My Gingerbread Boy, 7 yr. old Yorkie

[Gingermama]

Hi, I'm so glad I found a place to seek answers for my baby. Ginger has been through the mill the past few months. After weeks of on again off again vomiting/diarrhea, limping, hiding, trembling, thinning fur, pot belly apearance, a UTI, our regular vet referred us to a specialist for an ultra-sound and further diagnosis. One look by the specialist and he was diagnosed with PLE, his tummy was drained and he was started on Prednisone. I should also state that his Protein level was extremely low. Once a week we went back for blood work but the protein levels never increased. On week 4, after his levels were still low, we were told that the only option was to begin him on Vincristine therapy. Caught off guard we allowed him to be injected with this chemo drug. Worst decision of my life, we almost lost him, he became so sick, vomited all the time, lost 4 pounds, he was fur and bones. In a panic we took him back to our regular vet who immediately forced fluids in him and got him somewhat stable. We began force feeding him and literally begged him to just hang on...we'd get through this. Well, he's back to gaining weight, bright eyed and hungry all the time. Through all of this I began to wonder if he'd been misdiagnosed and began reading about Cushing's. I gently talked with our regular vet about my thoughts and he agreed to do a Cortisol test. When the blood work came back, all his levels were normal except the Cortisol level was 7.3. No one can explain why his RBC, WBC, Protein, Albumin were all normal. The vet suggested we start him on Lysodren, I refused, for a million reasons, the main one after his reaction to the Vincristine I wasn't willing to put him through another episode of potential horrific side effects. Needless to say, I'm so confused. Should I request an ACTH test? Where do we go from here? Right now his only issues seem to be thinning hair, pot belly (again) and hungry every 6 hours. HELP!!! Thanks for your shoulder.

[addy]

Hi Gingermama.

So sorry to hear about your baby but you have found a really wonderful group of experienced people to help you. The senior members will all be coming along soon with a ton of questions for you. They will ask you to post the results of any tests you have had thus far. You could get a start on that.

You can start breathing alittle easier now:)

Addy

[Roxee's Dad]

Hi Ginger's Mama,
Just wanted to welcome you and Ginger to k9cushing's. We are glad you found us and hope we can help you and Ginger get through this.

The "others" as I affectionately call them with much more experience and knowledge will be along to ask the traditional 20 questions ;) so we can have a better idea of what is going on with Ginger.


I gently talked with our regular vet about my thoughts and he agreed to do a Cortisol test. When the blood work came back, all his levels were normal except the Cortisol level was 7.3

What test was that? and what was the normal range for that result? There are a few test to dx cushing's

UC/CR is an inexpensive urine test that can rule out cushing's but not confirm it.

ACTH Stim test can dx cushing's but is not 100%.

Followed up by an LDDS which can confirm Cushing's and sometimes determine if it's PDH or ADH based.

Some prefer to do a High resolution ultra sound in place of the LDDS as you can get a good look at the adrenals and other internal organs.

I think you are right in holding off any cushing's treatment until you have a thorough and confirmed diagnosis.

Hang in there, the others will be along but in the meantime, please gather all of the test that Ginger has been through and the abnormal test results including measurement and normal range. If you don't have copies, please ask your vet's office, they should be happy to provide them to you.

Looking forward to hearing (reading) more about your baby.:D

[Gingermama]

Thanks for your help. The test was called a CORTISOL test, normal levels are 1 to 4.5. Ginger's was 7.3. He is scheduled for the urine test on Tuesday, he wasn't cooperating when he had the blood test so we had to reschedule the urine part. I'll attempt to get the complete lab results from the vet on Tuesday.

[StarDeb55]

Welcome to both you & Ginger! I am so sorry that Ginger has had such a struggle these past few months. John has given you a good start, but I need to ask a few more questions.


The test was called a CORTISOL test, normal levels are 1 to 4.5. Ginger's was 7.3.
Is this test something called a cortisol "snap test" that the vet can do in the office? If it is, I think it's just a screening test, I honestly don't how accurate it is to diagnose Cushing's. An ACTH is the test that is most normally done to measure cortisol levels, & the majority of vets can't do this in the office, it has to be sent out to a vet reference lab. Was this initial cortisol test that the vet did, done while Ginger was so ill or in the immediate aftermath of this illness? I'm asking because non-adrenal illness can elevate the cortisol levels which may lead to a misdiagnosis of Cushing's. When it comes to doing any further diagnostic tests for Cushing's, is Ginger doing well at this time? If he is, diagnostic testing should be ok, but if he isn't, you may need to hold up for the same reason I've mentioned, you may get a false positive result.

In the little bit of reading I did this AM when I saw your initial post, concerning protein losing enteropathies, I figured that steroids were probably one treatment which you did confirm in your first post. How long was your boy on the prednisone & is he still taking it? I ask because there is one type of Cushing's called iatrogenic that is induced by long term steroid use, the only cure is to slowly wean the pup off the steroids.

When you get those lab results at the beginning of the week, please post them. I'm a medical lab technologist with 30+ years of experience, so I can help out with making sense of them. When you post, please only post the abnormal values, along with the normal ranges, & reporting units.

Looking forward to hearing more.

Debbie

[apollo6]

Welcome
As every one will tell you, don't jump into treatment until you are sure of the diagnose , with the proper tests.
I think you said you had a blood panel? This would show if Gingerbread's reading are elevated.
The next would be an ultrasound of his abdomen to see if his adrenal glands are enlarged or if any other organs are enlarged or inflamed also.
Read my thread-Apollo trilostane. I did not jump into anything until I was sure, went to 2 specialists, internal medicine, familiarity with cushings and endocrinology. Debbie can help with the medical part as she said.
Read up on symptoms, note there are three different kinds of cushing, knowing which one is important to the treatment. Even then there are different treatment options. We are here for you.

[Gingermama]

The cortisol test was a blood test and a urine test that was sent out. Due to a mix-up the urine wasn't done correctly so I'm waiting on those results. In the meantime Ginger's abnormal results are: BUN/Creatinine Ratio 38..normal 4-27; Potassium 6.1, normal 3.6-5.5; Amylase 1450, normal 290-1125; CPK 41, normal 59-895; Platelet count 718, normal 170-400; Monocytes 1062, normal 0-840. He will have an ultrasound on Tues. am

[StarDeb55]

Yes, I do know that the cortisol is a blood test, but was it done at your vet's office or was it sent out? If it was done at the vet's office, it was, in all likelihood, the cortisol snap test as I mentioned in my prior post. I simply do not know how accurate a "snap" test is compared to measuring the cortisol level by doing an ACTH. The great majority of vets can't do an ACTH in their office, it has to be sent to a vet reference lab.

Debbie

Also, could you tell us how long your boy was on steroids & is he currently taking them?

[Gingermama]

Ginger was on Presnisone about 1 month following his supposed "PLE" dx. He as on 10mg daily for 2 weeks, then 15mg. for another 2 weeks, then the Vincristine was administered and the real trouble started. He was also getting drops in his eyes that contained cortisone, as well as an ointment for a skin lesion on his chin. All the testing that has been done on him recently has been when he is feeling better (altho I say that lightly). I know about stress affecting results so I don't allow anything to be done when he's under the weather. He is eating, drinking well, no excessive thirst, his urge to eat every 2 hours has diminished but his poor little tummy is getting so large, hopefully the ultrasound on Tuesday will help determine what we're dealing with. I struggle with trusting our vet anymore as well as the specialist we were referred to, that doesn't help the situation. I still shudder when I think the vet wanted to just start him on Lysodren 1/4 tablet once a week when a firm dx. hadn't been confirmed. I still refuse all cortisone in all forms....

[StarDeb55]

Can you clarify about the cortisol test that was done?

Debbie

[Gingermama]

The ACTH test has never been mentioned to us, although by reading about the disease I am well aware of it. After the ultrasound we'll probably go on to that step in narrowing down the actual cause of the Cushings. After the misdiagnosis on the PLE, I have trouble believing anything that isn't black and white.

[Gingermama]

All I really know is blood was drawn and sent away, I guess that's not real informative. The bill said CORTISOL TEST....I requested it, the vet didn't mention it before.

[StarDeb55]

If the blood was sent away, there is a good chance that this was an ACTH. IMO, you need to check with the vet as to specifically what "cortisol" test was done.

Debbie

[Harley PoMMom]

One of the recommendations we strongly urge to the furbabies parent's are to get copies of all tests done. This not only helps us when we ask about specific tests, it could also be of great value to the attending Dr. if an emergency situation would arise.

Harley's vet has no problem with me receiving copies of all tests done on him. In fact she has it written in his file that this is to be done.

Love and hugs,
Lori

[Gingermama]

All I have available right now are the most recent lab results, I will be getting them all in the future. I feel I should mention that we became Ginger's "parents" when the elderly couple that owned him couldn't care for him any longer and asked us to take him. They set up a Trust Fund for him at his regular vet so I've always taken him there.....the specialist we saw was in Sarasota and I can't seem to find another Internal Med. vet...do you know of any?

[judymaggie]

Hi -- I am sorry that you are in a position to seek out advice here but, as I'm sure you have realized already, the members are extremely knowledgeable and caring. I live up the road from you in Riverview. The internist who treated my beagle, Maggie (who passed away last year at almost 14 years old), was Dr. Erick Mears at Florida Veterinary Specialists. At the time there was no Brandon facility so I took her to the Tampa location. The phone number in Tampa is 813/933-8944 and Brandon is 813/571-3303. I think they have been bought out by Blue Pearl Veterinary Partners but they still use the FVS name. Dr. Mears was caring and compassionate. You would need a referral to be seen at FVS (unless it is an emergency situation).

[Harley PoMMom]

I feel I should mention that we became Ginger's "parents" when the elderly couple that owned him couldn't care for him any longer and asked us to take him. That was just so wonderful and loving of you! Bless you both for taking Ginger in.

Love and big hugs to you all,
Lori

[Gingermama]

Hi Judy, thanks so much for the info on Dr. Mears, Ginger will be having an ultra-sound at his facility on Tuesday. I don't think our Vet will have a problem referring us there for a dx. since he doesn't seem to be up to date on Cushing's, altho, I don't think he'd admit that to us. I feel so helpless in trying to find info myself....my poor little boy just needs to feel normal again. I thought I was being proactive in reading/learning and discussing findings with the vet, but from this site I can see I haven't begun to fight and have so much to learn. Thanks again for your help.

[Gingermama]

Lori, we feel so blessed to have Ginger with us, he's such a sweetie, so it was no problem taking him in to join our zoo. We have an 11 year old Westie, 2 cats, 1 is 18 the other is 9. Fortunately, none of them have ever had any health problems. Funny how we think we know what's going on and wham....we get thrown a curve and don't know where to start for answers. I'm so glad I found this site, I'm reading and learning as fast as I can.

[Gingermama]

The vet just called with Ginger's urine cortisol results so I wanted to share them with you: Urine 11.5, Creatinine 107. Ginger will still be having an ultrasound tomorrow. The vet suggested we start Trilostane, every other day, then recheck him once month.....he also said it was "my call" on whether we treat him or do nothing at this time.....does anyone have opinions on this? We also talked about the ATCH test.....again, I don't know if we should be treating him until all tests are done.

[Roxee's Dad]

Hi,

Just my opinion :) an I'm sure someone will chime in here, but I think every other day dosing of Trilo would not accomplish anything. The Trilo effect wears off in about 12 hours. Some who are not getting the results needed to control the symptoms are actually doing twice a day dosing but very few.

I still don't think I've seen Gingerbread's ACTH pre and post results posted here. May have missed it.:o The cortisol reading that you did post was a 7.3 with the norms being 1.0 to 4.5. 7.3 just doesn't seem to be that high to me. Does Gingerbread show any other symptoms? Appetite, excessive water drinking, thinning coat?

Treatment doesn't cure the Cushing's, it's only meant to treat and manage the symptoms. If Giger Boy :) doesn't have many symptoms, you may want to re-think treating immediately.

One last question, does your vet have experience treating cushing's with Trilostane?

[StarDeb55]

As John has already said, trilo has a half life in the body of about 12 hours, so dosing only every 48 hours would be a complete waste of time & $$. This suggestion by your vet raises a huge red flag about their experience with using trilostane. Also, a Cush savy vet will normally not treat a pup until they are displaying strong symptoms. One of the major ways of monitoring treatment with both drugs is an improvement in symptoms. It would be really helpful if you could get copies of all of Ginger's results & post them for us , especially the ACTH. If the cortisol result of 7.3 was the post result on an ACTH, I agree with John, it's simply not that high. We see newly diagnosed dogs who have post results on their diagnostic ACTH of >25, frequently. My Harley's diagnostic ACTH had a post of almost 30. If this was an ACTH, there will be a baseline, & a post result, we would really like to see both values.

Debbie

[Squirt's Mom]

Hi,

Your gut is telling you what needs to be done...the answer to your question as to whether to treat before all the testing is done or not, is NO. Cushing's is difficult to diagnose and no treatment should be started until you know that you are definitely dealing with Cushing's. Get the testing done first, find the answers you need to make an informed decision on the next step, and remember we are here to help you.

Hugs,
Leslie and the girls - always

[Gingermama]

Hi again and thank you all so much for your input/insight. I am anxious for the ultrasound tomorrow and hope to get some answers then. Ginger has NOT had an ACTH test done yet...but it has been discussed. As for the vet, no, I do not think he's experienced in treating Cushing's, so I'm not going to allow him to treat Ginger if/when we know what we're dealing with. Like I said, he was diagnosed with PLE by a specialist and know we know that was not the case....his symptoms have improved generally. He was never a playful guy, so it's hard to say he has more energy now. The diarrhea, hiding, trembling have gone away. His appetite is good, (he doesn't want to eat every 2 hours) the thinning and loss of fur seems to be somewhat better. The frequent urination also seems to be better as well. The skin lesions on his back are dried but his skin is still flaking. He eats Royal Canin Hypoallergenic and Hills WD....before he became so sick he was eating Hills Small Bites (which he had always eaten when he was with his former owners) All I know for sure is that he will not be given any drugs or treatments until we have a firm diagnosis and then I'll make some decisions. Right now, I just want to hug him, love him and keep him healthy. His poor little face looks so strange, he lost the fur around his nose, making his profile an interesting sight. Thanks again for all your kind words and hugs to all of you.

[Gingermama]

So...I have the ultrasound results but no discussion from the vet....yet! I picked the report up from his office this morning since he hadn't called us with any info. He was busy at the time so I left with the report. Anyway, I learned that on page 2 of his cortisol/creatinine test the ratio was 34.....the vet never told me that. The ultra sound indicated that the gall bladder/biliary system were normal as well as the spleen, kidneys and adrenal glands. The urinary bladder was thickened with small calculi. Small intestine was thickened with normal layers. No masses or peritoneal effusion. The assessment read: Hypoechoic and subjectively enlarged liver, thickened urinary bladder (dx. cystitis) and thickened small intestine. Ginger did have a UTI in mid April which resolved. There's no indication of infection on his testing since then. For days I thought the cortisol test was normal but now I read where the ratio was 34.....yes, the cortisol urine as 11.5, creatinine 107.0 but how could he leave out the ratio???? I'm upset and confused, still or maybe forever more. Any thoughts???

[StarDeb55]

This result is borderline. I just looked at IDEXX vet labs normal range for a UCCR, & they say that <34 is negative. Ginger's ultrasound is reasonably normal with no apparent enlargement of the adrenal glands. It is possible that Cushing's may still be the culprit normal adrenal glands are possible, but just not frequently seen. We still really need to see just exactly what test was done that gave a cortisol result of 7.3, along with the normal ranges & reporting units for that test. I am a medical lab tech with 30+ years experience, so looking at these numbers is what I'm used to, but in order to give you valid input on any lab result, I have to have the normal range & reporting units. These 2 things may vary from lab to lab & this is why we always ask that you post them.

Thanks,
Debbie