LDDS test not 100% conclusive….treat or not to treat? [Archive] - Canine Cushing's Information and Support Forums

Luvmylabs

01-01-2011, 07:29 PM

Hi, my name is Kathy, I’ve been struggling with the decision of whether or not to treat my 4 legged baby just yet. I came across this great forum and was hoping if anyone has had a similar experience you can give me some much needed advise. Our story begins here….
Murphy Brown is a 74 lb lab. She’ll be 12 this month. She started showing symptoms of panting, restlessness, aggression toward food/treats, drinking a lot of water and reluctant to jump on the couch. Her most prominent symptom is the panting…non stop!
The vet suspected cushings but preliminary blood tests were normal. After many return visits and still no answers we were referred to an internist looking for other causes for her symptoms. Along with many other tests they did an ACTH test which was negative so we stayed the course and agreed to do blood work again in two months. This time the blood work showed her liver enzymes to be over 500 so they scheduled a LDDS test.
This is where I become confused. The vet said that anything over 1.0 in the first and second blood draw of the LDDS test would indicate that she was cushingoid. The first number was 1.8 and the second was 1.0. He said that the second number isn’t 100% convincing but if it was his dog he would treat due to her symptoms. I was given the option of treating now or wait and give her Denosyl and Milk Thistle for liver support and do the LDDS test again in two months. If I choose to treat he prescribed her a low dosage treatment of 1 & ½ Lysodren (500 mg) for 3 days and 1 & ½ every 3rd day. I’ve been researching the risks of Lysodren and understand if she’s not cushingoid it could possibly cause her to have Addison’s. I’m afraid if I don’t treat now and she does in fact have cushings I’m doing her a disservice. I apologize for the lengthy post but I’ve been on information overload the last number of months and I want to make sure I cover the details. I’m so confused…any input would be greatly appreciated.

Harley PoMMom

01-01-2011, 07:41 PM

Hi Kathy,

Welcome to you and Murphy Brown from me and my boy Harley. So sorry for the circumstances that brought you here but glad you found this forum and we will help you in any way we can.

If you could get copies of all tests that were done on Murphy Brown and post the results here, that would help us so much.

The LDDS test, which Murphy Brown had, should have 3 numbers for you to post for us.

Any lab work that was done and any abnormal findings on there, could you post them here with the reference ranges and the units of measurements (ug/dl). You see, the more information we have about your furbaby the better our feedback will be, ok?

It most definitely sounds like Murphy Brown has some of the strong Cushing's symptoms but some of these symptoms are related to non-adrenal illnesses like diabetes and hypothyroidism, were these ruled out?

Is Murphy Brown taking any other medicines, herbs or supplements or in the past?

We are here for you, Kathy, and we will definitely help you in any way we can.

Love and hugs,
Lori

frijole

01-01-2011, 07:45 PM

Hi Kathy! Don't worry... alot of people come here with the same issues... diagnosing cushing's can be a challenge and not all vets are experienced. I'll warn you - we will ask alot of questions and the reason is simply so we can best get up to speed and help you!

OK so you did a blood panel, an acth test and the ldds test. All came back negative for cushings. Please post:

1. any abnormal readings from the blood panel (give us the read as well as the range for normal from that lab)
2. The 2 numbers from the acth test
3. The 3 numbers from the ldds test

You should get copies of all tests and put them in a file for future reference if you don't already have them.

Meanwhile - tell us more about your dog, the symptoms, when it all started - as much detail as you can think of.

There are other diseases that mimic cushings such as hypothyroidism, diabetes to name a few. You are right - you do not want to give lysodren to a dog without cushings. (this happened to me! My dog had 5 false positives on these tests)

Has the vet done a urine test called UCCR (urine creatine ratio)? It can be used to rule OUT cushings. Simple, fast and cheap.

There is a type of cushing's called 'atypical cushing's' which is caused by elevated adrenal hormones but the symptoms are similar to cushings. We'll hold off on that for now...

Tell us as much as you can and we will certainly do our best to coach you thru this... lots of experience on this forum!

Kim

Luvmylabs

01-01-2011, 08:10 PM

Hi Lori,
Thanks for your quick response. I'll most definitely get the actual test results from the vets office next week...I thought I was missing a number in the LDDS rusults. I've been given so many "numbers" lately I can't keep them straight. This has been going on since June. Amidst all of these symptoms she had to have her eye removed in August due to secondary glaucoma (from a mass in the iris). She was only on Rymadyl for a few days post operation. I have her on a daily regiminent of Glucosamine and Fish Oil. We just started her on Denolsyl and Milk Thistle at the vets recommedation until the next LDDS test because of the high liver enzymes.

They checked for diabetes which came back negative. I suggested Hypothyroidism but he said it's very uncommon so it wasn't pursued. Ugh...so many tests so little answers.

Kathy

Harley PoMMom

01-01-2011, 08:14 PM

Is Murphy Brown seeking cool places to lay down on or is she trying to find warm places?

Luvmylabs

01-01-2011, 08:21 PM

Lori,
She seems to prefer the hard floor where it's cooler rather than on the couch or bed.

Harley PoMMom

01-01-2011, 08:23 PM

She was not put on any type of steroid before or after surgery?

Luvmylabs

01-01-2011, 09:01 PM

Hi Kim,
Thanks for your response. I'm aftraid I'm a little unprepared with exact test result numbers...lesson learned I didn't think of asking for hard copies of the results. I've been going on blind faith in what the vets tell me but I'm now finding I need to educate myself as well. I'll be sure to get them from the vet's office this week. She's had many tests done, both by her regular vet and a referral Internist. In June they did an abdominal ultrasound, CBC, ACTH, Urinalysis, Thoracic and Abdominal Radiographs. I'm sure I'm forgetting some others. All of which were normal. Blood tests and ultrasound were repeated in August, nothing changed. The only thing they could hang their hat on was that she had arthritis and wanted to put her on Rymadyl which I'm reluctant to give her because her mother was intolerant of NSAIDs so they opted for Tramadol. She's no longer taking Tramadol. We agreed to follow up blood work every few months which the last test (December) showed highly elevated liver enzymes which promted the LDDS.
A few other symptoms that come to mind but not sure if it's related is that her skin is very dry and her coat is dull. She also gags alot but they tell me it's because she's slightly overweight (oops). But that's because she's constantly begging for more food. Hopefully I'll be able to provide more valuable information when I obtain the hard copy results from the vet's office.

Luvmylabs

01-01-2011, 09:03 PM

no she's not been given any steroid...

Harley PoMMom

01-01-2011, 09:17 PM

Where was the ultrasound done at? The reason I ask is because not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it.

There is a great difference in the quality of U/S machines. Is it a human grade (Phillips, GE, Siemens) My gen vet has an old (? brand) that just doesn't have the power to capture crisp, high-resolution images. Some studies are technically difficult anyway, and that accompanies with a poorer quality tool, results in a poorer image.

The technician; most will perform their own and therefore, it should those most experienced with capturing good windows and images. That would be a board cert. radiologist or board cert. Internal Med Spec. Likewise the one interpreting it should be the most experienced as well, and that's one of the 2 above. In addition, you could get a copy on disk and always have it over-read by another. JMO!!

Love and hugs,
Lori

Luvmylabs

01-01-2011, 09:37 PM

Lori,
She had many ultrasounds done. The first was done at our regular vet office, that time the only thing it showed was gallbladder sludge. She was treated for that and a repeat ultrasound showed clear but symptoms continued. I took her to another vet shortly thereafter for a second opinion who did another ultrasound which was normal also. After repeat visits my vet referred her to an Internal Med Spec in Akron, Oh who did the last ultrasound which didn't show anything worth noting either. It's very frustrating because every test they've done has been appears normal except for this last LDDS test but still not convincing enough for me to treat with such a serious drug.

Harley PoMMom

01-01-2011, 09:43 PM

But did any of these ultrasounds show the adrenal glands? The adrenal glands are very small and only an optimal machine can pick them up and the person reading the images really needs to know what they are looking at.

When my boy was first dx'd I took him to University of Penn. to get his ultrasounds. His GP back here told me that there was no way their U/S machine could pick up the images that the Univ. of Penn. U/S machine did.

gpgscott

01-01-2011, 09:53 PM

Hi Kathy,

If you are going to treat with Lysodren I think you need to know what Lysodren does and why you are administering it. The sole purpose of administering Lysodren is to reduce circulating levels of cortisol.

You have not posted the results of any testing or an explanation from the treating Dr. that indicates your pup has an overproduction of cortisol.

She does have multiple other health issues all of which can lead to a spontaneous overproduction of cortisol and mild Cushing's symptoms.

I think too much emphasis is being placed on the U/S. U/S is used to diagnose adrenal tumors which are less common than other forms of Cushing's.

To respond to your title, absolutely DO NOT treat based on what you have posted.

Scott

Luvmylabs

01-01-2011, 09:58 PM

I'm trying to recall the many conversations I had with the specialist in June but I believe they said the adrenal glands looked normal. In fact that was one of the reasons my vet sent me there was because he said they had machines that were more sensitive than theirs. I'm going to call them as well this coming week and request the records.

frijole

01-01-2011, 10:04 PM

I agree with the others.. if the cortisol is not elevated then you are not dealing with cushings. So there is no need to worry about treatment.

That is why getting the most recent blood panel results would be helpful.. I'd like to see what, if anything looks strange. You mentioned elevated liver enzymes. That can be caused by a large number of issues - only one of them being cushings. I thought I read somewhere in this thread that the alkphos was 500 (correct me if I am confusing with another thread) and that is really not very high. It would be above normal but many dogs, mine included had levels closer to 2000 when diagnosed.

Getting the test results would be helpful. In the meantime - what are the predominant symptoms that you are dealing with? Thanks! Kim

Luvmylabs

01-01-2011, 10:16 PM

Not to worry Scott,
I opted not to treat just yet based on the most recent LDDS test she just had. I was given the option to treat now or wait and do another test in February. The vet was somewhat sure she has cushings given the test results and her liver enzymes being so high but the numbers just weren't convincing enough for me. I went as far as to fill the RX but after doing research on Lysodren I changed my mind at last minute. I've been struggling with whether or not I've made the right decision though.

Harley PoMMom

01-01-2011, 10:18 PM

Most definitely if the cortisol is normal and then you have the U/S showing normal sized adrenal glands, treating is not a good idea.

I know this might be a strange question but...how are her bowel movements? :eek::) Color, form, are they runny...all details are welcomed!

Love and hugs,
Lori

Luvmylabs

01-01-2011, 11:02 PM

Kim, the most recent blood test showed her liver enzymes to be at just over 500 which the vet was concerned about because it was in the 200's in her previous blood test a few months ago. When you mentioned that her cortisol is not elevated are you refering to the results of the LDDS test I spoke of in my original post? I'm afraid that the vet is grasping onto the results of this last test because it's the only thing that is slightly abnormal and there's been no other explanation for her symptoms. Like I said, her most prominent symptoms have been the panting, hunger and water consumption. I've been measuring her water intake...it's varies between 2 & 3 liters per day.

Lori, her bowel movements have been normal in frequency and color/form. Not a strange question at all...I've been asked that many times by the vet! :)

frijole

01-01-2011, 11:29 PM

I am referring to the acth test that you did that came back normal. That meant the cortisol level was normal. It is designed to measure cortisol levels. I would love for you to phone your vet and get the two number results of that test. If the same vet did the LDDS then get those 3 numbers as well. Sometimes labs and vets mess up the numbers so its always good to check. (I learned this the hard way and never got any copies prior to my dog's diagnosis) Kim

Luvmylabs

01-01-2011, 11:47 PM

Okay, it looks like I have some phone calls to make this coming week. The (normal) ACTH test & Urinalysis was done over the summer at the specialist and the LDDS (I was told is not normal) was just done at my regular vet. I'll call and get them both. I'm getting a crash course in cushings...thanks for all of your patience!

Squirt's Mom

01-02-2011, 02:13 PM

Hi Kathy and welcome to you and Murphy Brown! :)

Murphy Brown! One of my favorite TV shows and characters! :D

I am very glad that Murphy has had several ultrasounds. An U/S saved my Squirt's life after she was first diagnosed. They found a splenic tumor and once it was removed, her cortisol level returned to normal. As a result, I always recommend an ultrasound as one of the most important tests for Cushing's. It can tell us so much about many organs and can provide a reason for elevated cortisol unrelated to Cushing's as it did in Squirt's case.

One test I would suggest for Murphy now is the UTK panel. Her signs are certainly indicative of Cushing's yet the usual Cushing's test do not so far support the diagnosis. This is when UTK panel comes it and it tests for the intermediates as well as cortisol. UTK stands for The University of TN in Knoxville and this is the only place in the world we know of that does this testing. If the intermediates are elevated but the cortisol is normal, then the pup has what is called Atypical Cushing's. This is the form my Squirt has.

The test is done just like an ACTH but the sample is sent to UTK not your vet's usual lab. Your vet would make the blood draws in their office, tho. I will provide you some links about Atypical and the testing involved.

You are doing a great job of trying to figure all this out and taking an active role in Murphy's care. Keep up the good work! Ask any questions and we will do our best to help you understand. You and Murphy are not alone; we will be with you every step of the way.

I am glad you found us and look forward to learning more about you both as time passes.

Hugs,
Leslie and the girls - always

Atypical Cushing’s*
(Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone – an elevation in one, all, or any combination of these hormones, without elevated cortisol.)

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

Beware of false positives, negatives in canine hyperadrenocorticism testing
http://www.vetcontact.com/en/art.php?a=132&t

UTK Panel
Explanation of hormones
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Luvmylabs

01-05-2011, 08:47 PM

Thank you all for your responses. I'm so happy to have come across so many knowledgeable people. Your input has given me a lot of valuable information to discuss with my vet. I have requested copies of the written test results from both the Internal Specialist and GP. I'll post them as soon as I receive them...hopefully by the weekend. I look forward to your input once again! Please stay tuned.

zoesmom

01-06-2011, 10:57 AM

Hi and welcome -

It does sound like a classic case of cushings, but I would absolutely NOT treat until everything is sorted out. A couple of things jumped out at me and are a concern

First - hypothyroidism is common in dogs, especially large ones. Maybe your vet was talking about hyperthyroidism, which IS rare. You mentioned recent aggression in Murphy and, in fact, that is one of the most common presenting symptoms for hypo. So I would insist on thyroid testing. The thryoid panel would be the best, but many vets start out with just the T4. The other thing is that low thyroid can be a side effect of cushings, as well. In some cush dogs who are hypothyroid, that will correct itself when cushings is under control. (Sometimes, not always). So you can see, it's complicated with all of the possible overlap.

The other thing that bothers me is that all of the ultrasounds show nothing unusual in the abdomen. Pituitary cushings often produces enlarged adrenals - both about equal enlargement. In some cases, however, it does not. Adrenal cushings will cause just one adrenal to be bigger. If the adrenals are normal and equal in size, that would not rule out PDH cushing completely. of course. However, other changes might also be evident on u/s for cush dogs. Liver is almost always enlarged. So that full report would be most helpful, too.

You've gotten many good suggestions so far. A negative uc:cr (urine cortiosol/creatinine ratio) is the cheapest and simplest way to RULE out cushings. A positive just means keep looking for the problem. The UTK panel that somebody mentioned is also a good idea, in view of the inconclusive results on the other cushings tests.

Usually an IMS is the best to one to decipher these more complicated cases. But not all are created equal. We''ve heard of an occasional IMS here who didn't get things right. Sounds like you're in Ohio?? Wonder if OSU has a vet dept (think they do) and if anybody here knows about that option? Also, any vet can correspond with Dr. Oliver at UTK about the advisability of doing the UTK adrenal panel. He's even answered many of our members' e-mails. But again, there are several options you could pursue before going those routes.

Anyway, knowing ALL those prior test results would be most helpful so please post as soon as you get them. Sue

Here is a link to our resource section which has many articles on not only cushings, but also hypothyroidism and atypical cushings/hyperstrinism/UTK test, ultrasounds, etc.
http://www.k9cushings.com/forum/forumdisplay.php?f=10

You can also access this section from the main page when you log on.

Luvmylabs

01-07-2011, 10:27 PM

Sue, you are correct, it was Hyperthyroidism that the vet said was rare. I got the terms reversed. He said he didn’t think her symptoms were suggestive of Hypothyroidism so I didn’t insist on any thyroid testing. Given what I’m reading on this forum I’ll definitely request that be done when we return in Feb for retesting. Unfortunately OSU isn’t an ideal option for a few reasons. It’s about 3 hours away and Murphy doesn’t travel well. Is going to a university costly? I’m afraid it may not be in the budget at this time due to the large amount of money I’ve already spent to date at the IMS and on her eye removal surgery. I’m hoping we can resolve this mystery at our local vet. I love my girl very much and want to do what’s best for her but I’m embarrassed to say I’m running out of financial resources.

Okay, here are the results of the most recent blood work done in Dec by the GP. I’m still waiting for the written results from the IMS for the blood work, U/S, ACTH and urine tests done over the summer. This all looks foreign to me so I apologize in advance if I’ve included more details than necessary.

12/7/10
Test / results /units / ref ranges
Hemogram-CleVet (CLVCLT)
Red Blood Cell Count 6.52 x10 6/uL (4.48 – 8.53)
Hemoglobin 14.6 g/dL (10.5 – 20.1)
Hematocrit 41.4 % (33.0 – 58.7)
Mean Corpuscular Volume 63.6 fL (63.0 – 78.3)
Mean Corpuscular Hemoglobin 22.4 pg (21.0 – 27.0)
Mean Corpuscular Hgb Conc. 35.3 g/dL (30.8 - 35.9)
Red Cell Distribution Width 17.0 % (11.9 – 18.1)
Platelet Count 482 x10 3/uL (140 – 540)
White Blood Cell Count 9.5 x10 3/uL (4.0 – 18.2)
Seg. Neutrophil Absolute # 7.79 x10 3/uL (2.50 – 15.70)
Band Neutrophil Absolute # 0.00 x10 3/uL (0.00 – 0.20)
Lymphocyte Absolute # 0.95 x10 3/uL (0.30 – 3.90)
Act Lymphocyte Absolute # 0.00 x10 3/uL (0.00 – 0.90)
Monocyte Absolute # 0.48 x10 3/uL (0.00 – 1.40)
Eosinophil Absolute # 0.29 x10 3/uL (0.00 – 1.30)
Basophil Absolute # 0.00 x10 3/uL (0.00 – 0.10)
Other Absolute # 0.00 x10 3/uL (0.00 – 0.00)
Blast Absolute # 0.00 x10 3/uL (0.00 – 0.00)
Promyelocyte Absolute # 0.00 x10 3/uL (0.00 – 0.00)
Myelocyte Absolute # 0.00 x 10 3/uL (0.00 – 0.00)
Metamyelocyte Absolute # 0.00 x10 3/uL (0.00 – 0.00)

Differential-CleVet (CLVDIF) (Note: No significant poikilocytosis or polychromasia seen)
Segmented Neutrophils 82%
Lymphocytes 10%
Monocytes 5%
Eosinophils 3%

Animal Profile 1-CleVet (CLANP1) (Note: The sample is slightly hemolyzed. Lipemia and hemolysis may skew serum chemistry results)
Glucose 116 mg/dL (74 – 145)
AST(GOT) 29 U/L (13 – 81)
ALT(GPT) 157 U/L (14 – 151)
Alk Ptase 503 U/L (13 – 289)
Total Bilirubin 0.1 mg/dL (0.1 – 0.5)
Cholesterol 263 mg/dL (98 – 300)
Total Protein 6.5 g/dL (5.0 – 8.3)
Albumin 3.6 g/dL (2.6 – 4.0)
Globulin 2.9 g/dL (2.0 – 4.4)
Urea N 17 mg/dL (8 – 30)
Creatinine 1.2 mg/dL (0.5 – 2.0)
Phosphorous 4.6 mg/dL (2.5 – 7.9)
Calcium 10.6 mg/dL (8.7 – 12.0)
Sodium 149 mmol/L (141 – 159)
Potassium 5.3 mmol/L (3.4 – 5.6)
Chloride 113 mmol/L (100 – 118)
Bicarbonate 25 mmol/L (16 – 31)
Anion Gap 16 mmol/L (15 – 25)
GGT <3 U/L (3 – 19)
A/G Ration 1.2
T4-Veterinary Add-CleVet(CLVT4AD) (Note: Thyroxine conversion factor is: Thyroxine ug/dL x 12.9 = nmol/L)
T4-VET 1.7 ug/dL (0.8 – 4.0)
Low Dose Dex Stim Test
CORT baseline cortisol - 3.0
CORT 4 hour post low dose dex - 1.8
CORT 8 hour post low dose dex - 1.0

Thank you for taking the time to look over the test results. Looking forward to anyone's input.

zoesmom

01-07-2011, 11:41 PM

T4-VET 1.7 ug/dL (0.8 – 4.0)
Low Dose Dex Stim Test
CORT baseline cortisol - 3.0
CORT 4 hour post low dose dex - 1.8
CORT 8 hour post low dose dex - 1.0
.

Actually, it seems that your vet did do a thyroid test (the T4) and that 1.7 is in the lower end of the normal range, but basically it's ok.

I don't know what all those lymphocyte, neurtrophil things mean. As for the LDDS, it is not what we usually see in cush dogs. Usually we see some suppression (lower #) at 4 hours and some degree of escape at 8 hours (higher # than at 4 hrs). However, a small % of dogs that have cushings will have an 8 hour # between .9 and 1.4. Based on the Murphy's other numbers that are out of range, there are only a couple and they aren't way out of range. Many cush dogs have ALK PH #'s that are much higher. There are some other things that can be high in cush dogs but Murphy's a still just at the high end of normal range, so not out of range yet. So it could be that Murphy is in the early stages of cushings.

Usually if a dog tests positive but has almost no symptoms, the recommendation is to wait until symptoms appear and then retest. But you've got the opposite problem. Murphy has all the signs but the tests are not strongly indicative, like you'd think would happen with such strong symptoms. So that's the problem. Maybe you wait 2 or 3 or 4 more months and then retest???? Or if her symptoms worsen before that, then test sooner???? Of course, it sounnds like she has so many of the classic symptoms already and so she may already be uncomfortable from them.

You named quite a few of th classic cush symptoms. Does she have any incontinence with the excess thirst. Or a pot belly or a skeletal looking head? Repeated infections (uti, ear, skin, ???) I think you said she drinks 2 - 3 liters / day. That's maybe 8 - 12 cups/day. That's above average but not ridiculously so. (I always went by the formula of 1 c./10 lbs. of wt. and my 80+ lb. Zoe drank 14-18 c./day sometimes. And I got into the habit of measuring her water intake every day and keeping a record (on tx, since uti's were a constant problem with Zoe and even on treatment, a uti would send her water consumption back up to 14 or 15 c./day. It was also a good way to tell how well her cortisol was being controlled by the trilostane.) So maybe measure just to see what she's really drinking.

If it were me, though, I don't think I'd start tx until there's more proof that it's definitely cushings. The ACTH test will tell us more as will the u/s report. If you don't want to wait, because of her pronounced symptoms, then I'd suggest maybe going ahead with the UTK adrenal panel. It runs about $140 plus whatever your vet would charge to draw, prep, and ship the sample. Plus, there are very specific instructions for that process. Think there's a link in our INFO section. If not, ask and one of us here can give you the link to t he website. As far as vet schools in general, they can sometimes be lots cheaper than regular vet treatment. Just depends, I guess, as lately, I've heard that some are getting more expensive. But I do understand about the 3 hour drive. Hard on an older dog.

Believe me, we here all know how draining this cushings thing can be on the ol' pocketbook, too. :eek: The tests and the tx can get expensive. There's a list in our info section, by the way, of resources for financial help with vet bills. Will be watching for those other results - ACTH, u/s, etc. :) Sue

Sue

Luvmylabs

01-08-2011, 12:22 AM

Thanks for your quick response Sue. Okay, so if I understand you correctly the T4 is the test done to rule out Hypothyroidsm? This is so confusing, either my vet is not explaining things to me clearly or I'm just on information overload...I'm guessing it's the latter. She's been displaying these symptoms since late spring. They came on almost overnight, the most predominate being the heavy panting and crazy eating. She hasn't had any accidents in the house or ear infections. She does get me up at least twice during the night to go outside. No pot bellied appearance, she has gained weight though. She gained 4 lbs between her vet visit on 12/7 and the return visit on 12/16 for the LDDS test. She's carrying most of her weight in the hip area. She doesn't seem to be lethargic if anything she's more wired. The only new development is I've noticed a few random patches of thinning hair and her skin is very dry. Her hair grew back quickly on her belly after her u/s. I'm feeling much better now about not choosing to treat with Lysodren just yet since talking to the great folks here. I don't understand why my vet would be so quick to treat based on symptoms alone if the numbers don't completely support it. Is that typical?

zoesmom

01-08-2011, 01:36 AM

Kathy -

Yes, the T4 is a thyroid test and Murphy's results are in the normal range. So unless, that number falls below 1, that would not be anything to worry about.

Her symptoms, though, do strongly suggest cushings. The problem is her lab results are verry borderline. Then again, her ALK Ph is on the increase. Makes me think that it's probably early cushings. So treating at this point is a tough call. About 10% of dogs with cushings will have that 8 hour number of around 1 - like Murphy did. Maybe your vet is recommending tx based on that ACTH result and u/s report. It will be interesting to see what those tests showed.

Nevertheless, just based on the LDDS and the few things in the blood work that are slightly elevated, I would be very hesitant to start treating. Cushings drugs are serious medicines and if it turned out not to be cushings, their use could be disastrous. Of course, the excess cortisol in their systems is NOT a good thing over the long term. But cushings is a slow progressing disease and waiting a little while longer and retesting won't hurt. Some dogs have full blown cushings for years before they are diagnosed. The symptoms, though, may be uncomfortable for Murphy (and you) in the meantime.

Maybe, if they haven't done one yet, the urine cortisol/creatinine ratio would be a good idea. Plus, it's cheap and you don't have to take Murphy in - just some of her morning pee. If it's negative, then you start looking for other explanations besides the cushings. If it's positive, then it could still be cushings. Did you say you already picked up the lysodren? If so, what instructions did your vet give for dosing. And did he also give you some prednisone? That can sometimes tell us how well-versed a vet is in treating cushings. Hang in there. And keep reading!! You are Murphy's voice. Sue

Did they do a urinalysis, by any chance?

foxandhound

01-08-2011, 03:12 PM

The thyroid is good for now. I too would be interested in the ACTH results and the utrasound readings before proceeding. Could you post this? Did you get the UTK ACTH complete panel or was the ACTH done by Antech, etc? I am asking bc you might be dealing with Atypical Cushings due to problems with intermediate hormones. <--- I learned that from the wonderful people here.

Treating Atypical with typical treatment is not the right way to proceed. Your vet should rule out Atypical before proceeding to suggest treatment plans. And maybe it was ruled out, but was not communicated to you???

I am in a similiar position, but we dont have any symptoms apart from pot bellied appearance. Our vet started suggesting Lysodren, actually she couldnt even name the drug. :/ She said things like not treating Cushings is worse than treating it. She is obviously not the authority on the subject. I basically use her office for the reasonable prices, of which only the ACTH/UTK full panel Adrenal was overpriced ($300). It is imperative that you stay on top of vets who suggest treatment for dogs who dont have conclusive results or real life-changing symptoms. They really need to sit down and read up on this before writing Rxs. You are like me, in possible beginning stages. I personally will not treat until my dog's quality of life could improve from it.

Luvmylabs

01-08-2011, 09:21 PM

Hello all, let me just start off by saying Happy Birthday Murphy Brown! Scooby Snacks all around! :)

Sue, yes, I already have the Lysodren but haven’t used it (don’t plan on it now until I see what the result of the repeat testing in Feb show). I was given prednisone to keep on hand. I was instructed to start her on 1 & ½ per day for 3 days then 1 & ½ every 3rd day. They told me to watch for any quivering in the back legs and if so to stop the Lysodren and give her a prednisone and call the office.

I’ve always had great confidence in my vet and have had a long relationship with him as he took great and compassionate care of Murph’s mother Mattie, who’s no longer with me. I miss her very much! :( This is the first time I’ve questioned any of his recommendations. In fact, he’s currently treating my sister’s dog for cushings as well. Only her dog’s numbers support the diagnosis.

It’s stange though… her symptoms vary in intensity at different times of the day. More often she’s calm and relaxed at the beginning of the day and as the day progresses she gets more restless and the panting increases. I've mentioned this to both the IMS and GP but neither seemed to really think anything of it. Is this common?

I received the results today from the tests run by the IMS in June and Aug. As far as the regular blood work the only notable changes from Aug to Dec (previously posted) are as follows:

August – ALT(GPT) - 85 (14 – 151), Alk.Ptase – 421 (13 – 289)
December – ALT(GPT) - 157 (14 – 151), Alk.Ptase – 503 (13 – 289)

Add’l blood work by IMS (June) is as follows:

1 Hr Cortisol-CleVet (CL1HCRT) - 14.1 ug/dL
Cortisol, Baseline-CleVet (CLBCORT) - 3.4 ug/dL (1.0 – 5.0)

(June) Abdominal sonogram findings:

Both adrenal glands are of normal shape. Left adrenal gland is of normal size; the cranial pole of the right adrenal gland is slightly enlarged, measuring 0.95 cm in thickness. Pituitary dependent hyperadrenocorticism cannot be ruled out. There is no evidence of adrenal neoplasia.
The liver, biliary tract, kidneys, pancreas, adnominal lymph nodes, gastrointestinal tract, and urinary bladder appear normal.

Conclusion:
Slightly enlarged right adrenal gland. Borderline splenomegaly, with mottled splenic exhotexture.

The urinalysis report (June) is hand written, so I’m not quite sure how to interpret it but here goes…

Color: yellow, Appearance: clear, Sp Gravity: 1.015, PH: 8.0, EPI: 0-1 sq epi (?), Crystals: (unable to read the writing), Collection method: cysto.

As always, thanks again for everyone’s valuable input! Now off to give Murphy a piece of birthday cake! Just kidding…a girl’s gotta watch her waistline. :)

zoesmom

01-08-2011, 11:00 PM

Kathy-

I think you are doing the absolute right thing by holding off. So you plan to retest in Feb, right? The ACTH test was definitely not indicative of cushings. BUT, it WAS done 7 mos. ago.

So what test did your vet suggest doing in Feb. The LDDS again? Or another ACTH? Maybe it would be wise to do the full adrenal panel thru UTK. They can do a combined LDDS/ACTH plus intermediate hormones. If you do another LDDS and it's still inconclusive, then you might end up doing an ACTH anyway, especially if the liver enzymes continue to rise and the symptoms are getting worse. So if you did the UTK panel, you'd get all the tests done at once - and with just one set of blood draws (i.e. one vet visit).

The dosing protocol that your vet gave you for Murphy is very unusual - and conservative, but maybe he was taking a cautious approach because of Murphy's numbers. Still, if it IS cushings, then that dosing regime probably wouldn't work. It would be like wasting the pills (and the $$). On the other hand, if it is NOT cushings, then any amount of lysodren could cause serious problems.

The normal protocol for lysodren is to begin with a loading period where the dose is given daily until the dog shows signs of the symptoms abating. That can occur in just 2 or 3 days or up to 10 days or more. Just depends on the dog. They need to be watched closely for the slightest improvement in symptoms. It might be something as simple as turning their nose up at a treat, leaving a few bites of their food, hesitating during a meal. It can be very subtle and it's best to watch them closely so as to catch the slightest change. Then an ACTH test should be run asap (within a day or two) and if they are "loaded" (that is, the ACTH shows their cortisol is in the therapeutic range of 1 - 5 ug/dl), then the dog is put on weekly dosing. Usually that's that daily dose spread over a weeks time - in one or two doses. My Zoe took trilostane, not lysodren, but if I recall. the standard lysodren loading dose is 25 - 50 mg/kg. Divide her 74 lbs by 2.2 to get her wt. in kg. That means Murphy is about 33 or 34 kg. That means the daily loading dose for a dog Murphy's size would range from about 825 mg at the low end up to about 1700 mg at the high end. (If I'm wrong on the dose or the math, somebody correct me.) Assuming the pills are 500 mg, right?

So your vet is saying to give 750 mg/day for 3 days and then 750 mg/day every third day. That amount is ultra conservative plus the number of days he's suggesting is very odd. If he's trying to be extra cautious, because he's not sure of the diagnosis, then why even start the lysodren!

When and if Murphy gets to the lysodren (when the tests are more conclusive), that dosing regime would be way off base. Each dog is different and there's no way to tell how long each one will take to 'load.' So whenever we hear that a vet says to load for a specific number of days, it's kind of a red flag. I'm just not sure what he's thinking with that approach. In his favor, at least he gave you the prednisone. Did he tell you to watch for anything else, other than the quivering legs, though? Because there are so many more signs to watch for. Weakness, lethargy, loss of appetite, vomiting, diarrhea. He didn't mention any of those things????

On the u/s report, not sure what that adrenal measurement might mean (the fact that one is larger, usually indicates adrenal cushings, but that right measurement may not be significant enough?) Will let the adrenal people comment.

But there was no liver enlargement as is often the case in cush dogs. Some will also show other changes, like pancreatic too. Also, Murphy's USG (urine specific gravity) is a little low, but not as low as many cush pups often have. So the only thing pointing to cushings so far, other than the strong symptoms, is the increasing ALP and ALK #'s and that very borderline LDDS.

IMHO, I think the UTK adrenal panel might be your next best step. Like In Feb. or even March. Which vet are you supposed to see in Feb. ? Looks like you haven't seen the IMS since last summer, correct??? Hope some other members will add their thoughts on Murphy Brown, the mystery. Sue

Luvmylabs

01-09-2011, 12:25 AM

Sue, we’re scheduled to do another blood panel to monitor her liver enzymes and a LDDS in Feb with our regular vet. We haven’t been back to the IMS since Aug. I kind of gave up going to the specialist because after 2 visits (June & Aug) and no apparent abnormalities on the tests she performed she concluded that her symptoms were probably due to the pain of arthritis. She had her on Tramadol and Gabapentin. Two months passed with no change. Every time I’d call them to say there’s no change she just kept increasing the dosage. Still no change. They started to make me feel like I was a nuisance, but you know when something isn’t right with your dog, right? I didn’t want to keep her pumped up on pain meds indefinitely if there was no improvement. So I thought, okay, if they’re saying it’s arthritis and pain meds aren’t working let’s try the holistic approach. I took her for acupuncture and reiki treatments….that didn’t help either. I’ve had dogs with arthritis before but they never displayed these symptoms. So this is what has led me back to my regular vet doing blood work every few months to see if something pops out at us. The only consistent abnormality has been the rise of liver enzymes which is why he just did the LDDS test.

My vet did say he was starting her on a very conservative dosage due to the borderline results. He explained the possibility of treating a dog that’s not cushings could lead them to Addison’s. That’s what had me on the fence about starting treatment which ultimately brought me to this forum. And yes, I forgot to mention he said to watch for vomiting and diarrhea.
I’m going to take your advice and talk to my vet about a UTK adrenal panel in Feb. Again, thank you for your valuable input.

Harley PoMMom

01-09-2011, 12:47 AM

Conclusion:
Borderline splenomegaly, with mottled splenic exhotexture.

Did they say anything about her spleen? I would be just a little concerned with Murphy's spleen being slightly enlarged and the discoloration of the surface...of course I am a worry wart!

Luvmylabs

01-09-2011, 01:23 AM

Did they say anything about her spleen?

Good point...no, the IMS never mentioned it. This is the first I'm seeing it myself. I think I'll take this report with me when I go back to my regular vet in Feb.

Squirt's Mom

01-13-2011, 02:30 PM

Hi Kathy,

How are things with Murphy? Would love to hear from you when you get a chance!

Hugs,
Leslie and the girls - always

Luvmylabs

01-15-2011, 02:31 PM

Hi Leslie,
Thanks for checking in on us. Murhphy's been pretty good aside of the panting and constant hunger. She's loving and playful (and bossy) as always. I always joke and say she runs the house and lets me live here with her. :) I'm still holding off the Lysodren until our next visit to the vet in Feb or March. I'm giving her Denosyl and Milk Thistle in the meantime to see if helps to bring her liver enzymes down. Hopefully our next dr visit will give us a clearer picture of what direction to go in. I am going to talk to him about a UTK panel and alot of the other great information I've learned here.

Luvmylabs

02-18-2011, 07:46 PM

Hi all,
This week we did Murphy’s follow-up blood work and LDDS test. The results seem to be more convincing this time. I think now she's even developed a bit of a pot belly.

ALT: 152 u/l (10-100)
ALKP: 1126 u/l (23-212) – up from 503 in December.

UC:CR: 72

Baseline cortisol: 3.3 (December 3.0 )
4 hour post low dose dex: 3.0 (Dec 1.5)
8 hour post low dose dex: 3.2 (Dec 1.0)

Based on this, we started the Lysodren (500mg) on Wed 2/16. My vet is starting her dosing on the conservative side. 1 & ½ tabs per day for three days then 1 & ½ every 3rd day. He gave me instructions to watch for indication of over loading which I have Prednisone on hand if needed. So the first thing he’d like to see happen is a decrease in water consumption. She’s been averaging about 10 cups per day. She weighs 73 lbs, so she should be drinking about 7 cups per day, correct? Yesterday she drank 12 (increase rather than decrease, a little discouraging). He wants me to call him Monday with an update, and then every few days after that so we can determine when to follow up with the ACTH test.

I apologize in advance for being so long winded but I’m so doggone nervous!

Okay, so now the questions. I thought I asked all the right questions when I was at the office this week but I still keep coming up with more. The poor doc, he was so patient with me. I was asking so many questions he eventually sat on the floor and let me ask away. I’m such a worry wart, I keep asking the “what if” questions over and over!

So first off, I’m so afraid I’m going to do something wrong or miss a sign of over loading. I’ve been watching her like a hawk; I even hate to leave her alone to go to work! I’m told to watch for tremors/quivering – is this subtle or very obvious? Even before medication her hind legs would sometimes shake a little when she’s sore, so I’m not sure if I’d know the difference. And of course vomiting, diarrhea and lethargy which is easily noticeable. Is there anything else?

Next question…she is so very restless, she’s beside herself. She pants terribly and seems so uncomfortable and can’t relax. Her level of stress seems to accelerate by evening, does this make sense? She’s been like this off and on since we first started searching for a diagnosis last summer, but over the last few weeks it’s gotten worse. Now, from what I understand about the over production of cortisol is that it stresses the body, correct? So is that what I’m seeing and is that typical behavior for a cushdog? If so, how long after starting treatment can she be expected to get some relief? I just want my calm, loving, happy, crazy little friend back.

The other thing that scares me is the marked difference in the test results in only two months. Also, why such strong physical symptoms long before the tests could confirm, has anyone else experienced this? I know I asked the doc all this, but then everything gets all jumbled once I get home. I told him they were probably gonna be sorry I had their phone number on speed dial. He said at this time we don’t know if it’s pituitary or adrenal but we’re hoping for pituitary.

Whew, now that I got all that out, I think I’m gonna take a deep breath. Thanks for reading. Comments, opinions and advice please!

Kathy & Murphy

Wolfpak

02-18-2011, 08:34 PM

Hi Kathy & Murphy, Just a newbie here, still working to determine a diagnosis for Penny, our Golden Retriever.

Noticed the similarity of our cases - Penny weighs about 75lbs, so she is almost the same size as Murphy, and she's just shy of 13, so they're the same age, too. Labs and Goldens are so much alike. Good to hear about the experience with some else who's case is so much like Penny's!

Also, Penny's & Murphy's lab tests are amazingly similar as well.
Penny's ALK Phos 771 (10-150) which is about 6 or 7 times the max, just like Murphy. Her ALT was 179 (5-107) both are about 50% over the laboratory max.
Penny's only LDDS was 3.4, 3.1, 3.7, again so similar to Murphy's recent test.

Since you had at least 50% supression on Murphy's earlier LDDS test, that would be positive result for PDH. Your treatment with Lysodren would be very appropriate. I always like to research the dosage levels.... I find it very calming and settling to have good scientific documentation on what I'm doing, despite what the vets say. I print the information up, and then Highlight the important stuff!

I'd be concerned during the initial loading phase, too. This change of her cortisol levels will certainly require her body to go through some adjustments, this would be milder than the symptoms of an adrenal crisis. You are wise to be very watchful of her. Wish I could share my treatment experiences, but we are still pre-treatment with Penny.

From what I've read thus far, all sounds pretty well with your Murphy. I'd advise you to re-read the information that describes symptoms of too low cortisol, and print a hard copy to refer to to boost your confidence -- mostly seems that they actually "crash" and get very lethargic, and just lay there if it gets too low, as the MAJOR symptom, but if you're very uncomfortable with what's going on with her, or if she seems too far "off" in your opinion, then get with your vet asap.
Hang in there, you're on the right track.

Luvmylabs

02-18-2011, 09:04 PM

Hi Penny's parent,
Thank you for your comments. Our pups do seem to be quite similar. What type of physical symtoms is Penny experiencing? Murphy's symptoms are what has me in a tail spin. She seems so uncomfortable...it breaks my heart! Do you plan to treat, or what is your next move?

Harley PoMMom

02-18-2011, 09:06 PM

Hi Kathy,

It seems your vet is taking a real conservative approach with Murphy. Usually the Lysodren loading dosage is as close to 50 mg/kg/day as possible, divided and given BID (twice a day).

At 50 mg/kg, for Murphy's weight of 73 lbs that would be 1659 mg divided and given twice a day. Since Lysodren comes in 500 mg tablets and can be cut, you could give Murphy 1625 mg. As of right now your vet is giving 750 mg, now, is this divided and given twice a day?

Although all dogs are different, but, at this low loading dose it may be a long time before Murphy is loaded.

Also the proper protocol of loading is to keep loading twice a day until signs of loading appear...not to load for 1 & ½ tabs per day for three days then 1 & ½ every 3rd day.

Please check out the Lysodren loading Instructions and related tips. (http://www.k9cushings.com/forum/showthread.php?t=181)

Love and hugs,
Lori

Luvmylabs

02-18-2011, 09:22 PM

Hi Lori,
The 750mg is given in one dose and yes, given your calculation, it does appear he is taking a very conservative approach on the loading dose. I wonder why that is, is that very uncommon? I'll have to address that when I speak to him again on Monday.

Harley PoMMom

02-18-2011, 09:51 PM

Usually vets that are not very knowledgeable about Cushing's and the treatment protocols will try these conservative approaches.

Many of us have an IMS on board as well as a regular GP. An IMS handles many more cases of dogs with diseases like Cushing's than a GP does.

Love and hugs,
Lori

Wolfpak

02-19-2011, 08:26 PM

Hi Kathy,
You asked about Penny's symptoms: About 1yr ago she was drinking more and piddling a whole lot. Took her in for a geriatric exam, bloodwork normal, but bladder infection present.

Recently, since the holidays or a bit before, Penny started drinking more, and then had a couple of accidents... very unheard of for her, BTW. Took her in 1st wk of Jan. for urinalysis - kidney infection, treated with Ditrim. Vet said its common for them to return. The symptoms did not change, same pu/pd, but her return check urinalysis was fine! At that point I was very concerned about kidney failure, we did bloodwork, and it came back suggestive for Cushing's, vet said he was 85% sure based on the these results.
Cushings was confirmed this week by LDDS.

Other than the pu/pd, there really are very limited other symptoms. She seems to be in no discomfort, no significant hair loss - maybe its a tad thinner on the sides. She has a slight potbelly, but she's had that for about 5yrs. Slight occassional panting. Slight hind end weakness. Nothing the least bit out of the ordinary for a dog her age. She's bright eyed and content, will go on walks up to a mile, and her attitude has really perked up this week since we switched her to 1/3 super-premium kibble, 1/3 raw hamburger from our natural beef we raise, 1/3 dog recipe 'stew' (cooked beef roasts, brown rice, veggies boiled in potato water). Big difference, actually.

I made the diet change since our food is a salmon-potato based (Premium Edge), and read something about low purine content food being helpful. We have LOTS of burger from the beef, so it was easy for us to give it a try. Go figure....!

Okay, having 11 dogs I can vouch that they're all VERY different from each other. Penny has always been a low-key, easygoing, go with the flow dog. And stubborn, too. NOTHING seems to phase her.

Now, if Murphy is more like some of my others, sensitive, more intense about things, then likely her system is more sensitive to the adrenal changes. Reading about the way high adrenal hormones make us (humans) FEEL, it makes sense that she's likely not comfortable.
It sounds like the blood sugar is higher, and the 'fight or flight' hormones are raging in her. Basically, its likely Murphy just is miserable due to the raging adrenal hormones!
If you Google "Cushing's Mood" there are articles that list what human's report feeling who have the condition.... and from what you're seeing with Murphy, I don't think the human descriptions are too far off! At least there must be some degree of similarity.

We all know how we feel if we eat way too much sugar, or have had a bad scare - the classic adrenal response! We might feel ill, aggitated, or become shakey, and just downright horrible for a while. Bet that's what Murphy is telling you with her behavior.

Fortunately, you are in the early stages of treatment, and assuredly these symptoms will certainly abate to a degree as the treatment progresses. I think you're doing the right thing for her!

Its likely to take a bit longer with the conservative approach, but hang in there. I'll let you know how it goes for us. Please keep me posted!

Luvmylabs

02-19-2011, 10:38 PM

Hi Penny’s parent,

Thank you so much for your words of encouragement! Murphy Brown is and always has been an over the top kind of dog. I always joke and say she has chocolate running through her veins. So what you said about her “mood” makes perfect sense. I haven’t been able to stop myself from thinking there’s something else going on with her in addition to this new finding that could be causing her pain and discomfort because of how she acts. But I did look up “cushing’s mood” and she does display similar behavior. Kind of eases my mind a bit, just wish I could do something to make her more comfortable. When I check in with the vet Monday I need to question him about the low dosage he has her on and why he thinks it’s beneficial. Goodness, I’m freaking out now with her being on a low dosage, could you see me if she were on higher?

Wow, 11 dogs! What a joy that must be - a whole lot of love! The diet you feed your fur babies is impressive. I wish I could cook for Murphy but shoot I can’t even cook for myself! I used to buy commercial dog food until I did some research on it and read things that horrified me. I switched them over to a high grade pet food from our local health food store. What a difference it made it their overall appearance even. I think I read in one of your posts that you have a u/s scheduled for Monday…good luck and hope all turns out as hoped!!!

Kathy & Murphy Brown

AlisonandMia

02-19-2011, 10:47 PM

If you Google "Cushing's Mood" there are articles that list what human's report feeling who have the condition.... and from what you're seeing with Murphy, I don't think the human descriptions are too far off! At least there must be some degree of similarity.

Fortunately for everyone it seems that dogs are not subject to some of the really bad and unpleasant mood and psychological changes that humans have with Cushing's (or steroid therapy). Humans not infrequently suffer from psychosis, mania, compulsive behaviors and extreme irritability and aggression as a result of high cortisol levels. Even reasonably moderate doses of corticosteroids (as used for asthma) can result in a certain amount of irritability and I have seen a few days of a moderate dose of prednisone turn someone usually tolerant and mild-mannered rather snappish and outspoken when provoked. Thank goodness it doesn't take dogs that way!

I believe that the worst suffering that many (untreated) Cushing's dogs endure on a day-to-day basis is extreme, unrelenting hunger. (This can make them food aggressive just as starvation would.) Not all dogs get this symptom but a great many do (mine did) and for them it must be a truly horrible torment.

My dog, like almost all others, remained her normal sweet self despite all the cortisol chuffing through her body. But she did bite my fingers quite hard once, albeit completely by accident, when trying to get a treat and did become insanely food-defensive/aggressive with other dogs as well.

Dogs (and humans) with Cushing's are flooded with cortisol and other steroid hormones (which are indeed produced in large amounts during stress) however they do not typically have rises in adrenaline and related hormones (catecholamines). It is adrenaline and the other catecholamines that are mainly responsible for that awful "flight or fight" sensation. Adrenaline is made in completely different part of the adrenal gland (the medulla) and is not triggered by the same things that trigger cortisol production in Cushing's. (Cortisol is produced by the adrenal cortex.)

The only exception to this is in dogs (and people) who happen to have a mixed adrenal tumor that is made up partly of cortisol-producing cells and partly of adrenaline-producing cells. This is pretty rare but does happen. Tumors like this are called corticomedullary mixed tumors. (Here's a link to a human case: http://jcem.endojournals.org/cgi/content/full/94/3/746)

Dogs and humans with these mixed tumors, or plain pheochromocytomas (which just produce catecholamines) do suffer from periodic surges in adrenaline which can result in feelings of fear and panic, and shakiness etc. These big surges of hormones can also result in really dangerous surges in blood pressure along with generally very high blood pressure.

Humans with Cushing's or on steroid meds also typically suffer from severe insomnia and restlessness. Dogs seem to get a milder version of this and it isn't uncommon for a Cushing's dog to be restless in the evening and to pace about, usually panting. That is almost certainly pretty unpleasant for the poor dog and certainly difficult to live with for the dog's people. They do however, usually settle down to sleep eventually.

Strangely enough humans who have underactive thyroids (hypothyroidism) are typically depressed, disheveled and gloomy (and maybe a little cranky as a result) whereas in dogs the same condition often results in uncharacteristic aggressive behavior. In fact if a previously nice dog becomes irritable and aggressive, hypothyroidism is one of the prime suspects.

Alison

Luvmylabs

03-04-2011, 09:29 PM

Hi, I’m back with another question. We’re in the maintenance phase of Murphy Brown’s treatment with Lysodren. Just a recap, the vet has her on a conservative dose which started with a loading phase of only 3 days (started on 2/16) and now 750 mg every third day. Here water consumption is still at about 12 cups per day. But this week her eating habit has changed, which I’m wondering if I should be concerned about or if it’s a good sign. She eats twice a day and usually she chases me to the dish and scarfs the food down in a flash. Now when I fill the dish she casually starts to eat and will pause to take a drink of water and maybe wonder off for a brief moment to see what I’m doing but then eventually return and finish her food. In 12 yrs she has never eaten like this. Keep in mind I don’t know what a normal eating behavior is for her since this had always been a 2 dog household up until about a year ago, so it was always a race to the finish for her and her momma dog. I’ve been checking in with the vet every Monday to give an update of any changes to determine when we need to follow up with the ACTH test. And of course she wasn’t eating like this when I checked in with him this past Monday. So I guess my question would be is this acceptable behavior and would just indicate that it’s time to check her cortisol levels? Thanks for reading and looking forward to your response.

Kathy