I need someone to hold my hand while I hold my Mikey

[maish costello]

Hello Everyone,
My name is Maish Costello....my world came tumbling down this past week..my beloved Mikey tested positive for Cushing's disease...he just had the 2 hour test and it came back positive. My husband and I have a meeting with Mikey's vet tomorrow to discuss future tests which will be carried out this coming week. We are both novices to this particular disease and so confused. We are so very worried,this past week we are just going through the motions of everyday activities....I don't know what to ask,I don't know what to say.....there are so many questions,I do not know where to begin..................

[Bichonluver3]

Welcome from Chloe and me. You came to the right place. Now, make yourself a cup of coffee, take 10 deep breaths and relax. Cushings is not terminal, it can be controlled. I am fairly new at this also but the wonderful people here have taken my fear away. Some VERY knowledgeable people will check in soon to get you started on the path to keeping Mikey well. Listen to them - they know what they are talking about and continually help many of us here. Stay with us. We will join you on your journey.
Carrol & Chloe

[Bichonluver3]

Oh, by the way, my vet is very much in favor of this board and takes the suggestions made here very seriously. You should also know that Dr Jack Oliver at the University of Tennessee vet school (one of , if not the foremost, expert in Cushing's research is always reachable by email and my vet has talked to Dr Oliver on thephone. Anytime I have emailed Dr O, he has responded within 24 hours.
Carrol

[Babysam52083]

Maish,
Sending big hugs from Pepper and I. Pepper was dxd in late september and was recently dxd with diabetes. My husband and I are new to this too, but this forum has been a tremendous help. The support and information that can be obtained are priceless. Take a couple of deep breaths, and remember that dogs dxd with cushings can go on to lead totally normal lives. I freaked myself out reading all the doom and gloom at the onset of Pepper's dx. DON'T DO THAT...the more research I do, the more reassured i am. My best friend told me to let the vets do their jobs, and my job was just to make sure my little guy knew he was loved and cherished. It's incredibly scary, and my heart breaks for you b/c i remember that fear. Just breath, it's a manageable disease.

Sending positive thoughts your way
Sam and Pepper

[maish costello]

Pepper's Mom.........you are a God sent to me this night....I have been in a total turmoil since Mikey tested positive to CD. He had his first 2 hour test which returned positive,his 8 hr test will be sometime this week. My husband and I are devastated to say the least...this is a whole new ballgame for us....I did some searching on the web to try and understand Cushing's disease,just to be more depressed by some of the information I found.....I stumbled upon this forum and thank God I finally found some support and generous people who understand the heart ache that we are experiencing with our boy,Mikey. It's taking me a lil while to figure out this forum lol...a novice thru and thru..lol
I finally exhaled when I read your reply,and I thank you for that....I will try to post here on this forum if I can just figure out the instructions,my mind is a little cloudy this past week.
Once again,thank you for giving me hope and especially taking the time to drop me a note...it's most certaintly appreciated..:):)

[Babysam52083]

Maish,
Us doggy mommy and daddys have to stick together. I know some people think us insane, but my two babies are exactly that they're my kids. i'm still trying to figure this whole website out too..I just figured out the profile thing tonight. You can always directly email me at samanthashafferpac@hotmail.com. Also there was a link somewhere that i read about a Dr. Jack Olivor that is one of the top vets in cushings at the Univ. Of tennessee. According to the posts on here, he will respond to emails, and has even spoken to vets over the phone. Just keep breathing and petting and hugging your Mikey. In my opinion he couldnt be in any better hands than your's. Take care and let me know if you need anything. I'm new to this too, but am here if you just need to vent or cry.

Sam and pepper

[maish costello]

thank you,thank you,thank you for telling me this...I have been going out of my mind this past while.....omg you have given me hope.............may God bless you and your darling......

[maish costello]

Sam and Pepper..............thank you from the bottom of my heart.............you will never know how peaceful you made me ...I have been in such a depressing mood this past week.....you gave me hope....I will give anything to make my Mikey better again....he means everything to me............God bless you and yours...
Maish

[maish costello]

Carrol,
Thank you for taking the time to speak to me and offering your most valuable information....is it possible that you would have an e-mail address on Dr.Oliver,any information would be most certaintly appreciated...God bless you for being YOU.

Sincerely,
Maish and Mikey

[maish costello]

Sam and Pepper..thank you for being our friends....it means so much to us to have special friends like you.....this CD is so frightening,we are all in dire straits since we've heard the news from Mikey's vet. You are putting us on the right track and now we have hope and with all this valuable information,it makes the load just a little lighter to carry.
Thank you for your help...and God bless you and yours.

Maish

[Franklin'sMum]

Hi Maish, and welcome to you and Mikey,

I assume the 2 hour test performed was the ACTH stimulation test? Would you mind getting a copy of the results and posting them for us here, please? The ACTH is a good test, but is not diagnostic in and of itself. Underlying conditions can skew the results of the test. The LDDS (Low dose dexamethasone suppression test) is generally considered the gold standard. It is an 8 hour test, a blood sample is drawn for a baseline, then a drug is given, after 4 hours draw blood, wait another 4 hours, do another blood draw. If you live nearby to your vet, they may allow you to take Mikey home between draws to reduce any stress he might feel from otherwise being at the vet all day.

Also, thyroid conditions and diabetes have a lot of symptoms that overlap with the symptoms of cushings. Cushing's is a very slow progressing disease, and one does have time to get a proper diagnosis, and to research the various treatment options. Take a breath, and take some time, okay.

Some questions for you please, to help us get a better understanding.
What signs was Mikey displaying that led you or your vet to think something was wrong? Does he have any other medical conditions? Is he on any medication, or herbs or supplements? If so, what are they, and how much does he get? How old is Mikey? How much does he weigh?

Many of us keep a diary to record our baby's happenings, such as energy level, food and drinking levels, poop formation and such. It is also suggested that you get copies of results (not the invoice) of all testing performed. Never know if you'll need to see another vet (travelling, after hours, etc).
If Mikey has had any recent bloodwork done, would you mind posting the things listed as abnormal (either high or low), the result and the reference ranges? That would really help us alot. Also, one of our members (Debbie/ DebStar55) is a lab tech with over 30 years experience in blood work, and she is invaluable with translating medical to normal.

That's all from me for now,
Jane, Franklin and Angel Bailey xxx

[apollo6]

Welcome
Read up on Cushing first. Don't assume it is this disease. You have time to first get an accurate diagnose, then time to decide what course of treatment options are available. It took me almost a year to make major decisions for my Apollo. You are not alone. We are hear to help you all the way.


First off I am coping a site which is a brief description on Cushing

http://www.kateconnick.com/library/cushingsdisease.html
Cushing is a very difficult disease to diagnose, three tests that help are a full blood panel, and ultrasound to distinguish which type( three types) , urinalysis, and a ACT STIM TEST(MEASURES CORTISONE LEVEL-THE MAJOR CAUSE OF CUSHING.) Overproduction of cortisone causes the symptons of cushing.

Hold off a little before you contact Dr. Oliver .

Here is Dr Oliver's email and phone number and website

Dr, Jack W Oliver
[joliver@utk.edu]
865-974-5729).
See www.vet.utk.edu/diagnostic/endocrinology.
Praying for you and your cutie.
Sonja and Apollo

[maish costello]

Thank you Sonja and Apollo...
I am so confused with all this..it's heart breaking...we have a meeting with Mikey's vet tomorrow...I will keep you posted...thank you for being our friends,it sure gives us hope....:)

[maish costello]

Jane ,Franklin and Angela...
I posted a response to your message earlier,I don't know if you received as such.
I have an appt.with Mikey's vet tomorrow and all I will get copies of all correspondence and results of testing that Mike has had so far.
Mikey experienced panting,excessive drinking and seemed to be always hungry.....those symptoms have since disapeared...he do experience panting somewhat when food is around,but nothing compared to earlier actions....I am so confused about all of this....omg....

[maish costello]

Me again..
Mikey weighs 26.4 lbs...he do not have any underlying health problems....as I said before,he panted for about 2 months,drank excessively and appeared to be hungry all the time.................but I am so confused....those past 2 weeks,none of those symptoms are present.................?????

[Bichonluver3]

Hi Maish!
Glad you are more relaxed. In a very short while this will become just daily routine and life will go on as usual. No need for panic or to hurry to any treatment. Take your time to get all the info from your family here and your vet. We are all in this together. To reach Dr Oliver, you can email him at joliver@utk.edu. Something I learned early on and do for Chloe with her Cushings and Sparky with his diabetes is keep a daily journal. This is so important at first until you get settled into your treatment (and after). Also, be sure you get hard copies of ALL TESTS done, for your records.Also, the really knowledgeable folks here will want you to post all your results. They can then help to interpret them. Do not rely on verbal results from the vet. My vet is great and, since I asked him, now automatically gives me photocopies. Be sure you are with a vet you trust as you will depend on him a lot. Be sure your vet explains anything you do not understand, even if you have to ask the same questions a few times. Sharpen your pencil and make lists of questions and record answers. This is important while you are still overwhelmed and perhaps not taking everything in. Tell hubby to relax also. Everything will be okay. Cushingoid dogs can live out their normal lifespan, just with some extra care. Hey, I take 6 pills a day, myself, and am still kickin'!!:D
Get your rest. We don't want to hear that "mom and dad" are not well because they didn't look after themselves.
Love,
Carrol & Chloe (she is the little one in the front in my avatar)

[maish costello]

Good Morning Carrol,
Thank you for this lovely morning message...I slept quite well last night,thanks to all of you wonderful people !!!!
Hubby and I have a meeting today with Mikey's vet...I am prepared,well,I think I am...I have some questions wrote down to ask her along with many doubts that still linger in my head. I do hope I will have full co-operation in obtaining ALL Mikey's test reports and etc...
So looking forward to talking with all of you again this evening....
Until then,have a wonderful day and we can connect later this evening.

Maish

[Squirt's Mom]

Hi Maish!

I am so happy to see you and Mikey here! :D:D

Gosh, you sound so much like me when my Squirt was diagnosed - nearly 3 years ago now. I had never heard the word "Cushing's" and I don't think I will ever forget how I felt when I did. My whole world came crashing in. Fear, anger, guilt, frustration, and confusion consumed me. My poor old brain couldn't understand anything I read or heard - it was all Greek and all bad. :( Someone could tell me the sun was shining and I would run for shelter! :rolleyes: By the time I found these wonderful folks, I was a complete basket case! :eek: A dear friend described me as looking like a woman who had stuck her finger in a light socket...she kindly left out the parts of bugged out eyeballs and flying slobber! :eek::eek::p

These kind folks took my hand and gently led me along until I could breath a bit again and wasn't crying ALL the time - and I began to learn. The more I learned, the calmer and more confident I became. You've heard the saying, "Knowledge is power"....that is never more true than when dealing with Cushing's in our babies. You are Mikey's first and last defense, his only voice, his advocate - and the more you know the stronger you will be in these roles. Sounds like a daunting prospect, huh? ;) You have found the best teachers in the world right here. The collective experience and knowledge found here is astounding and you cannot beat the good old-fashioned hand-holding! I know this for a fact...mine have been dripping sweat and not a single soul let me go for a second - not one second.

Some tips for you -

* take a notepad and pencil, recorder or another person with you to the vet to help you remember what is said

* make it a habit to get copies of all the testing done on Mikey to keep at home in a file for him - you never know when you may have to see a different vet and this way you will have all his info in hand - plus you can answer the many questions we will soon throw at you! :p

* start a diary/journal on Mikey - his eating, peeing, pooping, sleeping patterns, moods, any changes in his behaviors or patterns; this will be particularly beneficial once he starts treatment

Cushing's is one of the most difficult conditions to diagnose in our babies. Two things you want to be sure are ruled out right up front are hypothyroidism and diabetes. These conditions, and others, have signs that are the same as Cushing's so it is important to rule out any other cause for the things you are seeing. The CBC, or blood panel, will give your vet some good insight to other conditions that might be in play.

Don't feel like you have to do something about Cushing's RIGHT NOW. Cushing's is a slow progressing condition so you have time to make sure of what is going on with Mikey before you start any treatment. ~~breath in....breath out~~ It's ok to do that now. ;)

The most important thing I have to tell you right now is this - you, your hubby, and Mikey are not alone. If you have any questions - ask and we will do our best to help you understand. If we don't know, we will learn together. When those days come, and they will, when you don't think you can handle this - we are here to listen and share our strength and hope with you til you can stand on your own again. You are not alone any more.

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

[jrepac]

Hi Maish,

Cushings can be treated and controlled, so don't panic. Take some time to speak to your vet about the options; as the others have said, keep track of things (write them down, record them, get copies of test results). You definitely want to rule out thyroid problems and diabetes. And you need to find out what type of Cushings it is, if it really is Cushings, prior to selecting treatment. It sounds like it COULD be Cushings, but other conditions have similar symptoms.

What kind of dog is Mikey, by the way? He is awfully cute!

good luck!

Jeff & Angel Mandy

[maish costello]

Hi Jeff and Angel,
I am new to this forum,please excuse me if I am taking the wrong route here,it's a learn as I go....
I met with Mikey's vet today and requested all correspondence and print outs of his blood work. I would like to talk to someone concerning this...please steer me in the right direction. Thank you.

[Squirt's Mom]

Hey! You knew what you were doing all along! ;):D

You can post your results right here..."here" meaning in the box that will open when you hit the "Post Reply" button on this tread - at the top of this page.

You are doing good! You read all the posts on your thread by scrolling and clicking on the page numbers in the upper right corner from here.

Hugs,
Leslie and the girls - always

[maish costello]

Leslie......
I can barely see my computer screen...your words of encouragement is just what the doctor ordered...I have been going through so many emotions,emotions that I never thought that could all present themselves at one given time. I find myself so strong that I can take on the world, seconds later,I am a sparrow in a hurricane. I am blessed to have found this wonderful site..you people have given me inner strength and the courage to go on. Mikey is my baby...I will go to the ends of this earth to help him. I have all tests results for you people to view,so steer me in the right direction so that I can post them...omg,I can be so stund at times..lol.
Thanks once again......whew....it's great to exhale again.

[lulusmom]

Hi Maish and welcome to you and Mikey.

When you say you want to talk to someone about Mikey's test results, do you mean a specialist or would you like to post the results and receive feedback from members here? Do you know if your vet has any experience in diagnosing and treating cushing's? A lot of gp vets do not which is why a good number of members have consulted with an internal medicine specialist. If this is something you'd consider doing, please let us know where you are located and perhaps one of our members can give you a name and a good reference.

I see that Dr. Oliver's name has been mentioned and his contact information provided. Dr. Oliver is not an internal medicine specialist. He is a vet and professor at University of Tennesee Knoxville. He is the authority on Atypical Cushing's. It sounds as though Mikey has typical cushing's and until you get a confirmed diagnosis as to which form of cushing's Mikey has, you should hold off on contacting Dr. Oliver.

I'll be looking forward to seeing the test results.

Glynda

[destinylee75]

I am here! I read your message from Facebook, thank you. I just have no idea how to "get around" here yet!! :confused:"Talk" to you soon. God Bless!!:)

[maish costello]

Sam and Pepper,
Yes,we all have to stick together and I thank God I found this site and have friends like you to lean on......it sure makes the load a little lighter to carry. I certaintly appreciate you giving me your e-mail adress,a life-line for sure....
It's been a rough day..high's and low's.....when I think that it's not possible to cry any more.....well,you know.....
There are so many visions going thru my mind...........this evening when I looked into Mikey's eyes I lost it............I held his head and promised to him that I will do everything in my power to help him......omg....this is the hardest thing I have ever experienced in my life.................I'm broken hearted...

[maish costello]

Hi !!!!
I am having great difficulty also .....but we will learn as we go....
Good to cya....
xoxo

[Bichonluver3]

Hi Maish!
We have all "been there, done that" so we know exactly what you are talking about. Trust me, it WILL get better. Ask all your questions and vent (or cry) here whenever you need to - it all helps. Remember, you are still in the initial "shocky" phase. You have done exactly what you have needed to so far. The folks here will help guide you through the rest. You can "dump" a lot of that burden you feel on us - we have big shoulders. We're all going to help you get Mikey on the right path. Glynda was right when she said Dr Oliver is the expert with Atypical Cushings and also when she said to make sure that you are with the best vet for Mikey. My vet has had some experience (although not as much as others) with Cushings but he loves Chloe, spends countless hours of his own unpaid time with me answering questions for me, doing research, and consulting with other colleagues as well as Dr O. I couldn't ask for anything more and I trust him completely. HOWEVER, I still post results here and pay attention to suggestions made on this board. My vet also considers all suggestions made so that tells you something about the knowledge level of the folks here. Be patient with yourself. Everything will fall into place. And WE will also do everything in our power to help Mikey :) Oh, and hey, tummy rubs to the big guy!!:D
Love,
Carrol

[Squirt's Mom]

Mornin' Maish,

How are ya'll this morning? I hope you had a more restful nite last nite with a few less worries to haunt your dreams.

What did you learn at the vets yesterday? It occurred to me that you may be looking for a particular form or some such to post test results. We just post them in the threads, which is what the area where Mikey's story is called - here. ;) Here is a sample so you know what we are looking for:

************************************************** ****
EXAMPLE
CBC results:
ALKP - 500 ug/dl (50-75)
ALT - 75 ug/dl (25-60)

ACTH
pre - 13 mnol/L (11-35)
post - 38 mnol/L (6-20)
************************************************** *****

You only need to post those values on the CBC that are abnormal - either too high or too low. One of our members is lab tech and give us wonderful help in reading this test. For an ACTH, LDDS, ultrasound, or any other cushing's specific test, it helps if we can see everything on that report - including how to interpret them and any comments that may be present.

Keep making those promises to your sweet boy. One of these days not too long from today, you will be looking into those beautiful eyes with joy and hope instead of fear. You tell him that ya'll now have a whole host of new friends from all around the world who are here to help in any way we can.

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

[Bichonluver3]

[QUOTE...........this evening when I looked into Mikey's eyes I lost it............I held his head and promised to him that I will do everything in my power to help him......omg....this is the hardest thing I have ever experienced in my life.................I'm broken hearted...[/QUOTE]
When you look into those eyes, now you can say "I am keeping the promise..."
Hope today is brighter for you. Keep smiling.
Love,
Carrol

[Bichonluver3]

Any updates? Concerned that we haven't heard from you.
Carrol

[lulusmom]

Maish tried to fax me Mikey's paperwork and after driving 25 kilometers and three tries, it didn't work because I gave him the wrong area code. :o Hopefully the fax today will work. Once I receive, I'll post the results here.

[maish costello]

No worries....all is good....
You should receive all information tonight....ty..:)

[lulusmom]

I received Maish’s fax and am posting results of acth stim test and blood abnormalities below:


ACTH
Pre 667 nmol/L 24.2 ug/dl
Post >1379 nmol/L >50 ug/dl

Interpretation: This patient has a high baseline cortisol concentration and an exaggerated cortisol response to ACTH stimulation which is supportive of hyperadrenocorticism. Be aware, however, that an exaggerated response can also be seen due to stress associated with other conditions. Therefore, please interpret in view of the history, clinical signs and diagnostic findings. It would be unusual for stress to show this markedly an exaggerated response, so hyperadrenocorticism is still strongly supported. You may also wish to perform a low dose (1.01mg/kg) dexamethasone suppression test if you have not already done so, both for diagnostic support and to attempt differentiation of pituitary dependent hyperadrenocorticism versus adrenal neoplasia.

VETSCAN
ALB 47 (24 - 44 G/L) High
ALP >2400 (20 – 150 U/L) High
ALT 308 (10 – 118 U/L) High
GLU 7.0 (3.3 – 6.1 MMOL) High
CA++ 2.90 (2.5 - 2.95 ) High normal and asterisked by vet

CBC
HGB: 20.0 g/dl (12.0 – 18.0) High
HCT: 59.6 % (37.0 – 55.0) High
PLT: 733 (200 – 500) High
MCHC: 33.6 g/dl (34.0 - ?) Low

LIPEMIC INDEX: 2+

Vet’s decipherable notes of interest

Has begun sneaking cat’s food. Drinking a lot and behaving as if in pain. Has vomited a few times some weeks ago. Panting lately.

Very tight abdomen: tender when stomach palpated. Reacts with pain when pit of stomach is palpated.

Panting all the time in consult

Heart sounds – no murmur
HR = 138 bpm

Rectal Exam: removed gravel & grass from rectum.
Maish will fax results of LDDS test to me when available.

[maish costello]

....it hurts when I see those results...I don't understand what any of this means.........but I'm sure it's not good.:(:confused:

[maish costello]

Hi,
All of Mikey's test results are posted now............as soon as I receive the results of his 8hr test on Monday I will fax results as soon as I can....

[Bichonluver3]

Hi Maish!
hang tight. The experts will be zooming in to interpret.
Carrol

[maish costello]

Thank you Carol..!!! ...yikes...

[lulusmom]

Hi Maish,

I am going to ask our expert lab technician, Debbie, to take a look at Mikey's results and give us her interpretation. In the meantime, I'm going to list a few things that can cause these abnormalities. With the exception of the ALP and ALT, I believe the abnormalities would be considered mild but again, Debbie, would be a better judge. According to the notations on the bloodwork, your vet has zeroed in on the ALP, CA and Lipemic Index. Vet's plan looks like he wants to reduce pain with Tramadol as well as psyllium husks added to food to relieve possible constipation. psyllium husks may also reduce cholesterol which will help reduce the lipemic index. Liver support and liver friendly diet (Hills L/D) also prescribed to reduce liver enzymes (ALP and ALT).

I personally think Hills L/D food is terrible stuff and unless I was absolutely certain that my dog had very serious primary liver disease, I would be hesitant to restrict protein for either of my cushdogs. Dr. David Twedt at Colorado State University lectures on liver disease and his position is that unless a dog's liver is severely compromised and 70% of function has been lost, proteins should not be restricted as they are needed for support, repair and maintenance of liver function. It's quite possible that Mikey's elevated liver enzymes are 100% attributable to cushing's and cushing's dogs should be on a high quality protein, low fat diet. I would definitely discuss this with the vet.

VETSCAN

ALB 47 (24 - 44 G/L) High - This would be considered mild elevation which would not be a concern and is usually due to dehydration.

ALP >2400 (20 – 150 U/L) High This is definitely consistent with cushing's. This would be considered severe elevation but we've seen this liver enzyme in the 4,000's.

ALT 308 (10 – 118 U/L) High This moderate elevation is consistent with cushing's. Dogs with cushing's usually have high ALP and mild to moderate elevations in ALT. This is also a liver enzyme

GLU 7.0 (3.3 – 6.1 MMOL) High This would be considered a mild elevation which is usually due to the dog being stressed or scared when the blood is drawn.

CA++ 2.90 (2.5 - 2.95 ) High normal and asterisked by vet

CBC

HGB: 20.0 g/dl (12.0 – 18.0) High This is a mild elevation which is probably elevated because the HCT is slightly elevated or it could be due to dehydration

HCT: 59.6 % (37.0 – 55.0) High This is a mild elevation which is usually due to mild dehydration

PLT: 733 (200 – 500) High Not sure if this would be moderate or severe elevation but it could be caused by a combination of stress and cushing's disease. It is also elevated in dogs with no spleens.

MCHC: 33.6 g/dl (34.0 - ?) Low This is probably due to the high liver enzymes.

LIPEMIC INDEX: 2+ Help, Debbie

If Mikey were my dog, I would definitely want to have an abdominal ultrasound done. Has the vet mentioned this to you?

[Bichonluver3]

Hi Maish!
Hope you got my PM to sent to you this morning. Had this terrible feeling afterwards that I forgot to hit "send". Glad to see you are posting on other threads. That, in itself will give you more confidence and ease a lot of your fears.
Love,
Carrol & Chloe

[Babysam52083]

Maish,
Just wanted to check in and see how you, Mikey, and hubby were doing? Hope you are finding the answers to your questions. Keep us posted.

Sam and Pepper

[maish costello]

Hi Maish!
Hope you got my PM to sent to you this morning. Had this terrible feeling afterwards that I forgot to hit "send". Glad to see you are posting on other threads. That, in itself will give you more confidence and ease a lot of your fears.
Love,
Carrol & Chloe

Good Morning..

Trying to get a "handle" on this forum thingy...lol...slowly,but surely...ty for your kindness..it sure warms my heart to know such caring people are out there........:)

[Squirt's Mom]

Hi Maish,

I wanted to share with you my Squirt's story. She was diagnosed with PDH based on 5 tests - the LDDS, HDDS, ACTH, UTK panel and 2 ultrasounds. The second ultrasound found a tumor on her spleen. Once that tumor and part of her spleen were removed, in Sept. of '08, her cortisol returned to normal and has remained within range.

If I hadn't insisted that she be thoroughly tested before starting any treatment for Cushing's, there is no doubt in my mind she would not be with me today - her spleen would have ruptured due to that tumor. An ultrasound literally saved her life and for this reason, I cannot emphasize how valuable an ultrasound is as a diagnostic test for Cushing's. Not only will the adrenals be seen but so will the spleen, intestines, bladder, gall bladder, liver, kidneys and other organs.

This is one test I always recommend - strongly. ;)

Hugs,
Leslie and the girls - always

[maish costello]

Hi Leslie,
I just read your message and called Mikey's vet to set up an ultrasound. He has his 8 hr test this coming Monday (7th) .....so the following week,the ultrasound will be done. Thank you for this valuable info....:)

Maish and Mikey

[maish costello]

Hi Sam and Pepper,

We are doing much better...some days are rougher than others,but we are trying to chill out and stop with the "what if's"....I am learning so much from this website,a little over-whelming at times,but I'm hanging in there..lol.

Mikey and I were out enjoying another winter storm....he loves the snow !!!

He is doing great,...I noticed the "panting" has decreased enormously...don't know what that means,but he is sure holding his own...Mikey is a trooper !!!....

Will pop in later this evening to have a chat...thank you for your kindness..:)

Maish and Mikey

[maish costello]

Hi Maish!
Hope you got my PM to sent to you this morning. Had this terrible feeling afterwards that I forgot to hit "send". Glad to see you are posting on other threads. That, in itself will give you more confidence and ease a lot of your fears.
Love,
Carrol & Chloe
Hi Carol,

I am the new kid on the block here..lol...omg,this forum is difficult at times to get around...........but I am clicking and pushing buttons....hahahaha...something's gotta work sometime or later....tks for messaging us....you are so sweet...have a great day...:)

[maish costello]

Hi Maish!

I am so happy to see you and Mikey here! :D:D

Gosh, you sound so much like me when my Squirt was diagnosed - nearly 3 years ago now. I had never heard the word "Cushing's" and I don't think I will ever forget how I felt when I did. My whole world came crashing in. Fear, anger, guilt, frustration, and confusion consumed me. My poor old brain couldn't understand anything I read or heard - it was all Greek and all bad. :( Someone could tell me the sun was shining and I would run for shelter! :rolleyes: By the time I found these wonderful folks, I was a complete basket case! :eek: A dear friend described me as looking like a woman who had stuck her finger in a light socket...she kindly left out the parts of bugged out eyeballs and flying slobber! :eek::eek::p

These kind folks took my hand and gently led me along until I could breath a bit again and wasn't crying ALL the time - and I began to learn. The more I learned, the calmer and more confident I became. You've heard the saying, "Knowledge is power"....that is never more true than when dealing with Cushing's in our babies. You are Mikey's first and last defense, his only voice, his advocate - and the more you know the stronger you will be in these roles. Sounds like a daunting prospect, huh? ;) You have found the best teachers in the world right here. The collective experience and knowledge found here is astounding and you cannot beat the good old-fashioned hand-holding! I know this for a fact...mine have been dripping sweat and not a single soul let me go for a second - not one second.

Some tips for you -

* take a notepad and pencil, recorder or another person with you to the vet to help you remember what is said

* make it a habit to get copies of all the testing done on Mikey to keep at home in a file for him - you never know when you may have to see a different vet and this way you will have all his info in hand - plus you can answer the many questions we will soon throw at you! :p

* start a diary/journal on Mikey - his eating, peeing, pooping, sleeping patterns, moods, any changes in his behaviors or patterns; this will be particularly beneficial once he starts treatment

Cushing's is one of the most difficult conditions to diagnose in our babies. Two things you want to be sure are ruled out right up front are hypothyroidism and diabetes. These conditions, and others, have signs that are the same as Cushing's so it is important to rule out any other cause for the things you are seeing. The CBC, or blood panel, will give your vet some good insight to other conditions that might be in play.

Don't feel like you have to do something about Cushing's RIGHT NOW. Cushing's is a slow progressing condition so you have time to make sure of what is going on with Mikey before you start any treatment. ~~breath in....breath out~~ It's ok to do that now. ;)

The most important thing I have to tell you right now is this - you, your hubby, and Mikey are not alone. If you have any questions - ask and we will do our best to help you understand. If we don't know, we will learn together. When those days come, and they will, when you don't think you can handle this - we are here to listen and share our strength and hope with you til you can stand on your own again. You are not alone any more.

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

Hi Leslie,

You probably will be suprised when I tell you that it's only NOW that I am finally reading my messages and physically viewing the words..when I joined this forum/website I was and still to a point,a basket case..I replied to (hopefully I did) all messages,but my heart,soul and body was somewhere else....I was just going thru the motions,wiched,eh?....I am starting to calm down a tad,believe me I do have those horrible moments where I just lose it,but they are getting lesser and lesser. Sleep is not kind to me....visions sneak in there when I least expect and then it's on-going most of the night. I am trying to relax...I exercise more now than usual and Mikey is my coach....we have had some snow storms this past week which I thank the Lord for sending because Mike LOVES the snow and both of us are enjoying it to the fullest.
I just wanted to pop in and let you know that I most certaintly appreciate your kind words of encouragement and the most valuable information. I cannot put into words how I feel about all you great human beings....the support and compassion is over-whelming...God bless you one and all.

Love,

Maish and Mikey....:)

[maish costello]

Hi Maish!

I am so happy to see you and Mikey here! :D:D

Gosh, you sound so much like me when my Squirt was diagnosed - nearly 3 years ago now. I had never heard the word "Cushing's" and I don't think I will ever forget how I felt when I did. My whole world came crashing in. Fear, anger, guilt, frustration, and confusion consumed me. My poor old brain couldn't understand anything I read or heard - it was all Greek and all bad. :( Someone could tell me the sun was shining and I would run for shelter! :rolleyes: By the time I found these wonderful folks, I was a complete basket case! :eek: A dear friend described me as looking like a woman who had stuck her finger in a light socket...she kindly left out the parts of bugged out eyeballs and flying slobber! :eek::eek::p

These kind folks took my hand and gently led me along until I could breath a bit again and wasn't crying ALL the time - and I began to learn. The more I learned, the calmer and more confident I became. You've heard the saying, "Knowledge is power"....that is never more true than when dealing with Cushing's in our babies. You are Mikey's first and last defense, his only voice, his advocate - and the more you know the stronger you will be in these roles. Sounds like a daunting prospect, huh? ;) You have found the best teachers in the world right here. The collective experience and knowledge found here is astounding and you cannot beat the good old-fashioned hand-holding! I know this for a fact...mine have been dripping sweat and not a single soul let me go for a second - not one second.

Some tips for you -

* take a notepad and pencil, recorder or another person with you to the vet to help you remember what is said

* make it a habit to get copies of all the testing done on Mikey to keep at home in a file for him - you never know when you may have to see a different vet and this way you will have all his info in hand - plus you can answer the many questions we will soon throw at you! :p

* start a diary/journal on Mikey - his eating, peeing, pooping, sleeping patterns, moods, any changes in his behaviors or patterns; this will be particularly beneficial once he starts treatment

Cushing's is one of the most difficult conditions to diagnose in our babies. Two things you want to be sure are ruled out right up front are hypothyroidism and diabetes. These conditions, and others, have signs that are the same as Cushing's so it is important to rule out any other cause for the things you are seeing. The CBC, or blood panel, will give your vet some good insight to other conditions that might be in play.

Don't feel like you have to do something about Cushing's RIGHT NOW. Cushing's is a slow progressing condition so you have time to make sure of what is going on with Mikey before you start any treatment. ~~breath in....breath out~~ It's ok to do that now. ;)

The most important thing I have to tell you right now is this - you, your hubby, and Mikey are not alone. If you have any questions - ask and we will do our best to help you understand. If we don't know, we will learn together. When those days come, and they will, when you don't think you can handle this - we are here to listen and share our strength and hope with you til you can stand on your own again. You are not alone any more.

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


Hi Leslie,

You probably will be suprised when I tell you that it's only NOW that I am finally reading my messages and physically viewing the words..when I joined this forum/website I was and still to a point,a basket case..I replied to (hopefully I did) all messages,but my heart,soul and body was somewhere else....I was just going thru the motions,wiched,eh?....I am starting to calm down a tad,believe me I do have those horrible moments where I just lose it,but they are getting lesser and lesser. Sleep is not kind to me....visions sneak in there when I least expect and then it's on-going most of the night. I am trying to relax...I exercise more now than usual and Mikey is my coach....we have had some snow storms this past week which I thank the Lord for sending because Mike LOVES the snow and both of us are enjoying it to the fullest.
I just wanted to pop in and let you know that I most certaintly appreciate your kind words of encouragement and the most valuable information. I cannot put into words how I feel about all you great human beings....the support and compassion is over-whelming...God bless you one and all.

Love,

Maish and Mikey....:)

p.s.
I am "kinda" figuring out this message thingy too.....yay !!

[Bichonluver3]

Hi Maish!
How come I'm doing housework while you're playing in the snow???:D
I often think it is so strange that it is really our dogs who calm us down and not the reverse. I bet Mikey is having the time of his life in the snow without a care in the world. Maybe we should take our cue from them...........?:rolleyes:
Have fun.
Carrol

[maish costello]

[QUOTE=jrepac;48320]Hi Maish,

Cushings can be treated and controlled, so don't panic. Take some time to speak to your vet about the options; as the others have said, keep track of things (write them down, record them, get copies of test results). You definitely want to rule out thyroid problems and diabetes. And you need to find out what type of Cushings it is, if it really is Cushings, prior to selecting treatment. It sounds like it COULD be Cushings, but other conditions have similar symptoms.

What kind of dog is Mikey, by the way? He is awfully cute!

good luck!


Hi,

It's only now that my brain is finally back to somewhat normal mode....those past days have been a real roller coaster ride...
Please forgive me if I never messaged you sooner than now. I am trying to find my way around this forum,with so much on my mind even the smallest of tasks seem so very difficult.
My Mikey is a cross border collie/terrier. He adopted us in 2000 and our lives were blessed from that day on.....he is our pride and joy. I am learning as I go concerning Cushing's....so much information,so much to remember..but I'm gathering bit by bit each and every day...and I thank YOU.....thank you for caring,thank you for sharing....thank you for being YOU......I can't do it without you guys/gals....

Maish and Mikey

[Bailey's Mom]

Carrol,
Thank you for taking the time to speak to me and offering your most valuable information....is it possible that you would have an e-mail address on Dr.Oliver,any information would be most certaintly appreciated. Maish and Mikey

Hi Maish. Dr. Oliver's email address is joliver@utk.edu His first name is Jack. I emailed him several times when Palmer was first being treated for cushings. He does always respond within 24 hours.

It's true, true, true what all the others have told you. Not only are the people on this forum well informed, they are also very compassionate and understanding. When I first found myself dealing with Cushing's for Palmer, I too read on the internet for hours. I was able to get a general grasp of what we were dealing with, but the folks here put it all together for me. I asked questions and then I asked more questions. I input all of Palmer's test results so they all could see and comment. Their suggestions were wonderful and calming. My vet figured out early that I was doing some kind of "research." Most of the info I would take to her from this forum she was happy to consider and several times she was glad I had brought some of them up.

You will also find total acceptance and support here.....no matter what decisions you make for Mikey. There were a couple of times when I felt it necessary to "go against" the advice I was getting here....ie: Trilostane vs Lysogen. They all stood behind me all the way.

What kind of dog is Mikey? How old is he? Have you had him from being a puppy?

My head was spinning when I first started this journey. There is SO MUCH information that you will become familiar with. Many times I asked what this meant or that meant. They always welcomed my questions.

My unsolicited advice is enjoy what you have this moment. That's really all we all have. Try not to project. It is a waste of time. When I started with this forum, Palmer was drinking water madly, had a stomach two to three times what was normal for him and panted, panted, panted. Once treatment started to take hold, his little tummy went down (he had gone from being able to jump onto the sofa to being unable to get up there because of the size of his tummy.) And the panting stopped.

Mikey is right here. Treasure every minute....even if it turns into years. We all need to make the most of what we have now.

End of my unsolicited advice.

Hang in there!

Susan

[StarDeb55]

Maish, I'm the lab tech that Glynda mentioned earlier today. Sorry I couldn't stop by until now, but I have a new pup in the house that I adopted a week ago, & he is keeping me quite busy.

Anyway, Glynda gave you the following explanation of Mikey labs:


ALB 47 (24 - 44 G/L) High - This would be considered mild elevation which would not be a concern and is usually due to dehydration.

ALP >2400 (20 – 150 U/L) High This is definitely consistent with cushing's. This would be considered severe elevation but we've seen this liver enzyme in the 4,000's.

ALT 308 (10 – 118 U/L) High This moderate elevation is consistent with cushing's. Dogs with cushing's usually have high ALP and mild to moderate elevations in ALT. This is also a liver enzyme

GLU 7.0 (3.3 – 6.1 MMOL) High This would be considered a mild elevation which is usually due to the dog being stressed or scared when the blood is drawn.

CA++ 2.90 (2.5 - 2.95 ) High normal and asterisked by vet

CBC

HGB: 20.0 g/dl (12.0 – 18.0) High This is a mild elevation which is probably elevated because the HCT is slightly elevated or it could be due to dehydration

HCT: 59.6 % (37.0 – 55.0) High This is a mild elevation which is usually due to mild dehydration

PLT: 733 (200 – 500) High Not sure if this would be moderate or severe elevation but it could be caused by a combination of stress and cushing's disease. It is also elevated in dogs with no spleens.

MCHC: 33.6 g/dl (34.0 - ?) Low This is probably due to the high liver enzymes.

LIPEMIC INDEX: 2+ Help, Debbie

Glynda, has done a first rate job in putting this all together for you. I do want to add a couple of things. When Glynda mentions dehydration as a possible cause for some of these values, if Mikey was fasted for this blood work, there you go, he was dehydrated. Granted, the glucose is a mild elevation, but if Mikey was fasting when this was drawn, that is more of a concern. An elevated, fasting glucose may be an indicator of diabetes. To explain the lipemic index value, I have to explain a little bit about blood samples. When blood is drawn for labs, & this applies to people, too, some samples are allowed to clot, then placed in centrifuge to spin them down to separate the blood cells from the water portion of the blood which is called the serum. Serum contains all of the various components like glucose, potassium, calcium, etc. When the tube are taken out of the centrifuge, if the blood has a lot of fat in it, what you may know as cholesterol & triglycerides, the serum will have a cloudy, almost creamy look to it. Normal serum should be yellow & clear. Sometimes the serum can look so bad it will literally look like cream. The cream appearance is due to all of the dissolved fat. I would be curious to know if Mikey's cholesterol & triglycerides were measured on these samples, along with an amylase & lipase result. If Mikey was fasted, the serum looks like this, this is worrisome. If Mikey wasn't fasted, & had eaten within about 2-4 hours of the blood draw, that would be the explanation of the dissolved fat in the blood.

To sum up, the information I still need is the following:

Was Mikey fasted for this blood draw?
If you have results for cholesterol, triglycerides, amylase, & lipase, I would like to see those results, along with the normal ranges. If you're having trouble posting them, you can probably shoot them to Glynda & she can post them. Glynda is a little under the weather right now, so it may take her a little bit of time to get them posted.

Debbie

[maish costello]

Hi Debbie,
Mikey fasted from 9pm the previous night and was allowed water only.
I do not have any other results....everything that I have I sent to Glynda and it's all posted....
so where do I go from here?....more blood work?............or?

Maish

[maish costello]

Hi Susan,

I wish I had some medical education....all those words are freaking me out..I am feeling so lame,ugh!

Now I'm thinking of the possibility that Mikey has diabetes...oh dear...

There are so many tests to complete..he has his 8 hr this coming Monday and possibility of another to follow ...then an ultrasound and then possibly more blood work..............I'm starting to panic !!!!!

Maish

[StarDeb55]

You need to ask the vet if the tests I asked about were done previously. If not, I would suggest you talk to the vet about having them done. Since Mikey was fasting, that blood glucose is concerning to me, so this is another question for the vet. Has diabetes & thyroid been ruled out? Even if the vet said yes, I would ask again, as an elevated blood glucose on a fasting specimen is not normal. The elevated level of fats in the blood may possibly indicate a problem with pancreatitis, but the amylase & lipase tests will be a better indicator of that than simply the appearance of the blood. I would simply tell the vet that you now understand that the lipemia index is a general indicator of the amount of fat in the blood which may indicate other problems.

Debbie

[lulusmom]

Deb, the Amylase is 1035 U/L (20 - 1200). It appears the vet did an inhouse vetscan so it's not as comprehensive. Cholesterol, Triglycerides and Lipase are not shown.

[StarDeb55]

Maish, with no cholesterol & triglycerides being done, I can't offer a serious opinion as to what is causing the lipemia. I, now, think you need to ask the vet about having a comprehensive chemistry panel done to check some of these other values. It might be called a super chemistry panel or a senior wellness panel. If Mikey were my pup & with the report of moderate lipemia on a fasting blood sample, I would be asking for the above two things to be checked.

Debbie

[maish costello]

Thank you Debbie,

Mikey's next visit to his vet is Monday,Feb.7/11 for the Dex Supression Low Dose-AVC. These reports have to be sent out of province for testing and hopefully we will get the results within 48 hrs or less. I will speak to the vet Monday morning concerning setting up an ultrasound and as well this chemistry panel/senior wellness panel. Do you have any more suggestions or concerns?
This is all "new" to me and I do not know which direction to take..please advise.

Maish

[StarDeb55]

The appointment for the low dose would be the ideal time to get that chem panel done. Mikey has to be fasting anyway, & you want that chem panel done fasting. The one thing to look for on a repeat chem panel, besides the cholesterol & triglycerides, is whether or not the glucose is still high, even if slightly. If you end up with 2 straight elevated glucose levels, then you need to have a serious discussion with the vet about the possibility of diabetes. If the 2nd glucose is high, I would also want his urine checked for the presence of ketones. You could actually do this yourself at home as you should be able to buy urine test strips for glucose & ketones at any drug store. Human diabetics need them frequently, & you can use the people strips with Mikey. You simply look for a color change on the pads on the strip & compare it to the color chart on the bottle.

I know the next question is going to be, "How in the world do I collect a urine?" If you have some type of long handled spoon or ladle that you are willing to sacrifice, simply stick it in underneath Mikey when he lifts his leg.

Also, please remind me as to whether or not Mikey has gained weight or lost weight as one of his symptoms.

Debbie

[maish costello]

Debbie,
You are one awesome lady...wow,you are really getting down to the grind stone here and I love it !!! I will make note of all this valuable information and will DEFINITELY bring it to Mikey's vet. Thank you.

Well Mikey never really changed in his weight too drastically. His tummy is swollen,some days it appears to be smaller,while other days a lil larger? But on the average,yes he has gained.

We have a lot of work ahead of us and I am so looking forward to having all of those tests done and preparing for the results. Whatever is going to be,is going to be....

Thank you for taking the time to help Mikey get well again.God bless.

Maish

[maish costello]

Ooops,I forgot to ask....for this chem panel test,Mikey yes will be fasting but allowed water,right?.....when he had the 2 hr test done he had to fast from 9pm the previous night but was allowed water....

[StarDeb55]

Water is fine.

Debbie

[maish costello]

Water is fine.

Debbie

Thank you..:)

[maish costello]

Hi Everyone,

Just touching base and popping in to say hello to all you great people.
Mikey had his dex suppression low dose-avc yesterday as well a thyroid panel. Both tests have to be air couriered out of province for testing,therefore we will not receive results for another day or so.

In the meantime my Mikey is doing great..still active,eating normal but a lil more drinking but NO panting as previous. We sure missed having him around yesterday,the hands on the clock moved so slowly.

Hope you are all having a wonderful day. As I type we are experiencing yet another snow storm. Mikey sure enjoys being outside playing in the snow.

Wishing you all health and happiness.

Maish and Mikey..:)

[Bichonluver3]

Be sure to post results. So glad that Mikey and you are doing well.
Love,
Carrol

[lulusmom]

Hi Maish,

I'll by staying tuned for the results of the LDDS. Glad to hear Mikey is still feeling good and enjoying the snow.

Glynda

[maish costello]

Ty Carrol and Glynda....

Glynda,I will fax results as before....

Maish

[Bailey's Mom]

I'm so glad he is feeling well. Here's to a good report.
-Susan

[maish costello]

Thank you Susan....
Mikey never was sick or feeling sick to any degree...just those symptoms before Christmas which needed to be investigated....that's when the ball starting rolling and our world changed:eek:

I am dreading the phone call today if his test results are in....but,we're taking it one second at a time...

Tks again Susan..have a wonderful day my friend...

Maish and Mikey:)

[lulusmom]

Maish, when your vet calls today to give the results of the LDDS, ask him for the numbers. Be sure to have a pen or pencil handy so you can write them down. There should be three numbers, a pre/baseline draw, 4 hour draw and 8 hour draw. That way, you can just post them here and you won't have to worry about driving to fax the test to me.

[maish costello]

ok that's great...as soon as I get the call I will post....

any suggestions as per the thyroid panel?

[lulusmom]

Maish, the thyroid panel may have a bit more to it so it might be a bit much for you write down. Ask your vet if he can scan the tests and email them to you. That way you can forward them to me.

[maish costello]

will do....

[maish costello]

Glynda..
Information faxed to you ....
Thyroid test results are not available yet...when I receive I will fax asap...

Maish

[lulusmom]

Here are the results of the LDDS test:



Results in nmol
Cortisol Baseline Pre Dex 386 nmol/L
4 hour post Dex 191 nmol/L
8 hour post Dex 319 nmol/L

Converted to ug/dl
Cortisol Baseline Pre Dex 13.99 ug/dl
4 hour post Dex 6.92 ug/dl
8 hour post Dex 11.56 ug/dl

To summarize the interpretation, these results supports a diagnosis of hyperadrenocorticism; however results can also be due to stress associated with other conditions. It goes on to say that if it is felt that hyperadrenocorticism can be supported, the ("marginal!") decrease in cortisol concentration to below 50% of baseline at 3-4 hours may support a diagnosis of pituitary dependent hyperadrenocorticism but you may with so to a high dose dex suppression test. If not already performed, an ACTH stimulation test is recommended, particularly if you are contemplating medical therapy.

I don't think you can use these results to support a diagnosis of pituitary dependent cushing's as the 4 hour suppression is a hair short of 50%; however, I think this pattern is definitely more likely pituitary than adrenal. Maish, if you can afford it, you may want to consider having an abdominal ultrasound done to check the adrenals and surrounding internal organs.

[maish costello]

Here are the results of the LDDS test:



I don't think you can use these results to support a diagnosis of pituitary dependent cushing's as the 4 hour suppression is a hair short of 50%; however, I think this pattern is definitely more likely pituitary than adrenal. Maish, if you can afford it, you may want to consider having an abdominal ultrasound done to check the adrenals and surrounding internal organs.

Hi Glynda,
Mikey's vet indicated the same....therefore,another 8hr test is scheduled for this coming Monday and she informed me that she will be using a larger dosage. As for the ultrasound,yes,I have already brought this to the vet and it will hopefully be scheduled either this coming week or early the following week. Glynda tell me about this...if it's pituitary dependent,what's next? I have so many questions and so little knowledge ....whew!

Thanking you,
Maish and Mikey

[StarDeb55]

Maish, is the next test the vet wants to do a high dose dex? If it is, & you really want to do the ultrasound, the high dose really shouldn't be necessary. If you go with the ultrasound, you want to make sure that it is done on a high resolution scanner, by an experienced vet with these types of scans. The ultrasound is really a better bargain for the $$ than the high dose, as you can get a look at all of Mikey's internal organs thus getting a better idea of his overall health.

Now, let's assume that either the high dose or the ultrasound confirms PDH (pituitary). The next step is going to be which drug do you use for treatment, trilostane or lysodren. The choice is going to be dependent on what your vet is more comfortable using. I really can't offer more than that on trilo as I have never used it. My own experience is with lysodren, & I can say that I successfully treated 2 pups with the drug. My first boy, Barkley, was on lysodren for nearly years, crossing the bridge at 15 from causes unrelated to his Cushing's. They are both very good drugs, but from what I've read on this boards, IMO, trilo takes a little more monitoring than lysodren, until you get the dosage regulated. I'm sure others will weigh in on the subject of which medication to use.

Debbie

[lulusmom]

Hi Maish,

I see that your vet is opting to do a high dose dexamethasone test to differentiate between pituitary and adrenal based disease. If you want my opinion, I would save my money and skip the high dose dex test and go straight to an abdominal ultrasound. As long as it is done on a good quality, high resolution machine, your vet should be able to see both adrenal glands and tell whether it's adrenal or pituitary. You'll normally see both adrenals enlarged if it is pituitary and if it is adrenal, one gland will be enlarged and the other smaller or atrophied. Your vet will also be able to check out the surrounding organs for changes consistent with cushing's and other possible problems. We use the phrase, "you get more bang for your buck with an abdominal ultrasound" and I think you can see why we do.

If it turns out that Mikey has an adrenal tumor, surgery would be an option, as well as a total cure. If it turns out he has a pituitary tumor, surgery is not an option so you would need to start discussing effective treatments with your vet. There really is only two effective treatments, Lysodren and Vetoryl (Trilostane).

Maish, what cushing's symptoms does Mikey have at this time?

Glynda

[maish costello]

Hi Maish,

I see that your vet is opting to do a high dose dexamethasone test to differentiate between pituitary and adrenal based disease. If you want my opinion, I would save my money and skip the high dose dex test and go straight to an abdominal ultrasound. As long as it is done on a good quality, high resolution machine, your vet should be able to see both adrenal glands and tell whether it's adrenal or pituitary. You'll normally see both adrenals enlarged if it is pituitary and if it is adrenal, one gland will be enlarged and the other smaller or atrophied. Your vet will also be able to check out the surrounding organs for changes consistent with cushing's and other possible problems. We use the phrase, "you get more bang for your buck with an abdominal ultrasound" and I think you can see why we do.

If it turns out that Mikey has an adrenal tumor, surgery would be an option, as well as a total cure. If it turns out he has a pituitary tumor, surgery is not an option so you would need to start discussing effective treatments with your vet. There really is only two effective treatments, Lysodren and Vetoryl (Trilostane).

Maish, what cushing's symptoms does Mikey have at this time?

Glynda

Glynda,
Mikey's vet told me this morning that she is not %100 sure that it's pituitary and she thinks it's necessary for another hi dose dex to be performed and this will guarantee the final results which she really believes it's pituitary. I am having this test done on Monday for Mikey and an ultrasound to follow this week or early next week. I will definitely make sure the ultrasound is performed on a hi resolution machine...I do so appreciate your knowledge...thank you for "educating" me...and no doubt,there is so much more to learn.
Mikey showed signs just before Christmas(2010)..he was panting,drinking more and appeared to be hungry ALL the time. I have a cat also and Mikey was "sneaking" her food..I then put the cat food up higher where he couldn't get it.....so those red flags led us to the vet and testing started. But those past 3 wks or so Mikey's panting has decreased enormously !!!! As for thirst,yes he do drink a lil more than usual,but NOT as before Christmas.....his apetite,well,that varies. He always had a huge apetite (Excuse spelling) but before Christmas he was a lil savage...but this past 3 wks he is eating his meals like a normal dog,begs somewhat if he happens to be around the dinner table,but all in all his "before" symptoms have decreased......I'm confused...really I am...

Maish...

[maish costello]

Maish, is the next test the vet wants to do a high dose dex? If it is, & you really want to do the ultrasound, the high dose really shouldn't be necessary. If you go with the ultrasound, you want to make sure that it is done on a high resolution scanner, by an experienced vet with these types of scans. The ultrasound is really a better bargain for the $$ than the high dose, as you can get a look at all of Mikey's internal organs thus getting a better idea of his overall health.

Now, let's assume that either the high dose or the ultrasound confirms PDH (pituitary). The next step is going to be which drug do you use for treatment, trilostane or lysodren. The choice is going to be dependent on what your vet is more comfortable using. I really can't offer more than that on trilo as I have never used it. My own experience is with lysodren, & I can say that I successfully treated 2 pups with the drug. My first boy, Barkley, was on lysodren for nearly years, crossing the bridge at 15 from causes unrelated to his Cushing's. They are both very good drugs, but from what I've read on this boards, IMO, trilo takes a little more monitoring than lysodren, until you get the dosage regulated. I'm sure others will weigh in on the subject of which medication to use.

Debbie

Thank you Debbie,
To be honest,I am FRIGHTENED out of my skin when Mike starts treatment. I am SO scared that I will hurt him,yes,I have thoughts of over dosing my baby.............dear Lord.....!!!!! I have not yet discussed with the vet concerning any medication as of yet because more tests and the ultrasound has to be completed.....

Maish

[lulusmom]

I didn't realize that Debbie had posted just before I did and I want to make sure you understood what both of us were telling you about the need for the high dose dex test. If you have an ultrasound on a good machine and done by a highly experienced vet or technician, your vet should be able to determine the type of cushing's Mikey has by looking at the adrenal glands. The high dose dex test has actually fallen out of favor with a lot of experienced vets because a good number (20% to 30%) of dogs with pituitary tumors will fail to suppress in response to the high dose of dexamethasone.

It sounds like the symptoms that took you to the vet in the first place have completely resolved. Regardless of which testing you do, I would not recommend starting treatment until Mikey is showing overt symptoms and if your vet pushes you to do so, make sure he explains his reasoning. Is there anything about Mikey today that concerns you?

Glynda

[maish costello]

I didn't realize that Debbie had posted just before I did and I want to make sure you understood what both of us were telling you about the need for the high dose dex test. If you have an ultrasound on a good machine and done by a highly experienced vet or technician, your vet should be able to determine the type of cushing's Mikey has by looking at the adrenal glands. The high dose dex test has actually fallen out of favor with a lot of experienced vets because a good number (20% to 30%) of dogs with pituitary tumors will fail to suppress in response to the high dose of dexamethasone.

It sounds like the symptoms that took you to the vet in the first place have completely resolved. Regardless of which testing you do, I would not recommend starting treatment until Mikey is showing overt symptoms and if your vet pushes you to do so, make sure he explains his reasoning. Is there anything about Mikey today that concerns you?

Glynda

Glynda...and Debbie....

My question for you....why perform those supression tests if ultrasounds can determine the type of cushings? Maybe I am misunderstanding but with the greater majority of posts on this forum,supressions tests are mentioned regularly....what am I missing here or am I reading it wrong?...I was speaking with Mikey's vet just over an hour ago and she will try to get the ultrasound done on Monday when he is scheduled for his supression test....

Glynda...my concerns lately is the hair loss Mikey is experiencing..his snout is becoming a lil bald,not extreme,but noticeable. ..his belly is bald and I have noticed yesterday his left rear knuckle appears to be somewhat "red"..I will bring this to the attention of the vet on Monday. His energy is still up to par as usual,he LOVES to play and if I had the energy to continue,it would be non-stop. I often wonder if I should be "cautious" of this activity? is it causing harm in anyway....I worry if I am causing him harm?...I am so nervous around him at times....I am afraid to lift him since his belly is a lil larger...I miss the ole Mike..and I want him back.....:(

[StarDeb55]

I don't have a good answer for you, except vet preference. I think quite a few vets are getting away from a low dose, & making the diagnosis based on an ACTH & abdominal ultrasound. The problem with any of these diagnostic tests is they can yield false positives or false negatives, depending on what test you are using. This is why it's critical to confirm a positive test on either the low dose or an ACTH with a second test such as the high dose, or the ultrasound.

I will relate my experience with Harley. My GP vet did the UTK full adrenal panel which came back with serious elevations across the board. I took Harley to my IMS, who is actually my former IMS, to get the diagnosis confirmed. She had the results of the UTK panel, proceeding to tell me that Harley had one of higher elevations in cortisol that she had seen lately, She wanted the abdominal ultrasound done. I asked her if she needed anything else to make the diagnosis, even mentioning a high dose, she said no, all she needed was the UTK panel & the ultrasound. The UTK panel is basically an extended ACTH where it looks at not only cortisol, but the 5 associated hormones that the adrenals produce.

Cushing's is probably the hardest endocrine disease to diagnose, as there is no single test that is both 100% specific or 100% sensitive.

Debbie

[lulusmom]

Hi Maish,

Mikey has both an acth stim test and a low dose dex test, both of which were consistent with cushing's. Your vet could have easily done an abdominal ultrasound and validated the acth stim test, eliminating the need for the low dose dex. I think he was hoping the LDDS would validate the acth stim test as well as tell him whether you are dealing with pituitary or adrenal tumors. If you go through with the HDDS and the abdominal ultrasound, I believe Mikey will have received the most comprehensive testing I've ever seen. In your shoes, I'd save my money and cancel the HDDS test for reasons stated in my last post.

I think I may have mentioned to you before but loss of hair on the face is not the norm in cushing's, unless a dog has demodex mites. You also see mites on the feet and redness is common. Please mention this to your vet. A skin scrape will allow the vet to see mites under a microscope.

Glynda

[labblab]

My question for you....why perform those supression tests if ultrasounds can determine the type of cushings? Maybe I am misunderstanding but with the greater majority of posts on this forum,supressions tests are mentioned regularly....what am I missing here or am I reading it wrong?...I was speaking with Mikey's vet just over an hour ago and she will try to get the ultrasound done on Monday when he is scheduled for his supression test....

Hi! I've not had the chance to post to you before, but I'm going to throw in my two cents worth, as well. I want to be sure and clarify that there is a big difference in the purposes of the LDDS (low dose suppression test) and the HDDS (the high dose suppression) test. The LDDS is a general screening test for Cushing's. The ACTH is the only other general screening blood test that exists. As has already been pointed out, different vets have different preferences as to which of these two tests they wish to perform when they are in the process of diagnosing whether or not a dog has Cushing's of either form -- adrenal or pituitary. A "positive" ACTH points to Cushing's in general, but no result on that test will point toward which form of the disease is present. A "positive" LDDS also points to Cushing's, and depending upon the result, there can be a high degree of confidence that the dog suffers from the pituitary form of the disease. However, with some of the results on the LDDS (such as in the case of your dog) the result is inconclusive as to the type of Cushing's.

The HDDS cannot be used as a screening test for Cushing's, and in order to have any interpretive value, the general diagnosis must already have been positively established via a ACTH or LDDS test. The HDDS is solely a test designed to try to distinguish between the two types of the disease once the general diagnosis has been made, and as both Glynda and Debbie have said, it is a test which has fallen out of favor in recent years. Many vets prefer instead to rely on the results of an abdominal ultrasound to make this determination.

So in summary, I think you'll often see folks talking about the LDDS test here when they are in the process of obtaining an initial Cushing's diagnosis for their dog. It is a test which is commonly performed. I don't think you will see the HDDS discussed here nearly as often anymore.

Marianne

[Bailey's Mom]

Hi Maish-

I so vividly remember when Palmer and I first started down this path. I was scared, confused, totally unfamiliar with Cushings'. I read and read on the internet and fortunately found this forum. Here members have all kinds of experience and wisdom to offer. They will answer every question you ask. The folks here have walked this path and really understand what you are going through.

I put Palmer on Trilostane. I received a lot of posts that suggested I not do that-that we should start of with the Lysodren. Trilostane is a capsule. Your vet will tell you what amount to give....I think it relates to the weight. We tried the Trilostane for a month or so and new test results indicated it was working well. Next tests and the results were not as good. I became convinced that we should go to Lysodren. We talked with the vet about it and she did not feel we should do that. I got all kinds of suggestions for questions to ask her and questions about running tests. This forum saved me from going off the deep end. I started telling the vet that I wanted to try Lysodren. The vet had consulted with all kinds of colleagues and they supported her feeling that we needed to give this more time. I of course felt that giving it more time was unnecessary and risking Palmer's future. We reached a point where the vet wanted us to go see a specialist Internal Medicine dude. She told us that she felt she was being pressured to do something that she did not feel was appropriate at the time. She said we had initially had very good results and that we just needed to give this some time. Now-when we first talked about this she mentioned Lysodren as a treatment....so she was willing to do it then, but once we decided on Trilostane, with the initial good results, she wanted us not to be skipping around from treatment A to treatment B. She said if we kept our opinion she did not feel she could support us. She reminded me that she had a doctorate's degree and also that she could tell from my questions that I didn't really understand all there was to understand. (I think she was having a bad day.) She just really didn't like being second guessed. She had earlier told me how she was impressed by the questions I came in with and that my research was evident. We asked her that if the IM doc supported our position....what then? She said if that were the case that she would then support us. Talk about scary. I felt like I was in the middle of a tornado with all that I was trying to learn and with my worries about Palmer. Anyway-we stuck with the Trilostane and the results became much better. We never did go to Lysodren.

Palmer did well on the treatments. He lost some hair....a good bit, but some of that eventually came back. His belly had gotten so big that he could no longer jump up onto furniture. For a good period of time I had to lift him up when he wanted to come up. His belly went down a good bit and he returned to jumping up for himself. The symptoms were being controlled. We did not see any negative effects. I feel we made the right choice for us.

Part of what I find so frustrating about this is the vagueness of diagnoses. I have a math background and I always want 1 + 1 to equal 2. We could find out only so much about Palmer without having surgery. We were not going to put Palmer through surgery. In the end I don't know whether Cushings shorted Palmer's life or not. He continued to have good test results....we had an excellent report one month before he crossed. In those last 4 weeks Palmer went downhill very fast. He stopped eating. We took him in for various tests with the IM dude. His pancreas seemed to be causing the most problem. His poor little body-he'd lost 6 pounds in a couple of weeks-and he only had 20 to start off with-his body just gave out on him.

While I don't know if Cushing's hurried his departure or not I do know that we tried everything possible. If I had it to do over, I'd do exactly what we did. It was a very expensive process but we know we acted in Palmer's best interest all along the way. The support I got from this forum was invaluable.

This was kind of long but I wanted to give you our experience with Trilostane. Another day, another doggie I might do differently.
As I often say-you make the best decisions you can based on the information you have at the time. You can't second guess yourself. You will get honest opinions here and some you may not agree with and everyone here is going to support you anyway. We will stand with you shoulder to shoulder down your own path. I would suggest, while this is all very scary and upsetting, that you try to enjoy the moments. None of us knows how or when things will turn out. I received many posts on here about how Cushings' need not cause an early death...and many, many people said how they felt their pooches died from something unrelated to Cushings.

I hope this goes well for you.

-Susan

[maish costello]

Hi Maish-

I so vividly remember when Palmer and I first started down this path. I was scared, confused, totally unfamiliar with Cushings'. I read and read on the internet and fortunately found this forum. Here members have all kinds of experience and wisdom to offer. They will answer every question you ask. The folks here have walked this path and really understand what you are going through.

I put Palmer on Trilostane. I received a lot of posts that suggested I not do that-that we should start of with the Lysodren. Trilostane is a capsule. Your vet will tell you what amount to give....I think it relates to the weight. We tried the Trilostane for a month or so and new test results indicated it was working well. Next tests and the results were not as good. I became convinced that we should go to Lysodren. We talked with the vet about it and she did not feel we should do that. I got all kinds of suggestions for questions to ask her and questions about running tests. This forum saved me from going off the deep end. I started telling the vet that I wanted to try Lysodren. The vet had consulted with all kinds of colleagues and they supported her feeling that we needed to give this more time. I of course felt that giving it more time was unnecessary and risking Palmer's future. We reached a point where the vet wanted us to go see a specialist Internal Medicine dude. She told us that she felt she was being pressured to do something that she did not feel was appropriate at the time. She said we had initially had very good results and that we just needed to give this some time. Now-when we first talked about this she mentioned Lysodren as a treatment....so she was willing to do it then, but once we decided on Trilostane, with the initial good results, she wanted us not to be skipping around from treatment A to treatment B. She said if we kept our opinion she did not feel she could support us. She reminded me that she had a doctorate's degree and also that she could tell from my questions that I didn't really understand all there was to understand. (I think she was having a bad day.) She just really didn't like being second guessed. She had earlier told me how she was impressed by the questions I came in with and that my research was evident. We asked her that if the IM doc supported our position....what then? She said if that were the case that she would then support us. Talk about scary. I felt like I was in the middle of a tornado with all that I was trying to learn and with my worries about Palmer. Anyway-we stuck with the Trilostane and the results became much better. We never did go to Lysodren.

Palmer did well on the treatments. He lost some hair....a good bit, but some of that eventually came back. His belly had gotten so big that he could no longer jump up onto furniture. For a good period of time I had to lift him up when he wanted to come up. His belly went down a good bit and he returned to jumping up for himself. The symptoms were being controlled. We did not see any negative effects. I feel we made the right choice for us.

Part of what I find so frustrating about this is the vagueness of diagnoses. I have a math background and I always want 1 + 1 to equal 2. We could find out only so much about Palmer without having surgery. We were not going to put Palmer through surgery. In the end I don't know whether Cushings shorted Palmer's life or not. He continued to have good test results....we had an excellent report one month before he crossed. In those last 4 weeks Palmer went downhill very fast. He stopped eating. We took him in for various tests with the IM dude. His pancreas seemed to be causing the most problem. His poor little body-he'd lost 6 pounds in a couple of weeks-and he only had 20 to start off with-his body just gave out on him.

While I don't know if Cushing's hurried his departure or not I do know that we tried everything possible. If I had it to do over, I'd do exactly what we did. It was a very expensive process but we know we acted in Palmer's best interest all along the way. The support I got from this forum was invaluable.

This was kind of long but I wanted to give you our experience with Trilostane. Another day, another doggie I might do differently.
As I often say-you make the best decisions you can based on the information you have at the time. You can't second guess yourself. You will get honest opinions here and some you may not agree with and everyone here is going to support you anyway. We will stand with you shoulder to shoulder down your own path. I would suggest, while this is all very scary and upsetting, that you try to enjoy the moments. None of us knows how or when things will turn out. I received many posts on here about how Cushings' need not cause an early death...and many, many people said how they felt their pooches died from something unrelated to Cushings.

I hope this goes well for you.

-Susan

Susan,Marianne,Glynda and Debbie,

I am sitting here now reading all your responses over and over and over again. These past weeks have no doubt being a roller coaster ride for the whole family. Our world has changed in so many ways since Mikey changed,I cannot say that he is sick because he is the vibrant lil pooch as he always was,his energy levels are the same since we adopted him back in 2000. As I previously told you guys,his belly is a lil larger and some hair lost,but that's it...the panting has stopped and his thirst and "hunger" episodes have decreased enormously.
The first time I heard the word "Cushing's" I thought our world was going to end because our dear Mikey was not going to survive. Through the information I have tried to consume with this forum and with the support of Mike's vet and as a matter of fact the whole team/staff at the clinic,I am starting to relax just a tad concerning my fears of this horrible disease. I have a LONG way to go yet,I am still quite nervous around him since the swelling in his belly. I lift him very gently onto the furniture when he wants to torment me by stealing all the socks when I am folding laundry. He has always been a lover of playing with socks and when company is here,they have to guard their socks because Mike will literally take them off their feet..this is true.
Mike has that 8 hr test again this coming Monday and hopefully an ultrasound will be performed. I really don't know if I am doing right or wrong,some suggest canceling this test,but I am going to have it done. I have to do everything possible for Mike,it breaks my heart to have him go thru a whole day again at the clinic,but if I don't do this I feel that I am not doing all that I can do for him. Whatever is available to get Mike back on track again,it's going to be done. I am taking one day at a time,learning as I go,some days I pick up a lil information and trying to educate myself as much as possible. I sit alone most nights while Mike is snoring at my feet..I read and read whatever I can find concerning Cushing's. I can't say that I am any further knowledgeable on this disease,but I know that whatever is in my power to help my lil buddy I am going the full nine yards. Some people look at me as if I'm crazy,spending all that money on a dog...Mike is not just a dog to me...he is everything to me...we are together 24/7... When I adopted Mike from the shelter when he was 6 weeks old I feel in love with him at first sight. We were staying at a hotel while my husband was working on a job there and Mike had a fantastic time shredding 2 rolls of bathroom tissue while we went out for dinner..oh what a mess !!!! Memories,I can go on and on,but I don't want to bore you or take up too much of your time.
I am not an educated person,I have no degrees. I am just a mother,a wife and a grandmother...I love my family dearly. I work outside the home a couple of months of the year,with a pet sitter in place for Mike....I'm just an average everyday run of the mill person. I do not understand this medical terminology.....it's way over my head ! I want to continue to be a part of this forum,I a
m picking up some valuable information from time to time. I appreciate your advice and support..I told Mike's vet that I am doing some research concerning cushing's and she supports the suggestions I make...
I thank you each and every one for being here for Mikey and me...
We again are blessed with a new fallen snow and I'm beginning to think that the boss up above is creating all this for Mike because he totally enjoys playing in the fluffy white stuff with Mom in tow...
Wishing you all a wonderful joyous day....

Love,
Mikey and me....

[StarDeb55]

Maish, I don't want to alarm you even further. You have indicated that Mikey seems to like to run around, jumping up/down on things. You might want to try to slow him down some until treatment starts, & you get his Cushing's under control. Due to the muscle wasting that Cushing's causes, it appears that this also affects the tendons & ligaments. I don't know what a vet would say about this, but it appears that our pups have a higher risk of rupturing cruciate ligaments in their knees. My first boy, Barkley, was simply chasing a toy that I had thrown for him into the kitchen. He sort of slipped on the linoleum, & BOOM, he comes up limpling. He had ruptured that ligament, & abnormal preop labwork is what put us on the road to a Cushing's diagnosis. John, Roxee's Dad, had the same thing happen to Roxee. There are a number of others whose pups have suffered through this. Don't become alarmed, but it might be a good idea to try to slow Mikey down for awhile.

Debbie

[maish costello]

Thank you Debbie !!!!! I wondered about all this activity if it was dangerous in any way..............I will most certaintly slow him down...so kind of you to bring this to my attention...ty..:)
Maish

[maish costello]

Maish, I don't want to alarm you even further. You have indicated that Mikey seems to like to run around, jumping up/down on things. You might want to try to slow him down some until treatment starts, & you get his Cushing's under control. Due to the muscle wasting that Cushing's causes, it appears that this also affects the tendons & ligaments. I don't know what a vet would say about this, but it appears that our pups have a higher risk of rupturing cruciate ligaments in their knees. My first boy, Barkley, was simply chasing a toy that I had thrown for him into the kitchen. He sort of slipped on the linoleum, & BOOM, he comes up limpling. He had ruptured that ligament, & abnormal preop labwork is what put us on the road to a Cushing's diagnosis. John, Roxee's Dad, had the same thing happen to Roxee. There are a number of others whose pups have suffered through this. Don't become alarmed, but it might be a good idea to try to slow Mikey down for awhile.

Debbie

Hi,
It's me again...........
Mikey's test results of the 2nd hi dose suppresion test came back today and the results are identical to the first one !!!! I did not get a chance to get the results faxed to Glynda as I was not in the area of the vet clinic today but will get those results this coming week.
An ultrasound is scheduled for next Thursday,it could not be performed while Mikey was at the clinic having the supression test done...(last Monday)...
Please don't say,"I told you so..."...I should have not had this last test done but I was hoping against hope that it would determine which type of Cushing's,or if Mikey has cushings...I am so confused now.....
Please help and try to answer my questions...
When an ultrasound is performed,can it determine %100 the type of cushing's?.....or just adrenal cushing's?.....how can pitituary cushing's be ruled out?...........
As for Mikey's thyroid panel,the results have yet to reach the vet clinic....normal procedure for testing is sent to another province other than my province and the results are usually back with 3-5 days,tops...........however,the thyroid panel is not back yet...Question for you............is it possible that Mikey do not have cushing's and maybe he has a thyroid problem..I realize I am asking dumb questions here...but isn't it a possibility that something else is going on with him?.............
whew....I don't know what to think anymore....

Maish

[lulusmom]

Hi,
It's me again...........
Mikey's test results of the 2nd hi dose suppresion test came back today and the results are identical to the first one !!!! I did not get a chance to get the results faxed to Glynda as I was not in the area of the vet clinic today but will get those results this coming week.
An ultrasound is scheduled for next Thursday,it could not be performed while Mikey was at the clinic having the supression test done...(last Monday)...

Maish, The first dex test that was done was the "low dose" (LDDS) which was consistent with cushing's but did not differentiate between adrenal and pituitary disease. It is my understanding that you vet then did the "high dose" dex test (HDDS) to make this determination. Are you saying that your vet did two of the HDDS tests and that the results were identical?


Please don't say,"I told you so..."...I should have not had this last test done but I was hoping against hope that it would determine which type of Cushing's,or if Mikey has cushings...I am so confused now.....

Maish, we would never tell you "I told you so". We have all been where you are and we know how difficult it is for all this stuff to sink in and make sense. We're here to help you soak everything up and if you hang around long enough, I promise that one day the light bulb will go on and you'll get it. Just hang in there and keep reading and asking questions. Most of the time we're trying to to make members understand how important it is to do adequate testing done and here you are telling us that you shouldn't have done the last test. Nah, you are just being conscientious and Mikey is lucky to have a mom that's got his back. :D


Please help and try to answer my questions...
When an ultrasound is performed,can it determine %100 the type of cushing's?.....or just adrenal cushing's?.....how can pitituary cushing's be ruled out?...........


When the ultrasound is done on a good quality, high resolution machine and done by a vet or technician that knows what they are doing, they can usually see both adrenals and can determine the type of cushing's involved. If a dog has pituitary cushing's, the adrenal glands can be normal size but most of the time they are both equally enlarged. If an adrenal tumor is involved, one adrenal gland is usually much bigger than the other. The other gland is smaller or even atrophied.


Hi,
As for Mikey's thyroid panel,the results have yet to reach the vet clinic....normal procedure for testing is sent to another province other than my province and the results are usually back with 3-5 days,tops...........however,the thyroid panel is not back yet...Question for you............is it possible that Mikey do not have cushing's and maybe he has a thyroid problem..I realize I am asking dumb questions here...but isn't it a possibility that something else is going on with him?.............


I suppose it's possible but I think Mikey probably does have cushing's. If Mikey is like the majority of cushdogs, he may have low T4 but it will normalize once treatment has lowered the excess cortisol.

Maish, there is no such thing as a dumb question. Being a mom or dad to a cushdog is not easy and I know your brain is frazzled but try to relax. I promise we're all with you now and we'll get Mikey on the right track together.

Glynda

[Bailey's Mom]

Hi Maish-
I am just here to echo what the others have told you....there is no dumb question. If you look back at the beginning of my thread, and my journey, you will see that I asked a gazillion questions. I always got answers back.
I too found this overwhelming and felt like I was in the middle of a tornado, in my brain. It took quite some time before I started to really get this and understand what we were dealing with. At some point that light bulb will come on....it did for me. Even after the light bulb, though, I still had to ask questions based on Palmer's test results and the road we went down.
I won't mind being corrected but my feeling is that with Cushings you try to best treat the symptoms and therefore the disease. Once we got Palmer on track, he was back to his usual self. My goal was to help Palmer be as symptom free as possible and to do my best to see that he was feeling well. My friends here held my hands all the way. There seems to always be someone here who can answer any question. Most importantly they can give you the knowledge that you are not alone and there is a lot of support here for you. Keep getting the necessary tests, post the results here and love Mikey even more than you already do, if that's possible. All each of us has is today, this moment. It is so important, I think, to value where you are now. Your worrying will be sensed by Mikey and you don't want that. It's just putting one foot in front of the other. and maybe don't read a whole lot on the internet about Cushing's. There is a lot of misinformation out there and it can cause great distress. After I did my initial web research, I mostly relied on this forum. Don't worry about today.....it will be here tomorrow and when it is here, today will be yesterday..... Give Mikey extra hugs and kisses. You also don't need to have questions to post. You can just come on and say "I'm scared or I'm frustrated......or I need a hug."
Take care.:) Hug, hug.
-Susan

[maish costello]

Maish, The first dex test that was done was the "low dose" (LDDS) which was consistent with cushing's but did not differentiate between adrenal and pituitary disease. It is my understanding that you vet then did the "high dose" dex test (HDDS) to make this determination. Are you saying that your vet did two of the HDDS tests and that the results were identical?



Maish, we would never tell you "I told you so". We have all been where you are and we know how difficult it is for all this stuff to sink in and make sense. We're here to help you soak everything up and if you hang around long enough, I promise that one day the light bulb will go on and you'll get it. Just hang in there and keep reading and asking questions. Most of the time we're trying to to make members understand how important it is to do adequate testing done and here you are telling us that you shouldn't have done the last test. Nah, you are just being conscientious and Mikey is lucky to have a mom that's got his back. :D



When the ultrasound is done on a good quality, high resolution machine and done by a vet or technician that knows what they are doing, they can usually see both adrenals and can determine the type of cushing's involved. If a dog has pituitary cushing's, the adrenal glands can be normal size but most of the time they are both equally enlarged. If an adrenal tumor is involved, one adrenal gland is usually much bigger than the other. The other gland is smaller or even atrophied.



I suppose it's possible but I think Mikey probably does have cushing's. If Mikey is like the majority of cushdogs, he may have low T4 but it will normalize once treatment has lowered the excess cortisol.

Maish, there is no such thing as a dumb question. Being a mom or dad to a cushdog is not easy and I know your brain is frazzled but try to relax. I promise we're all with you now and we'll get Mikey on the right track together.

Glynda

Hi Glynda,
If at all possible I will try and fax the last test results to you asap...Mikey will have an ultrasound done this coming Thursday...I am in a tail-spin..I don't know what to write anymore..I will pop back in when I have more information for you and hopefully those recent test results...Thank you for being here...:)...Maish and Mikey.

[maish costello]

Hi Maish-
I am just here to echo what the others have told you....there is no dumb question. If you look back at the beginning of my thread, and my journey, you will see that I asked a gazillion questions. I always got answers back.
I too found this overwhelming and felt like I was in the middle of a tornado, in my brain. It took quite some time before I started to really get this and understand what we were dealing with. At some point that light bulb will come on....it did for me. Even after the light bulb, though, I still had to ask questions based on Palmer's test results and the road we went down.
I won't mind being corrected but my feeling is that with Cushings you try to best treat the symptoms and therefore the disease. Once we got Palmer on track, he was back to his usual self. My goal was to help Palmer be as symptom free as possible and to do my best to see that he was feeling well. My friends here held my hands all the way. There seems to always be someone here who can answer any question. Most importantly they can give you the knowledge that you are not alone and there is a lot of support here for you. Keep getting the necessary tests, post the results here and love Mikey even more than you already do, if that's possible. All each of us has is today, this moment. It is so important, I think, to value where you are now. Your worrying will be sensed by Mikey and you don't want that. It's just putting one foot in front of the other. and maybe don't read a whole lot on the internet about Cushing's. There is a lot of misinformation out there and it can cause great distress. After I did my initial web research, I mostly relied on this forum. Don't worry about today.....it will be here tomorrow and when it is here, today will be yesterday..... Give Mikey extra hugs and kisses. You also don't need to have questions to post. You can just come on and say "I'm scared or I'm frustrated......or I need a hug."
Take care.:) Hug, hug.
-Susan

Hi Susan,
Thank you...
Confusion is an understatement for a description of me right now...it's just that I was hoping we would have found out what is happening with Mikey...this is draining to say the least...test after test after test...and now this coming Thursday he is scheduled for an ultrasound..it's breaking my heart that Mikey has to go thru all of this testing...my husband keeps reassuring me that we have to do this in order to make Mikey well again...I realize this is true,but having Mike at the vet clinic is so upsetting to him....I count the seconds when he is away from me. As I type this message to you my face is soaked with tears. I hope please God that we will soon find out what type he has and treatment will get Mike back on even keel again. It's just that I don't want Mike to have cushing's...every time I hear that word I get sick to my stomach,I am being totally honest with you..it makes me angry that my Mike is sick. Please forgive my "venting" and being somewhat of a baby here...but I'm so very worried about my lil buddy and I don't want him to be sick...I will check back later with you kind people...thank you for being here for us....you are my safety net...
Wishing you a wonderful day...

Maish and Mikey...xoxo

[lulusmom]

Here are the results of the high dose dex suppression test (HDDS), which unfortunately did not differentiate between adrenal and pituitary based disease. I believe this is why the HDDS is falling out of favor.


In nmol
Pre: 272
8 hr: 342

In ug/dl
Pre: 9.86
8 hr: 12.4

Interpretation: Below 50% of baseline at 8 hours for High Dose = adequate suppression.

This dog has shown inadequate suppression of the cortisol concentration 8 hours following a high dose of dexamethasone. The result today does not allow differentiation between pituitary dependent hyperadrenocorticism and adrenal neoplasia.

I'm sorry that the HDDS was of no value but the good news is that your vet should be able to differentiate between pituitary and adrenal on the ultrasound findings. When looking back at the results of the LDDS test, Mikey suppressed at 4 hours and escaped suppression at 8 hours. While the suppression was not enough at either 4 or 8 hours to diagnose pituitary, this "V" pattern is what you see in 85% to 90% of dogs with pituitary dependent cushing's. I'm therefore betting that is what you are looking at.

Glynda

[maish costello]

Here are the results of the high dose dex suppression test (HDDS), which unfortunately did not differentiate between adrenal and pituitary based disease. I believe this is why the HDDS is falling out of favor.



I'm sorry that the HDDS was of no value but the good news is that your vet should be able to differentiate between pituitary and adrenal on the ultrasound findings. When looking back at the results of the LDDS test, Mikey suppressed at 4 hours and escaped suppression at 8 hours. While the suppression was not enough at either 4 or 8 hours to diagnose pituitary, this "V" pattern is what you see in 85% to 90% of dogs with pituitary dependent cushing's. I'm therefore betting that is what you are looking at.

Glynda

Hi Glynda,
Happy you got my fax..:)
Yes,the vet told me that she should determine with Mike's upcoming ultrasound on Thursday....
So what happens then? I realize treatment is the next step...what do you recommend?....I am thirsty for your opinion and all/any information you can give me.....

Maish

[lulusmom]

Maish,

I seem to recall that the only symptom you were seeing was hair loss on the face and knuckles. Is that correct? I already mentioned that this is not a normal cushing's symptom unless demodex mites are the cause. A skin scrape would have to be done to determine this. Were you able to discuss this with your vet? If the hair loss is not due to demodectic mange, then the cause of the hair loss needs to be investigated.

I may have mentioned this already but even if all of the diagnostic tests are consistent with cushing's, in the absence of symptoms, treatment is not recommended. Has your vet discussed this with you? If not, you really should get her thoughts on this. Just remember that symptoms are a huge component of a confirmed diagnosis and Mikey has no symptoms.

Glynda

[Buffaloe]

Hi Maish,

The diagnostic process for cushing's can be long and frustrating. It took us a full two months and a myriad of tests to finally get my dog's diagnosis.

I think the results of your low dose dex. test point toward the diagnosis of a pituitary tumor, PDH. The four hour value for Mike was 6.92 which is less than half of his baseline value of 13.99. Half of 13.99 is 6.99. Hence, he suppressed at greater than 50% at the four hour mark. Then, his value rose to 11.56 at the eight hour mark. Please see the quote below:

.• If the value at 4 hours is at least 50% lower than the basal value and increased again after 8 hours, PDH is very likely.
• If levels should remain high, it indicates a SCS and more likely an adrenal tumor, but it could be a dexamethasone-resistant pituitary tumor.

I think you are correct in proceeding with a top quality ultrasound for Mikey. If PDH is confirmed and he starts showing cushing's symptoms, you can treat Mike effectively with either Lysodren or Trilostane. Hang in there, you are doing absolutely great!

Ken

[maish costello]

Maish,

I seem to recall that the only symptom you were seeing was hair loss on the face and knuckles. Is that correct? I already mentioned that this is not a normal cushing's symptom unless demodex mites are the cause. A skin scrape would have to be done to determine this. Were you able to discuss this with your vet? If the hair loss is not due to demodectic mange, then the cause of the hair loss needs to be investigated.

I may have mentioned this already but even if all of the diagnostic tests are consistent with cushing's, in the absence of symptoms, treatment is not recommended. Has your vet discussed this with you? If not, you really should get her thoughts on this. Just remember that symptoms are a huge component of a confirmed diagnosis and Mikey has no symptoms.

Glynda

Hi Glynda,
This hair loss started about 3 wks ago,just off his snout...believe it or not,the hair is growing back,but it's white...????...age,maybe?....as for his knuckle,I had it checked out with the vet and she never made too much about it,she put some ointment to the area and now it's fine....weird,eh?
Around October Mikey started gaining weight,as I thought...and his apetite increased as well as thirst...this went on for a month or so,decreased a lil,then back in full throttle during the Christmas season...........while bathing him on 2 seperate occassions I noticed he was becoming heavier and his belly was rounder and "drum-like"....this raised red flags and off to the vet we went.....From that time to the present,his symptoms varies from day to day. If I give him a treat of people food,now just a morsel,the panting starts again if he is around us eating????...........other than that..nothing. The thirst,yes is still high on the scale........but all in all,all those symptoms presents themselves at different times............
so confusing.............!

Maish and Mikey

[maish costello]

Hi Maish,

The diagnostic process for cushing's can be long and frustrating. It took us a full two months and a myriad of tests to finally get my dog's diagnosis.

I think the results of your low dose dex. test point toward the diagnosis of a pituitary tumor, PDH. The four hour value for Mike was 6.92 which is less than half of his baseline value of 13.99. Half of 13.99 is 6.99. Hence, he suppressed at greater than 50% at the four hour mark. Then, his value rose to 11.56 at the eight hour mark. Please see the quote below:

.• If the value at 4 hours is at least 50% lower than the basal value and increased again after 8 hours, PDH is very likely.
• If levels should remain high, it indicates a SCS and more likely an adrenal tumor, but it could be a dexamethasone-resistant pituitary tumor.

I think you are correct in proceeding with a top quality ultrasound for Mikey. If PDH is confirmed and he starts showing cushing's symptoms, you can treat Mike effectively with either Lysodren or Trilostane. Hang in there, you are doing absolutely great!

Ken

Ken,
Thank you for taking the time to help my Mike...we certaintly appreciate your knowledge and kindness.
I am "new" and very uneducated concerning this cushing's disease,it's a whole new ballgame for me,we were thrown a curve ball without a catcher's mitt...but,we are still in the game !!!
From what I am learning here on this so informative forum and with Mike's vet sadly,I am coming to the realization that my boy do indeed have PDH. :(
I have been reading up on the treatments and it scares the be jeepers out of me...especially Lysodren !!!....Hopefully we won't have to go in that direction of treatment...fingers crossed here.
But all in all,I am starting to relax a tad concerning all this.....especially the support I am receiving from you guys/gals...super people...thank you for being here....!!!!!

I'll fax Mike's ultrasound test results if indeed there are results to fax???? Mike's previous test had to be sent out of province for testing,but I am unfamiliar with ultrasound testing?...oh well,that's another chapter...
Until then...God bless you all...thank you for caring...:)

Maish and Mikey..

[maish costello]

Good Morning,

Mikey has been diagnosed with pituitary dependant and started his first treatment with Vetoryl (Trilostance capsules),30mg as off 5 minutes ago.........ok,here we go.............!!!!! Fingers crossed,prayers bouncing off heaven's doors,the whole nine yards........

I am still a nervous wreck .......

Maish:eek:

[lulusmom]

Maish, what were the ultrasound findings? Since you started treatment, I am assuming your vet saw two enlarged adrenals which is consisten with pituitary dependent disease. Is that correct? Did your vet have any concerns with starting treatment in the absence of any real symptoms that are normally seen with cushing's?

Glynda

[maish costello]

Maish, what were the ultrasound findings? Since you started treatment, I am assuming your vet saw two enlarged adrenals which is consisten with pituitary dependent disease. Is that correct? Did your vet have any concerns with starting treatment in the absence of any real symptoms that are normally seen with cushing's?

Glynda

Hi Glynda,
Yes,Mikey's vet did indeed see both enlarged adrenals...:(
Mikey as I stated earlier do have symptoms....panting,which has decreased somewhat but his thirst is still over normal drinking pattern. Due to those symptoms that's why the red flags sent us immediately for a check-up.,which now has been determined he has pituitary dependent cushing's disease...

Maish

[Bailey's Mom]

Maish-
It's really not as scary as it seems. I only say that from hindsight. Keep thinking positive thoughts!
-Susan

[maish costello]

Maish-
It's really not as scary as it seems. I only say that from hindsight. Keep thinking positive thoughts!
-Susan

Thank you Susan....how sweet of you to drop a note to me...
Well,this is day 2 for the meds....so far,so good. I am watching Mikey like a hawk..lol...he has to visit the vet in 10 days for a check up and some blood work to see how things are going with the meds. Hopefully things will pan out now,God willing.

Maish and Mikey...:D

[Squirt's Mom]

Hi Maish,

How is Mikey doing these day? Would love an update!

Hugs,
Leslie and the gang

[maish costello]

Hi Maish,

How is Mikey doing these day? Would love an update!

Hugs,
Leslie and the gang

Sorry I haven't been here in 'dog's ages',but I am so very happy to report that Mikey is doing just wonderful !!! He is on 40mg of Vetoryl daily...he had a check up 2 weeks ago(acth) and his levels are decreasing...another check up in June. He is back to his old self again and can now jump up on the furniture again....We are thrilled !!!

Love,
Maish and Mikey

[addy]

I love this kind of update:D:D:D:D:D:D:D:D



GOOD NEWS!!!!!!! WE LOVE GOOD NEW!!!!!!!!!


Keep up the good work.

Hugs,
Addy

[littleone1]

Hi Maish,

This is such good news about Mikey. It's really great when we see our fur babies acting like their normal selves.

[Bailey's Mom]

Hi Maish-
That's GREAT news!! I remember how happy I was when Palmer could once again get himself up on the sofa.
Keep the good news coming!!
-Susan