Eileen's Daisy (12 y/o Chow mix)

[Eileen]

Hello,

Over the course of many months my 12yo, 69lb, Chow mx, Daisy, began gaining weight, limping and more recently, drinking alot of water.

Having been 'side tracked' with my diabetic (for 7.5 years), Mildred, who was dx with bladder cancer last year along with severe cognitive issues I sadly attended to her immediate needs (chemo) and set Daisy's issues aside, attributing the limp to her weight gain and, the aging process.

My Mildred (diabetic) passed away from her cancer this past January so my attention was then turned to Daisy, and several other pets.

Thru xrays it was found that Daisy has a torn knee ligament in her right back leg, indications of arthritis in her hips and left leg.
Bloodwork and the typical outward signs (can not believe I did not see this having been around diabetes/cushings for so many years) suggested to my vet that she may have Cushings.
She underwent the low dose dexamethasone suppression test earlier this week with vet wanting to now do the high dose dexamethasone test next week.
I must add that money is very tight so we are opting to do this instead of the ultrasound for now.

So, this is where we stand....she is on Tramadol for pain and will see where we go from here.
As most probably do in the beginning, I feel completely lost...knowing diabetes as I do I did test Daisy's blood when I saw the excessive drinking.

I look forward to reading thru past threads as well as following what I can that is current.

Thank You for any and all input,

Eileen

[frijole]

Hi Eileen and welcome. I would be interested in the results from the ldds test so that we can figure out why your vet is now wanting to do the high dose test. Normally after the ldds test either an acth test or sonogram (or both) are done.

Diagnosing cushings can be tricky. Have you had a recent blood panel done? If so it would be helpful to see the results from that as well (post the abnormal items please)

Glad you found us and best of luck! Kim

[Eileen]

Certainly, thanks...

Pre Dexamethasone~5.0000 / ref. range~1.0-6.0ug/dL
post 4 hours~3.1
post 8 hours~2.4
***
Alk. Phosphate~ 2335 / ref.range~10-150 U/L
ALT~ 145 / ref. range~5-107 U/L
CK~ 613 / ref. range~10-200 U/L
GGT~ 16 / ref. range~0-14 U/L
AMYLASE~ 1278 / ref. range~450-1240 U/L
Glucose~ 153 / ref. range~ 60-125 mg/dL
***
MCHC~ 36.2000 / ref. range~ 32-36 g/dL
Neutrophil~ 79 / ref. range~ 60-77%
Auto Platelet~ 561 / ref. range~ 164-510 K/uL
****
Protein in urine at 1+
***
T4~ 0.5000 / ref. range~1.0-4.0 ug/dL

I might add, she has many of the outward signs...pot belly, thinning fur on sides, excessive drinking, heavy panting, ravenous appetite to the point of becoming a bit agressive and limb weakness.

At this point I can not afford the $400.00 ultra sound which is why we are not able to do it at this time.

I spent a fortune on my diabetic/hypothyroid/bladder cancer/CDS Mildred over the years with a wide assortment of surgeries and medications....unfortunately I am wiped out, financially.

Vet is talking of starting her (Daisy) on Veteroyl.

Thank you so much for your insight on this...

Eileen

[frijole]

I am hoping that one of our members, Deb, who has 30+ years as a med tech can take a look at your blood panel results and offer some feedback. Typically with cush dogs we see elevated liver enzymes (alk phos and alt) high cholesterol as well.

My dog had an adrenal tumor and had two false readings on the ldds test and many more on the acth test.... that is why multiple tests are so important. Your dog certainly has typical cushings symptoms from what you described.

I assume your vet wants the high dose test to help determine whether it is pituitary or adrenal cushings as the ldds test was inconclusive - did he/she mention that? Here is a link that might be helpful in understanding the tests.

http://www.k9cushings.com/forum/showthread.php?t=216

Hopefully Deb can offer some thoughts before you have to commit to doing the next test. Did they say how much the high dose test would run?

Kim

[Altira]

Eileen,

Welcome. I'm glad Kim was here to greet you so quickly. I'm really not the one you want to talk to but hold tight, the other Angels will come soon!

(((hugs)))

[Eileen]

Thanks Janis, Kim, yes, the second test is to help determine which type.

Will continue reading thru posts to learn more....am certain I will have alot of questions.

[Squirt's Mom]

Hi Eileen and welcome to you and Daisy! :)

The signs you mention certain do come into play with Cushing's - but they also show up with Hypothyroidism and I notice Daisy's T4 is low. This can sometimes be a result of Cushing's, called Sick Euthyroid Syndrome, but it can also be Hypothyroidism independent of Cushing's. So I would want to make sure Daisy doesn't have Hypothyroidism. Before I started either Trilostane (Vetoryl) or Lysodren (Mitotane), I would talk to my vet about this when you have your next chat. ;)

Also, the Amylase level is a bit elevated. Was the Lypase normal? These two can indicate pancreatitis, common in cush pups. You haven't mentioned anything that would indicate this is a problem for her but it is something to keep in mind.

You can get an ultrasound for $400.00?!? I'm really impressed! I've never gotten out for less than $1000.00! :eek: It's been a few years since Squirt had one and I've been considering another lately; it would be nice if our new IMS is as reasonable on them. Sick babies can drain us in a hurry, can't they? But they are worth every penny! ;)

You're doing a great job, Mom!
Hugs,
Leslie and the gang

[lulusmom]

Hi Eileen and welcome to you and Daisy

I'm not Debbie but with two cushdogs and two CHF dogs, I've learned a lot about bloodwork and what to expect with both diseases. I can honestly say that Daisy's bloodwork is textbook cushing's. There is not one abnormality that can't be attributed to the effects of excess cortisol. I do want to note that the CK is pretty darn high. This is a muscle enzyme that can be elevated with cushing's, hypothyroidism and heart disease. Did your vet listen to Daisy's heart? Any murmurs?

Having four medically challenged dogs myself, I completely understand your financial difficulties. It's a pity that we can't do just one test and have all the answers we need but that's not how it is with this confounded disease. If there is some good news to share with you though. The results of the LDDS test you posted are consistent with pituitary dependent cushing's so there is no reason to incur the expense of a High Dose Dex test. Perhaps your vet may not know how to interpret the LDDS test. You should discuss this with your vet and maybe even share a great url (below) that can help greatly:

http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/580093

In listening to audios of various expert veterinary endocrinologist, I learned that a few of these experts have no problem confirming a diagnosis of pituitary dependent cushing's if 1)the dog has overt and very classic cushing's symptoms; 2) abnormalities on screening tests (blood chemistry and complete blood count) are consistent with cushing's and 3) the low dose dex (ldds) tests are consistent with pituitary dependent disease. I think Daisy fits this criteria so if it were me, I'd be fairly comfortable with starting treatment.

The one concern I have is with your vet's experience with cushing's. Because he didn't seem to know how to interpret the LDDS, which was diagnostic for PDH, and recommended that you incur the unnecessary expense of a HDDS, I would be concerned that he is not that experienced with treating cushing's according to proper protocol. Internal medicine specialists have the education and extensive experience, making them the optimum veterinary care giver but unfortunately, you have to pay for that experience and that's a deal breaker for a lot of folks.

The alternative to an IMS is for us cushparents to take a proactive participation in our dogs' treatment. That means learning everything we can about the treatment we choose so we understand the recommended dosing protocol, what to watch for in the way of side effects and how to properly monitor treatment. Cushing's is a very graded disease so you have time to learn the basics and discuss treatment protocol with your vet before starting treatment. We have lots of great information on Vetoryl in our Helpful Resources section that will help you become a great advocate for Daisy. See url below. Of course, we are here to help guide you and answer any questions so please know that you are not alone on this journey. We will do whatever we can to help you and your precious Daisy in any way we can.

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

Glynda

[Eileen]

Hi Eileen and welcome to you and Daisy! :)

The signs you mention certain do come into play with Cushing's - but they also show up with Hypothyroidism and I notice Daisy's T4 is low. This can sometimes be a result of Cushing's, called Sick Euthyroid Syndrome, but it can also be Hypothyroidism independent of Cushing's. So I would want to make sure Daisy doesn't have Hypothyroidism. Before I started either Trilostane (Vetoryl) or Lysodren (Mitotane), I would talk to my vet about this when you have your next chat. ;)

Also, the Amylase level is a bit elevated. Was the Lypase normal? These two can indicate pancreatitis, common in cush pups. You haven't mentioned anything that would indicate this is a problem for her but it is something to keep in mind.

You can get an ultrasound for $400.00?!? I'm really impressed! I've never gotten out for less than $1000.00! :eek: It's been a few years since Squirt had one and I've been considering another lately; it would be nice if our new IMS is as reasonable on them. Sick babies can drain us in a hurry, can't they? But they are worth every penny! ;)

You're doing a great job, Mom!
Hugs,
Leslie and the gang

Thanks for the welcome, Leslie!

Vet did discuss the results of the thyroid test as you mention, that it can be low because of Cushings, thanks tho for pointing it out.
My diabetic had hypothyroidism so am familiar with the condition.

Her Lipase was in a normal range, 504 with a ref. range of 100-750 U/L, thanks for questioning that and for pointing to the possibility of pancreatitis.
She shows no signs of being 'sick'...well, other than the signs of Cushings, hypothyroidism and diabetes ;-)

eegads!...and I thought $400 was bad.

My vet and I have an incredible relationship. He has been my vet for about 18 years...has done ALOT for my pets without charge or a reduction in costs over the years.
He actually gave my diabetic 4 free chemo treatments (Carboplatin) for her bladder cancer when she was first dx with it back in May of last year.
Also did several free ultra sounds for her as well as my crf/heart kitty, Melody.

He is one of those vets that you trust with your heart and sole...one that will do everything he can and honest enough to finally tell you when it 'is time'.

Thanks again!
Eileen

[Eileen]

Hi Eileen and welcome to you and Daisy

I'm not Debbie but with two cushdogs and two CHF dogs, I've learned a lot about bloodwork and what to expect with both diseases. I can honestly say that Daisy's bloodwork is textbook cushing's. There is not one abnormality that can't be attributed to the effects of excess cortisol. I do want to note that the CK is pretty darn high. This is a muscle enzyme that can be elevated with cushing's, hypothyroidism and heart disease. Did your vet listen to Daisy's heart? Any murmurs?

Having four medically challenged dogs myself, I completely understand your financial difficulties. It's a pity that we can't do just one test and have all the answers we need but that's not how it is with this confounded disease. If there is some good news to share with you though. The results of the LDDS test you posted are consistent with pituitary dependent cushing's so there is no reason to incur the expense of a High Dose Dex test. Perhaps your vet may not know how to interpret the LDDS test. You should discuss this with your vet and maybe even share a great url (below) that can help greatly:

http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/580093

In listening to audios of various expert veterinary endocrinologist, I learned that a few of these experts have no problem confirming a diagnosis of pituitary dependent cushing's if 1)the dog has overt and very classic cushing's symptoms; 2) abnormalities on screening tests (blood chemistry and complete blood count) are consistent with cushing's and 3) the low dose dex (ldds) tests are consistent with pituitary dependent disease. I think Daisy fits this criteria so if it were me, I'd be fairly comfortable with starting treatment.

The one concern I have is with your vet's experience with cushing's. Because he didn't seem to know how to interpret the LDDS, which was diagnostic for PDH, and recommended that you incur the unnecessary expense of a HDDS, I would be concerned that he is not that experienced with treating cushing's according to proper protocol. Internal medicine specialists have the education and extensive experience, making them the optimum veterinary care giver but unfortunately, you have to pay for that experience and that's a deal breaker for a lot of folks.

The alternative to an IMS is for us cushparents to take a proactive participation in our dogs' treatment. That means learning everything we can about the treatment we choose so we understand the recommended dosing protocol, what to watch for in the way of side effects and how to properly monitor treatment. Cushing's is a very graded disease so you have time to learn the basics and discuss treatment protocol with your vet before starting treatment. We have lots of great information on Vetoryl in our Helpful Resources section that will help you become a great advocate for Daisy. See url below. Of course, we are here to help guide you and answer any questions so please know that you are not alone on this journey. We will do whatever we can to help you and your precious Daisy in any way we can.

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

Glynda

Hi Glynda, thanks for your welcome!

Vet did listen to her heart and did not hear anything out of the 'ordinary'.

He also said that because of the bloodwork and results of the LDDS test he was pretty confident that she had pituatary.
He referrenced UC Davis protocals several times.....knowing him the way I do I know that if he was not comfortable with treating the disease he would be the first to say so.
He is not one with a huge ego or will not accept being educated himself.
I actually taught him a bit about using Humalog for a diabetic dog as he was not familiar with its use but trusted me enough in my knowledge of the disease to 'allow' me to use it.

I SO understand and agree with the need to educate one's self and to be very proactive!

I appreciate your suggestion of not needing the second test....will talk to him on Monday about this.

When the rains begin later today I will study more, thanks for the included link, meanwhile back outside to finish cutting the grass ;-)

Eileen

[lulusmom]

Hi Eileen,

I'm glad to hear that your vet is researching UC Protocol. Based on their own extensive experience with Trilostane, they are more conservative in their dosing protocol than the manufacturer. It's always better to start low and make upward adjustments if necessary. It can cost more in acth stim tests for us but the chance of adverse reactions are minimized or completely eliminated.

Good for you for being a proactive participant in Daisy's medical care and cheers to your vet for being receptive to learning from you. Like you, a number of us have provided continuing education for our vets and hey, it's free. :D Believe me, not all vets are receptive or appreciate input from us laypeople. We've seen our share of risk that can occur when inexperience and huge egos collide.

Keep up the good work!

Glynda

[Eileen]

yep, my vet did mention also that U C Davis' protocal was on the conservative side which as you state, can be a safer way to go.
I so understand the saying, 'start low-go slow'.

I appreciate the support!

Eileen

[Jenny & Judi in MN]

Hi Eileen, the folks here are so knowledgeable, glad to see you here.

My vet is not a specialist but when we found out Jenny's Cushings was caused by an adrenal tumor, he checked with some specialists at the University of Minnesota. Half of them would have used Trilostane and half would have used Lysodren.

We are sticking with the lysodren for now since it works.

My question for your vet would be, how would his treatment for Daisy change if he confirmed what is causing her cushings? For us, surgery was not an option even though it could cure her.

hugs, Judi

[Eileen]

My question for your vet would be, how would his treatment for Daisy change if he confirmed what is causing her cushings? For us, surgery was not an option even though it could cure her.

hugs, Judi

That is a great question, Judi, one that in similar circumstances I have asked before.

Surgery would not be an option here in Daisy's case either.

Eileen

[jmac]

Hi Eileen,
I just wanted to belatedly welcome you and Daisy. I see you have already gotten lots of good advice and I know you will find this a wonderful place with lots of resources and amazing, caring, helpful people. You are no longer alone and we will support you and Daisy however we can!

Julie & Hannah

[Eileen]

Hi Eileen,
I just wanted to belatedly welcome you and Daisy. I see you have already gotten lots of good advice and I know you will find this a wonderful place with lots of resources and amazing, caring, helpful people. You are no longer alone and we will support you and Daisy however we can!

Julie & Hannah

Thanks Julie!...my gosh...could Hannah be any cuter ;-)

I'm already really learning alot by reading thru threads and your forum's resources.

These reliable groups/forums are priceless!

Eileen

[marie adams]

Welcome Eileen and Daisy!! :) I am so glad you found us!

I am so glad you are already getting the help you need from the experts. They have so much knowledge.

Everyone is wonderful here and all of us have our stories to help you too.

Take care!!:)

[lauraperla]

Hello Eileen,
I wanted to drop by and welcome you to the site. I am pretty new here too but I have benefited hugely from the fantastic advice I have found here.
Our own sweet angel Bracken was lost to bladder cancer last Autumn so I have some similar experiences I am sure to yours with your beloved Mildred. It is the most awful disease and over many months I was not far off permanent nursing care for our lovely girl; I do not regret a minute of it, her last year was filled with love and caring, but it limited what I could do for our cushdog Saoirse, I did as much as I could but I did not and could not have done all I could, it just wasn't possible. We do what we can. I am sure that Daisy - as Saoirse did- will sense and know that you were doing all you could for them both.

Laura and Saoirse xx

[CarolW]

Hi Eileen,

I've been a member here for quite some time, but only post extremely rarely, since I don't have a cushdog. Just thought I'd add my welcome to you, who help so many with dogs with diabetes!

The help here looks to me similar to what you offer, and to what's available on the sister site for diabetes;

http://www.k9diabetes.com/forum/

Glad you're here; you have always earned your way!
Love and hugs,
Tue, 3 Apr 2012 11:16:53 (PDT)

[Jenny & Judi in MN]

Hi Eileen, how is Daisy doing? Judi

[Eileen]

Hi Eileen, how is Daisy doing? Judi

I was waiting until I had the results of her ACTH test to post with an update.

About a week into her Vetoryl she stopped wanting to eat. Her vet had me stop the medication for 2 days at which time I then started her back with the same 30mg dose.
It would appear that her lack of appetite was just a temporary thing as she then began eating again.

This past Friday I had the ACTH test run with the following results;

Pre-ACTH Cortisol ~ 2.9
Post- ACTH Cortisol ~ 8.6

Weight down 2.5 pounds, from 69 pounds to 66.5.

Her vet wants me to continue with the 30mg in the a/m with now adding 15mg at p/m.

Funny story, altho not so funny at the time...

Since there is not a 15mg capsule her vet suggested I buy the 60mg and have it compounded into 30mg liquid so to be able to administer 1ml equal to 30mg in the a/m with then 0.5ml or 15mg at night.
Dropped off the box of Vetoryl at the compounding pharmacy yesterday to pick up later that evening.
Since I have had compounding done before with the cost usually being in the neighborhood of $25.00 I assumed this would be the same.

Imagine my utter shock when the pharmacy called to say it was ready and that the cost was...$243.93!
I asked the woman on the phone to explain to me 3 times just how in the world it could cost so much...I got the same answer all 3 times, it was the compounding fee and the liquid they had to use (awfully expensive beef flavor if you ask me).

Disgusted I went to pick it up this morning, handing over my credit card with once it was rung out asking to speak to the pharmacist so she could explain this to me...I needed to understand!

She was taken back at the charge and said "oh no!, that would be the charge had I not supplied the Vetoryl".
She credited my card and recharged me, $25.00.

Still, I can't believe the Vetoryl if purchased thru them would be that expensive...I bought a 30 day supply, 60mg for 97.00 thru my vet.
He gave me a script and suggested next time I search online and find another less expensive source.

Sorry for the rambling....any input will be greatly appreciated.

Eileen

[Jenny & Judi in MN]

I don't know enough to comment on Daisy's results but thank goodness you kept asking at the pharmacy. yowsers

I'm really glad she is eating again. I'll be watching to see what the pros say. Seems like she is really close. hugs, Judi

[Eileen]

I don't know enough to comment on Daisy's results but thank goodness you kept asking at the pharmacy. yowsers

I'm really glad she is eating again. I'll be watching to see what the pros say. Seems like she is really close. hugs, Judi

Thanks Judi!, I'm following Jenny, both here and on k9d...lots of good vibes going your direction.

Eileen