8 Year Old Boston Terrier - No Symptoms, Need Guidance

[RockSplat]

Hello.

I have an 8 year old Boston Terrier, Laila, who has a small tumor on her back leg and a small tumor on her front leg. The vet wanted to send her through surgery to take them off and have them tested but her blood results came back and he was concerned.

I will list the abnormal levels. Everything else not listed was normal.

MCHC 37.9 g/dL
WBC 4.10 K/uL
EOS 0.08 K/uL
PLT 543 K/uL
ALKP 1010 U/L
GGT 16 U/L
AMYL 490 U/L
LIPA 4231 U/L (yes 4231 - he says he "was floored" when he saw this)

At this point he wanted to delay surgery until we know what's going on. The next morning we took her in and did an ultrasound.

Ultrasound Results:
* Both adrenal glands are larger than published normal with widths of 8.5-9.0mm (normal <7.5mm), but they have normal shape and echogenicity.
* No evidence of an adrenal tumor was identified.
* Gallbladder contains a large amount of echogenic bile that settled to the most dependent portion during the study.
* Liver demonstrates normal size, margination and echogenicity.
* Pancreas has normal size, margination and echogenicity.
* Remainder of the study was unremarkable.
* No enlarged abdominal lymph nodes were identified.

IMPRESSIONS:
Enlarged adrenal glands are most consitent with pituitary-dependent, but lab testing would be required to better define if Cushing's disease is present. Although lipase is signifigantly increased, the pancreas appears normal. Overall, except for the adrenal glands, this examination is considered unremarkable.

So the same day I left her there and they did a low dose dex test.

Low Dose Dex Test Results:

CORTISOL 1 9:30AM = 3.2 ug/dL (reference range 1.0 - 5.0)
CORTISOL2D 1:40PM = 0.7 ug/dL (reference range 0.0 - 1.4)
CORITSOL3D 5:40PM = 2.1 ug/dL (reference range 0.0 - 1.4)

The vet says this confirms that she has Cushings but he was surprised she had no other symptoms. She may drink a little more than normal but I don't know for sure. She seems the same as she did the past few years. Again she's 8 years old. She has always been a begger and always seems hungry but she has always been that way. Seriously, 5 years ago she was a begger and would be eyeing any food, checking for crumbs, etc. so I can't say that I see any differences there.

Her hair is fine, weight is 24 pounds which is normal and her blood pressure is good.

The vet recommends that we put her on Trilostane at 10mg a day and then do another low dose dex test after 2 weeks of medication.

I want to know if this may cause more problems than we have today? I would love to get her levels down to a normal area and not ignore them just because she seems healthy otherwise. I feel like if we treat her then the levels will drop and overall make her stay healthier.

Another thing we are considering is having a vetrinarian who does holistic medicine and ultrasound. She has been highly recommended by other people for issues other than Cushings so I know she is good and authentic.




****
But I want to ask what you all would do in this case? Money is not an issue so we will do what it takes. Her health is the main concern.
Should I try the ultrasound/vitamin therapy for a while, test and if no results go for the 10mg/day Trilostane?

Since she seems healthy and active I am hesitant but I have very little exprience. It seems to me the earlier that I get started on the medication, the better since it gives her body a break. I know her liver will have to work harder on the trilostane and there are other side effects so that's my hesitation there... it might be better to have those side effects than let her go without trilostane.
****





p.s. as far as the other issue (tumors on leg) we will be sending her to surgery here in about a week or so.

Thank you so much.

[Harley PoMMom]

Hi and welcome from me and my boy Harley!

With her Lipase levels being this elevated my first concern would be to rule out pancreatitis. I would highly recommend running a spec PL test on her. The spec PL will test for the lipase that is specific for the pancreas only.

My boy Harley also has pancreatitis, his last spec PL test done just this month was 900 (RR 0-200). Harley shows no signs of pancreatitis and his last ultrasound, which was done this month also, showed a pancreas within normal limits.

Non-adrenal illnesses, like pancreatitis and diabetes, can create false positives on Cushing's tests. This is why strong symptoms are a huge part of making the diagnosis, and a Cushing's savy vet will not initiate any treatment without strong symptoms and a proper diagnosis. Not one test can confirm cushings or the type of cushings, thats why you need a qualified GP or IMS for this disease.

Please remember you are not alone on this journey, we are here to help you in any way we can, ask all the questions you want and we will try to answer them the best we can.

Love and hugs,
Lori

[RockSplat]

Thank you for the information!

I have been paying closer attention later to her water drinking habits.

She got up last night and drank some water and then again this morning. For years I remember her always doing that though so it's really tough to tell if she's drinking more than normal.

She eats well, loves going on walks and seems healthy from looking at her.

I will see if I can get her a Spec cPL Test today for pancreatitis. I was reading and it does indeed look like those values can get 8-10 times the normal range when pancreatitis is at stake. Both of her adrenals are larger than normal and the doctor who did the ultrasound said "that can just be normal at times but more testing will need to be done".

Have you heard any good results by changing diet and working with a holistic doctor with things such as vitamins, strict diet and acupuncture working?

Thanks for your information.

[Harley PoMMom]

I will see if I can get her a Spec cPL Test today for pancreatitis. I was reading and it does indeed look like those values can get 8-10 times the normal range when pancreatitis is at stake.

Although it is usually the norm that the lipase and the amylase values are very elevated in a dog with pancreatitis this isn't always so and my boy Harley is living proof of that. His amylase and lipase values were in the the normal ranges when his spec PL test results came back at 464. :eek:


Have you heard any good results by changing diet and working with a holistic doctor with things such as vitamins, strict diet and acupuncture working?

Do you mean for pancreatitis or cushings? Doing some of these things, especially changing diet, for pancreatitis is a must. For cushing's disease, once your dog is properly dignosed, the two life-saving drugs, Lysodren/Mitotane and Vetoryl/Trilostane are the way to go. The other cushing med. Anipryl could be something one could look at too but its effectiveness is limited because the dog has to have PDH and the tumor has to be in a specific location in the pituitary.

Thanks for your information.

Hope this helps.

Love and hugs,
Lori

[RockSplat]

I guess my hesitancy with the 10mg/day Trilostane that our vet recommends was that she doesn't have any physical signs of Cushings that I can tell other than her adrenal glands being 8.5-9.00mm instead of <7.5mm.

I will test for Pancreatitis and if that tests negative then I guess we will go for the Trilostane to keep things controlled. I was thinking the acupuncture might be an alternative treatment but if it's not really going to help then we will go for Trilostane. I was worried that she might have negative results if we gave her Trilostane considering that she appears to feel good now.

I've heard some vets say they don't treat cushings unless there are physical signs. I never really got a reason why they avoid treatment though.

Thanks for your information.

[Harley PoMMom]

If she is showing no Cushing's symptoms, and if she were my dog, I would hold off giving her any Trilostane...JMO Giving these Cushing's meds to dogs that do not have the cushing's disease can be lethal to the pup.

Cushing's is a slow progressing disease, so you do have the time to get Laila diagnosed properly. ;):) Take some deep breaths...and if the spec PL test is between 0-200 then we know that she does not have pancreatitis and then we can move forward to maybe an ACTH stim test.

We are here for you and Laila, ok?

Love and hugs,
Lori

[labblab]

I've heard some vets say they don't treat cushings unless there are physical signs. I never really got a reason why they avoid treatment though.

Hello and welcome from me, too!

I am not a vet, but from my experiences with our members here, I'm gonna throw out a couple of reasons why there may be a reluctance to treat in the absence of outward symptoms. The first is simply that there always remains some doubt about the accuracy of the diagnosis if a dog is not exhibiting symptoms that are typically associated with the syndrome. Secondly, in addition to blood testing, behavioral "cues" can be important in determining whether or not the medication is being dosed appropriately. If a dog is not exhibiting typical symptoms in the first place (for instance, excessive hunger or thirst), it makes it more difficult to assess whether the medication is at the proper level.

In that vein, I have one follow-up question for you. You mentioned that your vet said that he plans to perform another low dose dex test ten days after beginning the trilostane? Are you certain that he didn't say he was going to perform an ACTH stimulation test? Because the ACTH is the appropriate monitoring test once a dog has begun treatment. The low dose dex test is ONLY used for diagnostic purposes. And actually, if you are willing to pay for it, it might be worth it to ask your vet his thoughts about performing an ACTH stimulation test prior to launching into treatment -- just to add one more piece of confirmation as to the diagnosis. The ACTH is another blood test, but it is less likely than the low dose dex test to be "skewed" by other, nonadrenal illnesses. So a "positive" on the ACTH is actually a more trustworthy indicator of Cushing's than is a "positive" LDDS. Also, you'd have a baseline reading as to your dog's cortisol level prior to beginning the trilostane. In the absence of physical symptoms, that may make it easier to judge how well the trilostane is working when subsequent monitoring ACTH tests are performed.

Just so you'll have more information about all this, here's a link to a thread with a lot of resource info about trilostane. Among other things, definitely take a look at the "Vetoryl Diagnostic Brochure" and "Treatment and Monitoring Flowchart" that are included there.

http://www.k9cushings.com/forum/showthread.php?t=185

Once you've had a chance to look over that info, definitely get back to us with any further questions.

Marianne

[RockSplat]

Hi. I am going to take my dog to the vet tomorrow to get a cPL Test to rule out pancreatitis. The doctor did say that there isn't a chance that she would have pancreatitis since her pancreas looked good during the ultrasound. She said with pancreatitits it would have looked enlarged and inflamed. She said her AMYL was low so she didn't think pancreatitis should be anything to worry about.

I am also planning to get a ACTH Stim test but she said that this was more likely to be a false positive than the 8 hour low dose dex test. She said we could do an ACTH stim test but she said the ACTH tests are done as a preliminary test before doing a longer more throughal low dose dex test.

What are you thoughts? Should I still go ahead and get the pancreatitis test done?

What about doing another 8 hour low dose dex test vs. the ACTH stim test? I had the last low dose suppression test 11 days ago. Which would you do?

I figure I will do both tests during the same day tomorrow -- they said they wouldn't conflict with each other.

Thanks!

[jrepac]

I have to agree; the ACTH test is less likely to yield a false positive than the LDDS, this is known and proven. Not sure why your vet would think the opposite...

I would be reluctant to treat w/out a confirmed diagnosis and symptoms...the ACTH is a must.

If the ACTH comes back positive, then it would concur w/the LDDS and some of the lab results and the ultra sound for presence of Cushings.

But, w/out symptoms, you may want to hold off on treatment; that's an individual decision based on the severity of the situation.

[Harley PoMMom]

Hi. I am going to take my dog to the vet tomorrow to get a cPL Test to rule out pancreatitis. The doctor did say that there isn't a chance that she would have pancreatitis since her pancreas looked good during the ultrasound. She said with pancreatitits it would have looked enlarged and inflamed. She said her AMYL was low so she didn't think pancreatitis should be anything to worry about.


Abdominal ultrasound was first described as a diagnostic tool for pancreatitis in the mid-80ties. Since then both the technology and expertise of veterinary radiologists in this area have markedly increased. While this development has led to a significant increase in sensitivity of this diagnostic modality for pancreatitis it has also led to a decrease in specificity. The sensitivity of abdominal ultrasonography for pancreatitis when performed by a veterinary radiologist has been reported to be up to 68% in dogs and up to 35% in cats.
http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml
This is article is really informative about pancreatitis, it is written by Dr. Jörg M. Steiner, who helped develop the spec PL test.

The spec PL test has a specificity and sensitivity of >95% for diagnosing pancreatitis.


I am also planning to get a ACTH Stim test but she said that this was more likely to be a false positive than the 8 hour low dose dex test. She said we could do an ACTH stim test but she said the ACTH tests are done as a preliminary test before doing a longer more throughal low dose dex test.


What if the patient has only biochemical changes and no or mild clinical
signs suggestive of Cushing’s syndrome? The ACTH response test may be the preferred
test. In these patients, it may be better to miss a diagnosis of HAC in early stages by
using a test with lower sensitivity than falsely diagnose HAC by using a test with lower
specificity.

This came from our Resource Thread; Canine Cushing’s Syndrome: Diagnosis and Treatment Rhett Nichols, DVM, ACVIM: http://www.k9cushings.com/forum/showthread.php?t=210


What are you thoughts? Should I still go ahead and get the pancreatitis test done?

I would and hopefully she does not have pancreatitis. Other things can make the lipase levels elevated but if it were me, I would want to rule pancreatitis out. Here is a link about the spec PL test: http://www.idexx.co.uk/animalhealth/laboratory/speccpl/

What about doing another 8 hour low dose dex test vs. the ACTH stim test? I had the last low dose suppression test 11 days ago. Which would you do?

I figure I will do both tests during the same day tomorrow -- they said they wouldn't conflict with each other.

Thanks!

Hope this helps.

Love and hugs,
Lori

[labblab]

If it were me, I would not bother to repeat the LDDS (low dose dex) test. Again, I would instead ask for an ACTH stim test. As Jeff has said, I'm not sure why your vet would dismiss it as only being a "preliminary" test prior to the LDDS. Throughout our Resource section, you will find descriptions of both these blood tests. The LDDS is considered a more "sensitive" test of Cushing's -- meaning that if a dog truly has Cushing's, the LDDS is less likely than the ACTH to come back with a falsely negative result. However, the ACTH is a more "specific" test of Cushing's -- meaning that if a dog does NOT truly have Cushing's, it is less likely to come back with a falsely positive result. Different vets do have different preferences when it comes to routinely using these two tests for diagnostic purposes. But to me, the quote that Lori gave you above makes a lot of sense. In a situation like yours, where a dog is not exhibiting typical Cushing's symptoms, I would prefer the test that is less likely to falsely diagnose Cushing's in a dog that does not have the disease.

And as Lori has suggested, you might want to hold off on any other testing until you get the results back from the spec PL test. If it does turn out that active pancreatitis is an issue, that could possibly skew the results of either the LDDS or the ACTH.

Marianne

[littleone1]

Corky and I would also like to say and welcome you both to a very special group of people. They have given you some good advice.


When Corky was first diagnosed with Cushings, he had all of the clinical signs. His treatment was set back, as he was taking antibiotics, and couldn't start the treatment at that time. For some reason, his clinical signs started disappearing. I was also advised not to treat him if there weren't any clinical signs. His signs were in remission for 7 months. Once the signs started to re-appear, he had a stim test, which confirmed that the Cushings started to act up again. Once the test results came back, he started treatment.

I agree with the other members, that unless there are clinical signs present, you don't want to start treatment.

You can mnitor the water intake by measuring how much water you are putting in her bowl, and measuring how much water is left when you refill it.

I hope you are able to find out what is going on in the near future.

Terri

[RockSplat]

Thank you so much! Without this forum I would not be scheduling my Laila to get the PL test for pancreatitis ...or... the ACTH Stim Test.

I am going to have the PL and ACTH Stim done tomorrow morning. I don't mind paying for the tests or medicine. My main concern is keeping her healthy.

If she does have Cushing's and it is in the very early stages I guess I need to decide if I am going to go for the trilostane or take the natural treatment path with herbs/vitamins and acupuncture. I realize the natural treatment may not be the most effective so that's probably something I will need to decide after figuring out what is wrong with her bloodwork. I could be mistaken but it seems that it would be better to treat her with trilostane and balancing out her levels than not treating her. On the other end of the stick are the potential side effects of the medicine.

A couple of you have mentioned that I should not treat unless there are clinical signs. A friend of mine who is a vet also mentioned the same to me (he didn't see my dog, only shortly discussed it) and I wondered why he said that. Would treating it with Trilostane slow down the effects of Cushings? I will start measuring her water intake -- would that be a clinical sign if she is drinking too much which would be worthy of medical treatment?

Thanks for the advice.

[RockSplat]

And as Lori has suggested, you might want to hold off on any other testing until you get the results back from the spec PL test. If it does turn out that active pancreatitis is an issue, that could possibly skew the results of either the LDDS or the ACTH.

Marianne

I may go ahead and do the ACTH along with the PL since she'll be in the vets office. If it comes back that she has pancreatitis then I will just disregard the results of the ACTH. I was told that the 2 tests together wouldn't conflict with each other but I understand what you are saying where pancreatitis itself could alter the results of the ACTH. I guess at that point the only thing lost is the money for the ACTH test which I am ok with that. (Unless I am misunderstanding something.)

The one thing that I am a little concerned about is right before the low dose dex test she had the ultrasound and was probably already a little stressed. The vet did say that she didn't think it would alter the results but that's still in the back of my mind. I suppose with the upcoming results we may be closer to a confirmation.

Thanks

[jrepac]

Thank you so much! Without this forum I would not be scheduling my Laila to get the PL test for pancreatitis ...or... the ACTH Stim Test.

I am going to have the PL and ACTH Stim done tomorrow morning. I don't mind paying for the tests or medicine. My main concern is keeping her healthy.

If she does have Cushing's and it is in the very early stages I guess I need to decide if I am going to go for the trilostane or take the natural treatment path with herbs/vitamins and acupuncture. I realize the natural treatment may not be the most effective so that's probably something I will need to decide after figuring out what is wrong with her bloodwork. I could be mistaken but it seems that it would be better to treat her with trilostane and balancing out her levels than not treating her. On the other end of the stick are the potential side effects of the medicine.

A couple of you have mentioned that I should not treat unless there are clinical signs. A friend of mine who is a vet also mentioned the same to me (he didn't see my dog, only shortly discussed it) and I wondered why he said that. Would treating it with Trilostane slow down the effects of Cushings? I will start measuring her water intake -- would that be a clinical sign if she is drinking too much which would be worthy of medical treatment?

Thanks for the advice.

treatment is a very individual decision, often driven by severity of symptoms; when the pup is having UTIs and peeing and eating constantly, well, then you are going to want to treat. But, you could be at a stage where the symptoms are barely noticeable. See what the ACTH test says first...you could be in the "borderline" zone...that was my story for about a year, however, I was noticing symptoms nonetheless (and began treating w/anipryl, which was a big help). Every case is different....

good luck:)

Jeff

[addy]

Hi,

In one of my many readings about Cushings, can't remember which vet said it, but the quote went something like "treat the symptoms, not the diagnosis." Something to ponder.

My Zoe has the diagnosis and really high numbers but mild symptoms except for her thin coat and rat tail. However, I have been watching her more closely and am finding some of her possible symptoms are not ones that get talked about alot because they are rare, like the wanting to lick everything.

I would spend some time watching your baby with an open mind. Don't talk yourself into symptoms but read as much as you can and watch your dog.

As others have said, you don't need to rush into treatment.

All my best,
Addy

[RockSplat]

Hello. I have some new information.

I've been watching my dog for the past few days and started monitoring her water intake the day after I took her in for her cPL test and ACTH Stim test.

The first day was after she fasted the night before and had a pretty big day at the vet so it appears that she drank about 20 oz. The second day she appeared to drink about 25 oz. That seems like a lot of water. She seems very very thirsty and then doesn't think about drinking for another hour or so. I'm not sure if 25 oz. is normal.

Today she had a holistic treatment with natural therapy and acupuncture. She was very relaxed during the treatment and got lots of treats from the doc. We got an A+ for the food we are feeding her and we have some herbal treatment/solution to support her adrenal glands and another solution for her pancreas.

I feel like if I do not treat her with Trilostane then she will deteriorate from Cushings. If I understand correctly Trilostane in effect cancels out the cortisone to help balance things out. She seems so healthy and normal now. I want to preserve that as much as I can and I feel like the Trilostane along with continued natural therapy will be the best thing for her. I feel like not treating her would make her get worse over time faster.

Her ACTH Stim Test came back a little high:

Cortisol Sample 1 = 8.0 (Reference 1-5)
Cortisol Sample 2 = 36.5 (Reference 8-17)

Her cPL test for her pancreas also came back a little high at 246. I was told 201-399 is borderline for pancreatitis. Her pancreas looked good in her ultrasound but it's my understanding that we still cannot know what is going on at the cell layer.

The vet that gave me the values for her cPL test thought this was just a coincidence or perhaps a fluke. I have had a few vets tell me they strongly believe she has Cushings.

Here are the original blood values that I previously posted:

MCHC 37.9 g/dL
WBC 4.10 K/uL
EOS 0.08 K/uL
PLT 543 K/uL
ALKP 1010 U/L
GGT 16 U/L
AMYL 490 U/L
LIPA 4231 U/L


Your thoughts and opinions are appreciated.

p.s. she still has the pending surgery to get her tumors off (one on her front arm and one on her back leg). This is how we found out she had cushings from the pre-surgery bloodwork. I am thinking we will put her on trilostane and test her in 2 weeks then do the surgery. It seems like she would be at a healthier state for the surgery at that point.

[Harley PoMMom]

A normal dog drinks 60 ml/kg/ day of water. 60 ml = 2.02884136 US fluid ounces...so approximately 2 fluid ounces. She weighs 24 lbs/2.2=10.9kg...10.9*2= 21.8 fluid ounces of water...so 22 fl. oz.
I believe she is drinking pretty normally. ;):)

As far as the spec PL test results being a fluke, I don't believe it. That test has a specificity and sensitivity of >95%!! of diagnosing pancreatitis.

If she were my pup, I would have the tumors taken off then I would get those pancreatitis numbers down under 200 and then I would retest her with an ACTH stim test...JMO. ;):)

Love and hugs,
Lori

[labblab]

Boy, this really is a tough call, and I don't think there is an answer that is clearly right or wrong. The ACTH result is definitely elevated and consistent with a Cushing's diagnosis. So now you have positive results on both the LDDS and ACTH, bilaterally enlarged adrenal glands, and some lab abnormalities that are also consistent with Cushing's -- but no outward symptoms of which we are aware. I agree with Lori that your dog's water intake is pretty much normal.

I also agree with Lori that I would doubt that the spec PL result was a fluke, given that lipase result of 4000+. However, when it comes to Cushing's tests and pancreas issues, I always wonder whether it's a situation of "the chicken or the egg." It's true that pancreatitis could skew the test results. But it's also true that uncontrolled Cushing's dogs are more susceptible to pancreatitis. So until or unless an elevated cortisol level in a Cushpup is effectively treated, I don't know whether abnormal pancreas values will ever totally normalize (similar to the issues with elevated liver values). I really don't know enough about the pancreas to say one way or the other. But I have noticed that we seem to be getting a fair percentage of new members in the diagnostic phase who are grappling with the significance of elevated pancreatic values.

I think that Addy makes a good point in suggesting that perhaps your dog may suffer from some Cushing's symptoms that are less common or well-known. If you haven't already done so, take a look at some of these websites and you'll find comprehensive lists of Cushing's symptoms. I'm surely not trying to manufacture symptoms for you, but just want to make sure that you're aware of the range of appearance and behaviors that can be affected by Cushing's.

http://www.k9cushings.com/forum/showthread.php?t=180

If you still don't see any abnormalities consistent with the disease, I really think the treatment comes down to a judgement call between you and your vet. If you do decide to start up with the trilostane, I will tell you that 10 mg. is a conservative dose for your dog, which would seem to be the safest way to start out. But once again, do make sure that your vet plans to perform a monitoring ACTH test after 10-14 days (and NOT another LDDS test).

Marianne

[SavingSimon]

A normal dog drinks 60 ml/kg/ day of water. 60 ml = 2.02884136 US fluid ounces...so approximately 2 fluid ounces. She weighs 24 lbs/2.2=10.9kg...10.9*2= 21.8 fluid ounces of water...so 22 fl. oz.
I believe she is drinking pretty normally. ;):)

As far as the spec PL test results being a fluke, I don't believe it. That test has a specificity and sensitivity of >95%!! of diagnosing pancreatitis.

If she were my pup, I would have the tumors taken off then I would get those pancreatitis numbers down under 200 and then I would retest her with an ACTH stim test...JMO. ;):)

Love and hugs,
Lori

I wanted to tell you I agree with this, and with everything that Lori has said to you so far. Since seem to want to take a holistic approach, you may want to have the first ACTH stim test results interpreted by the UTK. They will do a six hormone panel, and recommend some natural products that might be very helpful to your dog.

Simon has Cushings. I knew he did when his alk phos went up (a very unreliable indicator according to most vets, and yet when a number is 4 times what it should be, and then the next test has it double that, I just thought something was wrong. That, and ever so slight symptoms that most people would attribute just to their dog getting older. Simon never drank too much water - still doesn't - in fact last time I measured he was drinking the same amount as your dog, which in his case (your dogs) is less water than "normal" and in Simon's case when I started measuring it was less too. Due to lack of "clinical signs" according to all of the vets, they told me not to treat him, and I didn't. But I also did not agree that he did not have clinical signs. His back legs were weaker, his tail has a bald spot, he has a belly that looks like a guy with a beer belly, and he is more jumpy than he used to be. He also had a symptom that I have only seen two vets list as a symptom of Cushing's which was licking the furniture -so much that I thought one of my other dogs was peeing on the cushions. He used to be a picky eater, and the day he ate an empty pizza box (yeah, just the cardboard) I knew that those days were over.

For reasons of treatment, I believe most vets don't want to treat until a dog is showing symptoms - (side note- when I read your first post I thought you meant you thought your VET was drinking more than usual ROTFL!!) :eek: Anyway, symptoms tend to creep up. The only way you are going to know for sure is with the ACTH stim test, and that might not tell you for sure (it didn't with Simon - I wish we would have got our first results from the U of TN because I believe I would have known sooner - or I should say, convinced the vets sooner that he did indeed have Cushings).

I think the reason they wait to treat until the dogs have symptoms is because the treatment is for the symptoms - although I'm not sure about that after reading about dogs that are on Trilostane going into total remission. Older vets tend to be skeptical of trilostane and more familiar with lysodren, so they want to use it as a last resort. Vets that keep current with Cushing's disease - internal medicine specialists and some holistic vets, and endocrinologists seem to prefer trilostane, the newer drug in my experience. More "conservative" vets want to treat with something else first other than trilostane or lysodren, like my vet, who is treating Simon with ketokonazale (sp?) right now on a pretty low dose. If that doesn't work we will be going to trilostane. I already feel that it isn't going to work, but that's another story. Other than what Lori has already said to you mainly I just wanted to say that "no symptoms" especially not the "over drinking" or "over peeing" does not rule out Cushings. If you want to rule it out, get the ACTH stim test done, and if I had it to do over again I would have those results interpreted by the UTK because as far as I know they are the only ones diagnosing atypical Cushings. I would definitely not treat until I knew for sure. Sounds to me like your baby might have atypical Cushings. I hope not, but I am curious what your dogs alkaline phosphatase levels are, and if they have been rising between blood tests? That was my vet's first clue. My first clue was definite changes in Simons body and behavior that were very subtle, but he is my heart and soul dog and I just knew ...

I hope and pray that your dog has something more "black and white" - something with a clear treatment plan that will make her well. But if not, if you end up in this grey area, you have found the best support group in the world - so welcome!
Love,
Dena and pack

[apollo6]

Welcome.
I am Apollo's mom, just started Triolsatne. I do holistic ,acupuncture, massage also, because my Dachie has back problems. Holistic can help support your little angel but it is not a cure. It was my holistic vet who suggested I get a full blood panel first. My little guy has had pancreatitis through the years .
Apollo improved to a point, then stabilized. My vet then suggested I go to a vet specialist (Endocrinology ). The 3 tests I had before I did anything were as follows.
Sept 16, 2009-blood panel
January 2010-ultrasound-adominal (disc)
May 25, 2010-blood panel
May 28, 2010- ACTH Stim Test
Blood pressure
Urinalysis-Antech
Urine Culture MIC
Showed both adrenal glands enlarged, liver enlarged as well as kidney. All very common with cushing's. Other signs are increased thirst, lose of hair, skin lesions that don't heal, dark skin on belly, weakness in hind legs. I noticed in 2003 beginning of changes and Apollo was not diagnosed until March of this year.
Because you have other issues to deal with-the tumors, your vet should give you guidance. I am not a vet, but maybe the tumors need to be addressed first. Medications can interact with each other and may be too much for the little guy to deal with all at once. I am dealing with a lump on my little guy's tail also at the same time.
There are three different types of cushings- you need to find out which one it is before you consider treatment. Don't jump into this without being informed and confident in the vet you have, it is a tricky disease.

[Franklin'sMum]

Hi and a belated welcome :)

You've been given great info from the others. I know this is so overwhelming and scary right now, but it will get better, ok. Dietary changes will not cure cushings, but are highly recommended for a pup with pancreatitis- reducing the fat content. Herbs/ natural medicines are used for liver health (milk thistle, denimarin, sam-e) as these help the liver to remain healthy. The liver has the ability to regenerate, if the damage is not too severe.

The reason that treatment is not usually begun on a pup with no physical symptoms (excess peeing, drinking, pot belly, hair loss, appetite) is because when treatment is started, the symptoms are a major sign of how the pup is tolerating the meds. Such as the pooch being slower to eat- you can't pick that up if they're a fussy eater to begin with, etc.

I was in the same boat a year ago that you are now- and before I found these wonderful, incredible people who helped me save my Franklin, I had read that the average life expectancy for an untreated cush pup is two years. :eek: So I freaked out (as you do) and demanded treatment. Franklin only had a few mild symptoms, and could never really settle into a happy dosing schedule. We'd quite often skip a dose because he was off his food, or had a very soft poop, or he'd be lethargic. After further testing, it was found that he had atypical cushings, and that trilostane was completely the wrong drug for him. Meanwhile the trilo had been keeping the cortisol low, but elevating most of the intermediate steroid/sex hormones, which was still contributing to the cushings.

You might want to consider getting an adrenal panel done from the Uni of Tenn, to see if your pups hormones are elevated. If and when you and your vet decide to start treatment, you'll have a better idea of is trilo the right drug for your pup.

Cushings takes many years to do it's damage, so you do have plenty of time to get an accurate diagnosis. Please also keep in mind that cushings puts pups at an increased risk of developing pancreatitis, which I would think your vet would want to address before beginning treatment for cushings. Lori (HarleyPomMom) is one of our resident experts on pancreatitis, and has given you great advice on testing.

Also please ask your vet if he/she does plan on starting a cush drug before the surgery, as surgery is usually a stressful event for the pup and they need the extra cortisol that their body is producing. Prednisolone (a synthetic cortisol) is quite often given to pups recovering from surgery, too.

Hope that's useful,
Jane, Franklin and Bailey xxx

[RockSplat]

Hi and a belated welcome :)

You might want to consider getting an adrenal panel done from the Uni of Tenn, to see if your pups hormones are elevated. If and when you and your vet decide to start treatment, you'll have a better idea of is trilo the right drug for your pup.



Hello! My dog had her surgery and everything went great. Things have been a little delayed but I was planning to send my dogs labwork off for a full adrenal panel at University of Tennessee.

I suggested that we also do a Urine Cortisol test and this came back positive. He wanted to get that information before working with University of Tennessee due to the expense involved with sending/icing the bloodwork.

I believe he feels that the University of Tennessee is not necessary in my case since she did not pass the ACTH, Low Dose Dex or Cortisol Urine test.

I don't mind paying for the University of Tennessee "full adrenal panel" if there is value. Please let me know what your thoughts are.

The next step with my dog is to start Trilostane at 10mg a day. She is not showing any physical signs but if the Trilostane will help her deal with the cortisol then I am on board. To test the results of Trilostane we would follow up with more low dose dex tests since we can't really look at her and tell if it helps her.

Also has anyone heard of Anipryl/Selegilene? I believe I may have read that this is a fairly safe drug for Cushings. My vet did not bring it up but thought I'd ask here if anyone has tried it.

Please let me know if you think I should get the University of Tennessee full adrenal panel.

Thanks for your advice.

[Harley PoMMom]

Have you done another ACTH test after she has fully recovered from her surgery?

[RockSplat]

Have you done another ACTH test after she has fully recovered from her surgery?

Hi. We did the initial ACTH test before the surgery (different visit). Her problems from the surgery ended up being benign so I don't think that could have impacted her or caused her pain at all while she had her original ACTH test.

I have not had an ACTH since the surgery however, I just had the urine cortisol test done since we did not do that one yet. This was going to be done prior to the University of Tennessee full adrenal panel. My vet didn't come out and say it but I think he feels it would be wasteful to do the full adrenal panel. Have any of you done this test and think it could give value?

thanks.

[StarDeb55]

I would like to offer a belated welcome to both of you! I have tried to answer a couple of you questions in your last 2 posts. My responses are in blue.


To test the results of Trilostane we would follow up with more low dose dex tests since we can't really look at her and tell if it helps her.

A low dose dex test in inappropriate to monitor the effects of eith trilostane or lysodren, monitoring is done through the ACTH.


Also has anyone heard of Anipryl/Selegilene? I believe I may have read that this is a fairly safe drug for Cushings. My vet did not bring it up but thought I'd ask here if anyone has tried it.
Anipryl is effective only when the lesion in the pit gland is located in pars intermedia. This is a very small percentage of dogs diagnosed with pit Cushing's. About the only time we might suggest anipryl for a pup is a senior pup who may not be able to tolerate either of the other 2 meds, or there are financial restrictions that may not allow treatment with either of the other 2 meds. Anipryl may help with some of the symptoms such as excessive urination & drinking.

When it comes to the UTK panel, it will provide you information about the 5 associated sex hormones produced in the adrenal glands, along with the cortisol level. This may be useful in pups who are exhibiting symptoms but demonstrate normal cortisol levels in either the ACTH or low dose dex test.

Debbie