Mr. bojangles

[Faith]

My 10 year old shih tzu wen to urinate on the floor last month, and i knew he was sick......in 10 years he never did that, ever! I started observing him and noticed excessive water consumption, and panting. My local vet did a blood test and confirmed cushings. He will not treat a cushings dog, and he told us to see a nuerologist at the small animal hospital in NYC. Mwe had our appointment last week and were totally impressed. The dr. Spent about 45 minutes just talking with us.......the good news...no neurological involvement, and we caught the illness very early...no hair loss, or appetite change......just panting and excessive drinking.....
He wants to do an 8 hour blood test to determine if it is adrenal or pituitary cushings.......if it is pituitary, he then wants to do an mri to find out more about the tumor, and then he may recommend radiation treatment......if it is adrenal, he would then get us involved with their top cushings internist for a consult on meds.......any comments or suggestions on how to proceed?
Mr. Bojangles is the calmest sweetest creature who ever walked this planet, and i want to do right by him.....i always said if 10% of the people on the earth were like mr.B.......this planet would be a much better place.....thanks!

[addy]

Hi and Welcome,

I am glad you found your way here. Sorry to hear about your Mr. Bojangles possibly facing Cushings.

We have a wealth of information in our research section. It is always a good place to start.

Appx 80% of pups will have pituitary Cushings. Most of us with that diagnosis treat with Lysodren (mitotane) or Trilostane (vetoryl).

Our moderators will be along soon. They tend to ask a lot of questions, please don't get nervous about that;)

You have found a caring, knowledable, supportive group of people willing to help you in any way you choose.

Hugs,
Addy

[frijole]

Sounds like you are doing a great job. Glad the vet referred you to a specialist as they know more about how to diagnose and treat cushing's. The first thing you need to know is that the disease is not a death sentence and with treatment your dog can lead a normal life.

Addy gave you some great information about the statistics and she is right. The plan your vet mentioned sounds good. You want to do multiple tests because there can be misdiagnosis and you want to know what you are dealing with.

The best thing you can do right now is to read up and learn all you can about the disease as you are Mr Bo's voice. You will do great.

When you can, please post the test results so we can better help you. As you have more testing done, always get a copy for a file at home... trust me you will refer to them and it is handy.

My dog Haley was diagnosed and treated for 4 1/2 years. She had a great life. She passed away a year ago (non cushings illness) and she was well over 16. So don't let the disease get you down. Kim

[labblab]

He wants to do an 8 hour blood test to determine if it is adrenal or pituitary cushings.......if it is pituitary, he then wants to do an mri to find out more about the tumor, and then he may recommend radiation treatment......if it is adrenal, he would then get us involved with their top cushings internist for a consult on meds.......any comments or suggestions on how to proceed?

Faith, welcome to you and Mr. Bojangles!

I, too, am glad that your local vet has referred you for specialized treatment since he does not treat Cushpups himself. However, since you've asked for comments about the neurologist's suggestions, here goes!

I think it makes total sense to try to determine whether or not Bojangles' Cushing's is being caused by a pituitary tumor or an adrenal tumor. However, it may or may not be the case that the 8-hour test that he has planned will provide a definitive answer. If so, that will be great. If not, a good "next" diagnostic option may be to proceed to an abdominal ultrasound. If a dog suffers from an adrenal tumor, there are typically adrenal abnormalities that will be visible -- a single enlarged gland exhibiting a mass or growth. If a dog suffers from pituitary Cushing's, often both of the glands will be equally enlarged. Plus, an abdominal ultrasound can provide very helpful information about the status of other major organs such as the liver.

Even if this next test does indicate pituitary Cushing's, you may want to first consult with the specialty internist before leaping ahead to an MRI. An MRI is a very expensive undertaking and requires that a dog undergo a general anesthetic. Historically, few dogs with pituitary tumors have undergone an MRI unless they display neurological abnormalities which suggest that the pituitary tumor has increased to a size large enough to exert pressure on other areas of the brain. Most pituitary tumors remain very small, and do not create any neurological issues during the lifetime of the dog. But if they do enlarge so as to create problems, then radiation treatment (also a very expensive undertaking) can be considered in an effort to reduce their size.

Having said that, it is true that some clinicians and researchers have started to recommend that all dogs with suspected pituitary tumors undergo MRI imaging in order to assess the size and status of the tumor. Radiation treatment has a better chance of keeping potential neurological problems at bay if the tumor has not been allowed to first grow to a large size. Since an MRI of the head is within the specialty area of the neurologist with whom you are consulting, it may very well be that he is endorsing this newer approach so as to hope for the very best longterm result. However, as I said above, both an MRI and radiation treatment are very expensive and also involve risks themselves due to the anesthesia/treatment issues involved. So I hope you would have the chance to first consult with the Cushing's specialist in the practice before making such a big decision. Very few of our members have ever had an MRI performed on their dogs with pituitary tumors, and the non-neurological Cushing's symptoms are managed with medication.

Also, just so you will know, surgery has the potential to provide a total cure for a dog suffering from adrenal Cushing's. So in addition to medication options, surgery would be another consideration that you would want to discuss with the Cushing's specialist if it turns out that Bojangles' does have an adrenal tumor.

However, first things first. Please do let us know what the test results are for Bojangles -- both the earlier diagnostic test that your vet performed, and also the results of this next test (I assume it will be either a low dose dex test "LDDS", or a high dose dex test "HDDS").

Marianne

[Faith]

Thanks ........we did an ultrasound first.......results: liver r/o normal to slight incresed density c/w hepatocellular swelling non lipid
Kidneys r/o inflamation decreased corticomedullary ratio c/ w interstitial nephritis stage 1 normal bun/ cr and dilute urine
Adrenals wnl left adrenal 0.44 cm.......right 0.46 cm. Normal shape and density
Vet did a urine mic culture.....negative
Dex suppression 3 samples Pre acth. 6.8. One hour post. 35.3
2 hour post. 43.1
He is scheduled for the low dose dex test tomorrow in nyc......
Any comments will helpful once again

Thanks!

[addy]

Bumping up

[littleone1]

Hi Faith,

Corky and I also want to welcome you and Mr. Bojangles.

I'm also glad that you are going to a specialist experienced in treating cushings, and that you are having various tests done to confirm cushings and whether it is pituitary or adrenal.

I personally don't have any experience with pituitary cushings, as Corky has an adrenal tumor. He has been treated successfully with Trilostane for 20 months. As Marianne mentioned, if it is adrenal cushings, the best option would be surgery, if a cushpup is a good candidate for the surgery.

We'll be waiting to hear the results of the tests.

Terri

[Harley PoMMom]

Hi Faith,

If I am reading the results of Mr. Bojangles' ultrasound correctly then it appears that some form of kidney disease may be present and this would attribute to his drinking and urinating more. Has Mr. Bojangles' vet mentioned doing an UPC test?

Dogs with early kidney disease can have a normal BUN and creatinine. In fact with kidney disease the BUN and creatinine usually do not elevate until 50-75% of the kidney is non-functioning.

If it were me, I would not have a LDDS test done at this time because any non-adrenal illnesses and/or stress can create false positive results.

Please know we are here to help you and Mr. Bojangles in any way we can so ask all the questions you want, ok? ;):)

Love and hugs,
Lori

[Faith]

We did the ldds test saturday.....the vet said it is pituitary cushings.....

Cortisol baseline 6.7ug/dl(2-6)
4 hour 1.1 ug/dl(0-1.5)
8 hr. 3.0ug/dl(0-1.5)

Do you think we should still ezplore the kidney issue as the vet seemed certain of this.....also does anyone know of an excelle t vet in northern nj who will treat mr. Bojangles?
Thanks, Faith

[jrepac]

We did the ldds test saturday.....the vet said it is pituitary cushings.....

Cortisol baseline 6.7ug/dl(2-6)
4 hour 1.1 ug/dl(0-1.5)
8 hr. 3.0ug/dl(0-1.5)

Do you think we should still ezplore the kidney issue as the vet seemed certain of this.....also does anyone know of an excelle t vet in northern nj who will treat mr. Bojangles?
Thanks, Faith

Hi Faith, where in Northern NJ are you located? (I live in NJ also). Garden State Veterinary in Tinton Falls is very good, but may be a hike for you. Some people like the vets at Oradelle, but I will warn you that their pricing is pretty outrageous from most accounts.

[Faith]

I am in bergen county.....not a fan of oradell.......we have a great vet but he will not treat a cushing dog

We have been going to nyc for the tests, but would prefer someplace easier to get to........tinton falls is actually further for me than nyc....but THANKS!

[addy]

Faith, how far are you from Bedford Hills in Westchester County NY?

Just wondered, as you were going into NYC. Dr. Mark Peterson is in Bedford Hills and NYC.

http://www.drmarkepeterson.com/

He is an endocrinologist and well published and respected. Maybe he is too far away.

Hugs,
Addy

[Faith]

Thanks, Addy......bedford hills is further away than nyc, but probably easier to get to......no traffic, or parking hassles.......do you use him?
I am going to look him up......so far mr bojangles seems okay to me......if you didnt know him, you wouldnt think he was sick......i just dont know what to do as i hear such bad things about the meds......he is such a sweet, happy little guy! You should have seen his brother saturday when mr. B. Was in the city for 8 hours.......he is two years younger and has never been with out him.....he ran all over looking for him for hours, and then i guess he felt depressed and just went to sleep for the rest of the day....he never does that......how pathetic!
Thanks again for the info!

[addy]

I used him for a telephone consultation, I live in Wisconsin.

He is highly respected and other members have used him. A lot of us subscribe to his veterinary blogs.

Look at his bio and his websites.

Hugs,
Addy

[Faith]

Addy,
I checked him out and am totally impressed.....so lucky to have him neaeby and will be calling him tomorrow.......thank you so much, and hugs to your pup too!

[Faith]

Mr. Bojangles seems to be doing well....we have made an appointment with Dr. Peterson who is an endocrine specialist in ny.....we will be seeing him in about ten days......the one thing that seems to be the biggest symptom is the panting....any suggestions for this until we meet with the doctor to decide on the course of treatment? thanks, Faith

[addy]

the one thing that seems to be the biggest symptom is the panting....any suggestions for this until we meet with the doctor to decide on the course of treatment? thanks, Faith


Hi Faith,

Glad to hear you are able to see Dr. Peterson. He was very down to earth when I spoke with him and patient.

As for the panting, they can pant because they overheat easily or their liver is enlarged. Zoe only pants when she has gassy, tummy issues so it is hard for me to say about Mr. Bojangles.

I do know for Zoe, we try to keep the house cooler in the summer time and keep her out of the sun. Cold wet bandana around his neck may cool him down if it is from just being too warm.

Ten days seems like a long time but it will be here soon. Once you decide on a course of treatment, that will help the panting in most cases.

Every pup is so different.

Hang in there, you are doing a great job.

Hugs,
Addy

[MBK]

Hi, Faith.

I am not an expert on any of this stuff so I will leave all that up to others that have much more experience. I did want to welcome you and Mr. Bojangles. There are great people on here whose support can help tremendously through tough situations and who quickly become friends.

You are VERY fortunate to be able to take Mr. Bojangles to see Dr. Peterson. You will be in good hands with an expert in cushing's treatment! I was to have a phone consultation with him for my dog, Alivia, but had to postpone it when she had a pancreatitis crisis and was hosptitalized. When we (both) fully recover from that, we will go forward with the consult.

Hang in there! You are taking great care of Mr. Bojangles and he is luck to have you!

[Faith]

Thanks Mary Beth.....I will keep everyone posted as to the outcome of our visit with Dr. Peterson......I hope you and your precious pup are both doing a little better each day.......It is so nice for me to be able to share what is going on with mr. Bojangles with such a nice group of people who not only understand what we are going through, but really seem to care!

[Faith]

drove 40 minutes to Westchester to se Dr. peterson today only to be told they booked our appointment for his NYC office and he was there today.....very disappointed as I was not even aware there were 2 offices and was never asked which one we were going to.....plus my dogs were stressed from the car ride and I am feeling anxious about MR. BOJANGLES........Now we have to wait another week before we see Dr.Peterson.......I am surely going to confirm the appointment before we go.....Mr.Bojangles seems to be holding his own, but I realy want to figure out his treatment plan......will post again next week after FINALLY seeing the Dr.

Hope all the precious pups out there are doing well!

[Faith]

Saw dr. Peterson today.......he was very nice.....he said that even though mr.b.s numbers are high, he looked really good so we are going to monitor him and not treat him yet......a temporary breath of relief for me........I will keep you all posted as to how he is doing.........thanks for your support!
Faith

[lulusmom]

Hi Faith,

I'm so glad that you saw Dr. Peterson. Yes, you do have a breath of relief for a while and I think that's wonderful. Please keep us posted on how things go for Mr. B.

Glynda

[addy]

Faith, I am so glad you saw Dr. Peterson and that monitoring is the approach he took.

You have a break and that is a good thing. :):):)

Hugs,
Addy

[Squirt's Mom]

Hi Faith,

I am so glad you finally got together with Dr Peterson and that he has said no treatment just yet for Mr. B. :) Now you have plenty of time to learn about Cushing's, it's treatments and protocols, and you will be all ready when, IF, he ever does need treatment.

Now, just because you have been given a reprieve, that does not mean ya'll get to just disappear. Oh, no! Drop in every now and then and let us know how you and your baby are doing, k'?

Hugs,
Leslie and the gang

[Faith]

Just one more question for now......should I be giving Mr.Bojangles a special diet or supplements now? maybe there is something i can give him to help him stay strong so he can stay off meds as long as possible?
Thanks, Faith
Ps.....i think you are all incredible ......mr bojangles, his little brother Latka, and I are all so grateful for your kindness!

[Faith]

When i brought mr.b to see dr. Peteron, i had my other dog with me as well.....by looking at them, he could not tell which one was sick........he said he was surprised at how good mr.b looked considdering that his test results were so high.......since we first started seeing symptoms in him, and did all the testing, it seems as if my pup is now symptom free......he is not drinking so much, and panting at all except when it is so very hot....i am thrilled , but what could explain this? I know cushings just does not disappear, and he is on no medication......i am totally perplexed....THANKS for any responses!

[addy]

Hi Faith,

Terri's Corky went in to remission for a period of time. I am not sure if she ever figurered out why.

Hugs,
Addy

[littleone1]

Hi Faith,

Corky's symptoms were in remission for 7 months. They totally went away for that time period. We never did know why that happened. There are also other members that also experienced this. Enjoy it while you can.

Terri