Another Newbie

[Tibetan-Mom]

Hi everyone! My dog Annie has recently been diagnosed with Cushing's. She had a slightly elevated ALP and symptoms that included excess water drinking and urinating in the house. She has abdominal swelling and a pronounced sway back. Our vet recommended the low dose test.

Her results were as follows:

baseline cortisol 6.7
After 4 hrs 4.5
After 8 hrs 6.5

Annie (8 yrs old) is a very anxious dog with no appetite for change.
I think rearranging the furniture would upset her. I was very concerned that this would influence her test results. My vet assured me it would not.

Has anyone experienced a false positive due to stress? Are her other symptoms enough to indicate I am wrong to worry about a false positive?

Our vet has recommended an abdominal CT scan to determine the source. We are having that done on Friday. Any words of wisdom?

[jmac]

I have heard that stress can affect the test. She is getting a CT scan, or an abdominal ultrasound? My dog had an ultrasound to look at her adrenal glands and liver. I know there are some other tests that can be done as well. Hannah had a high Alk Phosphate level, which led to the low dose dex test, which was positive, then I got the ultrasound and we went on Anipryl because she just had very slight symptoms-a big appetite and an increase in water and urinating-no pot belly, panting, skin issues, etc. She has been on the Anipryl since March and it seems to be working. Her Alk Phos level dropped from about 1700 to 600 after one month. She will get tested again in early August. I'm sure someone else will come along to give you more helpful information, but I wanted to tell you what I've heard.
Julie & Hannah

[Tibetan-Mom]

Oh I'm sorry I said the wrong thing. She is having an ultrasound not a CT scan.

[frijole]

:D Yes. My dog Annie had 5 false acth tests and 2 false ldds tests. The test you did was the ldds. Stress can certainly affect the results. On all of her tests her first numbers (the baselines) were elevated above normal. It looks like your girls might be elevated also.

Come to find out... my dog's jitters are caused by a non cushings adrenal tumor that emits adrenaline. So yes.. you are wise to have that ultrasound and do additional tests as well to make sure before starting any meds.

Can you tell us what symptoms your dog has? Tell us everything. :) Welcome. Kim

[labblab]

I "second" Kim in confirming that stress can affect the results of an LDDS test. However, the symptoms that you have listed thus far are consistent with Cushing's, and it sounds as though your vet is taking a very reasonable testing approach. I heartily endorse his recommendation as to the abdominal ultrasound. Annie's LDDS result is consistent with a Cushing's diagnosis, but it does not help distinguish between the pituitary and the adrenal form of the disease. Hopefully the ultrasound will shed some additional light all the way around.

In the meantime, as Kim has said, it will help us if you will tell us as much as you can about Annie's symptoms and also her general health history.

Marianne

[Tibetan-Mom]

Annie's ALP was elevated (but not by much) when her last senior blood panel was done about 6 weeks ago. It wasn't too high but was over the normal level. Then suddenly she started drinking lots of water and urinating in the house. It was then that we returned to the vet. We've noticed other things as well. She suddenly pants for no reason. At times she is reluctant to jump up on the bed.

She is a high strung dog. We adopted her 2-1/2 years ago when she was almost 6. We spayed her immediately after we adopted her. A few months later she was diagnosed with hypothyroidism. She has been treated successfully since then. Her weight came down over the past two years but lately her tummy seems bloated.

[Tibetan-Mom]

Thanks to you both for assuring me I am heading in the right direction. I am trying not to be scared. I am grateful to have found this site.

Cathy

[frijole]

Heh Cathy... don't be scared. The dog I told you about was my 2nd dog diagnosed with cushings.. the first dog actually had it. I treated her for over 4 yrs and she died a year ago at the ripe age of 16 1/2 of an illness unrelated to cushings. Your dog can live a very normal life. You just need to learn about the disease - enough to question your vet and be your dog's voice. You are already doing a great job so keep it up and all will be well. Kim

[labblab]

It is really normal to feel scared, but I can promise that you and Annie will have tons of support to help you each step of the way.

All of the symptoms that you have listed are pretty much classic for Cushing's. My own Cushpup was also diagnosed with hypothyroidism prior to Cushing's. He continued to require thyroid supplementation even after being treated for his Cushing's, but thyroid function for some dogs returns to normal once the Cushing's is effectively controlled. It all depends upon the actual cause of the low thyroid function.

Anyway, take heart, because you and Annie now have family here to help you no matter what the next step turns out to be!

[Squirt's Mom]

Hi Cathy and welcome to you and Annie! :)

It sounds to me as if you are on the right path! The ultrasound is one of the best tests around IMHO. Not only will they get a look at the adrenal glands, which can help determine which type of Cushing's she has, they will also see the liver, kidneys, intestines, gall bladder and many other organs. An ultrasound saved my Squirt's life when a tumor was found on her spleen.

You are doing a great job so take a deep breath and try to relax a bit now. You and Annie are in good hands and we will be with you every step of the way.

Hugs,
Leslie and the gang

[littleone1]

Hi Cathy,

Corky and I also want to welcome you and Annie.

You have found a wonderful group of very caring, supportive, and knowledgeable people that are here to help in anyway they can.

You are definitely on the right track. Corky also has hypothyroidism. He's had it for 11 years, which was way before he was diagnosed with cushings. Keep up the good work.

Terri

[Tibetan-Mom]

I posted several nights ago about our Annie (an almost 9 yr old Tibetan Terrier) and her recent diagnosis of Cushing's. She had an ultrasound today. They saw normal size adrenals, a small mass on her spleen and an enlarged liver. Because I had to see a specialist to have this test done I haven't had a chance to talk over the results with our regular vet. I am guessing this means we are dealing with the pituitary type of Cushing's but I am not sure if the other findings are related to the Cushing's or something else. Her increase in ALP was only slight and discovered during her annual senior blood panel about 6 weeks ago. The test for Cushing's didn't come about until Annie started urinating in the house. We measured her 24 hr water intake (not easy with two dogs) and that led us to the LDDS test. Anyone have an opinion about the ultrasound result? I should
mention that Annie has been treated for hypothyroid but takes no other medication.

I can't tell you what a God send this board has been. I have learned so much in the past few days. I guess it does take a village.

Cathy, I have merged this post with your original thread. We like to keep all info about each pup in their own thread so everything is more easily found if someone needs to look back through her story. If you would like to have the title of her thread changed, just let one of the Admins or Mods know and we will take care of it for you.

[Squirt's Mom]

Hi Cathy,

What caught my attention was the mass on the spleen. Here's why -

Squirt was diagnosed as having PDH based on five positive tests, LDDS, HDDS, ACTH, UTK panel and two ultrasounds. When she has the second U/S done, they told me about a tumor on her spleen that needed to come out asap. Once that tumor was removed, her cortisol level returned to normal and remains within the norm. The stress from that tumor caused her cortisol to elevate.

What signs other than PU/PD are you seeing?

It is possible for the adrenals to be normal in size with PDH and the enlarged liver is typical with Cushing's - but it can also be from other things as well. I hope your vet will go over the findings in depth with you soon. It is a bit puzzling the IMS didn't do that when they gave you the results. Ours always have...well, other than the one who did Squirt's first U/S. The tumor was clearly present then but she didn't feel the need to mention it or note it anywhere. :mad:

Cushing's can be very difficult to diagnose so if I were you, I would follow up on the spleen and liver to rule any possibility of problems there first. As Squirt's case shows stress from non-adrenal illnesses can cause false positives on Cushing's tests. ;)

Hugs,
Leslie and the gang

[Tibetan-Mom]

They called me in to see the ultrasound and showed me the mass on the spleen. He pointed out the liver and adrenals. He said 'hard to tell what this is' about the spleen. He said he would send a full report to my vet.

The PU/PD are her main symptoms. I will be anxious to hear from my vet once she gets the US results.

Is Cushing's genetic or can some breeds be more prone to it? We adopted Annie thru a local breeder when she was six. I called recently to ask about this and they have not seen Cushing's in any of their dogs. We adopted our other Tibetan (Clementine, who is 11) from them as well.

Thanks for the info Leslie. The girls and I appreciate it!

[lulusmom]

Can you please post the abnormal values on the senior panel, including the reference ranges. With PU/PD being the primary symptoms associated with cushing's, did your vet do a urinalysis to 1) check urine specific gravity and 2) culture to rule out urinary tract infection? Dogs with cushing's who drink and pee a lot have low urine specific gravity and dilute urine. A good number of them will also have a UTI but because the urine is dilute, a culture should be done as the white cells will be diluted out.

I believe Annie is the first Tibetan Terrier I have seen on the forum. I think they are absolutely adorable and I hope you will be posting pictures soon. I found an interesting survey done by The Kennel Club/British Small Animal Veterinary Association Scientific Committee showing the results of the Purebred Dog Health Survey for Tibetan Terriers. Since I am not familiar with the breed, I was looking for anything I could find on Tibetan Terrier's health issues. While I don't think this survey is all that scientific due to limited participation, I do think it has some value and I noticed that cushing's doesn't appear to be a remarkable problem for the breed.

http://docs.google.com/viewer?a=v&q=cache:jCREQLHwxeQJ:www.thekennelclub.org.uk/download/1636/hstibetanterrier.pdf+tibetan+terriers+and+splenic+ tumors&hl=en&gl=us&pid=bl&srcid=ADGEESjdkeknMqswpENxfz9zk5zAHZu1FcYDuLDzeHnY YPnjwjgjaH6jS7sslLG0X1bBOGjq44b6R9XOjEvP8zEE3tqnom yl86XNcQs7WouYgaXKRtC3LNlqdeQf2lGAQKalrZ2MBgtG&sig=AHIEtbQX7eitihnmI3QIYKCDnhii7bDf2w

Looking forward to receiving more information on Annie's test results at which time, I'll give you my totally unsolicited two cents worth. :D

Glynda

[Tibetan-Mom]

Hi Glynda

Having Tibetans was such a lucky accident for us. We have always adopted shelter mixed breed dogs (always older adults because we are gluttons for punishment ) when a friend of mine was trying to place Clemmie, our first Tibetan. It was an instant love affair. We adopted a second Tibetan shortly after that. The girls were so bonded. Then tragedy struck. Sadie, our second (born deaf we adopted her at 7) died of cancer 2-1/2 years ago. Clemmie was not to be consoled. We spent three painful weeks watching her mourn before we adopted Annie. Clemmie accepted and bonded with Annie almost right away. They sleep together like cats. I've never seen dogs do that before. They bring such joy to our lives.

I don't know the specific gravity of the urine. When we had her checked for possible urinary infection our vet was disturbed by how dilute her urine was. That combined with the increased ALP led us to measure water consumption and check for Cushing's. I will get copies of all her test results to date. My vet is not in today so I need to wait until tomorrow to speak with her about the ultrasound results.

I don't know how to post pictures. Once I figure it out I will be happy to post pictures of our girls.

[Squirt's Mom]

How to post a profile pic -
http://www.k9cushings.com/forum/index.php

To post pics in your profile album, go to UserCP at the top just under "reply to thread" in the white box above. Then click on Pictures and Albums under Networking on the side bar. You should see an option for Add Album. Just follow the directions and you should be able to upload pics of your girls.

I can't wait to see them! Tibetans are so cute but I am partial to Terriers period, tho I gotta say Chis are starting to come in a close second!

Hugs,
Leslie and the gang

[Tibetan-Mom]

Thanks! I was able to add pictures! :)

[lulusmom]

I love the pictures and my favorite is #10. Awesome!!! They are so dang cute.

[Tibetan-Mom]

I had a long talk with our vet today. She got the ultrasound report. She thinks the mass (6mm) on her spleen is 'regenerative' (she said this is commonly seen in older dogs) and that the liver (enlarged & bright) presented in a way that is consistent with the Cushing's diagnosis. She felt her recent blood test results didn't warrant investigating the spleen further at this point but she would monitor that closely. All of her recent blood work has been normal except for the increase ALP. She would like us to begin with a low dose of Trilostane (1x per day) and have her blood work rechecked in 10-14 days. She told me to call her right away if Annie had any problems with nausea, vomiting or lethargy.

They didn't have the correct dosage in stock so they ordered it. We should be able to begin treatment in a few days. I am a little nervous about the side effects but after reading through so many posts here I feel this is our best course of action. I am hoping with successful treatment Annie will lose her recent nickname: "pee pee pants". :D

Thanks to all of you for your support and encouragement. {{{hugs}}} all around!

Cathy

[Squirt's Mom]

:D "Pee pee pants" :D That's funny! :p

And I love the pics!

[addy]

Hi,

Love the photos; how wonderful they are.:):) I love the Tibetan Terriers too. What a great breed.

Quick question:
What is the dose and what does your pup weigh?

Glad you found your way here.:)

Hugs,
Addy

[Tibetan-Mom]

I finally got the medication (Trilostane). Annie weighs 28 lbs. They are starting her on 10 mg per day to start. Then they will do a blood test in 10-14 days. Any advice on when to give the medication (AM vs PM)? Any other tips or things to watch for?

[addy]

Hi,

The one dose is usually given in the morning with food. You are starting on a very low dose which can be a good thing. My Zoe did as well.

You want to look for any unusual behavior, lethargic behavior, vomiting, diarrhea, these are signs she is going to low.

If you go on Dechra's website, they have a lot of information.

With Zoe I noticed a decrease in her water consumption early on. She never drank a huge amount but I did notice her thinking, maybe I want a drink, no maybe I don't or taking a few sips instead of gulping. The first few days she seemed like she felt icky, she did a lot of yawning and lip licking. Her cortisol was dropping like a ton of bricks.

On her 10 day stim, she was down to 11ug/dl. We started at somewhere around 44 ug/dl:eek::eek::eek:

I thought she was sick to her tummy. But then it went away, the lip licking.

Your pup will most likely be just fine but watch her.

Hugs,
Addy

[Tibetan-Mom]

Hello all!

Annie just had her first ACTH Stim Test since starting the Trilostane on 7/19. She is on a very low dose (10 mg 1x a day).

Baseline Result: 3.4
Post Result: 9.6

I am puzzled that such a low dose of Trilostane would result in a normal test result after two weeks.

Something doesn't feel right to me...or are my instincts wrong? :confused:

[labblab]

Even though Annie's post-ACTH result of 9.6 falls within the "normal" range for a dog without Cushing's, it is higher than is typically desired for a dog who has been diagnosed with the disease. If you revisit the link for Dechra's website, you'll see that the ideal therapeutic treatment range for a trilostane dog is between 1.45 and 5.4 ug/dl. However, as long as symptoms are being well-controlled, a result as high as 9.1 is considered to be acceptable.

How is Annie doing in terms of her drinking and peeing? Correct me if I'm wrong, but I don't believe you had an ACTH performed prior to starting treatment. So we don't actually know how far her cortisol has dropped since starting the trilostane.

As long as she is doing well, the general recommendation is to go ahead and stick with the original dose for at least thirty days since the cortisol level tends to continute to drift downward during the initial weeks of treatment. However, at that point, if her symptoms have not resolved and her cortisol remains higher than 5.4, her dose will likely need to be increased. Here's a link to Dechra's product info sheet for your reference:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[addy]

To give you an example, my Zoe weighs 19 pounds. We started on 10 mgs of Vetoryl, her test in January had her cortisol at 44 ug/dl:eek:

10 days on 10 mgs gave us 11.7 ug/dl post Quite a drop for such a low dose, huh?

at 30 days, we went up to post 16.9 ug/dl (wrong direction)

changed dose to 15mgs

14 days on 15 mgs gave us post 9.9 ug/dl.

we stayed on this dose which is still less than 1 mg per pound and retest this Wednesday.

I thought that my example might help.

Hugs,
Addy

[apollo6]

Dear Cathie and Annie
Welcome. Glad you found us. We are here to support and guide you.
Hugs Sonja and Apollo

[Tibetan-Mom]

Thanks...this helps... I keep worrying....:eek:

[addy]

I think 'Worry" is our middle name , I don't know if that ever goes away;)

If you start freaking too much, just come here and babble away. That helps!!!:D:D:D:D

Hugs,
Addy

[Tibetan-Mom]

post deleted by Tibetan-Mom