7 y/o Doberman - Diagnostic puzzle?

[tmknkef]

Hello my name is Karen and I have a doberman that will be 7 in January. She is the love of our life. She was diagnosed with crushing disease. My vet thought she had a food allergy so we put her on Blue Sweet Potato and Salmon. She was on this for about a month and then would not eat it anymore. She was give lysogren for the crushing and seemed to get back to her old self. Then she started vomiting, so she was given prednisone which helped her. We weened her off of it and she was doing great for about two weeks then she started peeing while she was sleeping and drinking a lot of water. So back to the vet. She lost 20 #'s. and was given a sonogram of her bladder to see if she had any tumors and it was negative. So she was put on the hormone pill which we have had her on now for 4 days. She seems to be peeing less but still wants the water which I take it away after 10:00 at night and give it back to her in the morning. She also has had thyroid problems for 3 years along with taking Proen for the past 2 years. We don't know what else to do for her. She is playing and eating again. Swithed her dog food to Blue Turkey and Barley. I cook her sweet potatoes and give her cooked carrots and raw ones. I feel like we are missing something here along with our Vet. Is there a special vet that we should be taking her to for all of this. Her last diagnosis was Diabetes Insepitus. Does anyone have any suggestions? She is taking a thyroid pill, a Proen and now the hormone for DI

[labblab]

Dear Karen,

I only have a moment to reply, but I want to welcome you to our family! I went ahead and shifted this first post of yours from our "Checking In" thread to a brand new thread of your own. This way, it will be easier for our members to respond to you directly with their suggestions and feedback.

I'm really glad you've found us!
Marianne

[labblab]

Hi Karen,

I'm back again :). In answer to your question about a specialty vet, yes, there are vets who have additional training and certification to handle more complicated cases. They are "Internal Medicine Specialists" (or "IMS" vets), and here's a website that you can search to see whether one is available in your area:

http://www.k9cushings.com/forum/showthread.php?t=182

It does sound as if your baby girl has been through a lot of treatment attempts so far :o. Can you tell us more about the original Cushing's diagnosis? What tests were done prior to starting the Lysodren? And were any ACTH monitoring tests done after she started on the medication, especially when she had the problems with vomiting?

It sounds as though she initially did well on the Lysodren, so it may only be the case that she needed to have the dosage adjusted downward in order to avoid problems associated with an overdose. If she was correctly diagnosed with Cushing's in the first place, I am puzzled as to why your vet would not have tried to re-stabilize her on Lysodren rather than electing to stop treating the Cushing's altogether...? If she really does have Cushing's, none of these other treatments are going to solve her symptoms. So please fill us in as much as possible about the tests that led to the Lysodren in the first place, and any testing that was done after she started having the problems.

Thanks so much in advance,
Marianne

[Squirt's Mom]

Hi Karen and welcome to you and your baby! :)

As Marianne said, the picture isn't clear yet to us either so the more info you can provide, the better. We love details, so don't worry about the length of the post.

In addition to the testing that has been done and the results of those tests, can you tell us if your baby has any other health problems? Is she on any other meds, supplements or herbs at the moment? If so, what, how much and how often? How much does your baby weigh and what was the Lysodren dose she was taking? Ok, that will help us get started anyway! ;)

One thing I wanted to mention - don't withhold water. Cush babies don't pee because they drink so much - they drink so much because the cortisol makes them pee an excessive amount. They drink to stay hydrated so withholding water can lead to additional problems. Cushing's isn't the only condition that causes pups to pee to excess and therefore need to drink more. ;) Thyroid problems will do the same thing.

I am glad you found us and look forward to learning more as time passes. Please don't hesitate to ask questions; we will do our best to help you understand.

Keep your chin up!
Hugs,
Leslie and the girls :D - always

[tmknkef]

Thank you for responding so quickly. I am very new to this so please bear with me. My Doberman's name is Lexi. I will start from the beginning of our trouble.
On 9-2-10 Routine exam since she was on Thyroid medicine. They did an exam, Blood test 3 (9523) Not sure what this means just taking the information off of my bills. She had her rabies shot.
On 9-9-10 She just was not herself, not eating and not playing so we took her back to the vet. She has always had a skin flair up on her one hind leg that she always licked until it bleed. We did everything to try to clear this up. While at the vet he seemed to think she had a food allergy, so we put her on Blue, Salmon and Potato. She has been on Blue now since this date. Her hind leg is better and she does not lick as much but she still was not herself. So they did a Dexamethasone Supp 3 Sam (Ant) t450. I am sure this was the blood test for Cushings. He called us two days later and told us she had Cushings due to excessive cortisol production. We then had to give her Lysodren 500 mg. She was given 1 and1/2 tablets 2x a week for 2 weeks. This was on 9-20-10 The blood test was like a 5 hour test where we had to leave her there and then pick her up. I have a copy of a blood test dated 10-2-10 that says Catalyst Dx in red on the paper it has BUN 6mg/dl 7-27 LOW and ALKP 804U/L 23-212 HIGH everything else on the paper were in the Normal Range. On 10-2-10 She was not herself , not eating and stared having watery Stools and some vomiting. We took her back to the vet on this day and they gave us Prednisone 10mg tablets. They also did a Pre-Anes./CBC/Elect IH test and Heartworm/snap(Ehr. Lyme, Anap. Took her blood pressure which was a little high and gave her fluids in her neck. The fluids perked her up along with the Prednisone. She was back to her old self again. After losing almost 20#. She was doing fine until she all of a sudden started drinking lots of water and started peeing her bed while she napped or slept. She never ever wet in the house. We took her back to the vet on 11-23-10 She had the Cushings test done again ACTH Stim Pre and Post (Ant)t440 . They found she had a urinary tract infection through checking her urine and she was given 500mg of Ciprofozacin. Her Cushing test came back in range is what they told me and said this was not due to her Cushings. She hasn't had any Lysodren since her initial doses. After the antibiotic, she still had the bed wetting problem and was still wanting to drink a lot of water. She was not eating real good either. We called the vet and he told us to switch her food to Blue, Turkey and Barley and she has been eating real good now. We took her back to the vet and had her urine tested again. They did a Urine Specific Graviety IH test and it showed some type of cells so they thought she may have bladder cancer. We had an ultra sound done of her bladder and it was negative. They also used Glucose Series Strips and then told us she has Diabeties Insipitus. She is now on Desmopressin 0.2mg a day.
She also has had thyroid problems first for the past 3 years and takes L-Thyroxine 0.8 mg a day along with Proin 75 mg due to her having some incontinence issues a year after she was diagnosed with her Thyroid problem. She was spayed when she was young. This is most of the history on Lexi. She is doing better on the hormone which she has been on now since 11-30-10. Still wants water, which I give her then take away at 11:00 and she gets it back in the morning. This also has not been as excessive. She hasn't peed her bed for the last 2 nights anyway. I just want to make sure she is getting treated for the right problems. It has been like a guessing game. Our Vet says her case is something else. She has seen 4 different vets in our Vets office all working together on her case. She is the love of our life and we want to make sure we are doing all we can for her. I have spent over $2000 on her and will do what ever I need to do as long as she is getting the right treatment. I just did not know what else to do. I take it day by day. Any suggestions?? Thank you so much for reading my lengthy post.

[Harley PoMMom]

Hi Karen,

Welcome to you and Lexi from me and my boy Harley. I am so sorry for the circumstances that brought you here but very glad you found this forum and we will help you in any way we can.

Strong symptoms are a huge part of making the diagnosis, and a Cushing's savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis. With Lexi not eating, this is an unusual symptom of a pup that has Cushing's Disease. Could you tell us what symptom's Lexi was displaying that led you or your vet to test her for Cushing's in the first place?

Not one test can confirm cushings 100% or the type of cushings and any non-adrenal illnesses can cause false positives results on Cushing's tests, especially the LDDS test, which it sounds like the one Lexi had.

I don't want to alarm you, but some of the things that your vet has done is raising red flags for me.



He called us two days later and told us she had Cushings due to excessive cortisol production. We then had to give her Lysodren 500 mg. She was given 1 and1/2 tablets 2x a week for 2 weeks.

For a pup that has a proper diagnosis of Cushing's Disease and is being treated with Lysodren, this is not the correct protocol for this medicine. When a pup has elevated cortisol and is first started with Lysodren/Mitotane a loading/induction phase is used first.

According to Dr. Feldman, who is a renown Cushing's expert:
Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

You can find more information about the Lysodren loading Instructions here:http://www.k9cushings.com/forum/showthread.php?t=181





She had the Cushings test done again ACTH Stim Pre and Post (Ant)t440 .

Could you post these numbers for us please. How much does Lexi weigh?



We had an ultra sound done of her bladder and it was negative.

Were the adrenal glands visualized in the ultrasound? How about the liver?



They also used Glucose Series Strips and then told us she has Diabeties Insipitus. She is now on Desmopressin 0.2mg a day.

I could be wrong here, but I have never heard/read that Diabetes Insipidus being diagnosed by Glucose Series Strips. Maybe they were ruling out Diabetes Mellitus?

If Lexi does have Diabetes Insipidus and also suspected of having Cushing's Disease then with-holding water could be detrimental to her well-being.

I am sorry for answering your questions with questions but the more we know about your girl the better our feedback will be, ok?

Love and hugs,
Lori

[Squirt's Mom]

Hi Karen,

How is Lexi doing today?

I am with Lori...several things in your post are a bit concerning so I am looking forward to your response to her post.

Again, please do not take Lexi's water up. This is not a case of her over-drinking just to be drinking...she is doing all she can to keep her body hydrated. With Cushing's or diabetes, this can lead to some serious problems and none of us want that for sweet Lexi.

Hugs,
Leslie and the girls - always

[tmknkef]

Thanks everyone for responding to my posts. Lexi weighs about 75 pounds. She is doing well, plays as normal, is eating much better but still peeing once or twice a day while she sleeps and still wants water more often then she ever did. They did a sonogram of her bladder but not of anything else. She is finishing up the antibiotic for her urinary track infection she had. Once this medication is finished I am going to take her back to the vets to get her urine checked. I do not know Lexi's numbers from her Cushing tests I only know what I wrote in my long post taken this information off of all my statements. She did have an ACTH test that cost me $175.00 and she had this test done twice. Is this the Cushing test? What should I be asking my vet? This is a state of the art Facility that has 10 vets on staff. Lexi has seen 5 of them all consulting on her case. Should I take her to a specialist vet? What questions should I be asking my vet about her condition. To me she is a real puzzle to them and they say this with all her problems. I am so frustrated. I just want her to get the right diagnosis and help. I appreciate your feedback. I will probably take her to the vets on Tuesday or Wednesday of next week.