Littleberry, diagnosis issues

[littleberry]

Hi, thanks to Natalie for letting me join this site. My dog is suspected of being in early stages of Cushings and I was a new member of the caninecushings.net/ which has suddenly gone off line.

I know many people here have also dealt with Cushings dogs so it's good to have a place to go as questions arise. Ten year old Poodle has suspicious blood work and physical signs, thinning hair on body, slight tummy and constant ear inflammation.

She recently went on Thyroid pills as that tested low but I learned Cushings can affect Thyroid levels. Not drinking excessive water or pottying too often yet

She has to retake the 8hr Dex test in a few weeks since the first one she took was lost in the mail. [We're waiting for inflammation from last test to heal before repeating the test]. I have new appreciation for everyone going through these difficult illnesses and I know many of these dogs are older and must leave us eventually but it's such a hard road to travel.

[BaileyBear]

Just wanted to welcome you! :D

Strange about the cushings site - I hope it's temporary and is back online soon. I know it's a big lifeline for many. My dog doesn't have cushings (as far as we know), but I'm sure there will be others more familiar with the disease who will chime in.

Welcome again - glad you had another place to post when the site went down. :)

[BestBuddy]

Hi,
I am missing the cushings site too so I hope it will be back online soon. I am so sorry that the stupid vet lost your first sample. My Buddy who I lost this last January, not to cushings but to age, also had thyroid problems but that resolved with the cushings treatment. He had the thinning/bald spots on his trunk and down his legs but didn't have a pot belly. He was drinking and peeing a lot but we also found out he had a UTI. The main reason we started the cushings testing was that his blood glucose (yes he was diabetic too) was all over the place and mostly high after years of having good regulation. Buddy had the LDDS and the HDDS testing done and also ACTH and he never had any injuries. He was always a little down for a day or so after but no swelling or holes in him.:confused:
Jenny

[littleberry]

Thanks BaileyBear, this is a great site.

[littleberry]

Jenny, I'm sorry you lost your Buddy, he was lucky not to have swelling from the repeated blood draws for that all day test. Everyone who's drawn blood from my 17 lb Poodle's neck always has to put the needle in over three times just to find the vessel. I gave her extra liquids before we go in just to plump up her vessels, too!

[eyelostit]

Hi littleberry, love your name :)

Welcome

Don't know about the cushings site, it should be up soon.

[littleberry]

Thanks eyelostit ... you've really got a unique name.

[eyelostit]

I went to the cushings site, I don't remember it looking that way.:confused: When I paste the site in my browser it has a M in front of the address line, maybe Nat or Kathy knows about it.

[eyelostit]

Thanks eyelostit ... you've really got a unique name.

LOL thank you. :D

[BestBuddy]

I suppose if there is trouble finding the vein then that would cause problems if they had to repeatedly put a needle in. The good news is that those all days test should only have to be done the once. My Buddy was only 11lbs and I'm sure his neck veins were not great either. I do know all the vets were instructed not to use his front legs to get blood as there were no usable veins. The initial testing really is the hard part and then if you decide to treat once you get the right dosage testing (ACTH) is only done every 3-6 months depending on with route you use.
Jenny

[CarolW]

I kept trying the Cushings forum; it's still offline. Let's hope it comes back up soon! Though my Kumbi doesn't have Cushings, I'm interested.

There IS another Cushings group; it is astounding! A friend of mine pointed me there. It's a Yahoo Group, so you would need a Yahoo ID (Yahoo will guide you on how to get one), and you have to apply to join the group, same as here. Too bad their messages aren't public, so you can't read them until your membership is accepted.

The group is here:

http://groups.yahoo.com/group/CanineCushings-AutoimmuneCare/

A shorter version of that link:

http://tinyurl.com/vdyw

When your membership is accepted, they send you a bunch of files, with quite a few links in them. I felt quite overwhelmed - but I've spent all my long life dealing with being overwhelmed, and I have a trade secret (ha!) about coping when you get thrown much more than you can possibly do (I was taught this in school, some 50 years ago):

Do what interests you most, and you feel able to do - and set the rest aside! You can always come back to it later!

I can say this about that forum: it is very thorough, and has truly excellent information. It is also supportive, in the same way as here and on the Cushings online forum that just disappeared.

So, I'd keep checking for the now-missing forum (I'll be doing that too, because I love reading there), but also, I'd go look at that Yahoo Group forum, and consider joining there. If you do join, you'll find me there too.

Sat, 11 Apr 2009 06:52:39 (PDT)

[CarolW]

Back from giving Kumbi his morning insulin, I want to add this about the Cushings.net online forum, and the Yahoo group I just pointed to. I am NOT suggesting you substitute the Yahoo group for our much-loved cushings.net forum! I'm suggesting it in ADDITION.

I don't think there's another forum quite like the cushings.net one. I really hope they can get back online soon. Hope they didn't get hit by some kind of technical problem - maybe a problem with billing, but surely they'd be able to straighten that out (I hope!) very soon .I'll be checking several times a day, till they come back online, as many of you here are my friends there (though I barely post there).

P.S. Today is Kwali's 14th birthday, and Kumbi's 12.5 UnBirthday.

Sat, 11 Apr 2009 07:09:13 (PDT)

[lulusmom]

I'd also like to thank Natalie for letting us cc.net folks use her site to communicate with each other. I'm a member of both sites but I know just enough about diabetes to be dangerous. I have two dogs with cushing's, one also diagnosed with hypothyroidism and the other we suspect has diabetes insipidus.

I'm sorry to say that I am disorganized and lose my train of thought easily so I take the easy road in responding to posts. See my comments in blue below:


I know many people here have also dealt with Cushings dogs so it's good to have a place to go as questions arise. Ten year old Poodle has suspicious blood work and physical signs, thinning hair on body, slight tummy and constant ear inflammation.

Hypothyroidism and cushing's are two conditions that are not uncommon to toy and miniature poodles. All of the symptoms you have listed are symptoms associated with both conditions as well. I'm not sure about the suspicious bloodwork though. Can you please post the abnormal blood values, including the reference ranges?

80%+ of dogs with cushing's experience increase in appetite (polyphagia) and/or excessive drinking and peeing (Polydipsia/Polyuria) Have you noticed any change in appetite or thirst in your dog.

She recently went on Thyroid pills as that tested low but I learned Cushings can affect Thyroid levels. Not drinking excessive water or pottying too often yet

Yes, Cushing's can definitely affect the thyroid. As a matter of fact a good majority of cushdogs, prior to treatment, have what is called Euthyroid Sick Syndrome. The elevated cortisol levels in a cushdog transiently lowers thyroid levels (low total T4 concentrations are common); however, once the cortisol is brought down to desired levels via effective treatment, the thyroid levels usually correct themselves.

She has to retake the 8hr Dex test in a few weeks since the first one she took was lost in the mail. [We're waiting for inflammation from last test to heal before repeating the test]. I have new appreciation for everyone going through these difficult illnesses and I know many of these dogs are older and must leave us eventually but it's such a hard road to travel.

I didn't have time to post to your thread on cc.net but I do remember reading your post and thinking about how angry I would be if the blood for or results of an LDDS test were lost in the mail. This is pretty inexcusable and I certainly hope the second one is free of charge. We'll look forward to seeing the results once you get them.


I'll be checking in again and look forward to more information.....the more you can give us the better able we can provide appropriate feedback.

Glynda

[acushdogsmom]

I really just have a minute but wanted to say that I don't think they absolutely have to take blood samples from the neck area. In fact I know they don't have to.

My Cushing's dog had ACTH stims done many times over the six years in which he was successfully treated with Lysodren, and they always took the necessary blood samples from his legs. Always.

Why? Because I asked them to do it that way.

My cushdog (15 lb Bichon) had a very bad experience when he was younger (at a previous GP Vet) which involved a blood sample being taken from his neck. So when I realised he was going to have to have numerous blood draws over the rest of his lifetime, I asked for the samples to be taken from the legs instead.

edited to add:

I think it may be easier for the Vet Techs to get blood samples from the neck area, but they can definitely use the legs for the blood draws.

Apparently, not all Vet Techs can get blood samples from the legs, maybe because it's a bit harder to find a good vein in the legs, but one of the two the Vet Techs who knew how to do it was always assigned to do our dog's blood draws.

[rhodesian46]

Hi and welcome,
I had a Siberian Husky named Pebbles. She was on thyroid pills( Soloxine),had Cushings and Diabetes. Dogs with these diseases are prone for more infections. Pebbles was on these thyroid pills even after her Cushings was under control. Also dogs that are first diagnosed with Cushings may have high blood pressure. Has your dog been tested for that? Normally the meds are given and usually discontinued after a few months.

If you could post more info as to the results of her blood work we would all love to help you. The liver enzymes are generally high with cush pups. Washter any more tests done such as an abdominal ultrasound?

[Squirt's Mom]

Hi Littleberry,

Glad to see you made it here! I posted to your thread at cc.net...I'm the one who's ACTH was in the freezer! LOL

Hope you are feeling a bit more settled now and not quite as angry. :p Tho lord knows you had reason!

Like Glynda said, the more info you can give us about your baby the better. Does she have any other conditions that you know of? Is she on any other meds, supplements, herbs at the moment? How much does she weigh?

This can be a frustrating, scary process at first but you will get through it. There will be folks here to help you along. And you don't have to do alone, either. There may not be as many of us here at the moment, but all it takes is knowing one other person out there knows what you are going throught to make it a bit easier.

Hang in there,
Hugs,
Leslie and the girls

[gpgscott]

Hi Littleberry,

Very sorry the cc.net is down and very glad you are here.

It stinks that the first LDDS sample was lost, and I agree with Cushy, unless you have an extremely small on you should not have to go for the neck, I am familiar with doing with with cats but not dogs.

The Ldds can return negative for Cushing's and the pup have what is called Atypical Cushing's, this was our case and many other members as well. Atypical Cushing's is when hormones other than and sometimes also including cortisol are elevated.

Please let us know of the results of the LDDS.

Best to you both. Scott

[lulusmom]

Hi again.

I just wanted to expand on Scotts comments about atypical. Miniature and Toy Poodles are at the top of the list of breeds that are over represented for atypical cushing's and pseudo cushings, also known as alopecia X. Both of these conditions involve an imbalance of adrenal steroids other than cortisol, which is common in typical cushing's. With the primary symptom being loss of coat, the breed being a Poodle and lacking the normal voracious appetite and excessive drinking and peeing, I would suspect that pseudo cushing's may be involved. Many dogs with this condition present with dermatological issues, like loss of coat, and liver abnormalities such as elevated liver enzymes and enlarged liver, which could be the cause of a slight pot belly. Perhaps the abnormal bloodwork you mentioned probably involved elevated ALKP and/or ALT?

http://www.michvma.org/documents/MVC%20Proceedings/Nichols2.pdf

Now here's the deal. In the absence of overt symptoms like huge appetite and excessive drinking and peeing, it is generally not recommended to treat with conventional and serious drugs like Trilostane and Lysodren, even if the LDDS were to be positive for cushing's. So if it were my dog, I would forego the LDDS and have a full adrenal panel done by the University of Tennessee Knoxville (UTK). They test both baseline and stimulated values for all adrenal steroids, inclulding cortisol, so you kill two birds with one stone. Not all vets are familiar with atypical of pseudo cushing's which is a shame because there are a good many dogs out there that go undiagnosed or worse yet, misdiagnosed.

I am providing a link to UTK general information page which has information regarding proper handling and shipping of blood sample. If you choose to discuss this with your vet, I recommend that you share this link with him/her. I am also including a link to their treatment consideration page which has some great information. Please take the time to read through it.

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info_07.pdf
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

If pseudo cushing's (usually only elevated progesterone and/or 17 oh progesterone) is ultimately diagnosed, the good news is that melatonin is the recommended treatment. This is inexpensive and can be purchased over the counter at just about any health food or drug store.

I have two cushdogs, one of which has pituitary dependent cushing's with elevation of all adrenal steroids. They are both Pomeranians, which is also a breed that is predisposed to adrenal steroid imbalances. My first cushdog, Lulu, was diagnosed and is still treated by an internal medicine specialist. They always request a full adrenal panel from UTK before confirming their diagnosis, especially if the dog is a breed commonly known to have adrenal hormone abnormalities, like Poodles and Poms. Internal medicine specialists are generally more experienced and knowledgable in diagnosing and treating cushing's so this may be something you might consider. If you don't know of one in your area, I am providing a link that might help.

http://www.acvim.org/websites/acvim/index.php?p=3

I hope this helps. I also hope that your head isn't swimming too badly and you can still feed yourself. :D I remember when my first one was diagnosed....oh my gosh, I was dazed, confused and probably a threat to myself but didn't know it. :o

Glynda

[acushdogsmom]

I love Glynda. :D

I also thought that this might be helpful and interesting reading for you:

Newer tests shed light on causes, treatment of adrenal disorders
By:Johnny Hoskins, DVM, PhD, Dipl. ACVIM
DVM Newsmagazine, Jan 1, 2008

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128

Page 1 of article:
http://www.dvmnews.com/dvm/article/articleDetail.jsp?id=485128&pageID=1&sk=&date=

Page 2 of article:
http://www.dvmnews.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=2

Page 3 of article:
http://www.dvmnews.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=3

[littleberry]

Thanks everyone for posting about Cushings, have to be off this Easter morning and hope be back to read all the posts tonight.

So much great information, thank you !!!!

[gpgscott]

I misunderstood your earlier post to say you were awaiting results from the second LDDS not waiting to perform another.

I also agree with Glynda that I would want to skip the LDDS particularly given the symtoms you are describing and go straight the the UTK full adrenal panel. Between the links provided by Glynda and Cushy you should have plenty of reading.

Scott

[littleberry]

Wow, I have so much reading to do, forgive me if I've missed anyone's question.

Lulusmom, that's such good information on pseudo Cushing, and one of the abnormal bloodwork items she has is ALT = 191.
I'll try to feel out my Vet on the other tests, dealing with doctors is like walking a fine line ... trying to be tactful and not wanting to appear to know more than the Vet .
Is there a separate test for "progesterone"? Do you know if it has a
different name?

Here are the bloodwork items I've copied...
Bun = 17
Glu =142
Alp report say's "can't measure"
T-pro= 8.9
Alt =191
Cre =1.2
Pcv/hct =60

[littleberry]

acushdogsmom, thanks for those great links [I have a lot of reading to do]
The Vet couldn't get enough blood from her legs, so he had to use her neck. When they tried the leg, they did as many sticks to find the vein as in the neck, sadly.

gpgscott, I'm going to have to ask the Vet about hormone testing for Atypical Cushings as she doesn't drink excessive water or pee too often yet. She does drink more than she did last year but she was never much of a water drinker in the past.

Squirt's Mom, [you must have read my thread on the Cushings board, lol .. I'm not so angry now and the Vet did blame it on FedX ]
She's 10yrs old, 17 lbs and the only suppliments I give her is flax oil and fish oil and she takes a Thyroid pill, which really pumps up her energy level!

rhodesian46, she didn't have Ultrasound test yet, he said that would follow the Dex test. [I posted the lab results in the previous post.]

CarolW, thanks for the tips on Yahoo's Cushing site [I'll save it, you can never have too much advice].
Hope Kwali enjoyed the birthday and Kumbi's "un" birthday, lol ].

[littleberry]

rhodesian46, I forgot to answer about the blood pressure. I didn't know they took blood pressure on dogs but I'll will definitely ask about it.

[CarolW]

CarolW, thanks for the tips on Yahoo's Cushing site [I'll save it, you can never have too much advice].
Hope Kwali enjoyed the birthday and Kumbi's "un" birthday, lol ].

I feel the same way - partly, too, that having multiple sources is ALWAYS a good idea. However, the CCAC list, I imagine, would be VERY tough for a human whose dog has just been diagnosed with Cushings - being so very overwhelmed, the CCAC list is not going to help a lot with that. To put it MILDLY! They load you up with a ton of links. All good (as far as I've investigated), but they are ABSOLUTELY NOT a first line of Help-The-Human aid. Whereas, your forum DOES do that - really helps the human, and it also has a lot of more detailed stuff when need be.

So as I see it, the CCAC list and your online forum have two quite different functions. No question, the CCAC forum has really excellent information, and a large variety of it, and they are ultra-careful, too.

But I'd generally recommend to a newcomer to Cushings going first to your online forum, and staying there, also, even if they later also join CCAC.

P.S. I did get notices onto my Home page and Links page about finding cc.net's temporary home, here. I don't have the techie knowlede to include the direct link (my pages wouldn't validate with W3C that way), so I direted to the the k9diabetes forum and said to look for Canine Cushings.

Mon, 13 Apr 2009 06:16:48 (PDT)

[lulusmom]

Hi again.

Progesterone is just one of the six adrenal hormones that the UTK tests for. Your vet would need to request the full adrenal panel. I'm not sure why the ALP could not be measured but that particular liver enzyme is usually elevated with both typical and atypical cushing's.

Glynda

P.S. Has your dog been spayed?
P.S.S. The adrenal hormones/steroids tested by UTK are cortisol, androstenedione, estradiol, progesterone, 17oh progesterone and aldosterone.

[Wylie's Mom]

Hi Littleberry,

Just wanted to let you know - under my GP vet's suggestion, I skipped the LDDS test and went straight to the ultrasound. Every case is different - I don't know your history other than what's posted on this site. I'm glad we did the ultrasound and I don't feel that I've missed out by skipping the LDDS.

I do, however, wish I had done the UTK panel earlier on. IMO, I think this test should be routine if cushing's is suspected (and if cushing's was suspected, but later ruled out).

When my pup had a gall bladder attack, they ran bloodwork and the ALP & ALT could not be measured (with their in-house equipment). They had to send the sample to Antech Lab - the levels were basically "off the charts" @ 7634 U/L & 1896 U/L. Did your vet sent the bloodwork out to a lab?

My vet has a hard time finding the veins in my pup's legs also. I often find bruising after his ACTH stim tests - I put a heated moist washcloth over the area 2 to 4 times a day for 5-10 minute intervals. I heat the washcloth with hot tap water & nuke the damp towel for 10-15 seconds and test how hot it is before putting in on the pup's shaved legs. I do this for a couple days - I think it helps.

It looks like, because of the cushing's site glitch, all eyes are on you:eek:!

-Susy

[littleberry]

Wylie's Mom and Lulusmom,
I found out that the Alp levels were 179 last year and are approaching 2000 this year. I think that's why he wrote "can't measure" next to Alp.

[This Poodle is spayed ]

I asked if we could do the ultrasound test while waiting to retake the Dex test and he wanted to have the Dex Suppression test results first.

[lulusmom]

It appears that you have chosen to go ahead with the LDDS as opposed to the full adrenal panel so I want repeat a few things and give you some additional food for thought.

If the LDDS is positive for cushing's, an experienced vet would normally take a wait and see approach with a dog that does not have the most common symptoms, being polyphagia (eats like a pig) and polydipsia & polyuria (guzzles great volumes of water and pees buckets). There are only two truly effective treatments, Lysodren and Trilostane.

Treating with Lysodren is definitely not recommended because the aforementioned symptoms are the only guage you have to determine if a dog is loaded. Loaded means that the Lysodren has effectively eroded enough of the adrenal cortex to stim the flow of excess cortisol. With no signs to use, you can overload a dog and the dog can get very, very sick when cortisol is too low.

While I have my own issues with Trilostane, I would much rather see a vet prescribe Trilostane for a dog that lacks the normal voracious appetite and excessive drinking and peeing. Unlike Lysodren that has a cummulative effect for up to 48 hours, Trilostane has a short half life with its effects lasting only about 12 hours. A dog that starts showing signs of cortisol withdrawal or cortisol that is too low will usually bounce back very quickly after withholding the dosing. There is very important information about this drug that some vets are not aware of....it alway increases one or more of the other adrenal hormones with long term use. Anybody with a Toy or Miniature Poodle or any Nordic Breed (Pomeranian, Husky, Spitz, etc), should never treat with Trilostane without first doing a full adrenal panel. One of my Poms had elevated sex hormones and I made the big mistake of treating her with Trilostane for two years. Those elevations skyrocketed due to the Trilostane.

If the LDDS is negative, you will have spent the money for that test and you still won't know if it is the sex hormones that are causing the problem. An ultrasound is a fabulous diagnostic tool; however, abnormalities in the liver and the adrenal glands are not always caused by excess cortisol. The other adrenal sex hormones, particularly estradiol, can adversely affect these organs as well. So in other words, ultrasound findings can be consistent with typical cushing's; however if the LDDS and/or the ACTH stimulation test is negative, it's a pretty good guess that it's the sex hormones that are the problem.

I am not a medical professional, I'm just a cushmom two times over with bad experiences with less than knowledgable vets. My first one was diagnosed in 2005 and since that time, I've read more stuff on this disease than all the print I read a half a century prior to that. Oops just gave away my age. I'd like to blame my poor vision on almost five years of computer glare but I am of that age when your arms get too short...if you know what I mean. :D Seriously and sincerely, please arm yourself with knowledge so you can become an excellent advocate for your baby girl. It's not an easy row to hoe but if I can become my vet's worst nightmare, so can you..your vet I mean. :D

Here are some additional links to sites on pseudo cushing's/alopecia X.

http://www.marvistavet.com/html/body_alopecia_x.html

(You will see Adrenal Hyperplasia-Like Syndrome mentioned in this site. This is referring to the intermediate/sex hormones I have been talking about.)
http://www.vet.utk.edu/hairloss/alopecia.html

No matter which route you take, we'll be with you every step of the way.

Glynda

[littleberry]

Lulusmom, I appreciate your advice, knowing you've been through this before. I'm going to be extra cautious when I reach the point of medications ... they sound so dangerous. I'll go ahead with the LDDS, since I've already paid for it and it will start the ball rolling, [sort of]. Most likely next week, her neck is looking normal now.

I'll definitely ask for a full adrenal panel before proceeding with chemical treatments. [I had to ask for the bloodwork that turned up the Cushings suspicions or she'd still be treated for low Thyroid ... wasting time]. For full adrenal panel, I'm hoping my Vet can send samples to the U of Tennessee instead of traveling there.

I'm still in the weak in the knees - trying to cope stage, walking the fine line between being a little dog's advocate and not step on the toes of my long time Vet.
Guess everyone's been there too!!

[Squirt's Mom]

Hi Littleberry,

I don't blame you for wanting to recover your cost on the LDDS that was lost and I am one who had alllll the testing done on my baby, Squirt. My vet was very thorough about that and I am very grateful to her for it. However, knowing what I know now compared to then, I could have saved myself about $600 by having the UTK panel done at the very first plus the ultrasound. Not to mention saving Squirt somewhere around 20 hours in the vets office waiting on draws. You might ask your vet if she would be willing to apply the cost of the LDDS that was lost to the UTK panel cost, and bypass redoing that test. Your baby would only have to be at the clinic for a few hours VS all day if she will do that for you.

As for "walking a fine line" with your vet, that is understandable to a degree. I am one who simply HATES confrontations and doesn't do well with them at all, especially with someone I perceive as an expert, which a vet certainly qualifies as. However, when it comes to Cushing's, keeping the vet happy has no place at all in the picture. It is sad, but many vets just don't have the experience or basic knowledge to deal with Cushing's properly. I am NOT saying your vet is one of these but it is an unfortunate fact that many cush parents have had to face with their own docs. We could tell you hours of horror stories about folks who loved and completely trusted their vets only to find out the hard way they were not qualified to deal with Cushing's. This is why it is so critical that cush parents educate themselves on the condition so they can work with their vets rather than trusting them blindly to do what is best. Cushing's requires team work, not a follow-the-leader approach.

Your vet is following the normal approach to diagnosing Cushing's and that is comendable! :cool: So many don't even do that! But if you can't talk with your vet for fear of what will happen, then team work will be difficult if not impossible. Just keep in mind that you are paying for their time, expertise and help...in essence, they work for you and you are the boss. No amount of schooling, degrees, practice or experience can come close to equaling your knowledge of your baby. We know our babies better than anyone and, as such, our vets should be willing to listen to us and work with us based on that intimate knowledge.

Now, having said all of that, the LDDS is a good place to start the diagnostic phase and, again, I am pleased to see your vet starting there. That says they do have experience and are following the procedures that have been established. That is very good news. :) AFter the LDDS is repeated, tho, I would forego the HDDS if recommended and go straight to the UTK panel. The UTK panel and an ultrasound will give you as much info regarding the possibility of Cushing's as well as get a good look at many other organs. By suggesting that you have the UTK panel done instead of repeating the LDDS, we are simply trying to help you save some money, save your baby (and yourself!) some added stress, and decrease the time for a diagnosis.

Hang in there! You are doing a fine job!
Hugs,
Leslie and the girls

PS. what is your baby's name, BTW? :o

Here are some links on Cushing's as well as the UTK panel and Atyipcal just in case:

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article.cfm?c=2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp

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

http://www.vetcontact.com/en/art.php?a=132&t=

UT Panel
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

http://www.vet.utk.edu/diagnostic/en...logy/index.php

[ventilate]

I wanted to add that the medications for treating cushings are not dangerous, it is when vets with no experience that do not follow the tried and proven protocols and do the much needed followup testing as required, and do not educate the client on what to watch for, for signs of loading or when the cortisol is getting to low, that is when things go bad. What is posted as side effects are actually when to much cortisol is reduced by to much lysodren or trilostane, many of us have never seen any of those symptoms in our dogs, I have been treating Nike for 3 years. It is true that both lysodren and trilostane are perscription medications and need to be respected as such and given as instructed by a vet that is well versed in treating cushings or an Internal Med specialist. As well even over the counter stuff like Tylenol can be fatal if not taken as advised.
Many of us use one of the medications or some of us have used both changing from one to the other. One medication is not any better or worse than the other, they are just different. So once the testing is complete and if your dog does have Cushings please dont be afraid of the medications they have saved many, many dogs lives, and truly are not dangerous or poison or toxic as some sites leads us to believe, and even if it was, one of the dangerous, poisionous, toxic drugs has kept my dog alive and well for the past 3 years:D
I agree with Leslie in that you have to be able to work with and talk to your vet. I was given some great advice when my dog was first diag. I spoke to my vet and told him that when I ask him questions about why he is doing this or that or why not do this or that it is not because I am questioning his expertise, it is because I need to fully understand what is going on., and the reasoning behind it. He told me he is the same way and if I have any questions or concerns or sugestions to please talk to him, He said that we both have the same goal, to keep Nike as healthy as we can and we can only do that if we work together. It had been an excellent relationship between us. As well I love my vet but I love my dog much more and will do what ever it takes to keep her well.

good luck, and please keep us in the loop
Sharon et el

[Wylie's Mom]

Hi Littleberry,

Just curious, since we don’t have the history here, could you please tell us if your pup has had the UCCR (Urine Cortisol Creatinine Ratio) test or ACTH stim test done? If so, what were the results?

I like Leslie’s idea about asking to apply the credit for the LDDS to the cost of the UTK panel. I don’t think it would hurt to ask. I think it will save you time & money in the long run…and don’t worry, you’ll find plenty more items to spend that money on:p.

You might want to read this and give a copy to your vet:
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroids%20Profiles%20in%20the%20Diagnosis%20of%20 .doc

I gave a copy to my GP vet – there are many vets that do not know about this. The blood would be drawn & prepared & packaged up & sent to UTK by your vet and then UTK will fax the results and any recommendations for treatment to your vet.

I know what you mean about not wanting to step on your vet’s toes. You may be pleasantly surprised (or not:eek:) at their response. You may have to just test the waters…for your pup;).

-Susy

[littleberry]

Squirt's Mom ,

You make a very good case for UTK [and I will ask tomorrow if my Vet would do a UTK panel [for Univ. of Tenn.] instead of LDDS.

[ Hope I don't hear a "thud" on the other end of the phone].

This is a small town and everything seems to be done cautiously and by established protocol. I'm suspecting not many people question procedure ...I've already gone past their current diagnosis [Thyroid] and insisted on the blood profile that turned up possible Cushings.
I appreciate all the the links, I'm armed and almost dangerous now.

[my 17lb Poodle name is "Littleberry"]
-------------------------------------------------------

ventilate,
*I wanted to add that the medications for treating cushings are not dangerous*

Thanks for the pep talk, everyone in our shoes needs one!!! And you do make sense.

Honestly, I almost fainted when I first read the challenges one faces when dealing with the meds ... made my knees shake and wanted hide under the covers. I can't be alone in feeling this but like everyone else, I try to keep reading and keep all the tests [and abbreviations] from confusing me. Actually, dealing with the Vet is the most difficult because doctors are like everyone else ... they have a preferred way of doing things.
------------------------------------------

Wylie's Mom ,

So far the only tests I have is this blood profile...

Bun = 17
Glu =142
Alp "can't measure" [approaching 2000 was 179 in 2008]
T-pro= 8.9
Alt =191
Cre =1.2
Pcv/hct =60

Thank you for the link, I just printed it out and think I better take it in to the Vet's office along with some info from the Tenn. State Hosp.site. Looks like the sample they need and the packaging has to be very precise.

[littleberry]

I just read the indications for the "Steroid Hormone Profile" test... is this the UTK test? Am I confusing something because I can't find UTK mentioned on the Univ. of Tenn. site.

Dr. Oliver recommends "Steroid Hormone Profile" test "when other routine tests of adrenal function, [like LDDS] are neg" but the dog still shows signs of Cushing's. So I'm guessing the Vet may feel justified in doing the LDDS test before proceeding to the UTK?

Does anyone know the exact name of the UTK test?

I just noticed there are several Adrenal tests at their site ...
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf

g. Adrenal Panel for Dogs and Cats (ACTH Stim) -Test for congenital adrenohyperplasia-like syndrome (dogs, cats), or Alopecia-X, Atypical Cushings Syndrome

and

h. Adrenal Panel with Combined Dex Supp/ACTH Stim Test for Dogs
This test will provide the same information as the adrenal panel with ACTH stimulation only however it will also provide information as to whether the hormones are suppressedby dexamethasone. With this approach, results from two separate testing procedures(dexamethasone suppression test and ACTH stimulation test) are achieved with one test.

These seem like the correct tests and test "h" combines Dex Suppression with the Adrenal Panel but doesn't say whether it's the LDDS or HDDS test.

[Squirt's Mom]

Hi Littleberry,

What you want is this from UTK:

Adrenal Panel (ACTH Stim) Dog, Cat Adrenal Function $135.00

The $135 is the charge from UTK, then your vet will add charges for her services.

UTK is a branch of UT...all the same but the school at Knoxville is where the veterinary school is for UT. UTK = Uni. of TN at Knoxville...I'm just too lazy to type all that. :p

The LDDS is a test to see how well the adrenal glands can suppress the coritsol when stimulated. The ACTH will give you the actual cortisol level; the adrenal panel will give you the cortisol level along with the levels of five other hormones - those that are involved in Atypical Cushing's. If all six hormones are elevated, then you have what Dr. Oliver (Dr O) calls "true Cushing's". In true Cushing's, or what we often call conventional Cushing's, treating the elevated cortisol will usually lower the other hormones as well, except for the Estradiol. Estradiol can be produced in areas of the body other than the adrenals and the treatments for conventional Cushing's only effect the adrenals. This is where the melatonin and lignans come into play. Now the flip side of this is that the treatments for Atypical, melatonin and lignans, can also lower cortisol to a degree.

While the LDDS can give an idea of whether it is PDH or ADH, the HDDS is usually done to give a better idea of which type, but it is still not definitive. This is why an ultrasound is so important. By looking at both adrenal glands via the U/S, you have a much better idea of where the tumor is - the pituitary or adrenals. If pituitary, both adrenal will be enlarged; if adrenal, one will much larger than the other, and the smaller one may be atrophied (withered).

So, if your vet really wants to do the LDDS, and you are comfortable with the expense etc, then have it repeated. But I would insist that the UTK panel and an ultrasound be the follow-up tests rather than the HDDS.

Hope this helps,
Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Littleberry's Mom,

This form is where you can see the $135 test that Leslie is describing - you might want to also give this to your vet along with the instructions that you have already found:
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endosubform06.pdf

I'm glad you are going to ask your vet about doing the UTK panel in lieu of the LDDS repeat. I was a little worried...thinking you might feel ganged up on or pressured to do what we think:eek:. Several of us just happened to have the same opinion in this matter.

For me, there was one particular difference of opinion between what my IMS (Internal Medicine Specialist) vet wanted to do and what people here thought I should do. It was regarding Lysodren dosing. I initially went with what the IMS wanted to do, but over time it wasn't working out. Most recently, I went ahead and did what was recommended here - to do a mini-load (instead of another increased maintenance dose that the IMS wanted to do). I think I probably felt the same as you do now, about "confronting" the "expert" - I have to say... I kinda chickened out - my GP (General Practice) vet is easier to get a hold of and seems more open to trying different methods than the IMS vet, so I discussed what I wanted to do with the GP vet instead :p. So far, the mini-load has worked well. I'm not saying that the people here know better than any vet (although, I do think so sometimes:rolleyes:, at least with regards to all forms of Cushing's), I'm just letting you know that I understand how you feel and I want to let you know that I did not get any less support from the people here when I initially went the IMS way;).

-Susy

Oh - regarding the Instruction sheet question:

I think they need to follow the instructions under these headings, but there is a phone number at the top of the sheet that your vet should call for clarification:

1. General Information
3. ADRENAL FUNCTION:
a. Cortisol - ACTH Stim Test -DOG, CAT, HORSE.
g. Adrenal Panel for Dogs and Cats (ACTH Stim)

[Wylie's Mom]

Wait a minute...

So far the only tests I have is this blood profile...


So, you didn't have a UCCR (Urine Cortisol Creatinine Ratio) test done? Now, I wouldn't say it's mandatory, but it is a simple (& cheap) urine test that can rule out Cushing’s (although it cannot confirm it) – this is typically the first screening test done. I have a feeling that maybe you should do this test first, but I'd like to know other people's opinion - it might me a mute point and the UTK panel would still be recommended.

-Susy

[littleberry]

Squirt's Mom,
Thanks so much for summarizing all this information, it really makes it easier to grasp. I'll definitely want the UTK's panel done before progressing to medications. My vet did mention following the LDDS test with the ultrasound test.

[ Do you know if in "addition to" the $135 Adrenal Panel-ACTH Stim test ... I should also ask for the $30 Cortisol-ACTH Stim test that Wylie's Mom listed at the bottom of her post #37 ?]

[littleberry]

Wylie's Mom,
I see you've been where I am now, thanks for that link, I printed out the service form. Actually I did bring a fresh urine sample in to the vets weeks ago thinking I was going to be so prepared and he didn't want to do the urine test. He said it wouldn't be useful at that point. At that time he wanted to do the LDDS before anything else.

I have a question ...
Is this test, [a.] Cortisol - ACTH Stim Test -DOG, CAT, HORSE [listed at the bottom of your last post] one of the tests I need to do, "in addition to" the $135 [g.]Adrenal Panel for Dogs and Cats (ACTH Stim) ?? I haven't seen that one mentioned before? So that makes two tests I need from the UTK?

[Squirt's Mom]

Hi Littleberry,

No, you won't need the $30 Cortisol-ACTH Stim (#37). The adrenal panel will check the cortisol, too. The $135 adrenal panel is all you will need to have done for Littleberry. It will cover everything that counts for Cushing's.

The [a.] Cortisol - ACTH Stim Test -DOG, CAT, HORSE, I think, is simply an ACTH without the other hormones (intermediate and sex hormones). This is a test that is usually done to monitor once treatment begins, but your vet can probably do this in their office and through their own lab.

So, all you need to have done from UTK is the $135 adrenal panel. The rest you can forget about. UTK is listing all the tests that are available through them on that list, but they don't all apply to Littleberry or Cushing's. That's a relief, huh? :)

Keep up the good work and let us know how things go with your vet!
Hugs,
Leslie and the girls

[littleberry]

No, you won't need the $30 Cortisol-ACTH Stim (#37). The adrenal panel will check the cortisol, too. The $135 adrenal panel is all you will need to have done for Littleberry. It will cover everything that counts for Cushing's.


I think I've got a grip on it now and can run it past the vet. Thanks so much!

[Wylie's Mom]

I'm sorry I have been away - Wylie got sick.

To clarify, Leslie is correct, you only need the $135 test. What I was descibing was based on the information you were looking at when you first posed the question - the instruction sheet "CLINICAL ENDOCRINOLOGY SERVICE":
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf

The $135 test includes the $30 Cortisol-ACTH Stim. In the instruction sheet, the vet has to read/perform (I believe) three sections to do the $135 test...
1 general info
3.a Cortisol (ACTH stim)
3.g. Atypical Cushing's hormones

I hope this makes better sense;), sorry for the confusion.

-Susy

[littleberry]

Thanks Wylie's Mom,
My vet appointment is. tomorrow, armed with lots of information. I appreciate all the help I've received here....what a wonderful site this is!!!

[Wylie's Mom]

It will probably take about two weeks before you get the results back - be sure to get a copy and post the results here. Good luck!!

-Susy

[littleberry]

Hi, [update] the low dose Dex test was positive for Cushings and the vet want's to do a ultrasound next.

The only problem is her drinking ,eating and peeing is not far from normal Do you think I'd be wise to get the Tenn. tests even though the low Dex is positive [I'm remembering the warning not to use Lysodren yet as there isn't anyway to judge loading in her].

I'm just spinning right now until the ultrasound is done. Not much else to go on other than weekly ear inflamation and thinning coat with only"slightly" more drinking and peeing..

[Squirt's Mom]

Hi Littleberry,

Got it back this time, huh? :p I hope it didn't cost you a cent!

If you are planning to use Lyso instead of Trilo, then the UTK isn't quite as important, tho I think every pup should have one done as part of the diagnostic phase. IF you think there is any possibility that you will use Trilo instead, then the UTK is necessary, IMHO. Trilostane will cause at least one of the other hormones to raise, but Lysodren will treat all but one of those other hormones, and sometimes is effective on that one (Estradiol) as well. So as long as you will use Lyso, the UTK panel isn't as important. I would certainly have the ultrasound regardless.

Could you please get copies of the results of the LDDS and post them here along with the units of measurements (ug/dl, mnol/L, etc) and the normal levels listed by the lab. Different labs use different measurements and norms so it helps to provide those when posting results. If you don't mind sharing, those will help us give you better feedback.

You are absolutely correct about the value of the signs in treatment. They are vital not only in treatment but in diagnosis as well. If Littleberry isn't showing signs that are consistent and strong, then waiting to start treatment is the best thing. My Squirt was diagnosed in 3/08 but because her signs were mild, we didn't start Lyso or Trilo and still haven't, tho she is on treatment for Atypical (diagnosed via the UTK panel in 8/08).

Thanks for the update and look forward to seeing those test results if you can. How is Littleberry doing? You are doing fine, honey, so just hang on, ok? Don't forget that Cushing's is slow progressing condition so you have time to make sure of what you are dealing with and to determine the best approach for your baby.

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Littleberry,

I'm not clear on the specifics of an LDDS (never did one with Wylie), but I think you would need an ACTH stim test at some point before treatment. I think it would be fine to wait till after the ultrasound. The ultrasound can tell you so much. But, if you can afford it, I would do the UTK full panel instead of the ACTH stim. Sure, if you're not intending to use Trilostane, you won't have to worry about increasing the intermediate hormone levels, but what if those hormone levels are already increased:confused:? Now, I admit, I may be more hypersensitive about this:o. I wish I had done the UTK panel earlier on. If I had know that Wylie was Atypical in addition to regular Cushing's, I could have treated both at the same time instead of waiting to find out that he was still having symptoms after several months of treating the regular Cushing's. That's just my opinion, I have no idea of what the chances are that your pup would also be Atypical.

Please post the LDDS results (although I wouldn't be much help in deciphering it, others can).

[littleberry]

Squirt's Mom and Wylie's Mo, thanks so much for all your help and support.
I'll try to get complete report for the LDDS so I can post it here [when she goes in for ultrasound].

Littleberry is napping more but otherwise as active as usual ...she's not particularly interested in food. She has to be encouraged to eat her meals and if there is paper towel under the food dish, she pulls it out and tries to cover the food with the towel instead of eating it. She does "eventually" eat [after guarding for awhile].

[Squirt's Mom, I'm curious what type of treatment Squirt is getting for Atypical ??]

[Squirt's Mom]

Hi Littleberry,

Squirt is on melatonin (3mg 2X/day) and purified lignans (40mg 1X/day) for the Atypical.

A little history: Squirt's first ACTH was a post of 18.2; the cortisol level on the UTK panel was 32.8 post; after the UTK panel we had another ultrasound and a splenic tumor was found, which was removed along with part of her spleen; the ACTH 3 mos. later showed a post of 14.2. Her docs and I are hoping the tumor was causing the elevated cortisol, I am REALLY hoping that was the case! We will be having another ACTH soon so that should tell us what we need to know.

The melatonin has properties that will help to lower cortisol, too. It and the lignans work to control the elevated hormones associated with Atyipcal - the intermediate and sex hormones.

I hope this helps.
Hugs,
Leslie and the girls

[littleberry]

Just finished "ultrasound" of Adrenal glands and results are:
Left : length 0.62 c
width 0.64 c

Right: length 1.00 c
width 0.64 c
The vet said it means that the cause is in the Pituitary but she won't need medication for now, as her symptoms are mild.
------------------------------------------------------------------
LDDS [Dex test] results :

Cortisol Pre ... 13.2 ug/dl
Cortisol 2 ....... 3.1 "
Cortisol 3 ....... 3.6 "

Interpretation of LDDS:

Normal: Cortisol level less than 1.4 ug/dl 8 hrs post-dex

If the 8hr post dex cortisol level is greater than 1.4 ug/dl the following can be used to differentiate pituitary dependent hyperadrenocorticism [PDH] from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH.
2 Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.

[if neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.]
Note" Aprox. 5% of dogs with PDH have normal results. False positives may occur with stress/nonadrenal illness.
----------------------------------------------------------------------
[to be honest the above is somewhat confusing but the vet said the LLDS is positive for Cushings and then the ultrasound test revealed it is Pituitary caused]
-------------------------------------------------------

Squirt's Mom, fingers crossed for Squirt's next test !!

[Squirt's Mom]

Thanks, sweetie! I have really been trying not to let myself hope the cortisol is still normal, but it's been no use. There is a great well of hope in my soul. Usually I am one to prepare for the very worst, but this time I can't seem to let myself go there. :rolleyes: So I really appreciate the good wishes!

Hugs,
Leslie and the girls

PS. Littleberry is a doll! I love the avatar!