10 y/o Pit/Lab mix -- Diagnostic/Treatment questions

[Oldskool454]

I have a 10yr old Pit/Lab mix that I am pretty sure has Cushings but I haven't been able to get him to the vet for the full tests yet.

He has been displaying most of the symptoms for around 2 months, drinking tons, peeing just as often, acting frantic about water and food. Food aggression and getting into the garbage etc.

I have seen other dog owners that have dealt with this disease post about their dogs going BLIND, but none of the info I find online mentions that as a major result or anything. One lady said her dog went blind 3 DAYS after she got it to the vet for meds...

I do have an appt set to get him in for testing in a couple of days but I am feeling a little frantic about even waiting 2 days to get the testing done, and then another day or two for results and get the meds started.

Is this usually in cases where Cushings is co morbid with canine diabetes maybe?

What causes the blindness? How fast will the meds stop the process if it has begun?

[lulusmom]

Hi and welcome to the forum.

I have seen people on other forums mention that if left untreated, cushing's will cause blindness. That isn't really true. If left untreated, diabetes can become a reality and cataracts are a complication of diabetes.

There is also a condition called SARDS (Sudden Acquired Retinal Degeneration Syndrome) and I believe the woman whose dog went blind 3 days after getting her dog on meds is probably dealing with SARDS. Dogs with this syndrome will start to show symptoms associated with cushing's shortly before the onset of blindness. One or more of the adrenal hormones are always elevated and sometimes these elevations resolve themselves within months of going blind so treatment may not be necessary.

We have hundreds of members and only a tiny fraction have experienced SARDS. Cushing's is a very slow progressing disease and it is the severely compromised immune system that leaves them open to infection that can prove fatal for an untreated cushdog.

The symptoms you have posted are certainly associated with cushing's. Has your vet done any bloodwork and urinalysis yet? If so, can you please post the results here. Relative the bloodwork, you only need to post the abnormal values and please include the normal reference ranges. The more history we have for your dog, the better able we can provide more meaningful feedback.

I'm sorry for the circumstances that brought you here but I'm glad you found us. Now that you are a member, you never have to walk alone again. We've been in your shoes and are here to help you and your precious pup in any way we can.

Glynda

[Squirt's Mom]

Hi and welcome to you and your baby! :)

Ok, first thing, sit down, take a deep breath and relax. Cushing's is not a death sentence, it is a VERY slowly progressing condition so there is no rush to treat, blindness is NOT a typical result, you will get through this just fine. Breath.....breath......breath......

Oh, how I remember when Squirt was first diagnosed. Heavens. I was a complete basket case, crying and snotting all over the place. Nothing made any sense to me, even things I already knew suddenly seemed foreign! And everything I read only made it worse...until I got here. These kind folk took me in and gently guided me along until I could stop pulling my hair out then they started teaching me. That was in March of '08, and my baby and I are still here, still have our hair! :D

Now, there is a form of sight loss in dogs called SARDS - Sudden Acquired Retinal Degeneration Syndrome - in which the pup suddenly goes blind. These dogs will display the signs of and test positive for Cushing's, but they don't usually actually have Cushing's. It isn't fully understood why, but SARDS pups will display Cushing's signs but within 6 mos or so of losing the sight the signs disappear and the pup is fine. This may be what the lady you spoke with is actually dealing with instead of Cushing's. If so, and her pup is on Trilostane (Vetoryl), it may be in trouble so if you know her pass this info on to her.

Does your baby have any other health conditions that you are aware of? If he hasn't had blood work done recently, that would be my first step. There is a very simple, non-invasive urine test that can rule Cushing's out but cannot diagnose it. This test is called the UC:CR. If it is normal, Cushing's is extremely unlikely; if it is abnormal, that simply means further testing needs to be done. Do you know what test you vet is wanting to do first?

Take the time you have to read the thread here, read in the Helpful Resource Section, and ask any questions you may have. We will do all we can to help you understand. The most important thing I can tell you today is that you and your baby are not alone on this journey. We will walk with you every step of the way.

Hang in there!
Hugs,
Leslie and the gang

[Oldskool454]

WHEW ok, glad to know my boy isn't going to go blind in the next couple days.

I have been dealing with this situation with him for a couple months.
We did a UA, they found bacteria and thought it was a UTI, after taking the antibiotics for that I took the pee in for another UA and they said he was fine. However the symptoms did not change.
So I took him in and they gave him an X Ray to look at his guts and did a "Urine Culture", both came back with no results to explain the problems.
So now they want to do the Cushings test. I have to drop him off Thursday AM and they keep him for a couple hours to do the tests.

[Squirt's Mom]

And just to alleviate some of your concerns about blind dogs, I have two who are blind but neither one of them knows that so keep it quiet, ok? :p

When folks meet Trinket, they are always shocked to learn she is blind because of the way she moves around - she has sonar and no fear! If they get a good look at her face, they see she has no eyeballs and are dumbfounded. In fact, the first time her vet here saw her she was roaming around his waiting room and after watching her for a few minutes, he said, "Well, I think she can see a little bit." To which I replied, "Dr. B, she ain't got no eyeballs!" :p

Brick still has his eyes but they are useless to him. However, that doesn't stop him in the least. He doesn't have the sonar like Trink does and his Hydrocephalus prevents him from developing it but he still does just great. He has no fear either plus a heart the size of Texas. He is the happiest little guy I have ever met!

So don't fret about blindness in dogs. WE suffer much more than they do when they lose their sight! :rolleyes: They go through an adjustment period but the vast majority do just fine after that.

Ok...back to Cushing's! :D Just wanted to share.

Hugs,
Leslie and the gang

[lulusmom]

If your dog will be at the vets for just a few hours, chances are your vet is going to do a blood test called the acth stimulation test. This particular test does not distinguish between adrenal and pituitary dependent disease so if results are consistent with cushing's, an abdominal ultrasound or an endogenous acth test should be done to make the differentiation as well as validate the acth stimulation test. A diagnosis should not be confirmed basedly solely on the acth stimulation test.

Did your vet do bloodwork yet to rule out diabetes and hypothyroidism? Symptoms for both overlap with those of cushing's so as a rule of thumb these should be ruled out. Some of the more common abnormalities on bloodwork are elevated liver enzymes with higher elevations in ALKP and mild elevations in ALT; elevated cholesterol; elevated triglycerides. I have provided a link below to questions and answers about diagnostics which hopefully will help you understand a bit more about the importance of proper testing.

http://www.dechrace.com/top10_diagnosing.html

[Oldskool454]

The vet thinks I am the normal hypochondriac type of dog owner or that I will get confused by the big words, or I presume such by the way she talks to me about things.
All she could say is that they did do a "full blood workup" and that they eliminated "almost everything that that could show, including diabetes" so that really only leaves Cushings, even though she didn't CALL it that. When I called it that and asked her if it was what she was describing to me she chuckled and said "Yes but most people don't know what that is so I don't just use that term".

She described the situation where it could be up on the Pineal gland in the skull, or down by his kidneys but said that the Pineal variety is very rare in big dogs so if they get a positive they will most likely go ahead with treating it as if it is the rear gland type.

[Squirt's Mom]

Your vet may be a bit confused. ;) Conventional Cushing's is caused by a tumor either on the pituitary gland or one/both of the adrenal glands. 85% of cush pups have PDH - pituitary based Cushing's - while only 15% have the adrenal form - ADH. I don't recall ever reading that the size of the dog had any bearing on which type was more likely.

Treatment can vary depending on the form of Cushing's being treated. ADH can be cured via surgery while PDH cannot yet in the USA (it has been being done in The Netherlands but we are just venturing into this arena in the US.) The key thing for you to know right now is NOT to let your vet or anyone else rush you into treatment. It is vital that Cushing's be confirmed. A single test cannot reliably do that. ;)

Hugs,
Leslie and the gang

[Oldskool454]

I FINALLY got a diagnosis for my dog, the vet, although STILL "wishy washy" about it says that she is "90%" sure that it is cushings, etc etc.
I was seriously getting aggravated with how non committal she was and I was already fairly sure he had it based on symptoms and what I have read here and other sites.

I am just a little nervous about the medication that she has prescribed, she is giving me 30 of some medication that I don't recall the name of right now, but she says it is the newer of the two drugs available and the more expensive but not approved for humans, so no cheapie Costco options. She says it is guaranteed to fix the kind of Cushings that big dogs get, where the adrenal glands are the problem. Rather than the kind little dogs get where the pituitary glands in their head are the problem.

From what I read online it sounds like this "loading" process is fairly involved and should be closely monitored. Whereas my vet basically just said give him 2 pills a day (morning/eve) and then come back for a test in 10-14 days so they can evaluate if the dosage is too high or low.

So I am going to read some of the info here first of all and find out EXACTLY what I am supposed to be doing since the vet is either too busy, or inexperienced to give me specific details on this process.

She also quoted me something like $180/mo for these pills for the rest of his life. So I am looking for info or sources to get this cheaper since that seems like allot for pills for a dog when I know vets add some degree of mark-up to medication.

[Squirt's Mom]

Oh, honey,

So, your vet did further testing? Or is she still basing the 90% on one test and observation?

I am begging you to get a second opinion before starting this medicine, which I think is probably Lysodren. If it is, the directions she has given you are woefully wrong and she is putting your baby at extreme risk. Please, please ask for a referral to an IMS, or this was an IMS, ask for another referral.

If it is Lysodren she has prescribed, here is a link from our Helpful Resource section about it. If you will read it, you will see that she is off base by a mile....sorry.

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

She is also wrong about big dogs getting one type and small dogs getting another type. The size of the dog has nothing to do with which type Cushing's a pup can have; only testing can determine that. If you will read through the threads here, you can see that for yourself. As I said before, 85% of dogs with Cushing's have the pituitary form - regardless of their size. The remaining 15% have the adrenal form - regardless of their size. The same two drugs are used to treat both forms, both with success. It has been shown that dogs with the brachycephalic skull shape, like the Boxer and Boston Terrier, are more prone to developing macro tumors on the pituitary. But, again, size of the dog has nothing to do with that either - only the shape of the skull.

It is increasingly obvious to me that your vet is way over her head here and has little to no experience treating Cushing's successfully.

Again, please try to get copies of all the testing your baby has had and post them here before you give any of this med. These are very powerful drugs and should never be given lightly.

My gut reaction to everything you have written concerning this vet is to run, RUN, very fast, as far away from her as you can get NOW. ;) It has been our very sad experience here to see pups left with long-trusted vets who have served them very well in the past - until Cushing's came on the scene. Then these long-trusted vets just didn't know how to handle it, and caused the pup and parent much unnecessary suffering. We know how hard it can be to stand up to one we see as more learned than us but when the life of our babies depend on us doing just that, we have no other real choice. Please, please, please.....seek another opinion. Please....

Hugs,
Leslie (the Queen Worry-Wart) and the gang

[dajophlptt]

You are taking about Trilostane? If it is it can be ordered online from Thrivinpet.com for about half vets price.

[Squirt's Mom]

Dave is right - there are several places you might can save money on the meds used to treat Cushing's....but let's get the horse before the cart first and make sure you baby has Cushing's and that they are under the care of a vet who has more experience and knowledge than your current one apparently does. Then we can offer you several places to look for better pricing...if needed. ;)

Hugs,
Leslie and the gang

[Harley PoMMom]

Hi and welcome to you and your furbaby!

Any dog, whether they are big, small, any breed, can have Cushing's and it can be the adrenal type, pituitary, or both. Cushing's disease, if it is from a mass on the adrenal gland, can be "cured" only with surgery.

If you are instructed to do a "loading," then it sounds like your vet prescribed Lysodren/Mitotane. The loading dose is based on a dog's weight and Lysodren is given at a dosage of 50 mg/kg/day, divided and given twice a day.

Here's a handy link from our Resource Thread regarding Lysodren: Lysodren loading Instructions and related tips. (http://www.k9cushings.com/forum/showthread.php?t=181)

I was wondering if you could get copies of all test/s that were done on your furbaby and post the results here, especially the test/s that were done to confirm the Cushing diagnosis.

How much does your furbaby weigh? And is s/he on any other herbs/supplements/medicines? Any other health issues? Has your vet given you prednisone to keep on hand in case of an emergency?

Cushing's is one of the most difficult diseases to get a confirmed diagnosis because not one test is 100% accurate at diagnosing Cushing's and any non-adrenal illness can skew the resullts on the Cushing test/s.

Both of drugs used to treat Cushing's, Trilostane/Vetoryl and Lysodren/Mitotane, can be compounded, which is a cost-savings.

Please know we are here to help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[labblab]

I am just a little nervous about the medication that she has prescribed, she is giving me 30 of some medication that I don't recall the name of right now, but she says it is the newer of the two drugs available and the more expensive but not approved for humans, so no cheapie Costco options...

From what I read online it sounds like this "loading" process is fairly involved and should be closely monitored. Whereas my vet basically just said give him 2 pills a day (morning/eve) and then come back for a test in 10-14 days so they can evaluate if the dosage is too high or low...

She also quoted me something like $180/mo for these pills for the rest of his life. So I am looking for info or sources to get this cheaper since that seems like allot for pills for a dog when I know vets add some degree of mark-up to medication.
The term "loading" is usually associated with treatment using Lysodren (generic name: mitotane). And just as Leslie and Lori have already said, if your vet has given you Lysodren, then the instructions are frightfully inadequate.

From the rest of your description, though, it sounds more likely that you have been given Trilostane. It is the newer of the two drugs, typically more expensive over time, monitoring testing is done after 10-14 days, and dogs must stay on the medication daily for the remainder of their lives. If you have indeed been given Trilostane, here is a thread that will give you more information:

http://www.k9cushings.com/forum/showthread.php?t=185

It would still be the case, though, that you really need to know a lot more about the test results and safe treatment procedures before you start giving any medication to your dog. You do not have to start the medicine today -- please do help fill in the additonal info that Leslie and Lori have asked for before launching into treatment.

Marianne

[Oldskool454]

The vet is frustratingly vague when she explains things to me.

I told her I had been online doing research so I was somewhat familiar with it and she could just tell me what she had found and she still "hem'd and haw'd" about it.
She said that the first test, which came back Neg was the standard "first test" but I can't remember if it was to suppress or stimulate. She said that like 25% of dogs will give a false neg so she wanted to do the "other test" which is the opposite of the first and has more blood tests involved, so the second would be either suppression or stimulation, whatever the opposite of the first, less expensive, one was.

She said something about "the older drug" would not do anything for the kind of Cushings she thinks he has (on his adrenaline glands) but the newer one would fix either, and the only way to be SURE which one it is was to get an ultrasound but she said an US was super expensive so I opted out of that.

The second one is what she said made her "90% sure it was Cushings". I told her that based on the visible symptoms and behavior alone I had already assumed it was so what do we do NOW?

What is frustrating is that if I call to ask about test results the tech/receptionist refuses to tell me anything and asks to have the vet call me back, which then takes hours to happen. I think I may go in and just ask for a physical copy of the test results.

[Oldskool454]

You are taking about Trilostane? If it is it can be ordered online from Thrivinpet.com for about half vets price.

I don't get anything at that URL and thrivingpet.com brings up a advertising/forwarding site.

[labblab]

I think that'd be great if you get physical copies of all the test results, including the blood panel that ruled out other conditions besides Cushing's. Also the result of any urinalysis that might have been done.

It sounds as though the first Cushing's test was the ACTH (stim test), followed by the LDDS (suppression test). Your vet is correct that the ACTH is more likely than the LDDS to mistakenly miss diagnosing Cushing's in a dog who actually has the disease. This is especially true if the dog suffers from an adrenal tumor. In addition to being a more sensitive test of Cushing's itself, the pattern of the LDDS results can help shed light as to whether or not an adrenal tumor is a possibility. It cannot prove an adrenal tumor, but it can indicate if it is a possibility. So getting an actual copy of these test results will be helpful to us.

It will also be very helpful to get the results of the standard blood panel that ruled out diabetes and thyroidism. There are certain blood abnormalities that are common with Cushing's, and it will be interesting to see whether or not they are present (elevated liver enzymes and high cholesterol). I do agree with your vet that an abdominal ultrasound can be very helpful in establishing a Cushing's diagnosis. But if you don't want to shoulder the expense of that test, it will be doubly helpful if we can sort through all the other lab testing that has already been done.

Marianne

[Rebelsmom]

I'm with everyone else, please get the test results and hold off on the treatment until you have more information. Pardon this but on the subject of Cushings your vet sound like an idiot. If you are at all able, I would get a second opinion or find an IMS that has more experience with Cushings. It really does sound she gave you Trilostane which is the newer drug and can be found cheaper elsewhere than your vets office. As far as getting copies of the bloodwork and all the tests I would call them back or just show up and demand them. You paid for all the tests you have a right to copies of them. This way you have them in case you do find another vet or IMS and they can have all the current info right then instead of waiting.

Trying not to offend but I had a bad exp with my pups original vet and don't want to see someone go through that also.

[Snoopy&Rummer_Mom]

Ok, I am new to Cushing's but judging by the adviced I have received here and based on how thorough my vet has been, I am REALLY concerned by how vague your vet is. For what is worth, I initially saw a vet that was not my original one and she was wishy washy about it, so I got a second opinion, and then sat with my actual vet and we developed a plan of action. I think you should get a second opinion on this. It is truly worth it.

Maria, Snoopy and Rummer

[labblab]

You will see that I have taken the liberty of revising the title of your thread in order to give our members more info about your current line of questions. I hope this change is OK with you -- if not, you can tell me or any other staff member what you'd prefer and we can make that change for you (unfortunately, members cannot edit their thread titles themselves).

In fairness to your vet, I cannot fault her for telling you that she is unable to diagnose Cushing's with 100% certainty. I'd actually be more worried if she told you she could. There is no single test that can give that information. And since your dog tested "negative" on one of the two basic blood tests and "positive" on the other, I do understand why she'd tell you that an ultrasound would probably be the most helpful next step in trying to confirm a diagnosis.

I can also cut some slack on the representation that trilostane, the newer of the two drugs, is now being more widely recommended for treatment of adrenal Cushing's in additon to the pituitary form of the disease. From what we are hearing from our members, it does sound as though a number of specialists are now preferring to treat adrenal Cushing's with trilostane instead of Lysodren (although we do have members who are successfully treating adrenal tumors with Lysodren, too).

However, the things that do concern me are her telling you that a larger dog is more likely to have adrenal Cushing's (??), and that apparently you have been given medication with no warnings or instructions, especially if she still has lingering doubts in her own mind as to the accuracy of the Cushing's diagnosis for your dog. If these things are true, they are huge problems. If nothing else, just the fact that you have trouble communicating with her is an enormous problem. So I have to agree with the others about the value of consulting with another vet before you start treatment. There are too many important issues and questions that you need to be able to talk over with any vet who is treating a Cushpup, throughout all phases of diagnosis and treatment. If you can't talk to your current vet about your questions, I really do think you need to find a knowledgeable vet with whom you can.

Marianne