My 15 yr old American Eskimo, Annie, just diagnosed

[Julieann]

This is my first posting. Just yesterday, I got the phone call from my vet that my 15 year old American Eskimo, Annie, has cushings. She had a test done when we left her for the day at the vet. This was the 4th time we had taken her to the vet after noticing back in early summer that she was urinating all the time. Previous visits had her on antibiotics for UTI and pancreatitis.

My vet told me on the phone that I would need to bring Annie back in for more tests. She said that it was fairly costly. What I am wondering is whether or not a 15 year old is going to be able to handle all of this. I'm just torn. I love her and don't want her to suffer, but I know she is old. Is treatment going to extend her life? I just don't know what to do. I'm thinking I should at least bring her in for the additional tests. Anyone know what these tests are for? What is the best and worse possible senarios?

Thanks for your help.... I only know what I have read online and it is all very confusing.

[frijole]

Hi and welcome! It will be overwhelming at first but trust me, if I can figure out cushing's so can you. :D;)

If you had Annie tested all day then that was most likely the low dose dex suppression test (LDDS). Get a copy of the results and post them - there will be 3 nos. That test can tell you which type of cushings your dog has.

That test can also have false positives (happened to me). It is wise to do additional testing because you really need to be sure it is cushings and not a thyroid issue or diabetes. Probably they want to do the acth test. It is a 2 hr test where they are measuring the cortisol level of your dog. Cortisol is what is overproduced in cush dogs which is why they urinate so much. (shortened version)

I strongly suggest you read on our information section and ask a ton of questions. We'll help you thru this. And it's free!:D

Most important - this is not a death sentence! Tell us more about your Annie, the symptoms, etc. Hang in there and just know things will be ok. Kim

[lulusmom]

Hi Julianne and welcome to you and Annie.

I'm sure sorry for the circumstances that brought you here but I'm glad that you and Annie are with us now. Canine cushing's is a difficult disease to wrap our heads around so nobody here is going to step up and tell you that dealing with it is a cakewalk. It's confusing, hard to understand all the medical jargon, scarey and a strain on our pocketbooks.

Understanding what is going on in Annie's body isn't going to come easy for you but that should be your goal so you can be the best advocate you can be for her. This disease is a lot easier on us and our dogs if our vet is experienced and we are educated. We've learned that that when either of those components is missing, a dog is more likely to experience adverse effects. I'm happy to hear that you have jumped in with both feet and are trying to read up on cushing's. I know that everything you are reading is probably Greek to you but I promise that you'll be reading Greek and understanding it before you know it. :D

Unfortunately, nobody has come up with a "Canine Cushing's for Dummies" book yet and until they do, we'll do our best to share our experience, answer any questions, encourage you to learn and point you in the right direction when you are feeling lost. As Kim has mentioned, we have a wealth of information in our Helpful Resources section so take a look around but also remember that each thread started by our members represents just one of hundreds of case studies to be found here.

I've included a link below to some helpful information for us laymen provided by the manufacturer of Vetoryl, one of the two effective treatments available to us folks in the U.S. I found this on their UK site so some words like "veterinary surgeon" may sound odd. There is information as to how to monitor treatment with Vetoryl but keep in mind that Vetoryl is the only effective treatment available for canine cushing's in the UK. It's great information if your vet ultimately chooses to treat with Vetoryl, but here in the states, we have another very effective treatment called Lysodren. We have plenty of information on that drug if and when we need to go there.

http://www.canine-cushings.co.uk/index.htm

It is a lot easier to provide you with meaningful feedback if we have a complete picture of Annie's physical appearance, complete list of symptoms you have noticed and the results of all testing done by your vet thus far. We aren't vets here but most of us have been dealing with the disease for a long time so we know the diagnostic patterns and how to read test results. Not all gp vets nor specialists have a lot of experience under their belts so it's a good thing for us to look over our vets' shoulders.

None of us can tell you which road to take but I've never been afraid to tell anybody what I'd do if I were in their shoes, with all things being equal. If my dog had already reached the expected lifespan for her breed and her symptoms were not problematic for me nor causing her any discomfort, I would think twice before subjecting her to testing and treatment. Strong symptoms are a huge part of a diagnosis and since the goal of treatment is not to cure but to remedy symptoms, unless Annie is overtly symptomatic, you have time to think things through. Cushing's is a very graded disease, taking a very long time to do damage to internal organs or shut down the immune system. The experts say that most dogs have had the disease for a year or two before the diagnosis so that goes to show how slow the disease progresses. The experts also say that whether you treat or not, the average life expectancy after diagnosis is two years. There are plenty of us here that will tell you that is bunk. My cushdogs are very much alive, one diagnosed six years ago and one four years. I doubt they would be here today without treatment but they were also much younger than Annie when diagnosed. My first cushdog was only three years old.

I apologize for writing a novel....brevity is not my strong suit. I think I like to hear myself talk too much. :D I'm looking forward to hearing more about your precious Annie and I promise to keep my future posts shorter.

[mytil]

Hi and welcome from me too.

I just wanted to add to the others by providing this link http://www.k9cushings.com/forum/showthread.php?t=180 - follow the links that describe a lot more about Cushing's, the testing and treatments. The more you know - it will be easier.

Keep us posted on the other testing your vet wants to do.

Terry

[Squirt's Mom]

Hi Julieanne,

Welcome to you and Annie! :)

Pancreatitis and frequent UTIs are common in cush pups, especially untreated ones. However, if these are the only signs Annie is displaying, treatment can be tricky as signs of extreme hunger and thirst are very important in gauging how treatment is working. How is Annie's appetite?

Treatment doesn't cure Cushing's, it simple relieves the signs for both pup and parent and helps protect organs from a constant assault of cortisol. But as Glynda said, this disease takes ages to do any real damage so at the age of 15, I would be hesitant to treat - UNLESS she is displaying strong signs that are making her miserable. Kate Connick has a great list of common cush signs -

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


The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

The testing phase can be quite expensive but once this is done and a diagnosis confirmed, which isn't easy to achieve, the cost drops. Treating with Trilostane (Vetoryl) can be a bit more expensive as it can take more testing to get the dose right. Lysodren is scarier to most folks because of the loading phase that is usually required. Both drugs can be life-saving however one is no safer than the other - both have the same potential for problems especially when protocols are not followed. This is where your education and our help can come in really handy. ;)

If I were in your shoes, I would be focused on Annie's current quality of life. Is she happy? active? eating well? sleeping well? These are the sort of things I would be looking at right now when considering whether to proceed with further testing and treatment. Another thing to consider is whether you would treat or not regardless of what the tests show. If you don't think you would treat, then the testing is a waste of money and just a source of stress for both you and Annie. So tell us more about Annie and her daily life. Not only to help you decide, but to let us get to know her better. She, and you, are family now and this is a pretty darn great family! :)

Whatever you decide, we will support you all the way. Ya'll are not alone; we will walk every step of the way with you.

Hugs,
Leslie and the gang

[Julieann]

I appreciate all of your very informative responses! They were all great!
As an answer to your questions...
The only symptom that I have noticed in Annie is her FREQUENT urination. She is ALWAYS squatting if she is not laying down, whether anything comes out or not! She has been housebroken since she was a pup, but now she pees even as she walks to the door. It breakes my heart. I am a clean freak and the accidents are constant, so you can probably understand my frustration. However, I know it is not her fault, but this can't continue on this way.

She does not act like she is in any pain what-so-ever. She feels bloated... like a balloon blown up. She has always been petite. Her appetite has not changed. She has always been a slow eater and only eats what she wants.

It's hard to tell whether her drinking has increased since she shares a self-waterer with my other 3 dogs.

I'm going to call the vet today and find out the next step. I plan to go further with tests and then figure out what we do from there.

Thanks again for all the concern and responses. I will keep you informed.

[Julieann]

Update....

Just called the vet...
She wants to put Annie on Lysodren for 7 days. Then they will check her ACTH again. If her levels are down, they she will remain on this medicine once a week. If not, then "we'll cross that bridge when it comes."

What do you all think?

[lulusmom]

Hi Julianne,

Based on Annie's symptoms, I would have to say that she does not have cushing's. Symptoms are a huge component of making a diagnosis and Annie simply doesn't have the normal symptoms associated with cushing's. Dogs with cushing's almost always have voracious appetites and while most also pee huge volumes, they also drink huge volumes to stay hydrated. If Annie's only symptom is having accidents in the house, a confirmed diagnosis cannot be made and treatment should not be prescribed.

Please remember that you have time to make absolutely certain that you are dealing with cushing's and not incontinence, which is common in very senior females. We can't offer up any meaningful feedback or answer to your question without more of Annie's medical history. Can you please obtain copies of all tests that were done by your vet to diagnose Annie and post the results here? That would include a full blood chemistry, urinalysis, low dose dexamethasone suppression test (LDDS) or ACTH stimulation test, and any differentiation tests like abdominal ultrasound, endogenous acth or high dose dexamethasone suppression test (HDDS). Regarding the bloodwork, you don't have to post all of the values, just the abnormal ones and please include the normal reference range.

Your vet should be happy to provide copies of everything. We recommend to all members to keep a folder with all testing, primarily so that you have Annie's most current medical history in your hands in the event you find yourself having to take her to an after hours ER clinic.

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

Glynda

[Squirt's Mom]

Hi Julieanne,

If it were me and my dog, there is no way I would start treatment on Annie. Not right now. As Glynda said, there are just no indications whatsoever that she has Cushing's and these drugs are very powerful, not to be used until all doubt is removed - and there are plenty of doubts with Annie.

Her incontinence could have many causes, none related to Cushing's whatsoever. Until you have exhausted all other possible causes, her testing has ruled out all other possibilities, and she has strong signs, I do NOT recommend treatment.

Please get copies of the tests and we may be able to point you in some other directions, other places to check out before looking at Cushing's. Right now, that condition just doesn't seem to be present at all.

Is this the GP vet wanting to start treatment or an IMS (specialist)?

For my vote, do not start the Lysodren. ;)

Hugs,
Leslie and the gang

[Squirt's Mom]

I have to run but I quickly want to share my Squirt's story with you. She was given 5 tests for Cushing's and all of them came back as positive for PDH. However, after the second ultrasound I was told about a tumor on her spleen. The tumor and half her spleen were removed in Sept. of '08. After recovering, I had another ACTH done and it came back within normal range and has stayed that way. Because of that tumor, her body was under a great deal of stress which caused abnormal amounts of cortisol to be released which caused all those tests to come back positive. Cortisol is one of the body's natural responses to stress of any kind and that is why thorough testing and strong signs are critical in diagnosing Cushing's.

Gotta run but I repeat what Glynda said - take your time, no need to rush into treatment.

More hugs,
Leslie and the gang

[Julieann]

I'm shocked and a little worried about the responses that I have read. They leave me a bit confused. Due to the fact that she has had the urination problem now for several months (since about June), I had the need to do something to help her immediately. All other tests including blood tests, urine tests, and ultrasounds, and xrays have ruled out everything else. She has also been on other antibiotics with no change. She doesn't just have accidents; she squats ALL THE TIME... even when walking. The ACTH came back positive for Cushings, so I trusted my vet's decision to put her on Lysodren. I started her on this 3 days ago. I hope I didn't make a mistake.

[labblab]

Julieann, how much does Annie weigh and how much Lysodren are you giving her each day? Here is a link that you will tell you some very important information about Lysodren "loading":

http://www.k9cushings.com/forum/showthread.php?t=181

As you will see, the signs that owners typically watch for in order to signal that loading is complete and Lysodren should be stopped include changes (even subtle changes) in appetite and a decrease in excessive water consumption. You do not want to wait to see more serious changes such as vomiting or diarrhea, but if you do see those changes it is definitely time to stop the medication immediately and have ACTH testing performed. There is no set time-table for the length of time that it will take for any given dog to load. We have seen dogs here who have loaded within just a couple of days. Others have taken much longer.

I am hoping that your vet has not told you to just keep giving Annie the Lysodren for seven straight days, regardless of how she is behaving. Since Annie does not exhibit the classic Cushing's symptoms of ravenous appetite and excessive thirst, it will be harder for you to judge whether/when the loading is complete and she may be at greater risk of being overdosed. You will have to watch her very carefully in order to see changes (such as acting "off" or lethargic) that could signal that she has had enough Lysodren. Also, has your vet given you prednisone to have on hand to counteract the effects of the Lysodren in the event that Annie is overdosed?

Please do look over the Lysodren loading tips, and check back with us ASAP regarding any questions that you may have, OK? Given Annie's lack of typical Cushing's symptoms, I share the same concern that the others have already expressed re: proceeding onward with Lysodren treatment. But since you are now in the midst of loading, it is important that you know as much as possible about the medication and its effects so that you are prepared to intervene if there is any hint of overdosing.

Marianne

[Squirt's Mom]

Hi Julieanne,

Please, please, please stay in very close contact with us over these next few days. And please do tell us how much Annie weighs, the mg of Lyso you are giving her, how often she is getting it, and how long your vet said to give it in this manner.

Can you describe how Annie is acting since starting the Lyso? Note ANY changes you have seen and tell us about them asap.

And, I am begging this time, please get her test results and post them here. This is now critical since treatment has already been started. We want to help you all we can but without this info we are walking blind.

To help you understand how Lysodren works - it's job is to erode the outer layer of the adrenal glands, called the outer cortex. This erosion prevents the adrenals from "hearing" the messages sent from the pituitary to release cortisol on a constant basis. If too much of the cortex is eroded, the pup ends up with the opposite problem from Cushing's, they end up having an Addisonion crisis, or can become permenantly Addison's. In Addison's, the pup is no longer making cortisol, which is required for the proper functioning of the body. Cushing's is too much cortisol, Addison's is too little.

Now, it is believed that Lysodren will not harm adrenals that are healthy - that it will not cause damage in a pup that does not have Cushing's. Exactly how this is supposed to work, I personally cannot fathom. So this could be a saving grace in using Lysodren in a pup that in no way sounds as if she has Cushing's - Annie. ;)

Once again, I am BEGGING you to post the results of the tests done to diagnose Annie as having Cushing's. Please, please, please.....

We are here to help, not frighten but I am very concerned about Annie and your vets knowledge about Cushing's or how to treat it. You can help us all by posting those test results and we will then be better suited to help you and Annie through this.

Hugs,
Leslie and the gang

PS. Call your vet RIGHT NOW if they did not give you predisone and DEMAND they give you some and explain when and how to use it. This could save Annie's life if the Lyso does have an adverse effect. This vet pushed you into starting treatment so it is your turn to push back and get the pred ASAP. You must do this for Annie's sake.

[Cyn719]

Julieanne - I just had to add my two cents by saying LISTEN TO WHAT THESE MEMBERS ARE ASKING YOU TO DO!!! Believe me first hand they know what they are talking about! My vet who I thought knew about Cushings didnt - these Cush Angels had to be the ones to tell me to stop Pennys trilo and give her Pred immediately when she took ill - thank God I listened!! Penny is being check now to see if the Trilo damaged her adrenal glands - if I didnt listen I dont know where Penny would be today -- Hugs and Support to you and Annie

p.s. Penny is 82 lbs and is a mixed breed

[Squirt's Mom]

I want to interject something here - Trilostane and Lysodren work completely differently. Lyso works directly on the adrenal glands themselves so they can't "hear" the signals being sent while Trilo works to interrupt the pathway by which the signals are sent to the adrenals.

As I said in my first post, it is believed that Lyso will not harm a pup who is does not have Cushing's. The same is NOT true of Trilostane - it should never, ever be given to a pup without a confirmed diagnosis.

Even when the diagnosis is right, Trilo as well as Lyso can cause problems when the vet is not up to the task. It sounds as if Cindy's Penny is in much better hands now and we are all so relieved! :)

I hope to hear from you soon, Julieanne. Don't panic, just talk to us, ok? ;)

Hugs,
Leslie and the gang

[Julieann]

After the initial doses of Lysodren, with no changes in Annie, I just had a gut feeling that my vet was on the wrong track. After bringing Annie back to the vet to get another ACTH test, the vet called me and said she wanted to keep Annie on the Lysodren at one dose every two weeks. I just didn't feel that this was what Annie needed and decided to get a second opinion. I love the new vet I found. She is very thorough and also not satisfied with the diagnosis of cushings. I took Annie there yesterday to stay all day and night for tests. I just got off the phone with the vet. She is fairly certain that Annie has a tumor in her bladder. That would explain the frequent urination and blood. Bad news, but relief that I got a proper diagnosis for her. Now we at least know what we are actually dealing with. The vet is still going to consult with a specialist to make a final determination that this is it, but then we have a really hard decision. I know what we have to do, but hard because it is going to break my heart. :-( I'm not looking forward to the next call that I hear from the vet.

You were all correct.... I just wish you hadn't been. I would have rather dealt with a cush-dog....

[Squirt's Mom]

Oh, Julieann,

My heart is breaking for you but don't give up hope just yet. There may be options for Annie that will help. Talk with the docs, especially specialists in this area, then decide what you can do.

Regardless, we will be here with you every step of the way, holding your hand, lending our strength.

Hugs,
Leslie and the gang

[StarDeb55]

I have not posted to you before. I am certainly very sorry to hear Annie's diagnosis. I know she is a very senior lady, & that you may not want to be to aggressive with her treatment. I did want to suggest that you seek an consult with an oncologist. My first cushpup, Barkley, developed lymphoma at the age of 13. Initially, because of his age & other medical problems, I had decided that I would not seek further treatment. I thought further & decided to have an oncology consult as I wanted all the information available as to our options so I could make the best informed decision I could on Barkley's behalf. As it turns out, we did do chemo, & my B had another 20 months with an excellent quality of life.

I will be thinking about you & Annie. Please keep us posted.

Debbie