Hi i'd like to introduce myself and my dog, Ernie

[nyc1967]

Hi everyone my name is Lisa..

My dog "Ernie" was just (yesterday) diagnosed w/cushings disease.

For months now he has been drinking ALOT and urinating more than usual and it seemed to get much worse the last couple of months - most recent is his appetite has increased. Anyway brought him to the dr. - blood came back normal and urine - the urine test for it came back at 33 think anything of 34 suggests maybe Cushings anyway dr. went ahead and did the 8 hours test and sure enough he has the beginnings of Cushings. i think his number was 11.6 and normal is 1-6. Anyway i have to go in on Monday to pick up meds..Vel (forgot the name - have it written down at home)

Ernie is 13 years old - a miniature poodle.

Any suggestions greatly appreciated -

For now we've been limiting his water in the evening - hoping this won't hurt him but trying to prevent "accidents" tried putting him gated int he kitchen but he cries all night as he is use to sleeping w/us..or sometimes we'll walk him in the middle of the night.

Any think else that might help - food/vitamins etc.

thanx

[StarDeb55]

Lisa, I would like to welcome both you & Ernie! The first thing I need to ask you to do is to check your spam mail box for an e-mail from the forum. It is necessary that you respond to that e-mail, so we can approve your membership. Until that is done, you may notice a delay when you post, as one of the administrative team has to manually approve your posts.

I will warn you that we tend to ask a lot of questions of new members, but that just helps us to give you the most appropriate feedback we can from the group's collective experience. There are couple of things in your first post that raise an alarm bell for me.


For now we've been limiting his water in the evening - hoping this won't hurt him but trying to prevent "accidents" tried putting him gated int he kitchen but he cries all night as he is use to sleeping w/us..or sometimes we'll walk him in the middle of the night.

This is a common misconception among parents of newly diagnosed pups. Please do not limit Ernie's water at any time. Our pups do not pee buckets because they drink buckets, it's quite the opposite. Their kidneys are working overtime, so they must drink buckets to keep up with what the kidneys are putting out. Without free access to water, they can easily dehydrate & become ill very quickly.


i think his number was 11.6 and normal is 1-6.
The results you have posted appear to be an ACTH. There are 2 values on this test, a baseline or pre level, & a post result which is 1 hour after the medication is given. Please recheck all of this, & we would like to see both results. Right now, I am going to assume the 11.6 you have posted is the post result. The normal range of 1-6 you have mentioned is the normal range you want for a pup under active treatment for Cushing's. The normal range for a healthy pup is 6-18 ug/dl, so you can see that a result of 11.6 is within this normal range. This also raises a red flag for me concerning your vets experience in treating Cushing's. We have seen it happen more than once that a general practice vet will confuse the normal ranges on ACTH for a healthy, non-Cushpup, with a pup under treatment. One other suggestion is that when you post any lab result, we will need the normal ranges, along with the reporting units as this can vary according to what lab has done the test. It sounds like the drug your vet want to use is vetoryl or trilostane. Could you tell us what Ernie's current weight is & the dose your vet wants to start at?

Did Ernie have any general labwork done such as a senior wellness panel or super chemistry panel? If so, we would like to see only the abnormal results. The are common abnormalities for our pups especially in the liver function tests that can tip off a vet to look at Cushing's. Is the ACTH the only test that has been done to diagnose Ernie? Cushing's is one of the most difficult endocrine disease to diagnose, & it is much better to confirm a positive result with another test such as a low dose dex test or even an abdominal ultrasound. Did your vet rule out both thyroid & diabetes? I ask about these 2 as their symptoms can overlap with Cushing's.

There is no hurry to rush into treatment as Cushing's literally moves at a snail's pace to do it's damage to a pup's internal organs. The most important thing for Ernie that you can do is to make sure that you have a confirmed diagnosis, & that you become a knowledgable, educated owner as you are Ernie's only advocate & voice. Along those lines, please take a look at the resources section of the forum where you will find tons of links that will take you to just about any information you may need concerning Cushing's.

Again, welcome! We look forward to hearing more.

Debbie

[nyc1967]

I will post my results later. He had blood work done and urine samples. My dr. did Not think he had cushings..he did rule out kidney and diabeties. I will get the results from the 8 hour test next week. I'm not sure what the 11.6 result was from BUT he did say thay 1-6 was normal so he was at the beginning stages of Cushings.

I will not limit his water - Thanks for letting me know...

His symptoms are excessive drinking, urinating, accidents/panting and starting to each much more...also his hind legs don't work as good...

[StarDeb55]

Since you say that Ernie had the "8 hour test", that is in all likelihood, the low dose dex suppression test. Was the 11.6 result from the 8 hour test? A low dose result will have 3 results total, a baseline or pre result, a 4 hour result, & an 8 hour result. We would like to see all 3. The low dose test is considered to be the gold standard for diagnosing Cushing's, but it has one huge drawback, it can show a false positive result in the presence of non-adrenal illness. If you have had a positive low dose result, it is critical that you confirm the result with a second test such as the ACTH or an abdominal ultrasound.

Again, 1-6 is not the normal range you want to use. That range is only for a previously diagnosed pup who is under active treatment.

Looking forward to seeing those results.

Debbie

[nyc1967]

yes, the 11.6 wa the result from the 8 hour test..i will try and have them fax over the results to me later on today..


Since you say that Ernie had the "8 hour test", that is in all likelihood, the low dose dex suppression test. Was the 11.6 result from the 8 hour test? A low dose result will have 3 results total, a baseline or pre result, a 4 hour result, & an 8 hour result. We would like to see all 3. The low dose test is considered to be the gold standard for diagnosing Cushing's, but it has one huge drawback, it can show a false positive result in the presence of non-adrenal illness. If you have had a positive low dose result, it is critical that you confirm the result with a second test such as the ACTH or an abdominal ultrasound.

Again, 1-6 is not the normal range you want to use. That range is only for a previously diagnosed pup who is under active treatment.

Looking forward to seeing those results.

Debbie

[nyc1967]

Yes, the 11.6 is from the 8 hour test. I am going to call my vet when they open and see if they can fax over the results..

Ernie is 12 pounds.

[StarDeb55]

We will be looking forward to seeing the complete results of the low dose. The low dose can frequently tell you what type of Cushing's, adrenal or pituitary, the dog has. We can't help you make that determination until you are able to post all 3 results from the low dose.

Debbie

PS- Please check for that e-mail I mentioned in my first post, so we can get your membership approved.

[nyc1967]

i did check my email and i clicked on the link...


We will be looking forward to seeing the complete results of the low dose. The low dose can frequently tell you what type of Cushing's, adrenal or pituitary, the dog has. We can't help you make that determination until you are able to post all 3 results from the low dose.

Debbie

PS- Please check for that e-mail I mentioned in my first post, so we can get your membership approved.

[StarDeb55]

Thanks! None of the administrators seem to be on-line at the moment. I have left a message for them, so hopefully, as soon as one of them pops in, you will get approved. Until then, it may be a little bit of delay before your posts appear as one of the moderators has to manually approve them.

Debbie

[nyc1967]

ok, I called, the girl told me these were the results:

11.5 base
1.7 - 4 hour
1.1 - 8 hour

i will go in on Monday and speak with the doctor

[Marlene]

Hi Lisa,

I have a toy poodle, Lacey, who is 14 1/2 years old. She was recently diagnosed with Adrenal-Dependent Cushing's. I am glad you found our forum. I am SO thankful I found these people. Everyone here has been so supportive. They have helped me greatly in knowing what to search for in an Internal Medicine Specialist. They have given me knowledge so I know the right questions to ask and confidence in what is being prescribed for Lacey. And when you get stressed, they are there to comfort and calm.

You can have confidence in the members who give you help with your results because they are VERY knowledgeable and will be a great help. I look at all the good results shared by our members with treatment for Cushing's and I am optimistic. My original vet told me to take Lacey home and make her comfortable; that she would not treat her. They encouraged me to find a specialist. The encouragement I found here has given me hope that I may be able to keep her for a while longer...and with a better quality of life!

Welcome and I wish the best for you and Ernie!!!

Hugggsss from Marlene and Lacey!

[StarDeb55]

Lisa, the pre result is very high which is a little unusual. Does Ernie get really stressed out & upset at the vets? I think these numbers do indicate PDH, pituitary Cushing's, but I would like one of the other members to confirm the way I'm reading them. I have posted for help with Ernie's results.

Debbie

[nyc1967]

He does get a big upset at the vet...

here r some blood results i have

CBC Comprehensive

WBC 4.4 (5.7-16.3 THOUS./uL) norm) Low
RBC 5.11 (5.5-8.5 MILLION/uL) norm) Low
MCV 93 (60-77fl norm) High
MCH 30.3 (19.5-26.0pg norm) High

Absolute Neutrophil Seg - 2684 (3000-11500/uL norm)Low

The above results r the only ones out of the Normal range..

Thanx again

[apollo6]

Welcome
I am Apollo's mom. Don't start any medications before the other's check your lab tests. Most importantly need to know what kind of cushing diagnosed- Adrenal or Pituitary or Atypical. This is very important as to what is the best treatment options/medicine.
Also if it is Trilostane?vetyrl- what is the dosage they want you to start on. Often times it is too high. If you read my link you'll see what I went through.
What I did with Apollo was go out each night before bed and wait until he urinated. He did have three accidents at the beginning when I started checking into the cushing. I was ready to buy doggie diapers if it got worse, but it got better. He sleeps with us also.
Hang in there. You don't have to rush into this, before you have all the information.

[nyc1967]

anyone notice personality changes in there dogs//for example my dog would Always bark when we were eating dinner - Now he just lays there..wierd -

[AlisonandMia]

Hi and a belated welcome to you and Ernie from me.:)

Those low dose dexamethasone suppression (LDDS) test results
(11.5 base, 1.7 - 4 hour, 1.1 - 8 hour) would be interpreted as being negative for Cushing's, I think. Usually the lab comments on the test in some way - if you have a copy of the test results can you see what they have said? From what I've seen, I would ignore the high base line reading because stress (at being at the vet's most likely) could be a very likely explanation for that, and the 4 and, most importantly, the 8 hour numbers show very good suppression. Good suppression is not consistent with Cushing's.

It is possible (although quite unlikely) for a dog to have Cushing's and to test negative on the LDDS test. That 8-hour number should be higher than 1.4 for a safe diagnosis to be made.

It sounds like his only definite symptom at this stage is urination problems. It is possible that it will turn out that Ernie is in the very early stages of Cushing's now but it is also very likely that something else is going on. Usually it is best to let the disease become fairly established and stable before starting treatment. It is an odd disease in that there is usually not much to be gained from "catching it early" and, in fact, treating too early can cause more problems than it solves. The damage done by treating too early (or treating a dog that does not in fact actually have the disease) are many times worse than the results of letting the disease run for a few months. Cushing's is a slow-moving disease that does its damage slowly over time so there is usually no need to rush to treat even when the dog is quite symptomatic. For this reason many experienced vets will take a wait-and-see approach with a mildly symptomatic dog - especially when lab tests don't really conclusively back the diagnosis up. I believe it is a disease that you want the diagnosis to be pretty much "beyond reasonable doubt" before treating with serious cortisol-lowering medications. These meds are wonderful and life-saving for Cushing's dogs but can cause major problems with a non-Cushing's dog.

With the urination issue - has the vet looked at the possibility of bladder stones? These can cause urination problems, presumably by taking up space in the bladder and also by irritating the bladder. I believe the best way to screen for bladder stones is an x-ray or ultrasound.

In your position I think I'd be looking for a second opinion, preferably from a veterinary Internal Medicine Specialist (IMS) before starting any treatment.

Alison

[nyc1967]

Alison, i will look at the results when i go see the dr. on Mon. or Tues - he did say that Ernie is at the "beginnings" of Cushings.


Hi and a belated welcome to you and Ernie from me.:)

Those low dose dexamethasone suppression (LDDS) test results
(11.5 base, 1.7 - 4 hour, 1.1 - 8 hour) would be interpreted as being negative for Cushing's, I think. Usually the lab comments on the test in some way - if you have a copy of the test results can you see what they have said? From what I've seen, I would ignore the high base line reading because stress (at being at the vet's most likely) could be a very likely explanation for that, and the 4 and, most importantly, the 8 hour numbers show very good suppression. Good suppression is not consistent with Cushing's.

It is possible (although quite unlikely) for a dog to have Cushing's and to test negative on the LDDS test. That 8-hour number should be higher than 1.4 for a safe diagnosis to be made.

It sounds like his only definite symptom at this stage is urination problems. It is possible that it will turn out that Ernie is in the very early stages of Cushing's now but it is also very likely that something else is going on. Usually it is best to let the disease become fairly established and stable before starting treatment. It is an odd disease in that there is usually not much to be gained from "catching it early" and, in fact, treating too early can cause more problems than it solves. The damage done by treating too early (or treating a dog that does not in fact actually have the disease) are many times worse than the results of letting the disease run for a few months. Cushing's is a slow-moving disease that does its damage slowly over time so there is usually no need to rush to treat even when the dog is quite symptomatic. For this reason many experienced vets will take a wait-and-see approach with a mildly symptomatic dog - especially when lab tests don't really conclusively back the diagnosis up. I believe it is a disease that you want the diagnosis to be pretty much "beyond reasonable doubt" before treating with serious cortisol-lowering medications. These meds are wonderful and life-saving for Cushing's dogs but can cause major problems with a non-Cushing's dog.

With the urination issue - has the vet looked at the possibility of bladder stones? These can cause urination problems, presumably by taking up space in the bladder and also by irritating the bladder. I believe the best way to screen for bladder stones is an x-ray or ultrasound.

In your position I think I'd be looking for a second opinion, preferably from a veterinary Internal Medicine Specialist (IMS) before starting any treatment.

Alison

[labblab]

His symptoms are excessive drinking, urinating, accidents/panting and starting to [eat] much more...also his hind legs don't work as good...
Hi Lisa,

Even though it does sound as though Ernie is exhibiting some classic Cushing's symptoms, I agree with Alison that his LDDS test results are not consistent with a Cushing's diagnosis. That being said, it is possible (although uncommon) for the LDDS to "miss" diagnosing Cushing's in a dog during the early stages of the disease. Per this article by Dr. David Bruyette, it may be advisable to administer an alternative blood test -- the ACTH -- to a symptomatic dog who tests negative on the LDDS:


When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

Here is a link to the article from which this quote is taken:

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

The bottom line is that I "second" the recommendations that you seek additional testing and/or clarification prior to beginning Cushing's treatment. Even though Ernie's symptoms do point towards Cushing's, I do not believe the diagnosis has yet been confirmed. If Ernie was my dog, I would first want to administer an ACTH stim test and/or wait for 1-2 months and repeat the LDDS to see whether the results end up shifting.

Marianne

[acushdogsmom]

I'm going to agree with Alison and Marianne here. I think that Ernie's result of 1.1 ug/dl at the 8-hour mark of the LDDS test would likely be considered normal suppression, and not consistent with a diagnosis of Cushing's. And that high baseline number could very likely just be because Ernie was stressed at the Vet's at the time of the blood draw. I'm not sure how your Vet is able to look at those results and conclude that they indicate that Ernie is at the "beginnings of Cushing's."

See if you can get a hold of a copy of the actual Lab Report. The 4-hour and 8-hour normal reference ranges for this particular test will be on the Lab report and often the Lab will include their own interpretation of the LDDS test results.

I certainly would not start treatment for Cushing's based on his LDDS test result.

Even with a negative Low Dose Dexamethasone Suppression test result, however, there is still a possibility that Ernie does have Cushing's.

If he were mine, I think I'd want an ACTH Stimulation test done next, to see how much cortisol is being stored up in his adrenal glands. Dogs with Pituitary Cushing's would usually have an excessive amount of cortisol being produced and stored in the adrenal glands and a positive result on the ACTH stim test would give you more evidence that he may actually have Cushing's, while a negative result would of course point away from Cushing's.

I think it would be a good idea to get a referral to an Internal Medicine Specalist for a second opinion, to confirm or refute the Cushing's diagnosis. Internal Med Specialists are the experts - they see and treat many cases of Cushing's and can often get a proper diagnosis and a good outcome for their patients even in the more complicated cases, when a GP Vet is not really able to. And if it isn't Cushing's, an Internal Med Specialist Vet would very likely be able to figure out what is going on with Ernie.

I'd also want an ultrasound done and an Internal Med Specialist could do that, too. They can have a good look at what's going on inside via ultrasound - and the way the adrenal glands look may also help to confirm the diagnosis. They'd also be able to get a good look at other internal organs with ultrasound.

If you are in New York (as your username suggests) then you likely would have quite a few Internal Med Specialists in your area. Maybe we can even help you to find one for Ernie.

Although I know that there are many others in the New York/New Jersey area, one of the most world renowned Veterinary Specialty Clinics is located in New York - the Animal Medical Center:

http://www.amcny.org/

http://www.amcny.org/endocrinology

http://www.amcny.org/internal-medicine

From what I can tell, they'll need a referral from your Vet, but your Vet should be glad to give you a referral to an Internal Med Specialist if you ask for it. After all, your Vet should be glad to get some expert input on Ernie's case.

http://www.amcny.org/veterinary-community/referral-policy

Many (although not all) Clinics who have Specialists, also have 24 hour emergency care available. And you never know when you might have a reason to need Vet care/help over the w/end or late at night (even if it has nothing to do with Cushing's) when the GP Vet's clinic is closed. If you do ever need the 24 hour ER, it's good to already have a chart there and some history about your pet noted in the file.

[zoesmom]

Hi and welcome to you and Ernie -

Have to agree with the others on a number of points. With those LDDS results, I would not treat yet or at least until further tests are done to confirm. A very small % of cush dogs will have an 8 hour # between .9 and 1.4, but overall, Ernie's test shows good suppression and it's just too risky, IMO, to give a cush drug based on those results - even if Ernie's in the early stages.

Second, finding a good IMS is the next best step. Take all results with you to avoid repeats. There are several good possibilities at this point. An ACTH test, for sure. And an abdominal ultrasound - you can never go wrong with that. If the adrenals are of equal size - and enlarged - that would go along with pituitary cushings. If one is enlarged and the other normal or small, that would indicate adrenal based cushings. And cush pups usually have an enlarged liver, too. Plus they can look at the other organs (kidneys, to rule out problems there, pancreas, heart, etc.) Also, sounds like a senior panel may have been done - blood and urine labwork? - if so, do take a copy of that with you, too. You mentioned several things that were out of range in the bloodwork, but normally, we'd expect to see one or more of the liver enzymes elevated in a cush pup and I'm assuming that was not the case with Ernie, since you didn't post anything about those (ALP, ALT, possibly cholesterol, etc.). If those are all normal, that would also make the cushings diagnosis more doubtful. Blood glucose checked, too, I presume (to rule out diabetes)? Its symptoms can be very similar.

There is one simple and cheap urine test that can rule out cushings. It's called the urine cortisol/creatinine ratio. You can even collect the urine samples at home and drop off at the vets. If it's negative, you can be pretty confident cushings is not what Ernie has. If it's positive, that just means you have to move onto some of the other tests already mentioned - ACTH, u/s, etc. An IMS will normally have lots of experience with all of the above tests and can't recommend enough how important it is to consult with one, especially in Ernie's case. But for now, please do NOT start him on any cush medicine. Will be looking for those more detailed test results so hope you will be able to post them soon. Sue

[nyc1967]

Yes, he did have the Urine Cortisol/Creat Ratio test - he had that b4 doing the 8 hour - the result was 33 - which was why my dr. thought he did not have Cushings, but then after the 8 hour thinks he's at the beginning of Cushings -

Actually crazy, but it seems as though many of my dogs symptoms are going away -- i am going to meet w/the dr. tomorrow just to sit down and get the results and ask him some questions etc. As for now, my husband an d I have decided to hold off and see how things progress.

Thank u everyone for the great feedback - i will post back after speaking w/the dr.

[Franklin'sMum]

Yes, he did have the Urine Cortisol/Creat Ratio test - he had that b4 doing the 8 hour - the result was 33 - which was why my dr. thought he did not have Cushings, but then after the 8 hour thinks he's at the beginning of Cushings -

Hi Lisa,

What measurement (nmol/L, ??) does the lab use for the UC:CR? Franklin's UC:CR read like this- urine free cortisol 163nmol, urine creatinine 5.8 nmol, cortisol/creatinine ratio 28.1 (<10.1) {lab note} uncontrolled hyperA.
If your lab uses nmol as it's UC:CR measurement, a ratio of 33 wouldn't rule out cushing's, but be reason for further diagnostics..

Hugs to you and Ernie
Jane, Franklin and Bailey xxx

[nyc1967]

This is exacly what it says:

Urine Cortisol/Creatinine: Urine Cortisol
Urine Cortisol Result 14.0 Reference Range ug/dL

Urine Cortisol/Creatinine: Urine Creatinine
Urine Creatinine 132.6 Result Reference Range mg/dL

Urine Cortisol/Creatinine: Urine Cortisol/Creat Ratio
Urine Cortisol/Creat 33 Result - no range

Comments
<34 Hyperadrenocorticism is highly unlikely and investigation of other causes of the dog's clinical signs is recommended

>34 Hyperadrenocorticism is posslble


Hi Lisa,

What measurement (nmol/L, ??) does the lab use for the UC:CR? Franklin's UC:CR read like this- urine free cortisol 163nmol, urine creatinine 5.8 nmol, cortisol/creatinine ratio 28.1 (<10.1) {lab note} uncontrolled hyperA.
If your lab uses nmol as it's UC:CR measurement, a ratio of 33 wouldn't rule out cushing's, but be reason for further diagnostics..

Hugs to you and Ernie
Jane, Franklin and Bailey xxx

[nyc1967]

OK so Ernie has been acting pretty normal the last few days - spoke w/dr. today - he said he believes he is just bordering Cushings - at the extreme early stages, and it might not progress. He believes if his symptoms went away to just hold off. From the 8 hours test he believes he can have Pituitary Cushings.

I have his results

the comments say Consistent with hyperadrenocorticism

because his 4 ours was more than 1.5 and more than 50% of baseline

and the 8 hour is inconclusive

anyway for now i'm holding off on anytreatment - he said it might not go full blown cushings just to watch him for now so thats what i'll be doing..

thanx for all the input

oh and next to the pre dexamethason result which was 11.5 the ref. range is 1.0-6.0 ug/dl HIGH