Tetsuo Chan-Boston Terrier just diagnosed with cushings

[Tetsuo]

Hello,
My name is Leon and Tetsuo Chan is a Boston Terrier born 5/16/2000 so he's now 10 1/2 years old. I'm glad I found this forum. I've been reading all over the internet since he was diagnosed on the 23rd (3 days ago). Yes, I spent Christmas with a fake smile and he's been with me every minute since. It gets kind of confusing with all the information out there and whom to trust. I've read everything from the cause, effects, and treatments. I have yet to find a success story though so I'm extremely concerned if the disease is curable.

A year ago, his blood test showed he was developing cushings but not yet, so the vet changed his diet to Hills W/D and he's been taking HP Omega 3 1545 mg daily to try and prevent it. Obviously it didn't work.

He shows all signs of the disease: Increased(super)appitite and water consumption, pot bellied, hair loss, thinning of the skin, and since July 2010 he has lost 3 to 4 lbs. of muscle mass.

I attached the latest blood test in hopes of getting sound advise. His new Dr. wants to do other test as I've also read up on. But I need to find a new Dr. that will follow thru with his treatment. This vet hospital has many Dr.'s and all of them would be doing his treatment as there schedules permit, not that they will work together on his treatment. Hoping that someone here knows of one that is in Los Angeles/Orange County area that has experience with this treatment.

Happy Holidays to everyone!

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[Tetsuo]

I really felt the need to add one more thing. When the urine sample was taken, Tetsuo was under great stress. Sorry to admit, but Tetsuo is super spoiled. He has 3 beds and full roam of our home. He never see's the inside of a kennel and was never tied up. So when they had him in a cage for 3 hours without being able to get a urine sample, they brought him out to me (I refused to leave) to see if I could. It 5 seconds I had his urine sample, but I know for sure that he was under duress because of being caged. I read that its important for the Urine Cortisol:Creatinine test that the donor not be under stress. Should I ask for a new test?

[frijole]

Hi! My name is Kim and I treated my dog Haley for over 4 yrs with cushings. She passed away at the age of 16 1/2 earlier this year but it was just old age - not cushing's that took her... so please know cushings' is NOT a death sentence!

Also - the tests you have done cannot confirm a cushing's diagnosis.. they can suggest additional testing but to be honest, the alk phos level is so minimally high that I wonder if something else is causing the issues.

So far you have done a blood panel and a urine test (UCCR). Neither one of these can give you a diagnosis of cushing's - There are several tests that can be done: the acth test and the low dose dex suppression test are two that are typically done along with an ultrasound.

You have found a wonderful resource for help for your dog and we have a great library of reference materials as well that you should check out.

We do have members in the LA area so no doubt they can help you with recommended vets to go to that are more experienced with treating cushings.

Glad you found us! Kim

[mytil]

Hi and welcome from me too.

Yes, stress can effect some of those numbers. Looking specifically at the urine cortisol/creatinine, I would recommend additional testing. Take a look at this link (sorry if you have read through it already) - http://www.lbah.com/canine/cushings.htm

The clinical signs (the symptoms) do point towards Cushing's, as well as the elevated numbers, but wanted to mention it is a difficult condition to fully diagnose so the testing series mentioned in the link above is usually performed before any treatment starts.

If your vets are not in concert in the treatment it could end up with conflicting treatment protocols and even mis-diagnosis.

Keep us posted
Terry

PS - forgot to ask, is your boy taking any other medication?

[lulusmom]

Hi Leon and welcome to you and Tetsuo Chan.

So as to keep myself on track and try to limit my usual meanderings, I am including my comments and questions in blue text within the body of your post below:



Hello,
My name is Leon and Tetsuo Chan is a Boston Terrier born 5/16/2000 so he's now 10 1/2 years old. I'm glad I found this forum. I've been reading all over the internet since he was diagnosed on the 23rd (3 days ago). Yes, I spent Christmas with a fake smile and he's been with me every minute since. It gets kind of confusing with all the information out there and whom to trust. I've read everything from the cause, effects, and treatments. I have yet to find a success story though so I'm extremely concerned if the disease is curable.

Unless a dog has an adrenal tumor which can be surgically removed, there really is no cure; however, with effective treatment, symptoms can be controlled and a dog can live out there normal life expectancy with a really good quality of life. There are many success stories to be told here, including my own two cushdogs.

A year ago, his blood test showed he was developing cushings but not yet, so the vet changed his diet to Hills W/D and he's been taking HP Omega 3 1545 mg daily to try and prevent it. Obviously it didn't work.

I'm not sure what you mean by developing cushing's as you cannot make this determination by looking at the results of a blood chemistry panel. Was an acth stimulation test or a low dose dexamethasone suppression test done last year to check cortisol levels?

I am also confused as to why your vet thought that changing the diet to Hills W/D would help stave off cushing's. A vet usually suggests W/D for dogs that are too fat or are diabetic. Is Tetsuo either of those two things? W/D is definitely not an appropriate food for a cushdog as there it is lower protein and the protein in it is poor quality. There are much better foods for cushing's and weight loss than W/D.

He shows all signs of the disease: Increased(super)appitite and water consumption, pot bellied, hair loss, thinning of the skin, and since July 2010 he has lost 3 to 4 lbs. of muscle mass.

These are certainly all symptoms of cushing's; however, most cushdogs who experience muscle wasting don't necessarily lose weight. Has Tetsuo actually lost three or four pounds on the scale and is there any chance the weight loss could be due to changing the diet to W/D?

I attached the latest blood test in hopes of getting sound advise. His new Dr. wants to do other test as I've also read up on. But I need to find a new Dr. that will follow thru with his treatment. This vet hospital has many Dr.'s and all of them would be doing his treatment as there schedules permit, not that they will work together on his treatment. Hoping that someone here knows of one that is in Los Angeles/Orange County area that has experience with this treatment.

The abnormalities in Tetsuo's bloodwork are definitely those that we see a lot. With the overt symptoms you mentioned and these abnormalities, I believe your vet probably wants to move on to diagnostic tests like the acth stimulation test or the low dose dexamethasone test.

The urine cortisol:creatinine ratio (UC:CR) can be falsely elevated from the stress of being at the vet's office. For this reason, the UC:CR is more appropriately done with a urine specimen collected by the pet owner, preferrably the first pee of the day before meals and any medication. A reknown endocrinologist once said that if you rolled a dog over and stuck a needle in their belly to collect a urine specimen, you should expect the dog to be stressed out to the max and you most certainly would expect it to affect the UC:CR That's not to say that even if the urine specimen were collected at home that the UC:CR would be normal; however, one must question the results due to obvious stress. Aside from the UC:CR, did your vet do any other urinalysis to check the urine specific gravity, ph, protein, etc.?

I am glad that you are considering taking Tetsuo to an internal medicine specialist. Both of my dogs treat with Dr. Michael Moore and Dr. Alyssa Mourning at VCA All Care Animal Referral Center in Fountain Valley. I can highly recommend either of these specialists. If you are closer to West Los Angeles, I would heartily recommend Dr. David Bruyette at VCA West Los Angeles. Dr. Bruyette is very well published and lectures quite frequently on cushing's and it's treatments.

http://www.vcaspecialtyvets.com/all-care/
http://www.vcawla.com

I'm sorry for the circumstances that brought you here but I'm really glad that you found us. We'll do whatever we can to help you and Tetsuo. You're off to a great start with your education and we sincerely appreciate the fact that you posted the results of Tetsuo's bloodwork. Believe me, that saved a lot of questions. We'll look forward to seeing the results of all future testing as well.

Glynda

[Tetsuo]

Thank you all for your help, it is appreciated greatly. This is the first real knowledge I've received. The clear it up, the current vet is the one that said he has Cushings based on the blood work, I read as well that one cannot determine it based on just that. But again, that is why I need to find a real Dr.

Tetsuo was always 22-23 lbs up til his hernia surgery 1/09, and he was neutered as the same time. He immediately put on weight to 30 lbs at his peak. When he had his first blood test 10/09 he weighted in at 28 lbs. That is when a Dr. in San Jose put him on W/D and prescribed the omega 3 vitamins. Last time I weight him on 7/10 he was 27.5 lbs and now 5 months later, he is 23 lbs. without any mass loss. His spine is poking up and his skin is very loose but he is still chubby.

As far as medication, the only things that he taking is: HP Omega 3 1545.5 mg daily, and Front Line flea medication. I wonder if that is causing any of these results. But no other medication and only had his rabies shot up to date. I'm holding off on all other til his health is stabilized.

I will see that vet in Fountain Valley that was recommended and have them take over his treatment.

I also know that the W/D is not good for him, but both his last 2 vets says that food is good, but again, they are getting paid to push that food. So hopefully, this new vet will put him on a good diet or if I can find some threads on diets here, I'll use that.

I will continue to post results and progress so this may help others.

[frijole]

Glad you are close enough to Glynda's vet to go there - she won't steer you wrong... been a big asset around here for a long time. Trust me, we've seen so many misdiagnosed dogs and going to a specialist usually saves you alot of time and gives you peace of mind. Alot of vets just don't have the experience which might be what you were dealing with. Anyway, glad you found us.

Cush dogs don't really need a special diet - keep the fat content low. Kim

[Tetsuo]

Tetsuo has a myspace from a few years ago, the most recent picture he has there is from 2009, before his surgery.

myspace.com/tetsuochan

[lulusmom]

I just finished looking at all of Tetsuo's pictures on myspace and he is really a handsome guy. I love the pictures of him as a baby, especially the one at two months old with a toy that is only 4 inches tall. Really, really cute!

[Tetsuo]

lol, Thank you lulusmom. He is what I call my life line. Without him, I would no longer be living, just existing.

I will be taking him in this week, but noticed that his drinking is not increased, and nor is his urination. I read that normal consumption is 1oz per pound of body weight. If that's so, then he is consuming a little less than normal consumption. I've been measuring and he is drinking only approx. 16 to 20 ounces a day. Does this matter? Or is the 1oz per pound of body weight accurate?

[Franklin'sMum]

Hi Leon,

A very belated welcome to you and Tetsuo :). There is no "normal" as such, just what's normal for Tetsuo. The 1 oz per pound /kilo is a guideline, it also depends on activity level, weather, and food. Some of the water intake comes from food, and there is a lot more moisture in wet food rather than dry food (obviously) :o. I know some people soak kibble in water before serving.

Kim (frijole) mentioned to you to keep the fat content low in his diet, that's because cush pups are prone to pancreatitis, which can happen due to too much fat in the diet, or injury to the pancreas (like surgery).

I'm so glad you found this forum, the folks here are a wealth of information and helped me save my little boy. Please keep us updated,
Jane, Franklin and Angel Bailey xxx

[Tetsuo]

Update:

Due to my own financial disaster, we were able to finally go into the VCA hospital in Fountain Valley. Today (3/26/11) we spent all day there. The doctor opt'd to do the Low-Dose Dexamethasone Suppression Test. I actually stayed at the clinic so he could be with me between tests and not in a cage for the 8 hours of testing. In the consultation, the Dr, spoke and said exactly what this forum has taught me in the past 5 months. So my confidence confirmed immediately. The results may come in as soon as tomorrow, and possibly Monday, we will do an Ultrasound. I will post up the result of the Low-Dose Dexamethasone Suppression Test when it comes available. Thanks again everyone for the wonderful support and guidance.

[Squirt's Mom]

Hi Leon,

Good to hear from you again!

Sounds like you are on the right road and I look forward to hearing what the results are.

Keep up the good work and stay in touch!
Hugs,
Leslie and the gang

[lulusmom]

Hi Leon,

I'm glad you got to get into VCA. I remember spending a great deal of time there when my Lulu was being diagnosed. I live 50 miles away so it wasn't convenient to go back and forth during those long days when they did the low dose and high dose dex tests but they made it comfortable for me on the days when I had to camp out there. I'll be looking forward to seeing the results of the low dose dex test.

Glynda

[Tetsuo]

Hi Glynda, they were actually surprised that I wanted to stay there and they tried to insist that he stay in a cage all day. Of course that would never happen. I just called them and the tests results are in but they did not give any info on it and will have a Dr call me. I hope they call soon.

[lulusmom]

Hi Leon,

If they don't call soon, call them again and rattle their cage a little. No pun intended. :D

Glynda

[Tetsuo]

I just got the call from Dr. Page and the results she told over the phone is: he does in fact have cushings, but she is only guessing at this point that it is Pituitary but expresses that it is only an educated guess. He also has high blood pressure which she says is associated with cushings. She suggests to begin treatment with Trilostane even before the results of the ultra-sound (which is against what I've learned on this forum). I am now waiting for her to fax over the test results and I will post them asap.

[lulusmom]

Hi again,

I think Dr. Page made her diagnosis based on the fact that Chan has every symptoms in the book that is associated with cushing's and from your description, he probably looks cushingoid as well. He also has blood abnormalities that fit the disease, a high UC:CR ratio and now the postive LDDS. All of those things are probably enough to go on but in your shoes, I would still want to know which form of the disease Chan has. Since at least 85% of dogs with cushing's have a pituitary tumor, Dr. Page's guess would be pretty logical but you never know. Make sure you get a copy of the LDDS results and post them here. It should be easy to do because there are only three numbers.

If you don't feel comfortable starting treatment until after you see the ultrasound findings, then don't hesitate to tell Dr. Page that you want to wait.

Glynda

[Tetsuo]

Here is the LDDS test

http://i1032.photobucket.com/albums/a406/Rotarywerks/Picture1.jpg

[lulusmom]

Hi Leon,

Thanks for posting the LDDS test results. The cortisol at 8 hours is more than 50% less than baseline so I don't think there is any question that Chan has pituitary dependent cushing's. I'm not sure why Dr. Page told you that she was guessing. :confused:

[Tetsuo]

Hi Glynda, I didn't mean to say she was guessing at PDH, but rather the LDDS test itself is not fail safe. But her plan is to begin Trilostane (liquid form) soon. She likes to use the liquid because I will be able to adjust doses without getting a new prescription. She wants to start with very low doses and work our way up over time.

[frijole]

Hi from me! Your vet is right - if other things are going on the ldds can yield false positives. That is why additional testing is usually done. Have you done the acth test? Many will also do an ultrasound to take a look at the organs. These extra tests cost money but they are insurance that the dx is accurate. Something to consider.

Wishing you the best. Kim

[Tetsuo]

Hi Kim, yes we are doing an ultrasound. I believe, and will confirm, that the acth test will be done every 7-10 days to monitor the Trilostane treatment. This treatment will cost nearly every penny I make, so cost is not a consideration with his treatment. This guy is everything to me :)

[lulusmom]

Hi Leon,

Can you tell us what dose of Trilostane you will be giving Chan? Since Dr. Page has prescribed liquid Trilostane, they will be using a compound pharmacy, probably the one they used when Lulu was first diagnosed. If you do a little shopping, I can guarantee that you can find it cheaper. I use Diamondback Drugs and VCA calls in my refills like clockwork. When you know what the dose is, call Diamondback and ask for a quote. Just remember that you are getting liquid so the syringe measurement is not necessarily the milligrams. For instance, if the vet prescribes 60mg but has you giving .5ml on the syringe, that's a 30mg dose. Diamondback is in Arizona but they ship all over the U.S. I get my meds within a day or two.

www.diamondbackdrugs.com

[Tetsuo]

Thanks for that info... I will know/have the dosage info soon. Dr. Page says she likes to use a pharmacy in Arizona. But I will contact that website you suggest. Any help on $ will help but not influence any treatment decision. Thanks again and I will update when I get the dosage info.

Leon

[Tetsuo]

Now that testing is over and treatment is beginning, what can I expect to see as far as recovery. For instance, will his muscle mass return some, all or not at all? And will his appetite subside to a level where he feels that he's not starving all the time? Also, what side affects can I expect and or watch out for?

[Squirt's Mom]

Hi Leon,

What dose of Trilo did the vet prescribe for Tetsuo? Is his weight still at 23lbs?

Here is an excerpt from the patient brochure for Vetoryl (Trilostane) about what to look for that indicates problems while on Trilo:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/48685_VETORYL_10mg_PatientBro_COVER_FLDOUT_2_0_dis .pdf


The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness. Occasionally, more serious reactions, including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis or adrenal necrosis/rupture may occur,and may result in death.

More info on Trilo can be found here:

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

Hugs,
Leslie and the gang