My Erin (11.5 yr. old Airedale) recently diagnosed, pre-existing arthritis

[lenaray]

hi everybody! it's my first time here: my 11,5 years old Airedale terrier was just (yesterday) diagnosed with Cushing's. i have impression that my vet doesn't believe that treatment would make sense because of harsh side effects. i would appreciate any opinions because right now i am complete mess.

[haf549]

Well, you've come to the right place. You're going to find plenty of support here. Others will be along soon to welcome you and question you. I just want to say, that your vet is wrong:(, Cushings is NOT a death sentence for your baby. Many here on this forum have dogs on treatment for years and they have happy and healthy (except for the Cushings of course).

Others are going to ask you how your vet came upon the diagnosis of Cushings. Were all other ailments ruled out? Several members here will list all the questions and links to appropriate pieces of information regarding Cushings (diagnosis, treatment options, etc). Have as much information regarding your pups symptoms handy to answer these questions.

My Kira was diagnosed over a year ago with Cushings and is living a normal happy doggy life. I know this is scary, but stay tuned here and you'll get everything you need to make informed decisions regarding your baby.

Heidi

[littleone1]

Hi and welcome from Corky and me.

You have found a wonderful group of very caring, supportive and knowledge people.

I know a Cushings diagnosis can be very upsetting. Corky has now been on Trilostane for 2 1/2 months and is doing very good.

Others will be along that have much more experience than I do. They will be asking you lots of questions, and as Heidi said, they will be giving you many links to very valuable information.

My first vet originally said not to treat Corky's Cushings, but I got a second opinion and I got advice from another vet. If it is left untreated, there can be more problems with their internal organs. As long as you monitor their medication, they can have a better quality of life.

Would you please let us know your first name and your furbaby's name. It is nice to be able to post to you using your name.

Terri

[Franklin'sMum]

Hi and welcome to you and your pup, from me and Franklin.

First off, what are your names if you don't mind me asking?
Ok, your pup is 11.5 years young, Boy or girl? Is he/she on any other medications, herbs, supplements? If so, what, what dosage, and how often? How much does your pup weigh? What test(s) were performed to diagnose Cushing's? Can you please post the results of those tests, along with the units of measurement (nmol/ ugdl) and the normal ranges for that lab?

It's a great idea to get a copy of the results for your own records (for if you need to see a different vet, or to answer questions here :))
Were any other conditions ruled out? (Diabetes and thyroid issues, to name 2 conditions that have symptoms that overlap with Cushing's.)
Does he /she have any other medical conditions? What symptoms were you seeing to take him/her to the vet to be checked out? (Excessive thirst, excessive urination, lack of bladder control, excessive hunger, thinning coat, panting, pot belly, excercise intolerance, heat intolerance, new phobia) I'm probably forgetting some...but that's a start. Not all pups have all of those symptoms.

Side effects aren't all that bad from either of the 2 main drugs used to treat Cushing's (trilostane and lysodren). The main side effects are loss of appetite, lethargy, diarreah (sp) and drinking less. The side effects are very important to watch for, so you can tell how the drug is affecting your little one. Also a great idea to keep a diary of your pup's behaviour, and eating, drinking habits, poop and mood. Others will chime in soon to fill in any blanks I've left, I'm sure. :)

You do however need a vet who is familiar with Cushing's and the treatment options, or an expert who will work with you and your vet to take care of your baby. This is teamwork, between your official medical team, and your new forum family team :D.

A cushpup can live out it's regular lifespan, with treatment. I don't understand why your vet would recommend against treatment.

Jane and Franklin xx
________
Body Science (http://bodyscience.ws/)

[Harley PoMMom]

Hi and welcome from me and my boy Harley. My Harley is a 13 y/o Pomeranian and he has cushings. He has elevated intermediate/sex hormones, which is referred to as Atypical Cushings if the cortisol is within normal range, which his is not :(...and he is also PDH.

Heidi is correct in her post on a number of things; :) we ask alot of questions, Cushings is NOT a death sentence, and you definitely have come to the right place for help. ;):)

Now for some of them questions, are you ready :eek::) First, if you don't mind me asking, what is your name and what is your pups name, we are sooo friendly around here and starting my post out with "Hi" well, just seems so impersonal. :)

What symptoms led you or your vet to test your pup for cushings? What tests were done to confirm cushings? If any of these tests were a LDDS or ACTH test, could you post the results and the units, ie (ug/dl) here. Was a CBC and/or Chemistry blood panel done on your pup, if so could you post anything that is marked "abnormal or high" with the reference ranges and the units here. Is your pup on any herbs or supplements? Does your pup have any other medical conditions besides cushings, ie...diabetes, hypothyroidism? How much does your pup weigh? Was an ultrasound done on your pup?

Ok, that's all the questions I'm going to throw at you for now :eek: I realize that I have probably overwhelmed you for right now, but I want you to know that the more we know about your precious pup the better we can help you help your furbaby.

Cushings is a slow progressing disease so you have time for a proper diagnosis, and a proper diagnosis is vital to a proper treatment plan.
I remember vividly when Harley was dx'd, just this past Feb., I was so terrified, and by a miracle I found this forum with these amazing and knowledgeable people who have many years of cushing experience under their belts. They have taught me so very much about this dratted disease and have helped me and my boy Harley tremendously.

Please remember you are not alone on this journey, we are here for you and your pup, so please ask all the questions you want and we will answer them the best we can. I am including two links for you, one is for our Resource Thread, the other is for new members, I believe you'll find alot of information in them.

Helpful Resources for Owners of Cushing's Dogs
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Links to Cushings Websites (especially helpful for new members!)
http://www.k9cushings.com/forum/showthread.php?t=180

Hugs,
Lori

[StarDeb55]

I would like to welcome you, too! This is so such HOGWASH when a vet tells you that treating Cushing's is not worth it. My first Cushpup, Barkley, was successfully treated for nearly 8 years with lysodren. He had a wonderful quality of life crossing the bridge at 15 due to causes unrelated to his Cushing's. Untreated Cushing's will eventually lead to multiple organ failure possibly including heart, liver, or kidney failure due to the overproduction of cortisol by the adrenal glands. My 2nd boy, Harley, was diagnosed in the spring of '08, & has been doing well.

I must warn you that we play 20 questions with new members, but that just helps us to give you the best feedback from the group's collective experience. First of all, could you post the actual results (numbers) of all tests that have been done to diagnose Cushing's? If you don't have copies of the your pup's labwork, your vet should be happy to provide them. Most members do keep files on their pups at home as you never know when the file might come in handy, especially if you end up at a strange vet. Some of the tests that might have been done to diagnose include an ACTH, low dose dex, & high dose dex. Was an abdominal ultrasound done to take a look at the adrenal glands? If routine labwork such as a senior wellness panel, or comprehensive chemistry panel were done, could you post just the abnormal results, along with reporting units & normal ranges? Have diabetes & thyroid been ruled out? I ask about these 2 issues as their symptoms do overlap with Cushing's. Could you tell us about the symptoms your pup has been bothered with that led you to go to the vet? Does your pup have any other medical problems? Last, but not least, what is your pup's name & your name? It's a little more personal than saying, "heh, you"?

The best thing you can do is to become a knowledgeable, informed owner as you are your pup's only voice & advocate. With that in mind, I would strongly suggest you take a look at the forum's important information & resource section where you will find a huge number of links that will lead you to any information you might need about Cushing's including the interpretation of test results, medication & the proper protocols on how to use the 2 medications, among many other topics.

We are here to help in any way we can, & are looking forward to hearing more.

Debbie

[lenaray]

Hi again and thank you all for your support. My name is Lena and my dog is Erin. She is 11y.6m.old, approx.80lb.weight. Her med.history: hip dysplasia from 9 month, bad arthritis now. She is on high dose of vit.C (for hip dysplasia), vit.E, yeasts tabs, Pet-Tabs Plus, Cosequin, PPA (Proin) tabs for leaking accidents. Erin started drink and urinating much more then before, has accidents in her sleep (never happened before), her hair is growing much slower, she lost some on her belly, got a lot of lumps over her body. I don't have exact numbers for her tests (going to get them ASAP), but what i remember: all liver functions (AST,ALP,ALT) were elevated, cholesterol >300, norm.<220; urine sp.gravity is 1.004, norm.1.025; low dose dex.test showed high level :2.6 over 1.4 base. We didn't do anything else yet. My vet didn't say that treatment is useless but imply that with her arthritis and her age the side effects could be worth then disease itself. that is for now.

[StarDeb55]

Lena, the elevated liver values you have indicated, along with the elevated cholesterol are quite common for our cushpups. The liver is under a lot of stress because it's responsible for breaking down all of the excess cortisol that is produced in the adrenal glands. A very low specific gravity is also another symptom as our pups can't concentrate their urine. One word of caution, a lot of folks with newly diagnosed pups think that their pups are peeing buckets because their drinking buckets, & will limit the pups water intake. This is quite the opposite, the pup is drinking buckets because they're peeing buckets. A cushpup must have ready access to water because of this or they can become dehydrated very quickly, & get quite ill.

When it comes to the low dose test, there are actually 3 blood draws or results for the test. The first draw which is a baseline or pre draw which is done prior to the stimulating agent being injected, a draw done at 4 hours, then the last draw is done at 8 hours. We really need to see all 3 numbers as soon as you can get them. Making a diagnosis of Cushing's based on a single positive low dose test can be an "iffy" proposition, as there can be false positives on this test in the presence on non-adrenal illness. It is critical that you confirm the positive on the low dose with a second test such as an ACTH or an abdominal ultrasound. The ultrasound really gives you more "bang for your buck" as you can take a look at all of Erin's internal organs & get a better idea of her overall health. Cushing's is one of the most frustrating & difficult canine diseases to diagnose as no single test is either 100% specific or sensitive.

When it comes to things like arthritis, the excess cortisol is a natural anti-inflammatory so there is a likely possibility that as the cortisol is brought down to a more healthy level, Erin's arthritis could get worse. There are a number of members who are dealing with arthritis also, so from them, I know there are a number of other good medications for both pain control, & for inflammation. I'm sure some of those folks will be along & can comment more in depth on this issue.

One last question, is Erin's treating vet, your regular general practice vet or an internal medicine specialist? If it is your GP vet, I would suggest you ask him/her how much experience they have taking care of cushpups. We have found in this group that there are huge numbers of GP vets who have extremely limited experience in treating cushing's which may lead to problems down the road for you & Erin.

Please keep us posted as to how you proceed.

Debbie

[Harley PoMMom]

Hi Lena,

High doses of Vit. C for a pup that has cushings is usually not a good thing. According to our experiences here and to this quote and link that I am including, I think if I were you I would ask Erin's vet if she could be taken off the Vit C.


Hi again and thank you all for your support. My name is Lena and my dog is Erin. She is 11y.6m.old, approx.80lb.weight. Her med.history: hip dysplasia from 9 month, bad arthritis now. She is on high dose of vit.C (for hip dysplasia),... that is for now.


...a dog with Cushing's disease will be over-producing cortisol (commonly known as "cortisone"). This hormone increases calcium excretion in urine. The extra calcium present in the urine will promote a stone.

In humans, the genetic predisposition for stone formation is coupled with dietary issues (problem foods include: spinach, peanuts, chocolate, dairy products, calcium supplements, vitamin C supplements, and tea).

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

There are other things members use for arthritis...adequan is one that comes to my mind.

Lena, usually the senior pups get the cushings disease, my boy Harley just turned 13 years old in October! He was dx'd in Feb of this year and the thought of not treating him just because of his age has never crossed my mind. We all understand how scary this is, trust me on this, but the more you learn about this disease and the medicines that treat the disease the less afraid you will feel and the more empowering you will become.

Hugs,
Lori

[Casey's Mom]

Hello Lena, my dog Casey was diagnosed in March with cushings but I did not find this site until August and I wish I had found it as quickly as you did - it would have eased my mind considerably!

Casey is on Lysodren and I was lucky that my vet advised treatment and said without it she would die a slow painful death. Casey never had any sign of arthritis until her initial loading dose of Lysodren, once the cortisol was under control her arthritis became evident. We could not treat with Metacam because of the elevated liver enzymes so she is treated with monthly injections of Adequan and she has tramadol for when her pain is bad. I have not had to use the tramadol since she has been on Adequan. She now walks and trots around the park without pain she just has a little hitch in her stride every now and then.

You have come to the right place - you will have lots of knowledgeable people here to hold your hand and guide you on this journey.

[haf549]

Hi Lena:

Yes, the arthritis will probably get worse as the dog is treated for Cushings. You've already seem posts for the various methods that others are using to control the arthritis. I've got another suggestion. Kira gets a 900mg tablet of glucosimine, with chondroiten (she's about and 80lb're). I was giving her lower doses of just the glucosimine for a number of years now, but once she started on trilostane, I noticed a definite increase in her problems, probably related to her arthritis. In the beginning she really didn't want to move very much and had trouble going up and down stairs. In January I switched her to the 900mg glucosimine/chondroiten and over the summer I noticed a definite improvement. She still gets some really bad days, when it's very cold or damp, but generally, either she's come to terms with the arthritis pain (I don't thing dogs reason that way though) or she's feeling better. On the really bad days I give her about 25mg of metacam, but that happens rarely. I'm really not thrilled about giving that to her unless she's obviously having a very bad day. She hasn't had any for over a month now.

As for going up and down stairs, well, she walks them like a little old lady; one paw at a time. At first I was really upset seeing her that way, but have come to realize that it's not the pain that is making her that slow and cautious; I think she's afraid. I mentioned it to our vet and in his usual droll manner he said 'if you were an 80lb dog, looking down the stairs, you'd be scared too. With the momentum that builds up when they go down, they could easily stumble and fall. So her being extra cautious is a good thing'. Occasionally, when she's really excited about something (like a walkee) she'll run down the stairs, right to the door. Actually, in the past years, she's dropped a couple of pounds (5 to be exact) and since then the arthritis seems to be a bit better too. She's not really over-weight, but the GRADUAL weight-loss seems to have helped.

Heidi

[Casey's Mom]

Lena I also give Casey 900mg of glucosamine/chondroitin daily. I belive it helps her.

[lenaray]

Hello, everyone! I got copy of blood tests for Erin: ALT 15H7.0 u/l (10-100), ALP 379.0 u/l (6-102), BUN 13.0 mg/dl (14-36); CHOL 394.0 mg/dl (75-220); HGB 17.9 g/dl (9.3-15.9); HCT 56.5% (29-48); MCV 73.0 (37-61); MCH 23.1 (11-21). LOW DOSE DEX. : CORTISOL PRE : 1.4 ug/dl; Cortisol 2: 2.7 ug/dl, Cortisol 3: 2.2 ug/dl. I post only abnormal results. I think it's look like adrenal tumor Cushings. My vet. said that our next step is sonogramm, but he is on vacation for the holidays, so I am trying to do my homework for now. Erin id doing OK for now, exept her arthritis of cause, and incontinence (which doesn't bother her much, I think). I'll appreciate any thoughts and suggestions from you all.
Lena and Erin

[Squirt's Mom]

bumping this up for comment...

[StarDeb55]

Lena, sorry it took so long to respond to Erin's labwork, kind of busy the past couple of days as I'm sure you can imagine. Anyway, Erin shows the typical elevations in alk phos, ALT, & cholesterol that the great majority of cushpups demonstrate. All 3 of these tests are considered to be liver function tests. The liver is quite stressed in our pups as it has to handle the breakdown of the excess cortisol produced by adrenals. Erin actually has a pretty mild elevation in the alk phos as I've seen cushpups with elevations on these one specific test into the several thousands. If the blood samples were drawn fasting, that will easily explain the elevated hemoglobin & hematocrit which is due to dehydration from fasting. MCV/MCH are specific measurements involved with the red blood cells, the changes here will relate back to the elevated Hgb/Hct. I really don't see anything that raises a huge red flag for me.

When it comes to the low dose results, I'm still not the world's best at reading these, so I have PM'd Glynda for her help with these results.

Debbie

[lulusmom]

Hi Lena,

I'm glad to see that Debbie dropped by to help with interpreting the bloodwork. I'm not sure the results of the LDDS are indicative of an adrenal tumor but because there was less than 50% cortisol concentration suppression during the 4 and the 8 hour mark, the definitive diagnosis of pituitary dependent cushing's can't be made and additional testing by way of an abdominal ultrasound and/or a HDDS test should be done to make the differentiation. In Erin's case, I think it can go either way but we'll will be waiting on pins and needles with you to find out, once the findings of Erin's ultrasound are in.

Glynda