New member intro: pituitary dependent Cushings in a 13 yr old dachsund

[Twistmare]

Hello everyone. My name is Marianne. MY husband and I are parents to three female dogs: Harley, a 13 year old black and tan dachshund; Heidi, a 7 year old red dachshund; and Bonnie, a 2 1/2 year old cairn terrier. Harley was just diagnosed with pituitary dependent Cushing's. I am happy to have found this forum so that I can be an informed veterinary consumer! Not that my vet hasn't been absolutely forthcoming, but I am a somewhat cautious individual!
We first suspected a problem with Harley a couple of months ago, when she she began to have many urinary accidents combined with significantly increased appetite and thirst. The results of a CBC, urinalysis and low dose dexamethasone suppression test provided sufficient evidence for a diagnosis of pituitary dependent diabetes.
I should receive an information packet from my pet in a few days which will outline treatment options that she briefly described via the telephone.
It seems like the members of this forum have a lot to offer in terms of experience, knowledge and caring. I will likely be a frequent visitor during the course of Harley's treatment.

[SachiMom]

Hi Marianne,

Just want to take a few minutes to Welcome you and the "family". This is a great place to find both facts and friends. The Resources forum has a ton of information and links. And soon you will discover many more members here to welcome you and help you once a treatment plan has been set out. One thing I know they will be wanting to know are the numbers from the LDDS test.

Doxies and Cairn Terriers (along with Bichons & Poodles) hold a special place in my heart, so I will be your number one cheerleader!!! :D

~Mary Ann

[littleone1]

Hi Marianne,

Corky and I would like to say hi and welcome you and Harley.

You have found a very wonderful caring and supportive group of people, who have a greath wealth of knowledge and experience.

Terri

[BestBuddy]

Hi and welcome to you and you family, two legged and 4 legged.

I am also going to be joining the cheer squad and hope to hear more info when you have it.

Jenny

[mypuppy]

Hi Marianne,
Welcome to you and Harley, and the rest of your babies, from me and Princess (7 year old lab) with PDH/Cushings. Quick question since I'm def. no expert with all this. You mentioned your Harley was diagnosed with pituitary dependent diabetes? Perhaps that was an oversight on your part or does your Harley suffer from diabetes or Cushings? I believe they are two different conditions, so it would be great if you would clarify such for when the real experts chime in to give you their wonderful advice. I'm sorry for your precious pup's diagnosis, but there is so much hope. When my baby was first diagnosed I was hopeless since I was receiving mixed information from my gp and IMS, but I joined this forum and they lead me and every step of the way to where I am today, and that's a happier place righ now. I look forward to reading on Harley's progress. All the best, Regards and luv, xo Jeanette

[StarDeb55]

Welcome to you & your pack, Marianne! I'm very sorry to hear about Harley's diagnosis, but you have come to the right place. I must warn you that we tend to play "20 questions" with new members. Before I start with the questions, I will tell you that my Harley, who will be 15 very soon, was diagnosed at 13, & has been doing pretty well the 2 years since diagnosis. He is being treated with lysodren. My 1st cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15.

The first thing, which Jeanette has already asked about, I assume you made a typo & meant pit dependent Cushing's, & not diabetes? Were both diabetes & thyroid problems ruled out? I ask about those 2 conditions as a lot of their symptoms overlap with Cushing's. You have given us a good start describing symptoms that led you to take Harley to the vet. Is Harley suffering from any other common symptoms such as muscle wasting especially in the back end, skin/coat issues, or infections that are difficult to control & heal? When it comes to the testing that has been done, could you post the actual numbers for us? If you don't have copies of Harley's results, your vet should be happy to provide them. Most members do keep files on their babies at home as you never know when they might come in handy, especially if you end up at a strange vet. When it comes to the general screening labwork, we would be especially interested in seeing any abnormal results on a chemistry panel including liver enzymes. There are very common elevations in liver enzymes in our pups that will often lead a vet to suspect Cushing's. If you could post just the abnormals, along with the normal range & reporting units, that would be great. When it comes to Cushing's specific testing, was the LDDS the only test done? There are normally 3 results on that test, a baseline, 4 hour, & 8 hour result. A Cushing's savy vet will normally do more than a single test to make the diagnosis as Cushing's is the most difficult disease to get a confirmed diagnosis. The LDDS is considered to be the gold standard for diagnosis, but it has a huge drawback, as it can yield false positive results in the presence of non-adrenal illness such as diabetes. Some of the other tests that might have been done are an ACTH, high dose dex, or even an abdominal ultrasound. Please don't misunderstand, I'm not trying to question your vet, but it can be extremely dangerous to administer either of the 2 medications to a non-cush pup. This is why it is crucial to have a confirmed diagnosis before starting treatment. Cushing's is a disease that literally progresses at a snail's pace taking several years to the damage to our pup's internal organs. You have plenty of time to make sure of the diagnosis & educate yourself about the disease. I hope you will take a look at the forum's important information & resource section as it contains a huge number of links that will lead you to just about any information you might need concerning Cushing's.

Looking forward to hearing more.

Debbie

[Twistmare]

Thanks everyone for the warm welcome. Yes, Jeanette and Debbie, I mistyped and meant "Cushings" and not "diabetes".
Harley does present with some of the other Cushing's symptoms: General sluggishness (except where food is concerned), a pot bellied appearance, and achange in her hindquarters appearance, which could be due to muscle loss. Also, she sort of waddles when she walks. Other than some bilateral loss of fur on her hind legs (what we would call knees), her coat is in pretty good shape.
At the moment, I only have the CBC results to share. The elevated liver enzymes were the first indicator that Cushing's may be present.
Here are the abnormals:

ALK. Phospahatase = 288 (high) reference range 10-150 U/L
ALT (SGPT) = 155 (high) reference range 5-1-7 U/L
Cholesterol = 347 (high) reference range 112-328
TCo2 (Bicarbonate) = 30 (high) reference range 17-24 EqL
T4 = .9 (Borderline hypothyroidism) reference range .9 - 3.9
Neutrophil SEG = 82 (high) reference range 60-77
Lymphocytes = 10 (low) reference range 12-30%
Eosinophil = 0 (low) reference range 2-10 %
Absssolute lymphocytye = 910 (low) reference range 1000-4800/ul
Absolute Eosinophil = 0 (low) reference range 100-1250 /ul

I'll post the LDDS and urinalysis test results after we see the vet on Saturday.
Thanks again everyone!

Marianne

[Harley PoMMom]

Hi Marianne,

Welcome to you and Harley from me and my boy Harley!! :D My very lovable 13 y/o boy, Harley, is a Pomeranian who has PDH Cushings and is being treated with Lysodren.

This Cushings Disease can be a scary, frustrating and confusing journey, at least it was for me until I found this forum with these amazing and wonderful people. The one most important thing you can do for Harley is educate yourself about Cushings because you are Harley's only voice, his only true advocate. The more you learn about this dratted disease, the more empowered you become. ;):) So ask all the questions you want and we will answer them the best we can.

Here is a link to get you started on your reading. :eek::D
Links to Cushings Websites (especially helpful for new members!)
http://www.k9cushings.com/forum/showthread.php?t=180

Just remember you are not alone on this journey, we are here for you and Harley.

Love and hugs,
Lori

[StarDeb55]

T4 = .9 (Borderline hypothyroidism) reference range .9 - 3.9

Harley may not be truly hypothyroid. There is an associated condition that goes with Cushing's called sick euthyroid syndrome. Once the Cushing's is under control, the thyroid function will test normal. In a cushpup that show a low regular T4 result, it is necessary to confirm with a free T4 by equilibrium dialysis to make absolutely sure that hypothyroid is in play. My Harley has tested with a low T4 on his last 2 chem panels & my vet & I have an understanding that any time Harley comes back with a low T4, the vet is to call the lab & add on a free T4 to confirm. Both times the free T4 has been done, it's been perfectly normal.

Your Harley does, indeed, show the classic elevations in liver enzymes that most cushpups demonstrate. I will say that the alk phos elevation is pretty mild as we have seen other pups in this group have alk phos values in the several thousands. My 1st boy, Barkley, could run an alk phos between 1200-1500 routinely. The vet never worried about as it was do to the stress on the liver from the Cushing's. The only time that raised a concern was when it climbed to over 2000, but adding some liver support supplements such as milk thistle helped the alk phos to go back down.

If you ever have any questions about labwork, please feel free to ask me. Just to let you know I'm a medical lab technologist with almost 30 years experience, so I'm kind of used to looking at these kind of numbers.

Debbie

[Squirt's Mom]

Hi Marianne and welcome to you and Harley....as well as Heidi and Bonnie! :)

Don't have anything to add to what others have said but wanted you to know how glad I am that you found us and have joined our family here. If you have any questions, please don't hesitate to ask. If you just need to talk, we will be here to listen.

Like Mary Ann, I will be rooting for Harley....I have a special place in my heart for Terriers in general (I have 3 mixes!) and my Squirt is 1/2 Cairn. She has so much personality even in her old age and give me much joy.

Please keep in touch often!
Hugs,
Leslie and the girls - always

[Twistmare]

Hi again Debbie,
I finally spoke with the vet and got copies of lab work (for the sake of brevity, I am going to post what seems like significant results):
This was in bold font--Urine creatinine = 17.2 reference range -mg/dL Flag = L
My vet circled this result:Urine cortisol /creatinine ratio= 114
The comments at the end of the report state that urine cortisol:creatine ratios equal to or greater than 13.5 indicate elevated serum cortisol but may be adrenal or non-adrenal illness.
Results of the LDDS:
Pre dexamethasone = 6.8 (range = 1.0-6.0 ug/dl) Flag = H
Post 4-hour dex = 2.5 (reference range = <1.5 ug/dl)
post 8 hour dex = 5.1 (reference range = <1.5 ug/dl)

According to the interpretations listed within the report, the 4 hour result is >1.5 or <50% of baseline and the 8 hour result is >1.5 and >50% of baseline which is consistent with pituitary-dependent hyperadrenalcorticism (PDH).
We are going to try L-Deprenyl first, as that seems the least invasive approach and Harley is still in relatively good shape, so we have time on our side.
I am crossing my fingers (and toes!) that Harley will be one of the 20% of dogs whose symptoms are relieved with this treatment.
I wonder if you could answer a burning question: Have you seen any significant differences in blood chemistry in dogs who are fed raw diets as opposed to traditional canine fare? My vet (who does not approve of my dietary choices) said that Harley's levels are pretty good for a dog her age. My pups have been on a raw diet for the last three years (since the contaminated pet food scare and some finicky eating problems). Bonnie the cairn has eaten raw since we first brought her home. Her early development was "phenomenal" as the vet said at the time. I would like to think that the raw diet has been helpful to Harley's overall well-being. Do you think it could explain her low ALK Phospahatase levels? What do you think?
Thanks,
Marianne and the girls

[lulusmom]

Hi Marianne,

I noticed that you have chosen to treat with Anipryl and thought you might be interested in a response we received from Dr. David Bruyette, the developer of the drug, as to when he chooses to treat with Anipryl.




1) For dogs with mild symptoms or for owners where cost is an issue we start with Anipryl for 2 months. If that fails to resolve the symptoms we move on to another drug.
2) For dogs that failed Anipryl initially or that have moderate to severe symptoms and we dont want to wait 2 months to see improvement we use trilostane.

Dave Bruyette DVM DACVIM

Dr. Bruyette has advised that Anipryl is effective 40% of the time; however, I believe our experience here would indicate a number much lower than that, which is more in keeping with the 20% effective rate you posted. I wanted to make sure you have all the facts from the very most reliable source and I do hope that you will be the first member who treats with Anipryl to monitor the treatment by way of routine acth stim tests and post the results here.

Glynda

P.S. My dogs have been on a commercially prepared raw food diet for two years and are thriving on it. Bloodwork has remained pretty consistent with both of my cushdogs having normal liver enzyme values.

[jrepac]

Welcome Marianne,

I thought I would say hello, as I am one of a small number of folks who have had success treating with l-denypryl/anipryl/selegiline (whichever name you choose to use). Despite it's lack of success with some cases, when it works, it works. And, hard to explain why, honestly. They say a lot of it has to do with where the pit tumor is located. I have been using anipryl for 18 months now for my Aussie and have to say I am satisfied w/the outcome; I use as part of a combo treatment (melatonin + lignans + anipryl) along w/other supplements for liver and UT function.

And, if the symptoms are mild, it is a very safe treatment to pursue; side effects are quite low, so it may be easier on an elderly dog to tolerate (mine is closing in on 13yrs).

You should see some response within 3/4 weeks, tops; if not, your vet will likely double the dose for another month to see if there is a response. If not, then you'd move onto something else (like trilo, as Dr. B suggests)

It is also my understanding that the ACTH test is not a useful monitoring tool when treating w/Anipryl; however, other research I have seen from Canada suggested LDDS can be used to monitor. This is something you'd have to discuss w/your vet. For some, resolution of the symptoms is enough and precludes further monitoring...(to each his own).

For monitoring, I'm doing something a bit non-traditional, which is taking a 3-day pooled urine sample and getting the UCCR test run from that. It gives me a decent read on the cortisol level and is less stressful than doing ACTH or LDDS. Something I picked up from reading comments on this forum! And, I do the full blood work profile at 6 month intervals, to make sure everything is AOK.

My only other advice would be to shop around for the drug, if you are sensitive to price. Brand name Anipryl is pricey, but may be convenient for you if your vet stocks it and you need a bigger dosage. But, getting the generic from an Rx Pharmacy may be cheaper (Walmart is my latest place for the drug...$118 for a 90 day supply, which for me is 180 5mg capsules, 5mg is the standard "human dose"). 1-800-Pet Meds is out of the generic (the manufacturer discontinued it) and only stocks the brand name now! [they were only charging me $75 for 3 months worth of the generic, so I was bummed when I could no longer get it!] Diamondback is also a very good source at a very good price (they quoted me $60 for 3 month supply).

OK..enuff yapping.

I hope the treatment is effective and everything works out for you.:)

Jeff

[StarDeb55]

Marianne, I can't really offer valid input on the raw diet. I had my boys on Primal for something like 6 months, but because of cost had to find a less expensive alternative. Now, that my other boy, Chewbacca, has had crystals in his urine for the 3rd time in less than a year, he was put on a urinary prescription diet permanently. I guess it's cheaper than paying for surgery to remove bladder stones. My Harley is an extremely picky eater, & he has just about quit eating the NRG food I have been feeding for about 4 months, so I guess I will be going back to one of the better grade of canned food for Mr. Fussy. Harley is on milk thistle for liver support, & his numbers have shown a slow, but steady decline since his diagnosis 2 years ago.

I did want to add that I agree with what Glynda has posted concerning Anipryl 100%. When it comes to using lysodren, there should be no problem as long as you educate yourself about proper protocol for using the drug, & your vet is familiar with those protocols. Where we see pups run into trouble with lysodren is a vet who does not follow standard protocols, flies by the "seat of their pants" when using the drug, & the pup pays the price. I don't want to discourage you from trying Anipryl as you know Harley best, but I also wanted you to know that lysodren is really not the big, evil chemo drug that it's made out to be.

Debbie

[lulusmom]

Hi Again,

I wanted to follow up and provide a bit more information regarding Anipryl. Based on the research I've done, I don't believe that it is not that the acth stimulation test is not effective in monitoring treatment with Anipryl but rather because the manufacturers do not recommend testing as the drug rarely has any impact on the usual diagnostic and monitoring blood tests.

I have provided a link below to further information on the drug and have also provided an excerpt that explains how it works for dogs that do not have tumors in the pars intermedia lobe of the pituitary gland.


There is an important caveat in the use of L-Deprenyl for the treatment of Cushing’s disease. While 85% of dogs with Cushing’s disease have pituitary tumors, only about 20% of them have tumors in the pars intermedia of the pituitary gland, which is where ACTH is dependent on dopamine. This means that if a dog with pituitary Cushing’s disease is not one of this 20%, the only effect L-Deprenyl will have will be a general stimulatory effect from its metabolites (see below).

Because of the unique way that L-Deprenyl works as treatment for Cushing’s disease, the usual tests needed or used to monitor response to therapy will not be relevant. Assessment of effect is solely by the owner’s perception of improvement in symptoms. There is no way to determine prior to treatment if a dog has a pars intermedia tumor that is likely to respond to L-Deprenyl but it is generally clear if a dog is responding or not within 3 months of therapy.


http://www.veterinarypartner.com/Content.plx?P=A&A=556&S=1

Like Debbie, I am not trying to talk you out of treating with Anipryl, I am merely providing you with facts. If Harley had concurrent diabetes, however, I would be doing double time trying to get you to go with a treatment whose proven efficacy is much higher. If my own two cushdogs were very senior and their IMS didn't feel they could handle Trilostane or Lysodren, I would give Anipryl a try and pray that they were in the small percentage of dogs that do well on it. No matter what, I feel it is extemely important that we know all there is to know about whatever treatment we choose for our sweet babies.

Glynda

[SachiMom]

Hi Marianne,

Checking in to see how Harley is doing on the Anipryl. Have you seen any improvement in the peeing department? That will probably be the first improvement along with the thirst issue. It still could be a bit early to see improvements, but we can always hope.

Just so you know, I also started Sachi on Anipryl. We did have to double the dose after a month or two, and then eventually she became a pioneer for trilostane (a whole 'nother story!!). So I totally understand where you are at, and hope that Harley does well. It also does improve some of the "senior" moments.

So keep us posted.
~ Mary Ann