possible cushings (7 y/o border terrier)

[madison's mommy]

just going through the testing phase with my 7 year old border terrier, I live in New Jersey, was wondering if anyone know of a vet in the jersey area? looking for a specialist.... Looks like maybe adreanal cushings... Her symptoms are thinning hair, elevated liver enzymes and urine infection.. Just finished antibiotics today re test urine Monday... Possible sonogram Tuesday....The thing that is stumping my vet is that her water and peeing are normal.... Her thyroid is low also.. and last year this time she tested lyme positive... any help would be appreciated thanks again, Sharon

[mytil]

Hi and welcome to our site.

Here is a link where you can locate a specialist near you - http://www.k9cushings.com/forum/showthread.php?t=182.

Terry

[lulusmom]

Hi Sharon and welcome to the forum.

The symptoms you describe are not exclusive to cushing's and as you mentioned, the most common symptoms seem to be missing in your dog's case. Any kind of infection can elevate liver enzymes so the UTI could have been the culprit. We will be able to provide you with a lot more meaningful information if you can provide us with additional information. To get the ball rolling, can you please get copies of all testing that has been done thus far and post the results here? With respect to the blood chemistry, just post the high and low values, including the normal reference ranges and reporting units, i.e. ug/dl, nmol.

How far are you from N.Y. City? If it's a reasonable drive, you may want to consider consulting with Dr. Mark E. Peterson. He is a world reknown expert/specialist in endocrinology and in my opinion, he's one of the best. I wouldn't hesitate to have him treat my two cushdogs.

http://www.drmarkepeterson.com/contact/

I'm really sorry for the circumstances that brought you here, Sharon, but I'm glad you found us. We're here to help you in any way we can. Please take a look at the Helpful Resources section in your spare time so that you can familiarize yourself with the disease and whatever treatment you may choose if your dog is ultimately diagnosed with cushing's. It's a serious disease that requires serious drugs but if your vet is experienced and you are educated, treatment can be easily facilitated with few or no side effects. You've just found a great bunch of hand holders with a wealth of experience so just know that you're not alone.

Looking forward to seeing the test results.

Glynda

[madison's mommy]

here are Madison's test results, which i don't understand..... dex suppression----------- pre 3.2 cortisol 2------ 2.0 cortisol 3------2.9 cortisool urine 38.1 creatinine 233.2 ALT 201, alkaline phosphatase 147, CBC, platelet count 417 (high), basophils 170(high) T4 0.6 (low) That'swhat I have... Thanks Any help would be grateful.............. Sharon

[Cushpup]

Won't comment on the Cushings part. Other people with lots of testing in that area can chime in.

The THYROID is wayyy too low. At .6 she's probably feeling dizzy. I would ask the Vet to put her on Soloxine or something ASAP. Normal range for Thyroid is 1.0-4.0. My Vet says that once they're placed on Soloxine the range should even be higher (3.5-5.0). I know it doesn't make sense, but that's what he learned going to some educational seminar.

Many of the Cushings, Thryroid, and Diabetes symptoms overlap so your Vet should test all. Those are all part of the Endocrine System.

FYI-I've had 2 dogs with a thyroid problem and I can tell you that Bladder and ear infections are pretty common when the thyroid is out of wack. In fact, my first dog with the thyroid problem had allergies, weight gain, and a couple of bladder infections. The drinking was normal. I took her in because I was feeding her less and she was gaining weight. A couple of times while I walked her she would squat a lot, like every 30 seconds, but didn't have a bladder infection....I guessed (not sure if there is any scientific evidence) that it had something to do with allergies/Thyroid. She was diagnosed right at that time. Once placed on Soloxine she was fine. She lived to be 18.

[lulusmom]

Hi Sharon.

Can you provide the normal references ranges for the values you just posted?

Glynda

[madison's mommy]

reference range for cortisol urine is 5-55 creatinine urine range is 100-500 .... AST 12-118 ALT 5-131, platelet count 170-400 basophils 0-150 T4 1.0-4.0 As for the Dex suppression I think from what i'm reading norm should be less than 1.4 8hrs post-dex nhyperadrencorticism cortisol level greater than 1.4 8hr post-dex also, on urinalysis PH 8.0 RANGE IS 5.5-7.0 and protein 2+ should be neg. thanks again sharon Just found another result cortisol/creatinine (urine) 51 (high)

[Rachel]

Do you have the albumin results? Albumin is a protein that binds with thyroxine so low albumin can contibute to a low T4.

[madison's mommy]

Albumin is 3.3 range is 2.7-4.4 what does this mean about her thyroid?

[lulusmom]

Hi Sharon,

Was the LDDS test done while Madison had an active urinary tract infection? If so, the results would be questionable as the LDDS is known to yield false positives in the face of nonadrenal illness and stress. Setting the LDDS aside, the bloodwork abnormalities are more consistent with hypothyroidism and so are the symptoms.

I recommended that if you were within driving distance of N.Y., you consult with Dr. Mark Peterson. I've listened to audios of his lectures on both cushing's and hypothyroidism and as a layman, I learned a lot from him. If you can't manage to see him or another specialist, ask your vet to do a full thyroid panel. You need the full panel because you cannot diagnose based solely on T4. Any number of conditions, and most certainly cushing's, can effect the thyroid and lower T4. This is called sick euthyroid syndrome and it is a temporary condition. The T4 will return to normal once the underlying illness is treated.

Glynda

[madison's mommy]

Thank you for your feedback,, I just spoke with my vet and madison still has an infection urinary... He canceled her sonogram for today and gave more antibiotics, Clavamox for 10 days and then re-test urine and we will be doing a blood test to check her thyroid. Thanks I will have him do a full panel on her thyroid.. He did tell me that Madison's number for the dex suppression test, were not critical. He didn't tell me an infection would not damage the test. She did have that infection when he did the test... Like I have told him she doesn't drink water alot, or pee alot, and never in the house.. I am home with her all day... I've been counting the times One day 4 drinks of water and 4 pees.. I think that is fine.. I googled the Doctor in NY.. He's about an hour away.. Not too bad, I'll see after her next blood test... Thank you so very much.... Sharon

[Wolfpak]

You should also consider doing a urine culture to determine what microbe is causing the infection. Otherwise it is a shot in the dark as to which antibiotic will be effective.

Likely your vet chose the antibiotic based on what he's seen work most often in his experience, if it doesn't work, then the infection continues, and they try something different to see if it works instead.

However if you also do a culture the antibiotic can be chosen based on what is known to work for the specific infectious agent. A big plus, especially when the dog has other health issues going on.

Best luck to you!

[lulusmom]

I forgot that I wanted to comment on Rachel's post. Rachel is correct but I wanted to point out that low albumin is not a cause but rather an effect of an underlying problem, most of which are pretty serious, such as liver failure and kidney disease. As I mentioned before, any number of conditions can cause a low T4 and that includes those condition that impacts the liver's ability to produce albumin. The good news is that Madison doesn't have low albumin levels. If she did, you'd be seeing a lot more blood abnormalities and a low T4 would probably be the least of your worries.

Glynda

[lulusmom]

Hi Sharon,

I am back with some very good information that you can find on Dr. Mark Peterson's blog. One blog is on diagnosing cushing's and I think once you read it, you'll see that a fair amount of information members have given you is included in this blog. The other two blog are on hypothyroidism and hopefully, they will be very informative for you. Dr. Peterson is the first world reknown endocrine expert to start a blog where both veterinarians and pet owners can ask questions. If you only knew what a total geek I am, you'd know that this blog is sacred to me and that I read it daily. :D:D:D Anybody with a vet that has little experience, or even a lot, should not hesitate to refer him/her to this blog to research information and/or ask questions. I'm not sure they all get answered immediately but if he does respond, it's free and you can take it to the bank.

Diagnosing Cushing's Syndrome in Dogs: When Should I test? What's the Best Test to Use?
http://endocrinevet.blogspot.com/2011/02/diagnosing-hyperadrenocorticism.html

How Do We Treat Dogs With Hypothyroidism?
http://animalendocrine.blogspot.com/2011/02/how-do-we-treat-dogs-with.html

Hypothyroidism: One of the Top 10 Diagnosed Diseases of Dogs
http://animalendocrine.blogspot.com/2011/01/hypothyroidism-one-of-top-10-diagnosed.html

[mypuppy]

Hi Sharon,
I'm sorry for your Madison's health problems. I noticed you said you live in New Jersey and are looking for a specialist. Not sure where in Jersey, but I live in New York State and take my dog to Oradell Animal Hospital in Paramus, NJ. it is an hour from my home but they are the closests specialist that know how to treat this condition so I don't have a choice. Good luck and hoping you get some answers on Madison. Warm regards. jeanette

[madison's mommy]

Thank you lulusmom, good blogs from Dr. Peterson... I have bookmarked his website.. Also Thanks to everyone with the knowledge you have.. I have learned so much from you, and this website. so glad that I have found it... I have 10 days till next tests with Madison... Just hoping she can get rid of this infection.. I will suggest that when he runs the urine test, the antobiotic be choosen on the test... Thanks all Sharon

[madison's mommy]

Hello again, I took Madison to the Vet today, He's testing her liver enzymes and doing a full thyroid panel, and also a urine test.. I will have her liver results tonight.. He did say that she may not be a text book cush dog.. He said that 10% of dogs don't show some symptoms. Which is her water and peeing still normal and no pot belly.... Her hair is still very thin and her energy level is low.. But he still thinks cushings.. Maybe doing that sonogram soon.. Hopefully that will clear some of this up.. He did mention the drug Lysodren.. Also Madison is lyme positive. This happened last year in Feb. She was treated for this. Poor baby... Thanks everyone Sharon

[madison's mommy]

liver enzymes result is 320. He said that they are higher than last time.. next step ultrasound.... Is 320 bad?

[frijole]

320 is only slightly elevated and could be caused by a variety of things. Since you really don't have any symptoms I probably would not even do the ultrasound. What was the result of the thyroid test and did you do a full thyroid panel?

There is absolutely NO need to rush into treating cushings and all of the national experts agree that you don't treat a dog without symptoms. So don't fret about the drugs yet. If over time symptoms come on you can go down that path.

My gal Haley had cushings and we used lysodren for over 4 yrs and she lived to 16 1/2 and died from old age. My other girl Annie was MISdiagnosed with cushings and we started on lysodren. Trust me you don't want to do that. Please take your time and don't worry you will do just fine. We'll help all we can! Kim

[madison's mommy]

Thank you Kim. I did get the full thyroid panel, and urine, results will be in on Friday.. I'm going to take the advise of Lulusmom and call Dr. Mark Peterson in NY.. I'll hold off on the ultrasound, with my Vet. I need to find another Vet in my area.. Thanks Sharon

[frijole]

Awesome, awesome! You will be in great hands and perhaps he will have an idea of a vet you can use. I have had the same issues and know it is difficult. Vets can't be experts in all things and cushings is certainly not easy to dx or treat. Good luck and keep us posted. Kim

[madison's mommy]

We have an appointment next wedsday the 16th, with Dr Peterson. Just faxed over the test results that I have to him.. Thank-you so much.. I'm a nervous wreck over this... Sharon

[madison's mommy]

Urinalysis results PH- 7.5 alittle bit down form the last one, Protein 3+ Both saying (HIGH) .. Also Crystals 4-10... Now for the thyroid results Total T4 0.7, the last one was 0.6... TSH 0.23, range for that is 0.00-0.60 Free T4 11. range for that is 8-40 Liver enzyme test ALT= 328 Range (10-100) ALKP= 250 range (23-212)... My Vet wants me to start more antibotics, for 14 days this is the 3rd round of antibotics for urinalysis.. She's been taking meds for this since 2/10/11.. I have a question, when she had that low dex supp test she had an infection like the one she still has, can that spoil the test results????? Thanks everyone Sharon.. We have an appt. with Dr Peterson on March 16th...

Moderator's Note: Sharon, I have move your new update with the lab results into your existing thread. We usually like to keep all posts on a pup to a single thread as it makes it easier for other members to refer back to the pup's history when needed.

[lulusmom]

Hi Sharon,

To answer your question, yes the LDDS most certainly can yield a false positive result in the face of nonadrenal illness or stress. If I were a betting woman, I would bet that's exactly what happened with Madison. I'm really happy that you will be seeing Dr. Peterson on the 16th and I'll be waiting anxiously to hear what he has to say.

Glynda

[jj68]

Sharon,

Did your vet do a urine culture to find out exactly what is causing the infection found in the urine? Without a culture, it is impossible to know if the correct antibiotic is being used. I would insist upon a culture.

The crystals are most likely being found in the urine as a result of the infection (I am guessing they are struvite based on the pH value), so I wouldn't worry about the crystals at this point. I have a dog with chronic crystals, so unfortunately I know too much about that issue. When an infection is present in the urine tract, it raises the pH and struvite crystals form. If the crystals are present when there is no infection that is when you need to be concerned about crystals being formed metabolically. In Madisons case, I don't think you need to be concerned about the crystals being metabolic. If they start forming into stones, that can be an issue, but at this point I would not worry about that.

Good luck, I am very interested to find out how your appt with Dr Peterson goes.

Jill

[madison's mommy]

Thanks Jill, I hope Dr. Peterson wants to do a culture.. Wednesday can't come soon enough, can't wait to meet him. I will post as soon as I get home that day.. Can't wait to hear what Dr. Peterson has to say about Madison, and the route he will take.. Thanks so much.. I feel blessed that I found this site. You guys are truely the best... thank-you Sharon

[StarDeb55]

Sharon, just be aware that the presence of crystals in urine without an infection can be a warning of a possible problem. My Chewbacca, had struvite crystals in his urine 3 times in less than a year, with no infection. The vet & I were very concerned, so after the 3rd occurrence, he was put on a urinary prescription formula dogfood which did clear them right up. At that point in time, my thinking was the prescription food was way cheaper than paying for surgery for bladder stones. Now, I will admit that the prescription food he was on was really poor quality feed, full of grains, & some other nasty stuff. He has very bad allergies, so I took it upon myself to pull him off the prescription food about 4-5 months ago, putting him on a better quality food that is grain free. I am waiting on the results of a repeat UA, & holding my breath that he will be crystal free.

Debbie

[jj68]

Debbie,

Since Madison does have an infection and did not have crystals in the first urinalysis (they showed up in the second urinalysis), the crystals are most likely due to the high pH caused by the infection. Yes, what you said is true, crystals without an infection is cause for concern as they would indicate the crystals being formed metabolically, however in Madisons case there is an infection, so at this point, I don't think Sharon needs to add that to her list of worries :(. I have 3 dogs, one has a chronic problem with struvite crystals. My other two do not have a problem with crystals, but when they have had UTI's, they do get crystals in their urine, however the crystals clear up when the infection clears. I suspect this is what Madison is experiencing right now due to the infection. Sharon, don't add that to your list of worries yet!

I know all too well about the trials of dealing with crystals as I have been dealing with them for several years now with one of my dogs. It can be very difficult to manage. I don't want to hijack Sharons thread, so Debbie, if you are interested in learning more, I would be happy to share the information I have with you, just send me a private message and I will send you some helpful information and links that might help you with your situation with your Chewbacca.

Jill

[madison's mommy]

Back from our visit with Dr. Peterson... What a pleasant visit. Dr. Peterson and another Dr. from Brazil, are so caring.. Well the latest about Madison, he ran more tests I will have the results Thurs. 17th.. He ran a Chemistry panel, Urinalysis, Urine Protein/creat. ratio, Urine cortisol/creatinine Ratio, and T4 level. He explained that he runs them differently, then the way my Vet ran them.... He is undecided about the cushings. Dr Peterson said slightly elevated liver enzymes could be due to her Lyme also. And her numbers for liver enzymes are reversed for cushings . The way Maddie's liver enzymes are they are opposite, the ALT is higher than the ALKP He said they should be the other way around. Thanks guys I keep you all updated. Sharon One more thing the office was so stress free, Madison and I felt very comfortable...

[madison's mommy]

Hi all, I have a question, how was your pups energy level before you were told they had cushings? As i watch Madison, her energy level is better. I've been measuring her water daily, she ranges between 1/2 cup to 3/4 cup.. The things that are still bad is her coat, and she pants quite often... Wed, we go for urine culture and sonogram.. I guess I'm just afraid to hear the Dr. say she has cushings... My stomach just sinks when I think of it. I did have a dog 16 years ago that was diabetic in 1987, then she got cushings in 1991. She lived till 15 and 1/2. I don't remember much about her cushings, didn't really understand it at the time. Didn't have a computer to research... I'm just getting nervous about Wed.. I may even be in denial.... LOL thanks, Sharon

[lulusmom]

Hi Sharon,

I never noticed a difference with Lulu because she's always been like an ant in hot ashes, especially when there is food around. Jojo, on the other hand, was pretty lethargic before treatment. He was a rescue we kept so I didn't really know he was acting lethargic until the meds kicked in. He became much more lively after we got him stabilized.

Being in denial at the moment is perfectly okay because until Dr. Peterson finishes his testing and he confirms a diagnosis, Madison doesn't have cushing's. Right?

Aside from Madison's coat and the intermittent panting, what about her makes you think she has cushing's? If her pee is concentrated and she is not having accidents in the house, I doubt you have to worry about watching how much water she is drinking....unless Dr. Peterson told you to keep track of it. I think I mentioned that most cushdogs' kidneys lose the ability to concentrate the urine which increases the frequency and amount they pee. Most people think they pee more because they are drinking more but the the opposite is true. They have to drink more to keep up with the excessive peeing, otherwise, they can quickly dehydrate.

Is Madison overweight at all? I ask because dogs that are even slightly overweight can have excessive fat in the thorax area which can labor the breathing which causes panting. Dogs with cushing's can lose hair pretty much everywhere but the feet, legs and head. My two dogs started losing their coat on their flanks and back. Where is Madison's hair thinning?

Glynda

[madison's mommy]

Yes, Dr. P wanted me to measure her water daily.. Madison's hair thinning is lower shoulder area, and at the base of her tail. Like the whole upper back... it looks alot most frazzeled.. no undercoat, and very dry. She's not over weight. Maybe a 1lb. she could loose.. She's been the same weight for about 4 years. Thanks Glynda---- Sharon

[frijole]

Sharon, I'd be surprised based on what you have shared that Madison has cushing's. I know you are in fantastic hands though and I would give anything to have my dog being taken care of by Dr P. Hang in there and don't be afraid. You aren't alone on this journey. Kim

[madison's mommy]

Thanks Kim... How's Annie today? hope all is well.. Sharon

[frijole]

Thanks Kim... How's Annie today? hope all is well.. Sharon:D You are so welcome. Miss Annie is having a good day. I got her to eat both meals and take all her meds so that is always a good day. Looking forward to your next update. Kim

[madison's mommy]

We are back from our visit with Dr.P... So the sonogram did show enlarged liver, kidneys and adrenals are good!!!!!! Bladder did show gunk floating around, they did get a culture of urine with the floating stuff, I will have the result Friday.. As far as cushing with Madison, Dr. P did say its a wait and see kind of thing.. He's not ruling it out, he kinda does think that could be the problem. I just need to watch her, and keep measuring her water intake... A wait and see.. I also need to get her liver tested in 3 months.. I did read about a supplement for the liver is it Milk thistle? If so I will ask Dr. P about that on friday. Anyhow it was a very exhausting day... They did a very through sonogram exam on Madison about 40 mins... Dr. P really didn't give me an answer on my one question so, I'd like to ask you guys , her hair thinning. could that be caused from an infection(bladder)? Thanks all Sharon

[jj68]

Sharon,

I can't really comment on the cushings because I was fortunate that my dog only has a mild case of atypical cushings, so I have not lived what most of the members on this forum have lived relative to cushings. There are two things I can comment on based on my experience with my dogs.

The enlarged liver - when my dog was being diagnosed, his ultrasound showed the opposite - he has a small liver. I was told the same thing as you - a recheck needed to be done. The reason for the recheck was to see if the size of the liver changed at all, if it did that would indicate a problem, if it didn't that would mean that he just has a small liver and that is ok. In my dogs case, the second check was done a year later and he liver was the same size, meaning it was not shrinking (or dying), so that was very good news. I am guessing that is what they are after in Madisons case, to see if she just naturally has a large liver, or if the liver is enlarging for some reason.

The "gunk" floating in the bladder ..... Did they say "gunk" or did they say stones? This actually concerns me a bit because Madison had crystals. My first impression regarding the crystals was that it most likely was a non-issue because the previous urinalysis did not show any crystals so my thought was that the crystals in the second urinalysis were just related to the high pH caused by the infection. But if they are seeing "gunk" floating in the bladder, my thought now (and concern) is whether that "gunk" is crystals starting to form into stones. Of course, I am sure there may be other explanations for the "gunk" other than crystals and stones. However, if the "gunk" is related to crystals I can give you information to help you with this issue. I have unfortunately been dealing with this for several years now with one of my dogs and as a result have resources that can help you. Since crystals is not a cushings issue, it would be inappropriate to discuss in this forum. I will send you a private message with my email address if you need to contact me, I don't visit this forum that often, so email would be the best way to get in touch with me if you need to.

Good luck, and hugs to Madison.

Jill

[madison's mommy]

Thanks Jill

[lulusmom]

Since crystals is not a cushings issue, it would be inappropriate to discuss in this forum. I will send you a private message with my email address if you need to contact me, I don't visit this forum that often, so email would be the best way to get in touch with me if you need to.

Good luck, and hugs to Madison.

Jill

I believe Jill is making reference to Struvite crystals because Oxalate crystals are very much a cushing's issue. Excess cortisol increases calcium excretion, which promotes oxalate crystals, which eventually collect into a stone. My cushdog, Lulu, had two bouts of oxalate stones with an accompanying painful UTI which required surgery. Surgeries were only 11 months apart with the last being done imediately prior to her being diagnosed with cushing's. I also have a healthy male Maltese who had oxalate stone surgery. I believe his problem was the kibble, which contained a lot of grain, primarily the ones that are high in oxalates. Between feeding grain free food the last three years and getting Lulu's cushing's under control, we've not had any more problems. Knock on wood!

Glynda

[jj68]

I believe Jill is making reference to Struvite crystals
Glynda

Actually Glynda, no, I was not making reference to only struvite crystals, I was making a reference to crystals in general. Yes, my experience is with struvite, and since my dog does not have cushings, I did not know that cushings could cause calox crystals. However, I do think there are better forums to discuss crystals and stones, which as you know, are very specific and difficult issues to deal with. I happen to belong to other groups that deal specifically with that issue and have found the information gained there to be extremely valuable, and the people in those forums to be extremely welcoming and respectful of all members input.

Sharon understood exactly what I was offering and she was very gracious. Let's all hope Madison's diagnosis will progress quickly and she will be on the mend very very soon!

Jill

[lulusmom]

Let me preface this by apologizing in advance for hijacking Sharon's thread for a moment but I felt it important to try to correct a misunderstanding created by my post.

Jill, I meant no disrespect to you and I won't address any issues you had with other members because it has nothing to do with my responding to a small, but very important portion, of your post which was not completely correct. For that reason, I have edited out remarks relating to anyone but myself. You mentioned that you rarely visit this forum so I understand why you may not know me, or other staff members, very well but we are pretty nice people who would never berate, belittle or take anybody to task for their post publicly. We're here to help people, not hurt them or their feelings.

Your post was actually very informative, however, I simply wanted to correct your partially incorrect statement, being, "Since crystals is not a cushings issue, it would be inappropriate to discuss in this forum." As an administrator and conscientious member, it is my job to correct or clarify any possible misinformation. We have had more than a few members with dogs with oxalate stones requiring surgery so it is very important that misinformation is corrected promptly. I came here as ignorant as they come and had I come here before I knew the connection between cushing's and oxalate stones, I would have read your post and still been ignorant of the fact that cushing's was the cause of my Lulu's problem.

A lot of our dogs have multiple issues and believe me, help and support from any forum is greatly welcomed. I refer people to condition specific forums routinely but if it's cushing's related in any way, as oxalate stones are, it's not necessary to send members anywhere. They can stay right here and get the best of the best. It is not against the rules to provide links to other support groups publicly on a thread. As a matter of fact, I personally like to do research and appreciate links to great sites so please feel free to post them here. We're all here because we care and steering people in the right direction is a good thing.

Glynda

[madison's mommy]

Just spoke with Dr. P and Madison's urine culture is Neg. as of today, he seems to think it will stay that way, I have to call him back Monday... He is saying Madison's case is Mild Cushings.. It's gonna be a wait and and see kinda thing. I will need to take Madison back to my vet to get her Liver enzymes checked..... Thanks, Sharon

[lulusmom]

Hi Sharon,

A negative culture is good news and as far as I'm concerned, is further evidence that if Madison has cushing's, it is, As Dr. Peterson says, a very mild case. As I recall, Madison's ALT and ALKP were mildly elevated so I'm hoping with everything in me that it was a transient elevation by unknown cause or by an infection that is now resolved. Please be sure to post the results here.

Glynda

[jj68]

[QUOTE=lulusmom;51789Your post was actually very informative, however, I simply wanted to correct your partially incorrect statement, being, "Since crystals is not a cushings issue, it would be inappropriate to discuss in this forum." As an administrator and conscientious member, it is my job to correct or clarify any possible misinformation. We have had more than a few members with dogs with oxalate stones requiring surgery so it is very important that misinformation is corrected promptly. I came here as ignorant as they come and had I come here before I knew the connection between cushing's and oxalate stones, I would have read your post and still been ignorant of the fact that cushing's was the cause of my Lulu's problem.
Glynda[/QUOTE]

Not quite sure what all the rest of post 41 is about, but the statement that I am quoting here is technically inaccurate regarding Madisons case. Since the goal of this thread (and I suspect of everyone replying to this thread) is to help Sharon with Madisons diagnosis I offer this information. Madison had a bladder infection that was causing a high pH and her urinalysis showed crystals. Since the pH was high, and without getting into too complicated of a disussion, the crystals were most likely struvite. Struvite crystals live high pH, they cannot live in a pH less than 7. Calox (calcium oxalate) crystals live in low pH (<7), calox crystals (and therefore stones) cannot live in pH greater than 7. Since Madison had a high pH, and she had crystals, the crystals could not have been calox and therefore, as Glynda has stated, could not be cushings related since cushings has the potential to create calox crystals (and therefore stones).

Actually, there are much more complicated stones that can form, and anytime someone has a dog with crystals or stones, it is advisable to refer them to those who specialize with that specific issue, regardless of whether or not cushings may be playing a role. Even if cushings is playing a role (though that is extremely doubtful, if not impossible in this case) there is an entire urinary system that is involved in crystals and stones that needs to be understood to be able to even start dealing with that issue. It is truly a very very specialized area, and I don't get the impression that that is understood based on the responses to my simple offer of information.

I won't be saying any more on this issue. I think I have provided Sharon with the info she needs at this point regarding Madisons situation, and this thread is for Sharons and Madisons benefit. Their struggle is difficult enough, let's not hijack them. ;)

[lulusmom]

Hello again, Jill. It is apparent by the tone of your response that my concerted effort to explain the reason for my post (#41) was an abysmal failure. You mentioned that you were not going to say anything further on the matter so please know that the purpose of this additional post is not to elicit a further response from you but rather to apologize to you and anybody else who may have misinterpreted my post as being anything other than helpful.

So let me have another stab at this so that hopefully you and members understand that I was not undermining you, contradicting you or discounting the information you have shared with Sharon and others on the forum. I was merely being conscientious by pointing out to members that the broad statement "crystals are not a cushing's issue" is not accurate. Had struvite crystals been specifically referenced by you, my clarification would not have been necessary nor would you have felt compelled, after the fact, to remind us that the information you provided should be disregarded by everyone but Sharon. This forum is about sharing knowledge and experience so without adding a disclaimer like "this information is for the sole benefit of the thread owner only", broad statements and inaccurate information can have consequences.

I would also like to make it perfectly clear that the target audience for post #41 is the general membership; the new members who come here addled by the confusion and shock of a new cushing's diagnosis or the existing members who are still educating themselves or the members who have experience with cushing's but have never dealt with urinary stones. I've been in all of those places and I know first hand that these members are probably not well versed on the differences between struvite and oxalate crystals nor have they had the benefit of years of experience and obsessive compulsive research under their belt, whether it be cushing's specific or urinary stones commonly associated with cushing's. I sincerely hope you now understand that this post, as well as my prior post, is not for your benefit but rather for the benefit of members who frequent the forum and want to learn about all things cushing's, and that includes crystals.

[madison's mommy]

Hi, Just wanted to let you guys know, Madison's urine culture is negative. So as of now, I will have to get her liver enzymes tested again in 2 months, and just keep an eye on her (which I always do).. The Dr. is saying she is a mild case of cushings.. Her energy level seems to be improving. Her coat is still very thin. Thanks, Sharon

[lulusmom]

Hi Sharon,

Thank you so much for updating us and YAY for a negative culture. I think I mentioned before that if Madison does have cushing's, she'll start to become symptomatic at some point. I'm hoping she doesn't have cushing's and that you will continue to give us updates on how well she is doing.

Glynda

[frijole]

Yeah. Sharon - there are alot of reasons those enzymes could be elevated so don't you fret at all about it being cushing's. You now have a better feel for what it is and if the signs come you will know... but I have a pretty good feeling your babe won't get it. As a mom to a dog who was misdiagnosed and it drug on for over a year... there truly are lots of other things that could have caused it. So just keep an eye on her for anything out of the ordinary and always start with the blood panel. Best of luck. Kim

[madison's mommy]

Thanks Glynda and Kim. I hope you both are right, that Madison does not have cushings, time will tell I guess, I will try and think positive, at least now I know I have a great Dr. to take her too. Also wanted to let you all know, Madison seems to be feeling better, much more energy... Thanks Sharon

[madison's mommy]

Hello to all. It seems Madison is not doing too well, Her hair is getting more thin, her belly is feeling sort of tight, and pot bellied. Her water has increased an extra 1/4 cup. Hungry all the time. I was to wait till 2-3 months to retest, But My husband and I can't wait another 3 weeks, so I'm bringing her Wed. Also she's been waking me up earlier for potty breaks.. She never did that. She is just not herself.... I know some of you don't think she has cushing,, But I really don't know what else it can be... Something is very much not right... Thanks guys,, Sharon and Madison

[labblab]

Hi Sharon,

I'm surely sorry that Madison is not doing very well. I can easily understand why you are anxious to move forward with the testing. Will you be taking Madison back to see Dr. Peterson?

Marianne

[madison's mommy]

No, Dr. P said, to go foward with my Vet. I will however fax him Madison's test results to see about Meds.. He did suggest 2 Meds for Madison in his report, if needing to be treated for cushings.. I just think its time for that step..

[addy]

Hi Madison,

Just wanted to let you know we are here for you every step of the way:) I am sorry Madison seems to be having increasing symptoms. I know that feeling because I am seeing it with my own dog.

I am sending moral support and hugs.

Addy

[madison's mommy]

Well I got Madison's test results back today.. She will begin treatment for cushings next week, with trilostane. Thanks all................... Sharon and Madison

[lulusmom]

Can you post the results of the test and let us know what dose of Trilostane your vet has prescribed? We're here for you.

[madison's mommy]

Here are some of Madison's results cortisol/creatinine ratio is 80. AST 69 ALT 456 Alk Phosphatase 330, GGTP (don't know what that one is) 66. Creatinine 0.3(low) Bun/Creatinine ratio 40, Sodiun 162 Cholesterol 420. Her platelet count 146 (low).. T4 <0.2 that at one time was 0.6 is that worse or better? Urine protein/creatinine ratio 2.0. Urinalysis Protein 3+ Everything is high and it all increased quite a bit from her last tests with were on 3/16/11.. The only thing that is low is the Creatinine and T4.. Sorry don't know the dose yet, will know more Monday when I speak to Dr P.. My Vet has been in touch with Dr. P. My Vet has never treated any dogs with trilostane.. Thanks Sharon and Madison

[lulusmom]

Hi Sharon,

I'm glad that you will be talking to Dr. Peterson on Monday. Madison's liver enzyme elevations are still not what we're used to seeing in cushing's. Her ALT has always been higher than the ALK and now it's higher yet so I'd be interested to see what Dr. P has to say about it. With three to four fold increase in ALT, I'm thinking there is something other than cushing's going on. Her thyroid is much lower this time as well. Did Dr. Peterson mention anything about possible primary liver disease?

Glynda

P.S. I forgot to mention that you may want to consider having an acth stimulation test done before starting treatment. A lot of vets will do this so they have a baseline post cortisol to use to assess the post treatment acth stimulation tests. Here's some frequently asked questions about Vetoryl (Trilostane) that can be found on the Dechra CE Learning Center.

http://www.dechrace.com/top10_managing.html

[addy]

Sending you moral support, love and hugs:):)


Addy

[madison's mommy]

Thanks Glynda for looking at Madison's test results. I have a list of questions to ask Dr P. Some are the ones you had mentioned. I will ask about liver disease.. Will let you know what he says.. Addy Thank you so much for the support... Today is Madison's Birthday, she is 8 today:)... Sharon and Madison..

[lulusmom]

Happy Birthday, Madison!!!

[Harley PoMMom]

Happy Birthday, Madison!!

[addy]

Happy Birthday to You

Happy Birthday To You

Happy Birthday Dear Madison

Happy Birthday to You!!!!!

From our house to yours, have the best birthday ever:D:D:D
Love,
Addy, Zoe and Koko

[Squirt's Mom]

Happy 8th Birthday, Madison!

Squirt says she remembers being 8 and it is a great age to be!

Butt sniffs from Squirt, Trinket and Brick,
Belly rubs and Hugs from me!

[littleone1]

HAPPY BIRTHDAY Madison. I hope you've been having a special birthday.

Terri and Corkster

[Franklin'sMum]

Happy Birthday Madison, hope you have a great day :D

Jane, Franklin and Angel Bailey xxx

[madison's mommy]

A Big Thank-You, from Madison, she is very touched with the Birthday Greetings. She had a special day with presents and extra treats.... She loves to open her presents... Thanks all Sharon and Madison xoxo hugs and kisses from Madison :)

[madison's mommy]

Madison will start Trilostane 10mg 2 times daily, she will begin this on wed. then in 2 weeks at my Vets office she will get a blood test, then in 4 weeks we go to Dr P for the acth test.. I hope this will bring my Maddie back to her old self.. Wish us luck.. Thanks, Sharon

[addy]

Hi Sharon,

I will hope and pray and cross everything I can that she will do well.

Keep us posted and let us know how Madison is doing. If you have any questions or just need moral support, we are here for you.

Hugs,
Addy

[lulusmom]

Hi Sharon,

Thanks for the update. I am assuming that the blood test you mention at two weeks is the acth stimulation test. I just want to remind you that when you take Madison in for that test, you need to have her at the vet's office no later than 4 hours after her morning dose.

Dogs are initially very sensitive to Trilostane so you may see improvements rather rapidly but you may also see her act a little puney. A good deal of the time, this is because the drug drops cortisol levels rather quickly so a dog will go through cortisol withdrawal. After all, here they've had all this feel good cortisol floating around and now the drug is dropping it like a rock. If Madison acts a little crappy after a day or two, that's probably what it is and she will adjust. However, more than crappy, meaning not eating, extreme lethargy, vomiting, diarrhea and tremors are signs that cortisol has dropped to low so if you see this, discontinue dosing and call your vet right away.

A lot of vets don't prescribe prednisone because Trilostane has such a short half life. Once you quit dosing, the dog usually rebounds rather quickly. However, when my dogs were on Trilostane, I still felt more comfortable with some Prednisone on hand so my vet gave me a few. That's something you may want to ask your vet about.

Glynda

[madison's mommy]

Thanks Addy and Glynda... No the test in 2 weeks is a blood test for liver and cortisol. Then in 4 weeks acth test with Dr. P. Is 10mg Trilostane twice a day alot? Madison weighs 17.5-18lbs.. My mother in law has prednisone on hand, so if I have an emergency she's right down the road from us she has 5 mg and 10 mg. I would call my Vet for the correct dosage on that.. I had thought half of the 5 mg.. if needed.. Also Madison's appt. for the acth test is 11:00 so I will feed her and give her pill at 7:00 am. Is that ok? Thanks all Sharon

[madison's mommy]

Quick update on Madison. She has been on the Trilostane now for 1 week. I seen a slight change in her about 4 days into treatment. But now I notice on day 6, kinda blah, (her moodand energy) and today no better, she didn't even want to eat her favorite things carrots, she did give in after some time though. Also today with her dinner she smelled it and backed off for about a half a minute. She did eat... her drinking has improved. but then again she's quite blah.. She goes for her blood test tues. for liver and cortisol. then in 3 weeks from yesterday she will have her ACTH test.. Anything I should watch for, from now till then? This is so difficult to watch,, I just want my baby back already its been such a long road. I'm very impatient sorry.. thanks for reading. Sharon and Madison..

[lulusmom]

Hi Sharon,

Madison should have an acth stimulation test no later than 14 days after starting treatment. I believe I mentioned in an earlier post that the test needs to be completed within 4 to 6 hours after Madison's morning dose of Trilostane. Trilostane will drop cortisol like a rock in the first couple of days and it will continue to drop cortisol well into the first 30 days. Since she is not herself today, please watch her for signs that her cortisol may be dropping too low. If you observe any vomiting, diarrhea, extreme lethargy and inappetance, discontinue the Trilostane and contact your vet. I highly recommend that you double check with your vet to make sure that s/he has scheduled Madison for an acth stim test within the next week or so.

Glynda

[madison's mommy]

I did call the other day because I had thought Madison had an appointment with my vet her in nj but its not till next week and that is just for a single cortisol and liver test. Dr. P. said to do that and then in 4 weeks with him in ny the ACTH test.. Thats what he said.. I'm watching her every move. On the 4th day she seemed to be feeling a bit better. but yesterday and today just like before we started the meds. Thanks Glynda , Sharon

[madison's mommy]

Just an update on Madison, she's been on trilostane 10 mgs twice daily since May 11th. During that time we had are ups and downs, eating habits changed. She now get veggies mixed with her dog food. ( to get her to eat). There are still some days she don't want that either.. June 24 she got an ear infection.. During this past wonderful weekend of fireworks and one thunderstorm that just topped it all off for her, she had a seizure. Here are some test results ACTH results after being on Meds for 4 weeks, Cortisol Pre 0.9 Cortisol 2 (5.1) Liver went down went from AST 74 now its 61, ALT was 350 now 266, Alk Phosphatase was 331 now 205. cholesterol also went down went from 375 now 238. Since Madison had a seizure on Sun Dr P suggested getting a basal cortisol test So I already had an appointment with my Vet here at home to get her ear rechecked, and he result for that is 20.2 range is (1.0-4.5). Dr P seems to think stress could have made the cortisol go up. Well thats where we stand as of now. Thanks for reading, Sharon and Madison Please say a little prayer that these fireworks around me stop, I'm tired of sleeping on the couch... :(

[madison's mommy]

Hello, I have a question. hope to get an answer on. First Madison seems to be doing well with her cushings. My question is why all of a sudden does she keep licking her one front paw? Is this cushings related? I hate to bother the Doctor for this.. It is getting pink in that area.. I do tell her to stop when I see her doing it... What can I do for her? Thanks Hope to get so replies... Sharon

[Squirt's Mom]

Hi Sharon,

Good to hear from you again!

Licking the paws could be an allergy. Has her feed changed lately - either you changed brands or flavors, or the company made changes? Is there something outside in your area that is different - blooming, etc. - that she could have gotten into? Have you used any different cleaners, etc. inside recently?

My Squirt will sometimes lick her front paw when she is going to sleep or when she is nervous. I've always felt the licking was comforting to her, tho neurotic at times. When she does it at nite, I have to tell her to stop but she doesn't lick enough to cause any hair loss or pinkness to the skin. Have there been any changes in her living environment that might be upsetting her emotionally?

Pups will also lick an area that is hurting them. Does she seem to show any pain when you examine the paw? Does she bear the same weight when walking on that paw?

Has her cortisol been checked since the basal test was done? Has she had any more seizures? Is she on any meds for that?

You got lots of questions in reply to your question, huh? Just running through my mind the causes for her licking and questions keep popping up so I shared them! :p I'm sure others will be along with their thoughts, or questions, soon, too.

Hugs,
Leslie and the gang

[madison's mommy]

Thanks for the reply Leslie, She is the nervous dog so maybe this is just a new habit.. also we did have alot of rain maybe its and allergy.. Her last ACTH test was good she had it done last week.. Her results are cortisol sample 1 (4.1) sample 2 (3.4).. also her liver counts are all Normal... for the first time since Jan 11, 2011.. All other chemistry panel Normal.. No seizures. Most of her undercoat is all back, just one spot kinda on her shoulder blade is still sparse. But I have noticed some new growth appearing. Her coat seems to be much thicker and the color more vibrant... Lots of energy. Always something though.. Thanks, Sharon

[madison's mommy]

Just wanted to let the group know that Madison's was taken to the emergengy vet this morning..... She was very uncomfortable last night, just couldn't seem to find a place to rest.. This morning she vomited and just couldn't rest.. So we took her to the emergency vet and she is a bit dehydrated.. She's on IV fluids they will do a sonogram in the morn to check liver, and adrenals.. The Vet she seen said she could have a mild case of pancreatitis.. The blood work really only shown slightly elavated liver. We will be able to go visit her today in about 1 hour and 45mins.. yes I'm watching the clock... Can;t wait to see her.. I should mention that on thursday evening she vomited 3 times.. Gave her a predisone seemed to feel better.. She didn't get her trilostane on Friday. did then continue her trilostane on Sat... This morning after she vomited I gave her a predisone but it didn't seem to help at all... Well thanks for reading... Sharon

[Squirt's Mom]

Hi Sharon,

So sorry to hear Madison isn't feeling well. :( I hope the fluids will help and they find the answer to her discomfort. Please let us know how things are and remember we are here anytime you wish to talk.

Hugs,
Leslie and the gang

[Harley PoMMom]

Oh Sharon,

I am so sorry to hear that Madison is not feeling well, will be keeping you both in my thoughts and prayers and sending healing and positive energy your way. Please keep us posted.

Love and hugs,
Lori

[labblab]

Dear Sharon,

I, too, am so sorry to hear that Madison is in the hospital! I am sending many hugs to you and your sweet girl, and I will be very anxious to see your next update. I hope you'll be telling us that she is soon headed back home again.

Maeianne

[madison's mommy]

Hi, Just thought I would let the group know that Madison is home.. She has a gallbladder infection.. She will be on baytrill for 21 days. She will need to get rechecked, and a ultrasound in 3 weeks.. Also had a difficult time with her eating. she does't want to eat her food. I boiled her a chicken breast and she ate some of it... Needed to give her pills.. She is back on her trilostane also. Hope everything goes well... Thanks, Sharon P.S she is so exhausted....

[Squirt's Mom]

Hi Sharon,

I glad she's home and eating a little bit. She probably feels pretty rotten so I wouldn't worry over much if she doesn't have an appetite right now. However, I don't think I would restart the Trilo just yet. If she were to get sick again, you need to have a fairly good idea why - the gall bladder or the Trilo. This can be tough enough without the confusion of additional illness clouding the issue. ;) Just MHO. :)

Being home and with you will help her feel better than anything. I hope she's up and at 'em again soon!

Hugs,
Leslie and the gang