New to the forum - Gizmo - Diagnosed with PDH

[eskiegizmo]

Hi everyone. My almost 10 year old american eskimo was recently diagnosed with PDH. Although he had the LDDT that brought about this diagnosis it is proving difficult for me to realize he has this. Reason being - at least from what I can see on the outside - he has very minimal symptoms. He is not drinking extensively, no pot belly, no excessive weakness of his back end, and still loves to play. He certainly wants to eat when it is meal time, but is not wolfing it down. The fur issues he has but this stems back from when he was first diagnosed with hypothyroidism a couple of years back. He is certainly less fluffy now then when he was back when this picture was taken. I have noticed he does pant a little more now then before. I am just wondering if I am kidding myself in believing he won't get worse or is it just inevitable? The vet thought for now we hold off on treating him. I do have the results of his liver profile and LDDT because in reading this forum I realized how important these details were:

Liver Profile - Done December 2010

ALP 1125 (20-150 U/L)
ALT 209 (10-118 U/L)
GGT <5 (0-7 U/L)
BA 19 (0-25 umo/L)
TBIL 4 (2-10 umo/L)
ALB 42 (25-44 g/L)
BUN 6 (2-9 mmo/L)
CHOL 6.0 (3.2-7.0 mmo/L)

LDDT - Done December 2010

O Hr - 177 nmol/L
4 Hr - 28 nmol/L
8 Hr - 58 nmol/L

I hope the numbers make sense as I am in Ottawa, Canada and we use Metric. In the meantime we are giving him Hepato Support supplement which has Milk Thistle, four different B vitamins, and a few other minerals/vitamins. He also takes a G/C supplement as he broke his leg as a puppy and last year spontaneously dislocated his hip. Sounds strange I know but he went to bed one night in his kennel and woke up with a dislocated hip.

[Franklin'sMum]

Hi and welcome to the forum from me and my little boy Franklin, but I'm sorry that you have the need to be here.

Strong symptoms play a huge part when one is treating Cushing's, and if your pup isn't displaying those (or any symptoms) then most Cushing's savvy vets won't recommend initiating treatment. When Franklin was diagnosed, I jumped the gun and started treatment (that was before I found these wonderful, knowledgeable folks here), as what I had read elsewhere terrified me. The resolution of some/certain symptoms are how we judge how our babies are feeling.

So glad you're doing the Milk thistle, there was a recent posting about the body needing to take a break from it instead of using it continuously, but I can't remember the title at this moment :0

Hope this helps
Jane, Franklin and Angel Bailey xxx

[mytil]

Hi and welcome from me too.

I have just a minute but I wanted to show the conversion of the LDDS test numbers you posted as many here also deal with a unit ug/dl (this is achieved by dividing by 27.59)

177 nmol = 6.4 ug/dl (this is what is called the baseline)
28 nmol = 1.0 ug/dl
58 nmol = 2.1 ug/dl

Here is a link on how to interpret these numbers.http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-low-dose-dexamethasone-protocol.pdf.

I am wondering if your vet is going to perform additional testing such as an ACTH or has an abdominal ultrasound been performed to get a view of the adrenal glands and liver.

Terry

[lulusmom]

Hi and welcome to the forum.

Thanks, Terry, for doing the conversions and yes, the LDDS would be interpreted as PDH. What was going on with Gizmo that prompted you to take him to the vet? Aside from the elevated liver enzymes, what lead your vet to believe Gizmo had cushing's? Aside from the liver support and supplements mentioned, are you giving Gizmo any prescription medication?

I agree with your vet that until Gizmo shows overt symptoms, treatment should not be prescribed. Every dog is different and every dog goes through the various stages of the disease at their own pace. The one thing you can count on is that the pace for all of them is really slow. It's a really graded disease so blood abnormalities may show up today and if cushing's is the cause, it could take several months even a year or better before you see a sign.

I know it's easier said than done but try not to worry yourself sick over this. Unless a dog with cushing's has been allowed to go untreated for a very long time and organs start to shut down or more likely a bacterial infection runs rampant, cushdogs aren't in any pain. Dogs with cushing's have excess cortisol coursing through their body. Cortisol is a feel good steroid so if a dog should have arthritis or any other condition that is inflammatory in nature, a cushdog is self medicating himself and feeling just fine. I have two cushpups and I've learned over the years that cushing's is actually much harder on us pet owners than it is for our dogs. This is particularly true in the early days of dealing with the disease. I'm happy to report that I no longer lay in the closet, rolled up in a ball, drooling like a worked up St. Bernard. :D:D:D I still talk to myself, however. :p

Glynda

[Bichonluver3]

Hello and welcome! Chloe has atypical Cushings, as well, although she had more pronounced symptoms than your baby shows. She has been doing fine on melatonin & ground flax hulls. So, you see, it is not all doom and gloom:). Stay with us. The folks here are awesome and we will all help you through your journey to keeping Gizmo well. So, take a deep breath, pour yourself a cup of coffee and relax!!
Love,
Carrol & Chloe

[mypuppy]

Hi there,
As the others I would like to also welcome you and your precious Gizmo to our family. My baby Princess (8 yr. Old now) was also diagnosed with PDH over a year ago, and thus far is being treated with Vetoryl. Unlike your Gizmo though my Princess had full blown symptoms prior to diagnosis which lead my IMS to test for cushings. It is clearly obvious that all dogs are unique in how they demonstrate signs of this condition and also how they react to treatment. I can happily say that I am in a much better place right now than I was over a year ago not knowing what I was up against until I found this forum and the wonderful, caring, knowledgeable, loving people behind it. Stay on and educate yourself and ask as many questions as possible. I can only assure you it will lead you on the right path in making some important decisions in order to help your baby. We all mean well and are basically on the same path together. Hang in there and be patient with all this. Take care and belly rubs to your Gizmo, what a cutie. Jeanette and Princess

[eskiegizmo]

Thanks everyone for your words of wisdom. To answer a few questions it was the elevated liver enzymes that alerted our vet. He went for a wellness test in June of this year (sort of like when our doctors take blood work when we have a physical) and his ALP was about 750 if memory serves. We then did a liver profile a couple months later and his ALP was 820 and his ALT was 129. Back then he was not demonstrating any symptoms at all so we decided to wait six months and re-test, this time around we would fast him. That is where the December liver profile results came in and she decided to test him for Cushings using the LDDT. The vet has not really recommended the ultrasound - the price of which is pretty crazy here. However we did discuss the ACTH test if he were to go on Lysodren at some point in the future. We also discussed that we would start monitoring his blood pressure and take a urine sample in the next few months to make sure he is not developing a UTI. In terms of medication the only thing he is taking are the Thryo-tabs for his hypothyroidism 0.2 mg 2x a day. It is reassuring to know he is not in pain, and yes the cortisol is probably making his previous injuries feel better. Still I am bummed that he has Cushings. We will see what the future brings.

[Bichonluver3]

Although I can't really help with your questions, just had to pop in to say "Hi and welcome" from Chloe and me.

I saw your avatar with Gizmo. That is TOOOOO CUTE!!!! What a sweetheart. We look forward to learning more about the little guy.
Carrol & Chloe

[bernie47]

Welcome to this big family...;)
And i am sure you will get the very best advice , from all these knowledgeable people ..[ hugs]..Catherine & Natcho

[eskiegizmo]

Thanks again everyone for the welcome. Pretty much the status quo right now, which I definitely cannot complain about. Unless something changes in the meantime we will see what the next set of tests in the spring yield. This would be the blood pressure, the urine test, and I think I will run the wellness test as well. The vet did not specifically mention it but I am curious if the new supplement he is on with the milk thistle will have improved his liver values and also to make sure he is not developing diabetes. I think the vet's opinion on that matter was she doubted he would develop diabetes just because he was Cushing's, particularly since he has never shown signs of that before. I don't know though - the thought of that keeps hovering there in the back of my mind.

[Bichonluver3]

Uh, uh, uh - no more hovering thoughts. Take 1 day at a time and 1 test at a time with no second guessing. For me, Cushings and diabetes came together but in 2 SEPARATE dogs. Things will be fine. You just need to get all the results, get the recommended treatment from your vet, post all results and recommendations here and the folks here will sort everything out. You're part of a big, loving family now and all of us, along with you, will be looking out for Gizmo's best interests.
Love & hugs Carrol & Chloe
Tummy rubs to the little guy

[eskiegizmo]

Hi everyone. I am sort of puzzled about something and I thought someone may have some experience with this. Yesterday morning we got up per usual, Gizmo did all of his business with no issues, and we came inside to eat. In about 5 minutes his behaviour changed. He was shaking, did not want to move, and had absolute no interest in eating. He did not have any vomiting or diarrhea, but was just sitting there wanting to be petted. He was also panting pretty heavily for a little while and that lasted maybe an hour or so. The shaking also passed after a little while, but then for the rest of the day he was really lethargic and did not want to get up. By dinner time though back to normal. If he was on medication I would have thought his cortisol had dropped to low, but he is not on meds yet. I am sort of stumped on what could have happened. I do have a call in to the vets but I thought I would pick everyones brains as well.

Kristina and Gizmo

[labblab]

Hi Kristina,

I'm sorry that Gizmo felt poorly yesterday. I am wondering whether he might have experienced a seizure. One of my two dogs has just started having seizures "out of the blue," so I am in the process of learning more about them myself :(. And I think that some of the things that you are describing about Gizmo's behavior could be consistent with a seizure episode. Have you had a chance to talk yet with your vet?

Marianne

[eskiegizmo]

Maybe, I am not sure. He was not convulsing or anything quite like that, just sort of shivering all over and that sort of came and went over an hour or so. I did not hear back from our vet yet, I will hopefully reach her today. Thanks for the tip though.

Kristina & Gizmo

[eskiegizmo]

Hey everyone. I thought I would check in. Nothing really new to report with Gizmo. His symptoms are still fairly mild, although I have noticed in the mornings he is more anxious to eat. At supper though sometimes he goes to eat and other times he waits. Maybe his natural cortisol cycle is higher in the morning...? Anyhow we are still holding off on treating him since right now it will be difficult to monitor his treatment. I did speak with the vet about his shivering, panting episodes. Since it seems to happen either during the weekend or on the Monday she thinks maybe he is over exerting himself since we are both home with him on the weekends and is having muscle spasms/pain. She also said it could be gastro related, although she doesn't suspect pancreatis, so she said to try Pepcid next time and see if that helps. I also took him for blood work (wellness test) last week. His blood work looks good and although his ALP and ALT are still high they both came down which is great news. Cannot say for certain if it is due to the liver supplement but if it appears to be helping we are keeping him on it. I thought I would post his numbers below. His glucose is high, but she said not to worry too much about that as he has always tested high for glucose. She actually put together and gave me an excel spreadsheet of all of his blood work going back to 2001. My vet is awesome. Next item on the list will be the urine test - the one where they insert the needle directly into his bladder. Not fun and she does not do it very often but she thought she would do that test just to see where he is at.

Chemistry NORMAL RANGE

ALP 20-150 u/l 975
ALT 10-118 U/L 159
BUN 2.5-8.9 mmol/L 6.6
CRE 27-124 umol/L 60
GLU 3.3-6.1 mmol/L 7.6
TP 54-82 g/L 62
ALB 25-44 g/L 33


Kristina & Gizmo

[addy]

Hi Kristina & Gizmo,

Sounds like things are calm. That is good.

My Zoe only pants when she's having gas and going to have a bad poo. I always know what that pant means now. For awhile she was laying under a glass top table with a lamp on it. She would come out panting like all get out. We finally realized it was the heat from the lamp. We keep the lamp turned off, no more panting:D:rolleyes:

Maybe Gizmo's panting is tummy related too.

Hugs,
Addy

[eskiegizmo]

Hi everyone. I thought I would check in since it has been a while. Nothing really new to report. His water consumption appears to be up, but it is hard to judge, particularly since it has been pretty warm here the past couple of months. When we are gone from the house he is in his kennel and when we get home he drinks like crazy for the first 10 mins or so. After that he only goes for a drink maybe once an hour if that. His food consumption also seems to fluctuate. Some weeks he acts like he can't wait to eat, other weeks he could care less and lets it sit there for a hour sometimes. We did decide to bring him for an urinanalysis. It was a free catch. His results were:

Specific Gravity: 1.012
pH: 5.0
Glucose/Blood/Ketones: Negative
Protein: 100mg/dl
Cytology: No seginificant findings in sediment


From searching the internet I think the Protein 100 mg/dl is a +2. The vet says it could be "normal" for cush pup or perhaps indicative of an infection. She suggest doing a culture or a UPC (Urine Protein/Creatine ratio) test. Is one preferential over the other?

[Harley PoMMom]

Protein loss can be common with dogs that have Cushing's.


She suggest doing a culture or a UPC (Urine Protein/Creatine ratio) test. Is one preferential over the other?

If it were me, I would have the culture test done first to make sure that an underlying infection is not present. If no infection is present than I would have the UPC done next. According to this article about proteinuria in dogs and the UPC test:
However, both the dipstick method and the urine protein creatinine ratio can be inaccurate and can yield false positive results due to contamination of urine with red blood cells, white blood cells and bacterial protein and therefore must be measured on urine sample with an inactive sediment and a negative culture.
http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=73072

Hope this helps.

Love and hugs,
Lori

[eskiegizmo]

Hi everyone. It has been awhile but I thought I would drop in as something new has cropped in the last few days. Just a quick back story. Gizmo was officially diagnosed with Cushings with a LDDS test in December 2010. Since then it has pretty much been business as usual and nothing has apparently gotten worse. His symptoms come and go and when it flares up it is not anything really alarming. Lately though his water consumption has really increased in the morning and I think he is starting to have other urinary issues. When I say the morning he will easily drink about 2 cups of water as soon as we get up. (He is confined to a crate at night). That is alot as he is only 16 pounds. After that he will proceed to have to go outside about 4 times in 1.5 hours. To be honest though I am not sure if he is having a full fledge pee or some are just tinkles. He does not appear to be in a pain when he pees. What is puzzling to me is that the water thing only really appears first thing in the morning. After that I would say it is normal water consumption for the rest of the day. He also has had no change in eating. He is not consumed with eating and at mealtimes he can easily leave his food for an hour if not more. He will eat it just takes him a while.

If it is his Cushings that is getting worse how would I medicate him if his food and drinking (for the most part) is fairly normal? It is obvious he is having some sort of water/peeing issue. Maybe Diabetes...although his last urine/blood tests this past summer were negative. It could even be a UTI. He does have an appointment with the vet Saturday morning. I just thought I would get some opinions before the visit.

[lulusmom]

Hi Kristina,

I would suggest that you have a urinalysis done to rule out a UTI. If Gizmo is not concentrating his urine, he needs to have access to water at all times. I have a dog with diabetes insipidus and if he doesn't have water for longer than a few hours, he will stick his head in the bowl and not lift it up for several minutes or until the bowl is empty. If the kidneys aren't concentrating the urine, a dog pees a lot more so he has to drink a lot more to stay hydrated. Does Gizmo ever pee in his crate and if not, does he pee a voluminous amount when you let him out in the morning?

[eskiegizmo]

Well, my dog has now been diagnosed with Diabetes. The vet checked his urine immediately and they knew instantly based on the value that he was Diabetic. I am not entirely surprised since I knew this could be a possibility. Of course I am thinking I should have treated his Cushing's when we first found out but his symptoms were so sporadic - especially the food consumption - that I was not confident in medicating him and the vet agreed to wait. I guess perhaps we waited too long. In any case he got blood work done and I am posting the values. They were pretty good considering and his ALT is back down into normal range. I think I will venture over to the Diabetes group and say Hi.

ALP 5-131 U/L 929.00
ALT 12-118 U/L 106.00
BUN 2.1-11.1 mmol/L 11.10
CRE 44-141 umol/L 83.00
GLU 3.9-7.7 mmol/L 31.00
TP 50-74 g/L 66.00
ALB 27-44 g/L 37.00


His BUN is right at the end of the range - I am going to assume it is because he has been peeing and drinking pretty heavily for a few days before we brought him in - or of course it could be related to the Cushings. Obviously his Glucose was very high. He was put immediately on insulin, 3 units twice a day. He is about 14 pounds which is about 3 pounds from his usual weight. He goes in next Monday for the testing curve.

[eskiegizmo]

I chatted with the vet just now as I did not know his urine test results from last week. Other then the sugar in the urine they were pretty good. His specific gravity went up from his last urine test in July which is great, although I was surprised considering the diabetes diagnosis.

Negative for Ketones/Blood
Negative for any sort of infection
pH: 6.0
Specific Gravity: 1.025

Now if I can just get the hang of dosing him with the insulin I would be one happy camper. With the glucose curve being done on Monday, with a few more to come I am sure, I will have a better idea of how well he is/or can be regulated. If it becomes an issue then we might have to address the Cushings as well.