New to your site - 11 y/o Akita

[dldy960]

Hi!

I hope I am doing this correctly. I have just been informed that my almost 11 year old Akita has PD cushing's. I work at the vets and am now wanting to decide what to do about treatments. "Kuma" my Akita will be having an ultrasound next Thursday. I have been reading about the different drugs and am a bit concerned and want to do the least invasive thing for him. I know the Dr.'s will recommend what they will and I just want to be prepared. Stats: urine 1.002 w/many epithelial cells(not getting a straight answer what this is)? LDDS pre-3.4 ref. range 1.0-6.0 ug/dl / post 4hr 1.8 / post 8 hr 3.1. I am concerned about the epithelial cells and cancer. Abdominal digital X-rays didn't show anything out of the ordinary. Thank you for your help, and please don't hesitate to tell me I am posting this in the wrong area. I apologize in advance.

[StarDeb55]

You have posted absolutely in the right place. I need to ask you to check your e-mail, especially your spam folder, for an e-mail from the forum. You need to respond to this e-mail so we can get your membership approved. Until we can get your membership approved, you will see a delay before your posts appear as one of the admin staff have to manually approve them.

Unfortunately, I have to run, so I will give you a quick start. Let me tell you that I'm a medical lab tech with 30+ years experience. Your question about urine epi cells, their presence is basically normal. As long as they're squamous cells, these cells are simply coming from the lining of the bladder, so the presence of a few of them is normal.

Debbie

[lulusmom]

Hi and welcome to the forum.

Can you tell us what symptoms your dog had that made your vet suspect that cushing's may be possible? The chances are that your dog has pituitary dependent disease but the results are barely shy of being able to make that determination without a shadow of a doubt. I'm therefore happy to hear that Kuma is having an abdominal ultrasound before starting treatment.

The two most effective drugs, Vetoryl (Trilostane) and Lysdoren (Mitotane) are serious drugs but you need serious drugs to get the job done. I have two dogs with cushing's, the youngest one was diagnosed 5 years ago at the age of three. Both dogs have treated with both drugs and neither had any adverse effects because 1) we have a vet that is experienced in treating with both and 2) I immersed myself in everything I could find on the drugs before I put one pill in my dog's mouth. It is always in our dogs' best interest if we take a very proactive part in their treatment.

With you working at a vet's office, you may actually have access to some really good information on cushing's. If so, start doing your research. We actually have some excellent reference material that covers just about everything you can imagine, including companion conditions that are common in cushdogs.

Has your vet treated a lot of cushingoid dogs? Have you asked him/her which treatment they feel most comfortable prescribing? It's normal to be afraid and concerned but you aren't alone anymore. We're here to help you in any way we can. No matter which treatment you decide on, there's a whole bunch of us that can help out if you have any questions or hit a snag. I've included a link to our Helpful Resources section below so you can start taking a look around in your spare time; however, please feel free to ask any questions you may have.

http://www.k9cushings.com/forum/forumdisplay.php?f=10

Looking forward to receiving more information about Kuma.

Glynda

[dldy960]

Thank you for your reply. Kuma has consistently had low T4's and TSH over the past few years indicating Euthyroid Sick.

About 3 months ago I had noticed that Kuma's hair did not grow(shaved due to bouts with seborrhea) back on both of his shoulder blades and the base of the spine, the rest of the hair is course and not his usually beautiful coat. Should have been completely normal by now. He was experiencing PU/PD with a few days of night time leakage. Tested again for Hypothyroid and with that coming back with a low normal for hypothyroidism he has been on a dose of .3mg twice per day for about 6 weeks. He was taking .6mg twice per day with adverse reactions as his water intake increased even more, panting, and seeking a cool place to rest;with reduction of soloxine the water intake went back to the same PU/PD as B-4 without any urine leakage to date.

The doc did say that with the excess of epithelial cells that he was a bit concerned about cancer, but wanted to do the LDDS and an ultrasound. Ultrasound is for next week Thursday as the Board certified Internist is a traveling one.

Thank you for the reference material I will be looking at that.

[dldy960]

I would love to summit a picture but I don't think I am able to put a picture with my user name as yet, I tried the User section earlier

Thank you again for welcoming me to your forum, its nice to know that I have some where to go for information with this.

Patsy:)

[lulusmom]

Patsy, as Debbie mentioned in her post, you need to check your inbox (and spam folder) for an email from k9cushings. Once you respond to that email, we can approve your membership. Right now all of your posts are having to be approved by a staff member. Once your membership is approved, I believe you will be able to post a picture. If you have any trouble with your avatar, here is a link to an explanation:

http://www.k9cushings.com/forum/showthread.php?t=2018

[dldy960]

Thank you for your help. I am now able to post immediately. Do you think by the test LDDS results that it is still possible that Kuma has adrenal cushing's? His results just seem to be border line. I am interested in Anipryl Rx, since its really about the symptoms and quality of life for the big guy. I was wondering what you thought about trying this drug for PD cushing's first? I was just thinking about trying it due to the reduced side affects of Anipryl vs Vetoryl.

[mytil]

Hi and welcome from me too.

To really get a handle of whether it is pituitary or adrenal based you really need to have an ultrasound performed (and I see you are) to see the condition and size of the adrenal glands. Here is a link of which shows how to interpret the LDDS numbers - http://www.k9cushings.com/forum/showthread.php?t=217. From the chart, you can see that your pup is really not considered borderline.


I am interested in Anipryl Rx, since its really about the symptoms and quality of life for the big guy.

I wanted to offer my comments on this. Many think it is about easing the symptoms (clinical signs) but what is happening internally is a different story with ineffective treatment. As the excess cortisol circulates UNCHECKED it continues to "break down" muscle tissue and organ function and can cause heart complications.

There are some who have used Anipryl effectively and in conjunction with other medication, but each doggie is different and each case is different. Take a moment to read through this link - http://www.k9cushings.com/forum/showthread.php?t=224.

Keep us posted
Terry

[Squirt's Mom]

Hi Patsy,

Welcome to you and Kuma! :)

I want to offer the other side of Anipryl (Selegiline). ;)

Anipryl is ONLY effective on dogs with PDH; it will not have any effect on an adrenal tumor, so if you are considering this approach, it will matter which form Kuma has. 85% of Cushing's pups have PDH; of that 85%, up to 25% will benefit from Anipryl. The usual protocol is to start with the lowest dose for you baby for 30 days; if there is no change or little change in the signs, then the dose is increased. Many pups will need to move on to Lyso or Trilo in 60-90 days.

Some vets prefer Anipryl as the first step as it is more benign than Lyso, Trilo, or Ketochonozol (Keto), another lesser used treatment for Cushing's. Anipryl does not have any effect on the adrenal glands themselves so there is no risk of an Addisonion event or crisis. Nausea seems to be the most common side effect.

My Squirt was on Anipryl for 9 mos. and, other than some mild tummy upset that Pepcid AC and Tagemet took care of, she had no real issues with it. Her story has not followed the usual Cushing's path so far since the original diagnosis of PDH is now in question. I will be back later to tell her tale. ;)

My old computer has all my files on it and it is in storage, :rolleyes: so I will have to find my info on Anipryl and get back to you with it. I just wanted you to know there are positives to Anipryl for certain of our cush babies.

I'm glad you found us and look forward to learning more about the both of you as time passes.

Hugs,
Leslie and the girls :D - always

[dldy960]

Thank you so very much for all your kind words and information! What a wonderful site you have here. I am going to look at the links that have been given to me and study as much as I can.

I am eager to have the ultrasound done, and am hoping and praying that we do not find anything else... I know that the Doctors are looking to make sure that he doesn't have a tumor in his kidneys due to the large amount of epithelial cells found in his urine. Also, his ALK. PHOSPHATASE is 562 and ALT (SGPT) is at 122 not sure what else they are thinking. Because I work there and one of the Doctor's is family (step son married my daughter) they are careful to protect me, as well as, tell me the truth...its tough for them too.

Anyway your all so nice to give me support and I am so glad that I found you!:) I will keep you posted.

[apollo6]

Dear Patsy
Welcome to you and Akita.
You are 100 steps in front of your self.:eek: First get the tests:ultrasound(to see if one or both adrenal glands are similarly enlarged) liver, pancreas, kidney abnormalities, then the ACHT STIM TEST, and a full blood panel to show if elevated reading are there. Once you get the results back you can post on your thread. Please be aware there are three kinds of cushing:adrenal(tumor in one gland) pituitary(both adrenal glands enlarged similarly) atypical(sex hormones out of wake). Only then start looking at what treatments are out there and research.
Hugs Sonja and Apollo

[dldy960]

Thank you Sonja and Apollo,

No drug has been suggested by the doctors; at our practice they usually recommend Vetoryl (have been importing from the UK until now available in the US), we also have Anipryl, but I am the type of person that likes to be informed well before a decision needs to be made....Its a problem I guess:o...I am an information junkie always a few steps ahead of everything!

It has been determined that Kuma has PDH, Pituitary Cushing's based on his LDDS test. He has had a complete Health Check, Health Check Plus, Thyroid Panel #4 & #5 done (I had the blood panels repeated in case of Lab error). Elevations in the areas listed prior.

The ultrasound as I understand it, is to determine if he has a tumor on any other organs (the Doc. is especially interested in his kidney's due to many large epithelial cells with large nuclei in his urine). They will of course also be checking adrenals, as well as, his other organs. A FNA (fine needle aspirate) will be done if in fact a tumor is discovered. Being that he has Pituitary Cushing's, unless I do a MRI of his brain it is unlikely that it can be determined how far along the tumor is there. Most tumors of the Pituitary are benign and slow growing if I have been informed correctly.

So at this point I am waiting for the ultrasound results. I will post the results of that as soon as I have them.

[apollo6]

you are on the right tract.
Hang in there.;)

[gpgscott]

Hi Patsy,

I have thought for a long time that the best first diagnostic is the full adrenal panel from UTK (university of Tennessee@Knoxville) This test looks at cortisol and five other adrenal hormones any or all of which can cause symptoms of Cushing's. Elevations of different hormones respond to different medical treatments.

Your case in particular catches my eye as your main complaint seems to be hair coat, and you have a nordic breed. These dogs a prone to hyper-estrinism a type of Cushing's which does not respond as well to conventional drugs such as Trilostane and Lysodren.

I do not see that you have posted the results of the LDDS, most of us keep copies of all labwork for reference and it is particulary helpful if you must see a new Dr. on short notice. Would you please post the results of the LDDS. I would urge you to ask about the first ACTH being done as the full adrenal panel rather than just cortisol.

Best wishes. Scott

[dldy960]

Hi Scott,

Thank you for your reply. My first concern was the pu/pd because it was so dramatic. He has always been a drinker, but he began pu/pd so quickly that I was alarmed. His LDDS results are as follows:

Pre Dexamethasone 3.4 Ref. Range 1.0 - 6.0 ug/dL
Post 4 hr 1.8
Post 8 hr 3.1 "

He is hypothyroid or Euthyroid Sick but has been taking .3mg of Soloxine BID since 7-23-2010. He was on .6mg BID, but began showing signs of Hyperthyroidism (panting, seeking out cold floors, and even more excessive drinking) so Doc. reduced the dosage to the .3, all symptoms resolved. He was still drinking alot of water although not at the rate when on the .6mg of Soloxine. So I took in another urine sample 8-31-10 and again with the low specific gravity 1.002 and then the detection of the Epithilial cells. Detection of Epithilial Cells were few on 7-1-10, and 7-16-10.

I was told that there are only two types of Cushing's PDH & ADH. Why has my doctor not mentioned these things to me?:confused:

Any help you can give is much appreciated!

[gpgscott]

Many Dr.s do not consider the other adrenal hormones and focus exclusively on cortisol.

I did not see the pu/pd issue this combined with the LDDS which does support a diagnosis of elevated cortisol changes my view somewhat.

I still think the full adrenal panel is important as some dogs with elevations of intermediate hormones in addition to cortisol benefit from a treatment of a mant dose only of Lysodren skipping the loading. Also Trilostane has the known side effect of elevating intermediate hormones and if you have elevated intermediates to begin with may not be the best medical treatment.

All of this comes under the heading of atypical Cushing's, I am placing a link from our resources area for your reading.

Scott

http://www.k9cushings.com/forum/showthread.php?t=198

[dldy960]

Thanks again. I will post again after the results of the Ultrasound. I will definitely read the research link you gave me. Full adrenal panel will be what I ask for with regard to the ACTH.

Warm Regards,
Patsy

[Marlene]

Patsy,
I wanted to welcome you to our forum. You have found a spot where you will find people who have tons of experience, a wealth of well-researched knowledge and lots of compassion and support.
Hugs to you and Kuma,
Marlene and Lacey

[dldy960]

Hi Marlene & Lacey,

I am so glad that I found your site too, and thank you for the welcome! I am taking Kuma for the Ultrasound tomorrow...I hate that he cannot eat in the morning, especially because my other 3 will need to eat. I was wondering; I understand that he needs to drink and that I may NOT withhold water ever, but what about food? Why can I withhold food?

Patsy

[gpgscott]

Why can I withhold food?
Patsy

Hi Patsy,

Looking forward to the results of the U/S. Partially digested food is denser that most of the surrounding tissue and can obscure the view of important areas.

Good luck. Scott

[lulusmom]

I was wondering; I understand that he needs to drink and that I may NOT withhold water ever, but what about food? Why can I withhold food?

If Kuma is drinking and peeing excessively, that's probably because he is no longer concentrating his urine. This condition is called polyuria (excessive peeing) and polydipsia (excessive drinking) and this is very common in cushing's. These dogs must have access to water. They don't pee a lot because they are drinking too much...it's the other way around.....they drink to keep up with the peeing and if deprived of water, they can dehydrate very quickly.

[dldy960]

Hi everyone,

Kuma had his ultrasound today. I observed the ultrasound and with the preliminary results from the Specialist Kuma has no other tumors!
He concurs with the diagnosis of Pituitary based Cushing's! I will receive the official report at some point today and that will give me all the measurements and such. I discussed with my Vet. the different types of medications available for treatment. Both the Specialist and my Vet. would like me to start Vetoryl, but since Kuma has a mild case at this point, the Vet. was willing to let me try Anipryl. I am going to give it a go...The risks of the other drugs are not something I am willing to start out with, I wouldn't do it to myself either, so why would I do it to my beloved Kuma. Who knows maybe Kuma will be one of the 10% that will have a good result from the Anipryl. If not then on to the stronger drugs.

I will certainly let you know about the ultrasound results as soon as I have received them.

I feel that Kuma has been blessed with only Cushing's and nothing else at this point...I hope you all understand what I mean...

Patsy

[dldy960]

Well, Kuma vomited a bit the afternoon after the ultrasound. But then had a bad case of vomiting and diarrhea the next morning. I took him to the Vets for a check. He was given an injection of cerenia and also some flagyl. He was really in a bad way, and I discussed with my Vet the possibility of a reaction to the Torb. he was given to relax him during the ultrasound. They have never seen a reaction like that, but its possible. Have any of you heard of this?

I have not started any meds for the cushing's, since he is not back to his normal health, although he is on the mend. Poor guy...:(

Also, the ultrasound results are very good. His other organs are normal, slightly enlarged adrenals. No other abnormalities found.

Thanks for any info.

Patsy

[lulusmom]

Hi Patsy,

Loss of appetite, vomiting and diarrhea are all listed side effects of Torbutrol. Good luck with the Anipryl.

[apollo6]

Dear Patsy
You are doing the right thing. I did not start Apollo on trilostane until other issues had resolved themselves. It took me over a week before I had the courage to start him on the medication.
Please post the dosage the vet wants to start Akita and his weight.
Other's can give you input as to what the right dosage should be for Akita.
Hugs Sonja and Apollo