign:

http://www.compendiumvet.com/Media/PublicationsArticle/PV_29_03_132.pdf


Administration of 2 mg/kg PO q24h has reportedly had very few side effects, and no specific monitoring has been recommended. However, the efficacy of selegiline must be questioned. In one early study of the drug’s use in patients with PDH, 83% of dogs improved within 2 months of L-deprenyl administration. However, this study was based mainly on owner observations and did not stringently evaluate objective criteria.

In a more stringent evaluation of 10 dogs, L-deprenyl was administered as already described, and monthly evaluations included owner observations as well as results of a complete blood count, serum chemistry profile, urine cortisol:creatinine ratio, low-dose dexamethasone suppression test, and corticotropin-releasing hormone stimulation test. At the end of the 6-month study, all dogs also underwent repeat ACTH stimulation tests and adrenal ultrasonography. Improvement was noted in only two dogs, and deterioration or no change was noted in the other eight dogs.

These results strongly suggest that L-deprenyl should not be used as the sole therapy for PDH.


I have his complete file now and will go to the VEC SOUTH animal hospital and request Dr Mason (thank you so much for that info!!!)You will probably need a referral from your GP Vet to get your dog in to see Dr. Mason or any of the other Internal Med Specialists in your area.

Once you get in with the Specialist, you'll need to decide whether you want the Specialist to re-confirm the diagnosis and just get the treatment started, then send you back to your regular Vet for all followup testing etc. Or you can see if you can get the Specialist to work along with your Vet - ie consult on all dosage adjustments etc. Or you can have the Specialist take over the case and be Teddy's Vet for all things Cushings-related. It's up to you, but you have to make your choice and make it clear to both the Specialist and the GP Vet - especially if you choose to have the Specialist take over as Teddy's Cushing's Vet - that it is your choice, so that the Specialist won't be accused of stealing your GP Vet's patients.

We have people here whose GP Vets work really well with the Specialists and have learned alot from the Specialist input. There are others who have had Vets who were very insulted when the client even asks for a referral to a specialist. I personally chose to have the Specialist take over and be in charge of everything Cushing's related for my dog. My GP was insulted so I found another GP Vet who loved working with Specialists. The Specialist made all treatment decisions and kept the GP Vet in the loop, and voila! My dog lived for a long time and he lived well and happy for all those years with Cushing's and on Lysodren. It was one of the best choices we ever made.

Squirt's Mom
10-17-2009, 07:21 PM
Hi Christine,

I am one of maybe 2 Anipryl supporters here and will nearly always speak up on it's behalf. :D My reasons for this are based on my experiences with it, which were positive.

Squirt was one of those pups who did well on Anipryl, tho it seems she may not have PDH after all but rather high cortisol due to a splenic tumor. Her signs were mild; excess peeing and drinking, panting, lethargy, and general loss of interest. Very shortly after starting the Anipryl, she was acting much better which told me she was feeling much better.

Her vet told me that Squirt would more than likely have to go on to Lysodren in 60-90 days because Anipryl usually lost it's effectiveness in that period of time. But Squirt stayed on it for about 6 mo with good results. We did have to go up to the max dose, tho. Once the tumor was removed, her cortisol level went back to normal and has remained there, so she is not on any treatment for cortisol.

I took quite a bit of flack from another group for choosing to stay with the Anipryl VS going ahead and starting her on the Lyso; these folks here told me the same things and showed me the same studies but in a much gentler manner. :) Regardless, I saw it helping Squirt so I chose to stay with it until her signs became stronger, there were more of them, and/or her cortisol went up a great deal. Thank goodness I made that decision! If I had started her on Trilo or Lyso she could have suffered from it because she didn't have high cortisol due to Cushing's but due to the tumor. The Anipryl made her more comfortable, gave us time to learn more, and have more testing done which led to the surgery and the discovery of Atypical Cushing's, plus spared her adrenals the possibility of being damaged by drugs she didn't need.

Cushy is absolutely correct about Anipryl's ability to address the cortisol production. It rarely does help in cases of pituitary based Cushing's. It will have no effect whatsoever on adrenal based Cushing's. But it can help in controlling the signs when the disease is in the early stages or at other times when treatment with Lyso or Trilo isn't feasible. If you do choose this route, please keep in mind that Teddy will more than likely have to go on to either Lyso or Trilo at some point in the future. I will give you some links on Anipryl to look over to help you make up your mind about it perhaps.

Hang in there!
Hugs,
Leslie and the girls

Anipryl info*
http://www.pfizerah.com/product_overview.aspx?drug=AR&country=US&lang=EN&species=CN

http://www.marvistavet.com/html/body_anipryl.html

http://vetmedicine.about.com/cs/diseasesall/a/aniprylseniors.htm

http://www.lbah.com/anipryl.htm

http://www.selegiline.com/

http://www.1800petmeds.com/Selegiline-prod10305-10305.html

http://www.petplace.com/drug-library/selegiline-hcl-anipryl/page1.aspx

http://www.drugs.com/vet/anipryl-5-mg-can.html

caz
10-17-2009, 11:10 PM
Thank you both for your opinion, I appreciate your points of view and will read all of the links before making a decision. Greatly appreciated.

jrepac
10-17-2009, 11:58 PM
Hi Christine,

I'm the 2nd anipryl user/supporter on this board. I use it in tandem w/several non-Rx supplements. My Aussie, Mandy, has been on it for a bit over a year now and it has proven helpful. You can read up on it via the links Leslie has provided and through general internet searching and reach your own conclusions. Its use has been controversial...it either seems to work, or not. When it got cleared for use in Canada, the trials there suggested that it did lower cortisol...yet other research here in the US says dogs either "tended towards" normal (in the US clinical testing) OR it did not help at all (successive independent testing).

It does have a few good points: side effects are minimal and you will have a pretty good idea if it is working within 2/3 weeks of treatment [but they do say up to 1/2 months for some] and no special testing is required. Plus, the generic version, selegiline is relatively inexpensive ($25 for 60 5mg tabs from 1-800-pet meds).

Happy Hunting!

Jeff

caz
10-18-2009, 12:26 AM
Thank you Jeff I appreciate your support, it feels horrible thinking I'm holding Teddy's life in my hands with my decision, but you are right- at the end of the day its MY decision, I will definitely read everything I can before I go to the specialist and the homeopath (for his diet). I find it interesting to see that so many dogs with cushings have heart murmurs and allergies like Teddy, it was also interesting to read some are on Hills diet, which Teddy is also on.

I know I'm at the beginning of the journey, and its scary not knowing what lies ahead. I hate the thought of putting Teddy through more testing but after readings Squirts mom's posting I feel I need to before making any further decisions.

I just want the best for him as he has given me so much- I'm so grateful to have this forum to get educated (even with the some of the harsher postings, as I can appreciate we all love our dogs and want the best).

Thank you, knowing this forum is available has been comforting.

caz
10-18-2009, 04:53 PM
Thank you Jeff I appreciate your support, it feels horrible thinking I'm holding Teddy's life in my hands with my decision, but you are right- at the end of the day its MY decision, I will definitely read everything I can before I go to the specialist and the homeopath (for his diet). I find it interesting to see that so many dogs with cushings have heart murmurs and allergies like Teddy, it was also interesting to read some are on Hills diet, which Teddy is also on.

I know I'm at the beginning of the journey, and its scary not knowing what lies ahead. I hate the thought of putting Teddy through more testing but after readings Squirts mom's posting I feel I need to before making any further decisions.


I just want the best for him as he has given me so much- I'm so grateful to have this forum to get educated (even with the some of the harsher postings, as I can appreciate we all love our dogs and want the best).

Thank you, knowing this forum is available has been comforting.


Update: Oct 18/09

Teddy vomitted last night and this morning so I went to the VEC animal clinic. Teddy had an x-ray and fluids. The vet on duty wants further testing as he suspects an underlying cause for the elevated liver results. Teddy sees the specialist on Tuesday and will have an ultrasound at that time. The clinic staff were very nice.

Thank you all again for your support- it is appreciated.
Christine

Squirt's Mom
10-18-2009, 05:33 PM
Hi Christine,

Did the ER docs tell you why he had vomited? I know how scary that can be! :eek: Of course, I'm a twitcher soooo..... :p

Please let us know what you learn from the ER and specialist about your sweet Teddy.

Hugs,
Leslie and the girls

caz
10-18-2009, 07:44 PM
Hi Christine,

Did the ER docs tell you why he had vomited? I know how scary that can be! :eek: Of course, I'm a twitcher soooo..... :p

Please let us know what you learn from the ER and specialist about your sweet Teddy.

Hugs,
Leslie and the girls


Hi Christine,

Did the ER docs tell you why he had vomited? I know how scary that can be! :eek: Of course, I'm a twitcher soooo..... :p

Please let us know what you learn from the ER and specialist about your sweet Teddy.

Hugs,
Leslie and the girls

Thank you Leslie for your concern, I appreciate it. The ER vet didnt say what he thought it could be. The x-ray showed air in his stomach so they gave him suircate liquid (and some for me to give him tonight and tomorrow), as well as subcutaneous fluids as he was slightly dehydrated. He felt that Teddy was not displaying the typical signs of cushings and questioned the underlying cause of the elevated live enzymes. (I was so glad I had his complete file on me!!)

He felt the ultrasound would shed more light on it. I had brought his urine sample as I thought they may want to anaylyze it (I had read on Lulu's dad's page someone had recommended a urine test for bichons which havanese are a relative of). They did not analzye his urine. I also brought his poop sample in as it was loose thinking he may have picked up something from the vet or goose poop in the park since Lucy (my other dog also had diarhea yesterday)- but they didnt analyze that either.

This afternoon I went through all of his files, sorting them and highlighting all of his results and weights. I cant believe the discrepencies between doctor records and how they read reports- it has been an eye opener. I will be requesting reports from now on for all of my dogs. I have also created a spreadsheet which I intend to complete everyday which details the following:
Appetite
Heart Wheezing (Y/N)
Panting
Coughing (Y/N)
Sneezing
Vomiting (Y/N)
Itchiness (Y/N)
Licking

R Front
L Front
R Back
L Back
Skin (dry/normal)
Coat (baldness/good condition)
Lumps/Bumps/Wart (Y/N)
Location
Scabs

(Y/N)
Location
#

Lameness/Stiffness (Y/N)
Urination

AM
PM


Poop

AM
PM
Accidents (Y/N)
Diarrhea (Y/N)
Difficulty pooping (Y/N)
Supplements
Yogurt
Medication
Comments

Is there anything else I should add to my list?


Ohh-My friend got back to me and she recommended Dr Gillick at the Toronto Veterinary EmergencyHospital. Their web site is: http://www.tvrh.ca/Main.aspx. Has anyone heard of her?


She also recommended that I go to the Ontario Vet Clinic as soon as his cushings disease is confirmed by Dr Gillick and Dr Norris. So my new course of action is to pursue both specialists to see who I feel most comfortable with, then go to OVC for a second opinion.

Teddy has been sleeping along side me all day and has now woken up and raring to go-- so that's a good sign. We are going to take him out for a short walk

Thank you all once again for your information and support - I have truly appreciated it. I really really dont know how I would have gotten through these last week without your postings.

Have a great Sunday- please give your pups a hug from me!
Christine

acushdogsmom
10-18-2009, 08:32 PM
Ohh-My friend got back to me and she recommended Dr Gillick at the Toronto Veterinary EmergencyHospital. Their web site is: http://www.tvrh.ca/Main.aspx. Has anyone heard of her?According to what I saw on the link that you posted, I think that Dr. Gillick is a he. ;) The name sounds a bit familiar, but I can't remember what (if anything) I've heard about him.

It says on that wensite that he is the Founder of the Morningside Clinic in Scarborough and I think that the Toronto Veterinary Emergency Hospital and Morningside are actually the same place.

It says in his "bio" on the site that
Dr. Avery Gillick founded the Morningside Animal Clinic-Referral Service in 1974. He is a graduate of McGill University and completed his DVM and post-graduate degrees of Diploma Small Animal Medicine and MSc at the University of Guelph. As an Assistant Professor at the Ontario Veterinary College he was responsible for referrals in Companion Animal Medicine as well as teaching.But I can't find him listed on the ACVIM website, where he would be listed if he was an ACVIM Boarded Diplomate (an Internal Medicine Specialist, as Dr. Mason and the other two Internists at VEC South are). "Diploma Small Animal Medicine" and "Diplomate of the American College of Veterinary Internal Medicine" (ie Boarded by the ACVIM and able to call themselves an Internal Medicine Specialist) are not the same thing.

I did note, howver, that there is a listing on the ACVIM website for Dr. Katrina Smith, who is also listed as a staff member at the TVEH/Morningside Clinic. And there may be another ACVIM Diplomate who also works there - Dr. Wendy Foster. So even if Dr. Gillick himself is not an Internal Med Specialist, he does seem to have at least one or maybe two ACVIM Diplomates on staff there.


She also recommended that I go to the Ontario Vet Clinic as soon as his cushings disease is confirmed by Dr Gillick and Dr Norris. So my new course of action is to pursue both specialists to see who I feel most comfortable with, then go to OVC for a second opinion. You should seek a second opinion if you really feel that you need to, but keep in mind that Dr. Gillick, although he has quite an impressive CV, doesn't seem to be a Boarded ACVIM Internal Med Specialist. And there's probably nobody at OVC in Guelph (actually the Ontario Veterinary College, not Ontario Vet Clinic ;) - unless you are referring to another Clinic that really is called the Ontario Vet Clinic) who is better qualified and experienced than Dr. Mason and the other Specialists at VEC are.

So I think what you may need to also consider when choosing which Vets and Specialists you want for your Teddy, is which of the three places (Morningside/Toronto Veterinary Emergency Hospital in Scarborough, or OVC in Guelph, or VEC South in Toronto) has a 24 hour ER and which is closest to you? I'm not in Ontario, but I am pretty sure those three Clinics are quite a distance from each other - so one or more of them is also probably quite a distance from where you live.

If you ever have an emergency situation late at night or on a w/end you want a nearby ER if possible, and it would also be good if you can take your dog to an ER where his Specialist works and has all of the pertinent records and charts etc. If your Specialist Vet is affliated with the ER (works in same building as the ER facility is in) then the ER could also get a hold of your Specialist in off hours if need be.

Glad to hear that Teddy is feeling better this evening.

Harley PoMMom
10-18-2009, 08:34 PM
Hi Christine,

My heart goes out to you and Teddy and my thoughts and prayers are with you both as well.


He felt the ultrasound would shed more light on it. I believe the ultrasounds to be a very valuable tool for our pups, on my boy Harley, his u/s showed a nodule on one of his adrenals, pancreatitis, nodule on his spleen and some other things that I must keep an eye on.


I will be requesting reports from now on for all of my dogs. I have also created a spreadsheet which I intend to complete everyday... Great job, Christine. :D


Is there anything else I should add to my list?These are JMO, ok. :)

Poop can tell alot, so I would also add the color and texture of said poop. :eek::)

Eyes, ears and nose: check for any kind discharge from all, check for any funky smell from the ears, is the nose moist or dry and cracked or flaky.

Gums: make sure the gums are pink and moist.

That's all that I can think of, you did a great job with your list.


Teddy has been sleeping along side me all day and has now woken up and raring to go-- so that's a good sign. We are going to take him out for a short walk Awww Christine, that's a wonderful sign...sounds like Teddy's is feeling much better. Please keep us posted, we do tend to worry...alot.

Hugs.
Lori

Squirt's Mom
10-19-2009, 12:25 PM
Hi Christine,

The list looks great! The only thing I think I would add is a space to comment on mood and energy level. Lethargy can come into play both before treatment and after, and is considered a sign of the condition itself and a sign of an overdose when on treatment. Our babies moods can signify how they are feeling. When Squirt is having an off day, she hides under the furniture and just isn't interested in much of anything...except food! :p On the rare occasions she isn't interested in food, I know something is really bothering her. So keeping up with those types of things can help as well.

You're doing a great job so just keep it up!
Hugs,
Leslie and the girls

caz
10-19-2009, 10:10 PM
Thank you all fo your support and advise- I will add these to the list. You also rose some great points about selecting a vet clinic. I will give you all an update tomorrow- will they give me the results of the ultrasound tomorrow or will I need to come back??

Squirt sounds like a real character, I think the one thing I am learning from this whole experience is that I need to become more observant of Teddy, Lucy and Allies behaviours/body, learn more about canine health/disease/treatment options, and do more investigation of the vets that treat our babies. It certainly has been an eye opener- I wish it didnt take crisis like this to make me more aware- but at least I'm learning and educating pet owners around me.

Teddy has been quiet energetic today- he took the lead in our walk this morning and evening; and ate both the dry/wet food- and of course he also ate 1/2 salmon treat after taking his medication! He's cuddled up along side me as I send this posting- ahhh, I love him!!

Anyways thank you all once again for your support and guidance- it has been so reassuring and helpful to have you all.
Christine & Teddy

Harley PoMMom
10-19-2009, 10:35 PM
Hi Christine,

When I take Harley for his ultrasounds I get the results that day, I also ask that they put the ultrasound on a CD so I can take it along with me.

So happy that Teddy is continuing to improve every day.

We will be looking for your updates tomorrow. :)

Love and hugs.
Lori

caz
10-20-2009, 02:27 PM
What a rollercoaster ride, Monday he was great, this morning he was energetic and this afternoon when I came home I gave Teddy his suicrate and roughly 10 minutes later he vomitted and was wheezing.

I'm so glad I'm seeing the vet this afternoon- this uncertainty is so difficult- its so hard watching him being sick and feeling helpless.
He's sleeping by my side right now,

I'll give you an update this evening, keep your fingers crossed whatever it is- is treatable.

Take care
Christine

Squirt's Mom
10-20-2009, 03:14 PM
Hi Christine,

I am so sorry that Teddy is having these difficulties. :( Did the vets mention pancreatitis? That might be one thing to look into.

Do let us know what you learn tonite at the vets and know we are with you both.

Hugs,
Leslie and the girls

caz
10-23-2009, 08:49 AM
Sorry for the delay, we've had a wild ride! The vet left on Tuesday night without telling me anything, so I have been waiting for his call (and calling him repeatedly). He called to tell me that Teddy's adrenal glands and liver are all within the normal ranges. The ACTH test did confirm cushings, so he stated that Teddy's cushings disease is dorminant. He said I didnt need to treat him for cushings at this time, but should get him ultrasound every 6-8 months. He said that they found a bladder stone in Teddy which he wants to remove surgically and then take a live biopsy. He stated that the vomitting was probably due to picking up a bug as Lucy (my yorkie also had diaherra).

So, I have been given grace time to learn more about cushings disease and treatments which is relieving. I will also be going to a homeopath recommended by a vet to put him on a diet that addresses his allergies and suppots his immune and digestion system.

My worry now is the fact that if Teddy gets the biopsy it means an extended time in the clinic (3 days vs 1) Teddy has neve been in a kennel. The LDDS test was the longest time Teddy spent at the vet office and he lost his voice barking all day-- so I am really worried about the stress this will put on him (and admittedly me).

I will be reading all of the resources on anipryl and trisodane listed on this website, any other resources I should be investigating? Any thoughts regarding Teddy's care? Do you think it is worth me taking him to OVC or the clinic my friend suggested, or should I wait until Teddy's cushings progresses?

Squirt's Mom
10-23-2009, 12:26 PM
Hi Christine,

So glad you have a plan and that it is one you are content with. The bladder stone is a bit concerning but others with more experience than I with this will chime in, I'm sure.

As for what you can be looking into - don't limit yourself to just what the vets have suggested or want. Teddy is your baby and you have every right to question, suggest, even require that they listen to you and what you want. Ideally, they will work with you as a team - especially when you come to them with knowledge about this condition and all it's permutations.

Along with Trilo and Anipryl, study Cushing's itself, both PDH and ADH as well as Atypical, and Lysodren. Our Helpful Resource section is packed with valuable info. And if that isn't enough, I will give you some more links to look into. :eek::D:p Can't have you getting bored! :p Keep reading the threads here, asking questions and listening as you have been. When it's time, if it's ever time, for Teddy to start treatment, you will be armed with knowledge - and knowledge is truly power when dealing with this condition.

I am glad Teddy has a reprieve for now and hope his days are full of happiness as well as yours. But you don't think you can leave us now! Oh no! You gotta keep in touch, ok? We will worry if you don't and Lori or I just may come looking for you! ;)

Hugs and belly rubs,
Leslie and the girls

:eek::eek: More links! :D:D

K9C Resource section:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

PowerPoint Presentation
http://talkoftheinternet.com/etvma1/hac-3-13-07.ppt

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article.cfm?c=2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp

StarDeb55
10-23-2009, 12:49 PM
Christine, strong Cushing's symptoms are a huge part of making the diagnosis. Any Cushing's savy vet will not treat a pup who has few or no signs, so kick back, relax, & both of you enjoy this time. As Leslie said, take the time now to become an educated owner, so that when the time does come, if it ever does, you can be the best advocate you can for Teddy.

Debbie

caz
10-23-2009, 08:17 PM
Thank you so much for you support- I have truly appreciated it! I am truly relieved - I will be speaking to my vet about the stone, and am hoping the homeopath will put us on a good diet. I will definitely keep you posted- hopefully information I learn about diet will be helpful to someone.

Again- words cant express how thankful I am to you for your support, it kept me going and informed!!
Christine&Teddy

Franklin'sMum
10-23-2009, 08:43 PM
Hi Christine and Teddy
We're so happy to hear Teddy doesn't need to be treated right away, and you have some grace time :) :)
Franklin and I hope Teddy is feeling better soon from his tummy bug.
All the best
Jane and Franklin xx
________
LOUIS CHEVROLET (http://www.chevy-wiki.com/wiki/Louis_Chevrolet)

caz
10-25-2009, 12:47 PM
Have any of you heard Dr Alfred J Plechner?

http://www.drplechner.com/home.php

Any thoughts? Comments?

PS-Franklin is a great name!! I think Teddy and Lucy would be great pals with him, Star, Squirt and the gang! To bad we cant have an outdoor party!! Well better run the fall colours are out and the weather is beautiful so we're heading for a hike!!

StarDeb55
10-25-2009, 02:36 PM
Christine, I would use extreme caution with anything you find on the web claiming to be a "miracle cure". After reading the front page of this guy's website, IMHO, he falls into this category. Apparently his product adds cortisol to the system which is stating will resolve many issues. This is absolutely NOT what you want to do with a cushpup, add cortisol to their bodies when the adrenals are already on overdrive producing cortisol. I know you very badly want to help Teddy, but there is really no homeopathic product that will reduce cortisol levels. A lot of people claim that their product does reduce cortisol but when you press them to see the follow-up testing that actually demonstrates a reduction that either are unwilling or can't provide the necessary documentation.

Debbie

caz
10-28-2009, 09:49 PM
Hi all,

Well I finally recieved Dr Norris' report for Teddy. I was hoping you could help me decifer it as I'm not sure I fully understand it. Here are some of the statements I'm unclear about:

1. Under Diagnosis "suspicious of a steriod hepatopathy"
2. There is no polyuria-polydipsia or polyphagia (in English does that mean no excessive urination, pot belly, loss of hind leg muscle and hair?)
3.Teddys heart rate was 80 beats per minute, any idea about normal ranges?
4.BCS is 3/5- what does that mean? Does that mean overweight??
5. Bilateral epiphora??
6. chest: WNL ??
7. abdomen: WNL ??
8. Urine analysis: specific gravity of 1.033, 2+ bilirubin ???
9. ACTH - 0 hr = 110 nmol/L (normal 15-120)
1 hr = 731 nmol/L (150-550)
2 hr = 881 nmol/L (150-550)
(I recognize this is higher than normal, but how sever is it? Can you give me a sense? When a dog is treated with drugs would their ACTH results be within normal range?)
10. abdominal ultrasound showed:
- left adrenal 0.6 cm, right 0.52 cm (aparrently this is within the normal range but not sure by how much?)
- a siderotic nodule in the spleen--- what does that mean? should i be concerned, there is no mention of this in the case summary or diagnosis.

I just wanted to let you know that I am seeing Dr Foster on Friday who my friend recommended. I'm seeing her for a second opinion becuase I need to feel comfortable with my vet and I didnt get a comfort feeling with Dr Norris as he is now recommending a liver biopsy to see why his liver enzymes are high-my family doctor feels that would be very stressful on Teddy and unnecessary- hence the second opinion.

I have to say, I felt overwhelmed by the fact that I hold Teddy's life in my hands making decisions about his health, but having you all here for support has provided me with a great deal of comfort, thank you so much!
I will fill you in on Friday.

Thanks again for your support and knowledge!
Christine

StarDeb55
10-28-2009, 10:23 PM
Here we go with some answers for you. I'm sure some of the others will have additional comments.


1.
Under Diagnosis "suspicious of a steriod hepatopathy"
Hepatopathy indicates liver. Dogs with Cushing's disease have a certain appearance to their liver which is visible on an abdominal US. This appearance is indicative of the liver have to process the high levels of cortisol that the adrenal glands are producing.

2
Bilateral epiphora??
Overproduction of tears in both eyes.

3. WNL=within normal limits

4.
Urine analysis: specific gravity of 1.033,
This is within normal range. The great majority of cushpups can't concentrate their urine, & their specific gravities are usually something like 1.001-1.008. 1.000 is the specific gravity of water.

5
ACTH - 0 hr = 110 nmol/L (normal 15-120)
1 hr = 731 nmol/L (150-550)
2 hr = 881 nmol/L (150-550)
(I recognize this is higher than normal, but how sever is it? Can you give me a sense? When a dog is treated with drugs would their ACTH results be within normal range?)
First of all, I must explain that normal range for a normal, non-cushpup is totally different than normal range for a cushpup that is being treated.

A cushpup being treated should, ideally, have a cortisol of 1-5 ug/dl.
Norm range for a healthy dog is:
Pre: 2-6 ug/dl
Post: 6-18 ug/dl
Now, we must convert Teddy's values to ug/dl which is what those of us in the US are used to seeing.

Pre: 3.9 ug/dl
1 hr: 26.2 ug/dl
2 hr: 31.5 ug/dl

As you can see both post values are considerably elevated, therefore indicative of Cushing's.


5.
Siderotic nodule in the spleen.
All I can tell you about this is siderotic indicates that this nodule contains a certain amount of iron. I don't know how worrisome this is because the spleen is one of the organs that breaks down RBC's, & one of those breakdown products is iron. This is something to ask the vet.

6
BCS is 3/5- what does that mean? Does that mean overweight??

This is the scale that vets use to grade weight & body conditioning of a pup. The following link will explain better than I can, & also includes a downloadable BCS chart.

7. Polyphagia= excessive hunger
Polydypsia= excessive thirst
Polyuria= excessive urination

Debbie

Harley PoMMom
10-28-2009, 10:39 PM
Hi all,

Well I finally recieved Dr Norris' report for Teddy. I was hoping you could help me decifer it as I'm not sure I fully understand it. Here are some of the statements I'm unclear about:

1. Under Diagnosis "suspicious of a steriod hepatopathy"

Dr Norris thinks Teddy's liver is compromised by excessive steroid, either through exogenous administration or secondary to hyperadrenocorticism.

2. There is no polyuria-polydipsia or polyphagia (in English does that mean no excessive urination, pot belly, loss of hind leg muscle and hair?)

polyuria = excessive peeing; polydipsia = excessive thirst; polyphagia = excessive hunger.

3.Teddys heart rate was 80 beats per minute, any idea about normal ranges?

Normal pulse rate in dogs is between 60 and 140 beats per min. The pulse rate should be the same as the heart rate unless there is a heart problem (an irregular rhythm) and can be taken in the groin (at the femoral triangle).
http://www.vet.upenn.edu/RyanHospital/K9FirstAid/K9NormalVitalSigns/tabid/1373/Default.aspx

4.BCS is 3/5- what does that mean? Does that mean overweight??

BCS = body condition score, 3 out of 5 is ideal. :D

5. Bilateral epiphora??

6. chest: WNL ?? WNL = within normal limits

7. abdomen: WNL ??

8. Urine analysis: specific gravity of 1.033, 2+ bilirubin ???

9. ACTH - 0 hr = 110 nmol/L (normal 15-120)
1 hr = 731 nmol/L (150-550)
2 hr = 881 nmol/L (150-550)
(I recognize this is higher than normal, but how sever is it? Can you give me a sense? When a dog is treated with drugs would their ACTH results be within normal range?)
10. abdominal ultrasound showed:
- left adrenal 0.6 cm, right 0.52 cm (aparrently this is within the normal range but not sure by how much?)

- a siderotic nodule in the spleen--- what does that mean? should i be concerned, there is no mention of this in the case summary or diagnosis.


Siderotic nodules or ‘Gamna-Gandy bodies’ are common in elderly dogs and are not clinically significant. They indicate previous bleeding.

http://www.vetcancercare.com/literature/oncology/Splenic%20Tumors.pdf
I would still ask about the siderotic nodules, tho.

I just wanted to let you know that I am seeing Dr Foster on Friday who my friend recommended. I'm seeing her for a second opinion becuase I need to feel comfortable with my vet and I didnt get a comfort feeling with Dr Norris as he is now recommending a liver biopsy to see why his liver enzymes are high-my family doctor feels that would be very stressful on Teddy and unnecessary- hence the second opinion.

I have to say, I felt overwhelmed by the fact that I hold Teddy's life in my hands making decisions about his health, but having you all here for support has provided me with a great deal of comfort, thank you so much!
I will fill you in on Friday.

Thanks again for your support and knowledge!
Christine

Christine,

I'm sorry I didn't get to answer all your questions, but I did give it my best shot. :o:p:)

You are doing such a wonderful job and if you don't feel confident in Dr Norris or didn't feel comfortable with him then I truly believe you should seek a second opinion. Best of luck to you and Teddy on Friday and I will looking for your post.

Love and hugs.
Lori

caz
10-28-2009, 10:47 PM
Thanks so much Lori- you are amazing!!

I have highlighted all of the things I dont understand in the report, so when I get the answers I will post them for us!

The Spleen thing scares me a bit, what would cause bleeding?

I was reading an article on the forum and had a couple of questions:

1. What is meant by animal receiving trilosdane "... develop fulminant hypoadrenocorticism." What does that mean??
2. "As trilostane may cause hyperkalemia.." what is that?

Thanks for your help, I'm hoping Dr Foster can take the time to explain things and also provide further resources for review.
Thanks again!
Christine & Teddy

StarDeb55
10-28-2009, 10:55 PM
fulminant hypoadrenocorticism= Addisonian crisis

Hyperkalemia= potassium is very high.

An Addisonian crisis where the cortisol drops very low frequently wreaks havoc on the electrolytes which include the sodium & potassium. This is why it is so important to be monitoring your pup closely, no matter which drug you are treating with, keep prednisone on hand, & get them medical attention ASAP, if you suspect an Addisonian crash. If severe enough, an Addison's crash can be life-threatening.

Debbie

Harley PoMMom
10-28-2009, 11:21 PM
Hi Christine,


The Spleen thing scares me a bit, what would cause bleeding?That I really do not know, I believe our "Spleen Guru" probably is Leslie since Squirt had to have hers taken out. Hopefully she'll pop in and give you some advice and/or links to articles to read about spleens. :eek::) I know Leslie has some really good links on alot of different things.

Good for you Christine for reading and asking questions, keep doing what your doing because you're doing a fabulous job. :D

Love and hugs.
Lori

AlisonandMia
10-29-2009, 01:45 AM
I think Debbie forgot to put in the link re BCS. I don't know which one she had in mind but here's a link I found: http://vet.osu.edu/1851.htm

It looks like a BCS of 3 means his weight is ideal.

Alison

StarDeb55
10-29-2009, 04:10 AM
Oops, sorry about the lack of the BCS link, Christine! Thanks for catching that, Alison. I was concentrating so hard to make sure that I had said everything I wanted to say, I didn't even notice the lack of the link.

Debbie

caz
10-29-2009, 08:58 AM
Thank you all- I am really hoping that I feel comfortable with Dr Foster as I will need to have a vet in Toronto now that Teddy has cushings.
Before this diagnosis I use to drive to London (where we grew up- its 2 hr away) to take the dogs for their check ups as I really trusted and worked well with my vet there.

My husband, while supportive, doesnt understand why TRUSTING and having a relationship with my vet is so important to me- but the weight of making decisions about Teddy's health and the need for me to work as a partner with the vet is very important to me- I want a vet who doesnt mind me asking questions and one who doesnt think my record keeping and research into cushings is obsessive.
Anyways- I find leaning from you all vey empowering it has truly helped me feel more comfortable with the diagnosis. I know I have said it before but I really cant stress how grateful I am to have you all- I have been telling all my friends about you!!

caz
10-30-2009, 04:37 PM
Hi again!

I just got back from the vets and she has recommended that we send blood samples to the U of Tenessee to see if he has atypical cushings. So that's what we're going to do.

Thanks again
Christine & Teddy

lulusmom
10-30-2009, 07:32 PM
Hi Christine,

Thanks for the update. Be forewarned that the UTK adrenal panel takes anywhere from 10 days to two weeks to get results but the good news is that you have a whole bunch of us that will be sitting on pins and needles with you.

Debbie knows the UTK schedule for running the adrenal profile so I am hoping she drops in to tell you what days are best to have the blood drawn and shipped. I used to know that information in my head but like everything else, it has disappeared into a black hole.

Glynda

gpgscott
10-30-2009, 08:15 PM
Hi Christine,

UTK puts all the samples in their fridge in the week they are received and begins testing the week after receipt.

So, it takes about two weeks to get the result. But it is still a good thing to do IMO.

Please let us know about the results, and the treatment recomendation.

Scott

StarDeb55
10-30-2009, 08:34 PM
I'm pretty sure UTK starts pulling all adrenal panel samples out from the prior week to run every Monday. Considering you are in Canada, I would say you absolutely do not want blood drawn on Thursday or Friday as you have to overnight the samples to UTK on dry ice, & there is no one in the lab on the weekends to receive samples.

Debbie

littleone1
10-30-2009, 09:32 PM
Hi Christine,

Corky just had the adrenal panel done. The blood was drawn on Monday, the 19th, and the results were faxed to my IMS on Tuesday, the 27th.

Terri

Casey's Mom
10-31-2009, 02:06 AM
Hi Christine, hang in there and know that you are doing a great job with Teddy - you are a great mom.

I don't know what I would do without this site, lots to learn every day.

Squirt's Mom
10-31-2009, 12:04 PM
Hi Christine,

I am so glad that Teddy will have the UTK panel! I think you will be glad as well once it is done. ;) Do let us know the results once you have them....but be patient, as others have said it takes a couple of weeks to get them.

You are doing a great job with Teddy and I know he is absolutely confident in you and your TLC.

Hugs,
Leslie and the girls

caz
10-31-2009, 01:36 PM
Thank you all for your support- your point about getting blood drawn on Thurs/Fri is a good one. I will try and reorganize me work schedule so we can get the test done of on Wed instead (unfortunately Dr Fosters hours are Wed-Fri).
I am grateful to have the time to do a thorough investigation before deciding on treatment options. This has certainly been a journey for me- it has made me more active as opposed to passive in my dogs health, and I thank you all for helping to educate me. Are there any other tests that you think would be helpful? I would much prefer to get the facts before deciding on a treatment plan than plunging into something with half the knowledge. If Teddy has atypical cushings that would certainly change the course of treatment. As for Teddy's spleen, Dr Foster told me she would monitor that to see if it changes before doing anything about it, at this point it could just be normal aging.

Thanks again! Its a rainy day today- perfect for cudding Teddy!

Harley PoMMom
10-31-2009, 03:13 PM
Hi Christine,


My husband, while supportive, doesnt understand why TRUSTING and having a relationship with my vet is so important to me- but the weight of making decisions about Teddy's health and the need for me to work as a partner with the vet is very important to me- I want a vet who doesnt mind me asking questions and one who doesnt think my record keeping and research into cushings is obsessive
We understand how important this is...members have fired vets for the reason/s you mentioned; not trusting/comfortable with them, vet/IMS not willing to work as a team/partner, and a vet/IMS getting miffed because one asked them questions.

I am also so happy that you are going to get the UTK full adrenal pane done, I had it done on my boy Harley and he has Atypical Cushings, plus he also has PDH. I am only treating his Atypical cushings as of right now because his cortisol levels are within the normal ranges.

I know this cushings journey can be a frustrating, scary, and tiresome trek, especially when one is trying to get their pup properly diagnosed. But a properly diagnosed pup is vital to proper treatment plan, and however frustrating, scary, and tiresome this trek becomes just remember we are always here for you and Teddy, ok. ;):)

Love and hugs.
Lori

caz
11-01-2009, 01:13 PM
Thanks all

It feels so good to have your support- I have to admit, when Dr Foster suggested this blood test a huge weight was lifted off me as I feel like I'm making progress, and whatever the results show, at least I know I have gotten to the bottom of things and will be more confident in whatever treatment is recommended-I just didnt feel comfortable- you're support has given me the confidence to keep pushing my vets for more answers, which I may not have done had you not provided me with all of your feedback- so Teddy and I both thank you.
I am also going to a homepathic vet this Monday (she was recommended to me by a vet friend)- I hope she will provide me with information on diet as I am not comfortable with the diet he is on (his liver enzymes and weight increased since we changed his diet, while this may not have caused the problem, I'm not convinced its helping him either).
I am just thankful I have time to make decisions, if he does have to start taking trilsodane I will probably start during xmas vacation when I have 2 weeks off to watch him- I dont think I would feel comfortable leaving him alone at home during this time.

Thanks again for your help, you all mean so much to me, it is a very comforting feeling knowing you are not alone! I am so happy about UTK!!
Have a great weekend- we're heading for a hike!
Christine & Teddy

Roxee's Dad
11-01-2009, 01:41 PM
Hi Christine,
So glad you are moving forward on a thorough diagnosis. Good job! :)

Regarding liver support, many of us use Milk Thistle and or SAMe. Here is a quick link:

http://www.k9cushings.com/forum/showthread.php?t=192

caz
11-03-2009, 08:19 AM
Just an update- I have rescheduled my UTK test for next Monday so that we can ensure it gets across the boarder and refridgerated upon arrival- thanks for the tip!

Harley PoMMom
11-03-2009, 11:01 AM
Just an update- I have rescheduled my UTK test for next Monday so that we can ensure it gets across the boarder and refridgerated upon arrival- thanks for the tip!

Hi Christine,

Good job with rescheduling the UTK panel, we will be anxiously waiting with you for the results.

When you do get the results, I know this is alittle early for me to post to ask :) but could you post the results of the UTK panel here with the reference ranges, and there should be a summary comment made by a Dr. on there, it is usually Dr. Oliver, but it could be another Dr. Anyways, could you post that summary comment too.

I was wondering how you made out at the homeopathic vet this past Monday?

Love and hugs.
Lori

jrepac
11-03-2009, 12:37 PM
Hi Christine,
So glad you are moving forward on a thorough diagnosis. Good job! :)

Regarding liver support, many of us use Milk Thistle and or SAMe. Here is a quick link:

http://www.k9cushings.com/forum/showthread.php?t=192

there is also a combo product called Denamarin, which is fairly new (from the maker of marin and denosyl)....it's a little price, but has both supplements in one tab

Harley PoMMom
11-03-2009, 01:43 PM
Hi Christine,

I was just rereading your thread and this issue with the bladder stone has me worried, I know I'm a worry wart :D but if Teddy has made a bladder stone, he is more than likely to make more. Back in Feb. I had my own issues with kidney stones :eek: very painful and they made me very sick...throwing-up sick, well the Dr. had my stones analyzed, had me change my diet and put me on special meds for them stones. Has the vet looked into Teddy's bladder stone issue any further...change of diet, meds??



Sorry for the delay, we've had a wild ride! The vet left on Tuesday night without telling me anything, so I have been waiting for his call (and calling him repeatedly). He called to tell me that Teddy's adrenal glands and liver are all within the normal ranges. The ACTH test did confirm cushings, so he stated that Teddy's cushings disease is dorminant. He said I didnt need to treat him for cushings at this time, but should get him ultrasound every 6-8 months. He said that they found a bladder stone in Teddy which he wants to remove surgically and then take a live biopsy. He stated that the vomitting was probably due to picking up a bug as Lucy (my yorkie also had diaherra).

So, I have been given grace time to learn more about cushings disease and treatments which is relieving. I will also be going to a homeopath recommended by a vet to put him on a diet that addresses his allergies and suppots his immune and digestion system.

My worry now is the fact that if Teddy gets the biopsy it means an extended time in the clinic (3 days vs 1) Teddy has neve been in a kennel. The LDDS test was the longest time Teddy spent at the vet office and he lost his voice barking all day-- so I am really worried about the stress this will put on him (and admittedly me).

I will be reading all of the resources on anipryl and trisodane listed on this website, any other resources I should be investigating? Any thoughts regarding Teddy's care? Do you think it is worth me taking him to OVC or the clinic my friend suggested, or should I wait until Teddy's cushings progresses?

Love and hugs.
Lori

caz
11-05-2009, 09:26 PM
Hi Lori

I went to the homeopath on Monday and she copied Teddy's complete file, she spent an hour asking questions about Teddy's behaviour, history, everything and she will review the vet's records and call me in a week once she has developed a plan.

With respect to Teddy's bladder stone, both Dr Will and Dr Foster don't recommend surgery at this point since his behaviour and urine show no signs (just the xray). Neither vet recommended changing his diet, but vets never seem to know or acknowledge the importance of diet.

I mentioned it to the homeopath and she will develop a plan for that, his allergies and potential cushings. She gave me a cook book to look at "Complete & Balanced: 101-Healthy Home-made Meals for Dogs" by Hilary Watson, and stated we would evaluate appropriate diet meals at our next visit.
Better run!
Christine & Teddy

Dr mitch
11-13-2009, 11:00 PM
Glad to see you are making some headway and getting some answers. I don't want to "thread-steal" - but if I could, I would like to clarify some earlier questions regarding Dr Gillick at the Toronto Veterinary Emergency Hospital. It is true, he is not board-certified by the ACVIM. He completed his Diploma in Medicine and was practicing referral medicine prior to the existence of the ACVIM. Who knew it would grow into the organization it now is!
Morningside was the clinic he started back in 1974. Recently the practice moved into a new much larger facility in Toronto where it continues to offer referral services (medicine, surgery, critical care & radiology) and is open 24 hours a day for emergencies. There are technicians and at least one veterinarian on staff in the facility on the floor working at all times. Hopefully that will help to comfort you a little should Teddy have to return to the clinic for any further diagnostics.
My knowledge of the clinic comes first hand as I work in the surgery department there, and am one of the partners at the clinic (and Dr G is my father). :)
We wish you and Teddy all the best!

Cheers!

acushdogsmom
11-15-2009, 05:34 PM
I don't want to "thread-steal" - but if I could, I would like to clarify some earlier questions regarding Dr Gillick at the Toronto Veterinary Emergency Hospital. It is true, he is not board-certified by the ACVIM. He completed his Diploma in Medicine and was practicing referral medicine prior to the existence of the ACVIM. Who knew it would grow into the organization it now is!

Morningside was the clinic he started back in 1974. Recently the practice moved into a new much larger facility in Toronto where it continues to offer referral services (medicine, surgery, critical care & radiology) and is open 24 hours a day for emergencies. There are technicians and at least one veterinarian on staff in the facility on the floor working at all times. Hopefully that will help to comfort you a little should Teddy have to return to the clinic for any further diagnostics.

My knowledge of the clinic comes first hand as I work in the surgery department there, and am one of the partners at the clinic (and Dr G is my father). :)
Thank you, Dr. Mitch, for the clarification regarding your father's credentials. Although his credentials as listed in his "bio" on the TVEH/Morningside Clinic looked to be quite impressive, I couldn't find him listed on the ACVIM website as a boarded diplomate, and now we know why. And from what I can tell on the TVEH/Morningside Clinic website, it certainly does look like a great facility for pets in need of specialty referral services, emergency services and 24-hour care in the Scarborough area of Toronto. :)


Hi again!

I just got back from the vets and she has recommended that we send blood samples to the U of Tenessee to see if he has atypical cushings. So that's what we're going to do.

Thanks again
Christine & Teddy


Just an update- I have rescheduled my UTK test for next Monday so that we can ensure it gets across the boarder and refridgerated upon arrival- thanks for the tip!So I guess you've had the UTenn adrenal panel/ACTH stim test done by now and are waiting for the results. Please let us know when you get the results and what Dr. Foster thinks would be the best way to proceed. :)

caz
11-23-2009, 02:08 PM
Dr Mitch- I love the Toronto Vet Emergency Hospital- I highly recommend it!
Dr Foster listened to me and didn’t treat Teddy like a science project or money making trophy. When all the other vets wanted to give him drugs and treated me like I was in denial, she took her time to listen to me and then recommended the blood test at U of T! And as a result I don’t have to put Teddy on drugs as he has Atypical cushings. Here are his results:
ALT – 39 (norm 12-118)
ALP – 397 (5-131)
Cortisol (ng/ml) 72.2 (2-56.5), post ACTH 132.3 (70.6-151.2)
Androstenedione ng/ml 1.43 (0.05-0.36), 5.2 (0.24-2.90)
Estradiol pg/ml 60.2 (23.1-65.1), 69.9 (23.3-69.4)
Progesterone ng/ml 0.86 (0.03-0.17), 3.40 (0.22-1.45)
17 OH Progesteron ng/ml 0.75 (0.08-0.22), 4.55 (0.25-2.63)
Aldosterone pg/ml 110.7 (11-139.9), 421.0 (72.9-398.5)
Teddy is now taking melatonin 3 mg, 2x/day; flaxseed hull 20 mg/day

He will have recheck (ultrasound and UoT blood test) in 3 months to assess the bladder stone, spleen and adrenal function.

I have continued to research cushings and read that BHA is a preservative in dog food (found in Hills Salmon and potato diet which Teddy is on) which is thought to damage adrenal function. Have any of you heard of this? Have you looked at your dog food ingredients? (unfortunately I'm told its not always listed). I'm considering homemade cooking for Teddy.

lulusmom
11-23-2009, 04:46 PM
Hi Christine,

I'm so glad that you had a great experience with Toronto Vet Emergency Hospital and Dr. Foster sounds wonderful.

With respect to the BHA, I believe that Science Diet and other low quality foods use this chemical preservative to stabilize the animal or other fats. Good quality foods include named fats are BHT and BHA free. If you have time to cook for Teddy, then my hat's off to you because I barely have time to cook for the hubby and I these days. However, if you'd prefer not to cook, there are many excellent good quality, balanced dog foods out there that are much, much better than Science Diet. Before I switched my dogs to Primal raw, I fed them Natural Balance which is a really good food and they have single source protein foods for dogs with allergies. If Teddy has allergies like my little Maltese, the sweet potato & fish or duck & potato dry food would probably work well. I used to buy the canned and the dry and mix it. All five of my furkids loved it but not as well as they like their raw food. If you want to try a grainless food, check out the foods that are top rated with six stars at www.dogfoodanalysis.com

Glynda

Roxee's Dad
11-23-2009, 10:15 PM
Hi Christine,

I am truly happy that you and Teddy have had a good experience and a thorough diagnosis. Looking forward to hearing about his progress for many years to come. :D

Regarding diet, all that news about additives and contaminated food from China have made us even more aware of what is in our pups food. We do a rotation diet with our pups and my wife makes all their treats. The most important ingredient is "love"

Keep up the good work and belly rubs to Teddy.:)

caz
11-24-2009, 10:17 AM
Thanks guys- I think what upsets me the most is that I thought I was buying Teddy high quality food- its the vet's Hills Science Diet and prior to that MediCal---

I have found that unlike with humans the information and scamming regarding pet foods, ingredients and research is just not there -- I too dont buy anything with China on the label-- but manufacturers are getting smart- now they say "packaged in Canada" and stick a premium price to lead consumers to believe its made in Canada-- UGGGH-
In the new year I'm registered in a holistic nutrition program (part time as I'm a fulltime engineer) but given Teddys medical issues and my asthma I think its time I get informed.

Thanks again for your support and guidance it has made such a difference in his treatment and my stress level!

StarDeb55
11-24-2009, 10:26 AM
Don't feel bad about the SD food, I, too, learned the hard way about SD food a number of years ago, & I will not feed any brand of SD no matter what. I feed Primal raw which both of my boys love. I have started moving them to Sojo's raw food which is also good. It's nothing against the quality of Primal, but simply a matter of cost.

Debbie

Harley PoMMom
11-24-2009, 11:51 AM
Hi Christine,

I don't know if you are still contemplating home-cooking but if you are here is a post from Cushy to another member about Dr. Remillard, and I've included Monica Segal too, now Monica, as far as I know is not a certified veterinary nutritionists.


Karen,

Just another idea I thought you might like to know about. I don't know if you'd be interested in this, but if you are looking for help with formulating a good homemade diet for Jed, maybe you and your Vet can work with Dr. Rebecca Remillard, who works at the Angell Memorial Vet Hospital in Boston.

Here's a little blurb about her on the Angell Memorial website:
http://www.mspca.org/site/PageServer?pagename=nutrition_Team (http://www.mspca.org/site/PageServer?pagename=nutrition_Team)

She is a Board Certified Veterinary Nutritionist (DVM, Diplomate ACVN) and in addition to her job at Angell Memorial, she also has a website http://www.petdiets.com (http://www.petdiets.com/) where she does offer consultations and formulation of diets for pets with medical conditions.

I've never used her service, but I did know someone (online at another e-group) who consulted with Dr. Remillard in person at Angell Memorial in Boston, and she was very happy with the homemade diet that Dr. Remillard created for her dog.

Here's some info about Dr. Remillard's services from her website:

https://www.petdiets.com/Consult/default.asp (https://www.petdiets.com/Consult/default.asp)


We specialize in making sound dietary and nutritional recommendations for dogs and cats with medical conditions. Your pet may be sick and not eating the recommended diet well. Your pet may have more than one medical condition for which there is no single best commercial pet food. We make recommendations and formulate diets based on current principles of dietary management and the pets' food preferences. We offer choices based on the known current scientific literature and our clinical experience.

This is a Nutritional Consultation through your primary care Veterinarian:
Your primary care veterinarian as a vital partner in the care of your pet. Legally, we must work through your veterinarian because we do not have a primary doctor/patient/client relationship with you. We work as a specialty consultant to your veterinarian. Our recommendations will be sent directly to your veterinarian for review and you will be notified when the information has been sent to his or her office.

Client Education:
We also consider client education an important part of our mission and service. We provide you with the most current information specific to your pets’ medical condition(s) in an understandable prose written specifically for pet owners. Pets only need one nutritional formulation (one recipe) however, food substitutions are offered when appropriate.

Recommendations:
We fax our written recommendations to your veterinarian for review. You will be asked to provide this contact information. We will complete our recommendations generally within 10-14 business days of receiving confirming medical information from your veterinarian. Our charge for a personalized Nutritional Consultation is $250 for your first pet, but then discounted ($100) for your second pet or discounted further ($50) for the third pet in the same household IF different diet formulations are required. Most times, we can design a diet that accommodates more than one dog or cat in the household.

This fee covers product research, review of medical information and a diet formulation. It also covers all questions you may have about our diet recommendations. Food substitutions are always offered if appropriate. Please understand there is an additional charge of $100 to reformulate another homemade diet if you should later request a change in ingredients, foods or supplements that were not previously specified or if the pet should develop another medical condition.


Note that she provides different kinds of dietary advice (commercial diets, homemade diets, or a mix of the two) depending on what you ask for:

https://www.petdiets.com/popup/popup.asp?url=body.asp&sT=Types of Nutritional Recommendations (https://www.petdiets.com/popup/popup.asp?url=body.asp&sT=Types of Nutritional Recommendations)


You may only want specific commercial product recommendations for the pet. Each letter of recommendation will include specific product names, our reason(s) for suggesting those products, our order of preference (if there is one) and the recommended amount to feed the pet.

You may only want a homemade diet formulated specifically for a pet or you are feeding a homemade diet and want to know if it is complete and balanced, and appropriate for the pet's condition. Each letter of recommendation will include a recipe using both metric and common measurements on the amount of each food ingredient to feed the pet per day. The recommendations also include specific and easily obtained nutritional supplement(s). We also provide information on the preparation and storage of the food, monitoring of the pet and veterinary instructions. All diet recipes are guaranteed to be nutritionally complete and balanced according to current scientific information and our clinical experience.

You may want recommendations that consider both commercial and a homemade diet formulation.

As you can see, Dr. Remillard's service is not exactly cheap, and the client's Vet has to also agree to work with Dr. Remillard as a consulting Specialist, but if you are interested, I don't think it matters that you are in Canada and Dr. Remillard is in the States. You and your Vet can communicate with Dr. R. via e-mail and/or fax, I'm sure, or via long distance phone calls if necessary.

Monica Segal, AHCW


Monica Segal is certified in Animal Health Care through the University of Guelph with studies in animal nutrition,physiology, diseases and parasites, as well as pet care.
She writes featured articles in many publications throughout North America. Monica conducts seminars and workshops by invitation, hosts an Internet discussion group at K9Kitchen, and authored a book called "K9 Kitchen, Your Dogs' Diet: The Truth Behind The Hype," published in June 2002. Her second book, "Optimal Nutrition" inlcudes a foreword wrtten by Ana Hill DVM, PhD and was published in 2007. Monica lives in Toronto, Canada, with her husband Morley and dogs, Cassie and Tori.

Nutritional Philosophy

Each dog is an individual and needs to be fed that way. Itchy skin, runny eyes, gastrointestinal problems and a myriad of other complaints can often be traced to dietary sensitivities. Certain breeds and individuals are predisposed to particular ailments that may be addressed by dietary modifications. Addressing disease may require a unique change in diet plans.
Respecting the needs of individual dogs translates to feeding a diet that supports uniqueness. The notion of there being one perfect way to feed all dogs is a myth. Some will thrive on an all raw diet, others will do best on cooked foods while yet others will do well eating a combination of both. The choice is based on the dog owner's comfort level with a particular method of feeding and the dog's tolerance level of that choice.

http://www.monicasegal.com/

Harley is on a diet formulated by Monica Segal, but he's only been on this home-cooked diet since 10/31/09. So far he is doing really well, but it still too early to tell.

Hope this helps.

Love and hugs.
Lori

caz
12-05-2009, 07:56 PM
This is amazing information- exactly what I'm loooking for given Teddy's allergies, bladder stone and need for adrenal support! THANK YOU THANK YOU!!! Teddy is responding REALLY well to the flax seed hull and melatonin- I'm soo happy! He's like a puppy again chaising after poor Lucy and I!!
I will definitely investigate!!

caz
12-14-2009, 06:39 PM
Just wondering if any of you have a sense of how common atypical cushings is-- the reason I ask is I would like to educate my vet on cushings as he stated that he has roughly 60 cushings patients in his practice. Furthermore the specialist I first went to stated that he sees 2-3 cushings patients a day-- given that both of them diagnosed him as cushings and wanted to give Teddy drugs, makes me wonder how many dogs are actually misdiagnosed.

Also wonder of the Atypical cushings dogs how many are male/female and neutered. Just some questions, not sure if you have a sense. Are there any articles I could refer my vet to.

Teddys doing great- I'm so happy! I'll post some new photos of my little xmas elf!

caz
12-14-2009, 06:40 PM
Ohh almost forgot- I submitted a request to Dr rebecca for a diet plan given Teddys allergies and bladder stone I want to ensure he's on the proper food!!

Thanks again!!

StarDeb55
12-14-2009, 06:47 PM
One of the reasons that vets may not know or want to attempt to diagnose Atypical is that fact that when using lysodren, lysodren will control all adrenal produced hormones under the great majority of circumstances. The one hormone that will always be a problem is estradiol as it has non-adrenal sources such as fatty tissue, gonads, & brain tissue. This is why the melatonin & lignans are usually used to control this non-adrenal production of estradiol. My vet & I have discussed this a couple of times, & his feelings are that since lyso controls all the adrenal produced hormones, the pup gets better with symptoms disappearing, & no one is the wiser. It's when symptoms do not subside completely or possibly get worse that the other hormones may come into play.

Debbie

Harley PoMMom
12-14-2009, 07:22 PM
Hi Christine,

When Harley was dx'd with Atypical Cushings, his GP Dr Owings, didn't know anything about it, I took articles, which I printed out from here, and took them in for her to read. She also contacted Dr. Oliver by phone and e-mails to discuss Harley's case and she continues to do so. She has even brought his case to the attention to her fellow colleagues so they can keep abreast on his Atypical Cushings. This was/is Dr Owings, and I am pretty sure her colleagues, first case of Atypical Cushings.

Here is a link in our Resource Thread about Atypical Cushings:

Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's"

http://www.k9cushings.com/forum/showthread.php?t=198

Kudos on submitting a request to Dr Rebecca Remillard for a diet for Teddy!!

Love and hugs,
Lori

lulusmom
12-14-2009, 07:23 PM
Hi Christine,

We have a lot of good information on Atypical Cushing's in our Helpful Resources Section. You can use the link below and print out anything you think may be helpful to your vet.

http://www.k9cushings.com/forum/showthread.php?t=198

I hope this helps.

Glynda

caz
12-14-2009, 07:44 PM
Thanks everyone!

jrepac
12-15-2009, 12:27 PM
I'm not sure how well known ATYPICAL Cushings is...I had not heard of it until I visited this board and checked out the UTK site. I'm not even sure my vet knew about....I know he was unaware of UTK testing and was impressed after we sent the bloodwork there.

It DOES seem that Cushings is fairly common, but some vets will have more patients than others. And, some vets/owners elect not to treat (which I think is a mistake, IMHO).

My feeling is that you need to be comfortable w/the vet you are working with and he/she should be considerate and open-minded to your treatment concerns. That is tops on my list...some vets can be more experienced, but they can also be more opinionated, which is not always helpful. Experience can be a double-edged sword. But, when it comes to treating w/lyso and trilo, which do have some risks, I'd want to be sure my vet has a good track record (I am not using either now, but went thru this in the past w/a junior vet who was very inexperienced).

Jeff

caz
12-17-2009, 10:06 PM
Thanks for all your thoughts- I cant tell you how lucky I feel to have learned so much from all of you-I feel that we are on the right track with the supplements and diet
-I have to say I'm a bit disappointed with my vets lack of interest in UTK and Atypical cushings- so I agree with you Jeff that experience doesnt always mean you have a vet who is also willing to learn- I have also learned that no one loves or knows Teddy as much as I do so I need to do what's right for us.
Thank you all I really appreciate your support- my breeder just referred a client of hers to me as her dog is also showing signs of elevated liver enzymes- I have referred her to the forum - so hopefully she will join us!

caz
04-11-2010, 01:30 PM
I JUST WANTED TO GIVE EVERYONE AN UPDATE!!! GREAT NEWS!!!
Teddy had a recheck with full UTK panel and ultrasound after 4 months of being on flax seed hull and melatonin- and two of his hormones are NOW NORMAL and the other two have trended down- I dont have the report yet, I meet the vet on Friday so I can give you the exact numbers then!! But I'm so thankful the Dr Gillick called to give me the good news before the weekend so I wasnt waiting!!

I cant tell you how thankful I am to ALL of you for your advise- had I not learned about the UTK panel I would have put Teddy on trilosdane based on the advise of 2 vets, from the blood results Dr Gillick said that would have been the wrong medication for Teddy as it would have excerbated the hormone which is causing the problem. Lysodrene will be the drug of choice if the flax/melatonin doesnt resolve his elevated cortisol!! It just goes to show you- one solution/drug doesnt work for everyone, we need to find out what is causing the problem and then treat the problem.

SOOOOO thank you-- you saved me and Teddy, and gave us more quality time together!! You also taught me so much-- I learned to take things in my own hands and become responsible for educating myself and if I dont like what I'm being told- trust my gutt and get another opinion!!

Thanks to VEC staff- what a great place, the receptionists are so friendly and Dr Gillick has been very patient and supportive!! We're off on another hike!! Teddy hiked 17 km with us last week!! What a trooper!!

I really wish we all lived closer as it would be great to have a Cushing picnic to celebrate our wonderful furry friends!!

Harley PoMMom
04-11-2010, 02:54 PM
Hi Christine,

Oh what a great report on Teddy!!!! I am so very happy for you both.

What a wonderful mom you are to Teddy. Christine, we showed you the tools that you needed to help Teddy, it was up to YOU to implement them, and I believe YOU have done a excellent job implementing those tools. ;):D

Love and hugs,
Lori

Casey's Mom
04-11-2010, 11:10 PM
Wonderful news!!:):):)

Love and hugs,

Franklin'sMum
04-12-2010, 07:53 PM
Excellent news Christine :)

I'm so happy for you both :D:D

Jane and Franklin xx
________
Lovely Wendie (http://www.lovelywendie99.com/)

jrepac
04-13-2010, 11:37 AM
that's all excellent news!:)

caz
04-18-2010, 08:19 PM
Thank you all so much I'm still celebrating the news!! I cant tell you how much I have been hugging and kissing him!! He's also down to his original weight so that's also a great sign!! THANK YOU SO MUCH!
This experience has definitely given me confidence to trust my gut, research and get a second opinion!

Bichonluver3
05-18-2010, 07:48 AM
Greetings from the desert in California.11
I have 2 rescues: 11 yr old female bichon (Miss Chloe), 3 yr old maltipoo (Grover) - who thinks he is a bichon and a 7 yr old pure bred male bichon (Sparky) who is our Director of Security!
It has been a rough year: death of my father-in-law, my father, and also my best friend who died at 62. I am also dealing with a recurrence of skin cancer (thank goodness, so far, it is basal cell) and now this.
I am a nurse and recognized the symptoms of Cushing's in Miss Chloe. However, sometimes these symptoms creep up slowly and, looking back, there were signs previously but, at the time, they didn't ring any bells.
I am familiar with Cushing's in people but certainly not in dogs! Well, as soon as the voracious appetite and the excessive panting started, accompanied by a pot belly, I knew it was off to the vet's and back to the books.
Chloe's initial testing showed nothing remarkable in her blood panel other than increased triglycerides. They were not severely elevated so the vet put her on a Hills AH diet (although I was giving her a little canned ID to get her glucosamine down!).
Her urine was concentrating well. She was drinking more than usual and urinating a little more but nothing "out of the ballpark".
She had a low dose dex suppression test done and suppressed well.
Of course, her symptoms continued. The first vet had, in the meantime, left the practice and so we were now seeing one of his colleagues who told me the next test would be the panel done at UT. In the meantime, I suggested to him that we start Chloe on the Melatonin and Flaxseed oil with Lignans. I also decided to keep her on the current diet so there would be no changes other than the "meds". He agreed.
We just got the results on Friday from UT and, even though he was not at work on Friday, our vet called one of the techs and had her read the results to him over the phone. He called me to let me know the results indicated Atypical Cushing's.
Today, he had the opportunity to review the actual hard copy of the results and called to tell me that she is showing Atypical + mild Cushing's.
I am so blessed to have Dr. Lingreddy to man the ship. He called me after hours (before he left for home) and spent more than 1/2 hour on the phone while we brainstormed and looked at all our options.
We decided to continue Chloe on 3mg. Melatonin twice a day and 1 tsp of flaxseed oil with lignans once a day for now.
He will re-evaluate her in 2 months (or earlier if the need arises). He has suggested that down the line, an ultrasound may be a good idea to determine the state of the adrenals. He also talked about Lysodren but said that will depend upon how she responds to the current treatment.
Meanwhile, Chloe is still as active as she can be with her pot belly. She continues to bark at her food, dance around it and throw it in the air before she eats it!
The one thing I miss is the fact that she would curl up in bed with my husband and I for the night and, now, she does spend some time on the cool tile floor. I suppose she will not be happy outdoors when the summer weather hits the desert.
But....she can still put her brothers in their place!
If you have made it this far - thanks for lending an ear!
When we rescued Chloe (she was very badly abused, required surgery etc), we promised her that she would have the best life we could give her. She has stayed by my side through a couple of extremely tough times and stayed up many nights comforting me. Now it is my turn. The times I must wake up during the night to lift her on and off the bed is small compensation for the love, warmth and steadfast companionship she has given me over the last 10 years and which I hope we can share for another few years.
WHEW!!! Thanks for being here for Chloe and I and God bless all ou "treasures" - big and small!

Administrative Note: A new thread has been started for Chloe here: http://www.k9cushings.com/forum/showthread.php?t=2095