New here; 5 year-old Newfoundland, Noah

[Chris]

Hi:

My name is Chris and Noah was diagnosed with Cushing's last week. He has an ultrasound scheduled for tomorrow morning to check the adrenal glands. We did the LDDS test first. The first one done in the morning was 3.6; the 4 and 8 hour were 2.0

We are waiting until tomorrows report to see how we should proceed.
I have been researching since we found out. It was a bit overwhelming, to say the least. Glad I found this site.

Will update tomorrow when I have additional information.

Chris

[StarDeb55]

Welcome to you & Noah! I will say that 5 is a tad on the young side for Cushing's, but we've had members with dogs even younger, so I know it's not impossible.

If you wouldn't mind sharing Noah's history with us, it would help us to give you more specific feedback. Could you tell us what symptoms Noah was suffering from that led you to take him to the vet? If the vet did general labwork such as a super chemistry panel, liver function panel, or urinalysis, could you round up copies of those results, & post only the abnormal values for us, including the reporting units & reference ranges. We are especially interested in the liver function tests & the specific gravity on a urinalysis, if one was done. Did your vet rule out diabetes & low thyroid? I ask about those 2 as their symptoms can overlap with Cushing's. Does Noah have any other health problems or concerns? Is Noah currently taking any medication including any type of supplements? Sorry for playing 20 questions, but as I mentioned, it helps us to give you more specific feedback.

When it comes to the ultrasound, you want to make sure that it's being done on a high resolution machine so you can get good images of all of Noah's internal organs. Most general practice vets do not have this type of equipment. We would be delighted to see the results of the ultrasound.

Now, for the good news. With treatment, including a vet experienced with Cushing's, Noah should be able to live out his full life with a great quality of life. I have been lucky or unlucky enough to have been through Cushing's twice, now. My first boy, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15 from medical causes unrelated to Cushing's. My 2nd boy, Harley, was actually diagnosed at 13, so he was a very senior gentleman when diagnosed. He was successfully treated with lysodren for 2 1/2 years, crossing the bridge at 15 1/2 from caused unrelated to Cushing's.

The best thing you can do for Noah is to educate yourself on Cushing's, including the medications used to treated, proper protocols for using the medication, including dosages & monitoring. We have a huge library of links in the "helpful resources" section that will help you to learn anything you will probably need to know about Cushing's.

Let us know how the ultrasound goes. We are here to help in any way we can.

Debbie

[mytil]

Hi Chris,

Welcome from me too.

Here is a link to some great reading - in pretty easy to understand lingo - http://www.k9cushings.com/forum/showthread.php?t=180 (sorry if you have already looked at this)

Keep us posted
Terry

[Chris]

We adopted Noah about 7 months ago. He came into rescue over a year ago severely underweight, hair loss over 80 percent of his body and a severe skin infection. His feet were so raw they would bleed spontanously. Over the next few months Noah improved considerably. His allergies were well controlled with Atopica and Ketoconazole. He had allergy testing and is positive for numerous environmental and food allergies. He is also hypothyroid. He takes Thyro-tabs .08 twice a day.

Noah is now living in the Northeast and his allergies were well under control. We slowly weaned him from the Ketoconazole and Atopica. He is now medication free, accept for his thyroid medication. Although his allergies were controlled, his hair growth is extremely slow. What we thought was normal for Noah, after reading symptoms of Cushings once we had a diagnosis, he seems to fit most. He drinks a lot of water, but then again, he has since day one of coming to us. He needs to urinate frequently, but never had any accidents in the house. His energy is low and he seems to tire easily. My other Newf is almost 8 and my female Newf is 6. Noah has a hard time keeping up with them. He has a difficult time getting over ear infections, his skin is very thin and sometimes will split. It takes a long time for that to heal when it happens. Despite daily exercise, he still has muscle weakness. He does seem to be a bit more hungry than what was once normal for him.

After a vet visit last week, his vet felt we should test him for Cushings. We did the LDDS test last week. Results above in my first post.
He had his ultrasound yesterday and he was diagnosed with an adrenal tumor. I don't have the complete report yet, but will list the results once they are available.

He had labwork done in December, but nothing recent...the abnormal values are:
Mono 0.29; Normal range is 0.3-2
Lipase 141; Normal range is 200-1800
Chloride is low normal at 109; Normal range is 109-122

We are trying to decide the best course of treatment at this time.

Chris

[Jenny & Judi in MN]

Hi Chris: at least you know you are dealing with an adrenal tumor now so you have more options. Noah is so young. Sorry to have to welcome you to the forum. Let us know what you decide. Judi

[Chris]

I must say, at this point, I am a bit alarmed at all I've read. The medication and dosing frighten me. I keep reading about cortisol levels getting to low and becoming very sick. What is a "normal" cortisol level suppose to be?

If anyone has treated an adrenal tumor with medications and not surgery, was there any success with it?

It seems the more I read, the more questions I have.

[frijole]

Chris - It doesn't look like you have done a cortisol test yet. That is called acth. Normal range for normal dogs is around 18 or lower. I hope you read that link that Terri provided because it is a fantastic primer on all this stuff... don't worry we were all new to this once.

The meds are designed to lower cortisol thus ridding dogs of their symptoms and allowing them to lead very normal lives. Cush dogs must be monitored with these acth tests on a regular basis to make sure the meds are maintaining the desired level of cortisol. Cush dogs need to be between a 1 and 5 on the test. (this is oversimplified but you get the gist)

Where dogs get into trouble with meds is when the owner isn't involved/paying attention/getting up to speed and /or the vet is not experienced. Like any drug - if it isn't used properly it can cause trouble and yes even death. But you obviously are on top of things already. :D

Dogs can lead normal lives but in the case of adrenal tumors it frankly depends on the type of tumor (yes there are more than one type), its location, and size. Given the fact that Noah is only 5 years old I would at least consider surgically removing it. This is not a surgery that could be done by a regular vet - it requires a very seasoned specialist but we have had lots of members who have had success. Once removed the cushings is gone and there are no meds.

You would need to determine if there is a specialist in your area and they could get the testing info from your current vet and at least take a look and give you an opinion. Did the vet that did the ultrasound provide you with the written report? It should detail the size and location of the tumor. Get a copy if you don't have one. You can type it out for more free advice. ;)

Glad you found us. Kim

[jmac]

Hi Chris,

I just wanted to belatedly welcome you and Noah. I am sorry Noah has Cushing's, but am glad you now have the diagnosis of the adrenal tumor so you know what you're dealing with. As Kim mentioned, many members have had their dogs successfully get the tumor removed, if that is the route you choose.

You have found a wonderful place with helpful, caring, and knowledgeable people to guide you and support you as you embark on your Cushing's journey. We are here to support you in whatever way we can.

Julie & Hannah

[Squirt's Mom]

Hi Chris,

A belated welcome to you and Noah! :)

Just wanted to pop in and say Cushing's feels much scarier in the beginning that it really is. Learning all you can about the condition and the treatments available will do absolute wonders for your comfort level...the fears will become much, much less. And the good thing is, Cushing's is a very slowly progressing condition, usually taking years to do any real damage, so we typically have time to educate ourselves. It sounds like Noah is not exhibiting strong signs yet so you do have time to breath a bit and learn some things before making any decisions about treatment. ;) You have found the very best place to help you learn and offer support that is unbeatable.

I'm glad you found us and look forward to learning more of yours and Noah's story.

Hugs,
Leslie and the gang

[Chris]

Noah went for a consult today with a Board Certified Internal Medicine Specialist and additional ultrasound. NO adrenal tumor was found on ultrasound. We did an ACTH test today and are awaiting results over the next couple of days. Here are a portion of the findings: Left adrenal was 6.5mm; Right adrenal was 6.6mm. Both adrenal glands were imaged and had normal architecture. There is no vascular invasion at the level of the adrenals and no evidence of a mass lesion at this time. The liver is normal echogencity and not significantly enlarged. These findings do not rule out hyperadrenocorticism. Recommend additional testing prior to starting on treatments.

So that's where we stand right now...Just waiting on the ACTH results to see what, if anything it shows.

Chris and Noah

[Squirt's Mom]

Hi Chris,

Oh, that's a good beginning! No tumors and normal adrenals, huh? PDH is still possible tho we would expect to see the adrenal glands enlarged at least a little bit but stranger things have happened. :D I hope this report is on it's way to ruling out Cushing's, tho.

Hugs,
Leslie and the gang

[Chris]

ACTH results are back.
PRE. 1 . 9
POST. 3 . 5

Waiting to hear what we need to do now.
I think this leans more towards not having Cushings.

Chris and Noah

[frijole]

Wow. First ultrasound showed an adrenal tumor and this one did not? By chance did you get to bring the film from the first ultrasound to the specialist's office? I'd love to see what he/she thinks the 'tumor' is then... perhaps the first ultrasound wasn't on a high resolution machine?

LDDS test can have false positives which is probably what happened to you. I had it happen twice.

I would think that the specialist would be able to have some thoughts as to the next steps. You ruled out cushings. You know Noah is hypothyroid and I assume that is under control?

Please list again all symptoms so we can brainstorm on this a bit. THanks. Kim

[lulusmom]

Hi and a belated welcome to you and Noah.

Routine blood chemistry and urinalysis are usually done before launching into diagnostic tests like ACTH Stimulation and LDDS tests. I see that you posted the abnormal values from bloodwork done in December but tests this old is definitely not accurate for anything going on with Noah now. Has either your gp vet or the specialist you saw recently done a complete blood chemistry, cbc and urinalysis, including a culture and sediment? When was the last time Noah's thyroid hormone levels were checked?

Glynda

[labblab]

ACTH results are back.
PRE. 1 . 9
POST. 3 . 5

Waiting to hear what we need to do now.
I think this leans more towards not having Cushings.

Chris and Noah
Wow, for a dog not being treated with any medication designed to decrease cortisol, that ACTH response seems awfully low. Can you tell us what the "normal" reference range was for Noah's test? I'm wondering whether those test results might actually be more consistent with an Addisonian condition rather than with Cushing's. I do believe that many of Noah's symptoms could be present with Addison's as well as with Cushing's. I'll be really curious to see what the specialist's opinion is after seeing these test results.

I honestly have no idea how an Addisonian dog would respond on an LDDS test. So I'm clueless as to whether Noah's earlier test results make Addison's seem more or less likely...

Marianne

[Chris]

Well, to say I am confused at this point is an understatement.
This is the normal range for the ACTH Test.

PRE Noah was 1.9 Reference Range is 2-6
POST Noah was 3.5 Reference Range is 6-18
18-22 Equivocal post-ACTH cortisol
>22 Consistent with hyperadrenocorticism
<2 Consistent with hypoadrenocorticism

Dogs with iatrogenic Cushings Disease will have flatline response test results in the low end or below the normal value.

No other lab work has been done since December. It's been a bit over 6months. His Dr's haven't suggested doing any other bloodwork.

Noah was on Atopica for about 8 months, along with Ketoconazole. Ketoconazole was used to boost the effects, so to speak, of Atopica. In December 2011, he was SLOWLY weaned from those medications and is no longer on them. The IM specialist thinks he has iatrogenic from the medications and feels he will go back to "normal" cortisol levels in the future.

His symptoms are hair loss, pot bellied appearance, but looks thin and boney in some areas. Hind end weakness, knee issue, difficulty healing, thin skin, low energy. Drinks a lot of water, but for his size, we think it is his normal. He does need to go outside frequently, but he does drink a lot of water. They calculated his water intake to be about 14-15 cups per day...So according to that calculation, his intake is normal. I need to separate him from the other dogs for a day and monitor exactly how much water he consumes in a day. I'm sure I'm forgetting something, but it's been a long day.

So that's where we are at this point....

Chris and Noah

[lulusmom]

Hi Chris,

I certainly understand your confusion because I'm confused too. To recap, we have a positive LDDS, a negative ACTH stimulation test, no adrenal or liver abnormalities on imaging, no current urine analysis and the latest bloodwork is six or seven months old and the three slight abnormalities on that old test aren't really associated with cushing's. Did the specialist at least recommend that you have a full blood chemistry, cbc and urine analysis done? I am blown away that your gp vet didn't do this and I will be even more taken aback if the specialist didn't want current screening tests either. :confused:

You mentioned that the specialist indicated that Noah has iatrogenic. Does he have iatrogenic cushing's as a result of Atopica, which would be odd because it is not supposed affect the adrenal glands like prednisone does with long term use......or does Noah have iatrogenic/secondary addison's as a result of the ketoconazole, which would also be odd because this drug isn't suppose to cause adrenal insufficiency. FYI, ketoconazole is an anti-fungal medication that is also used to limit cortisol production. With the FDA approval of Vetoryl, it's rarely used now because of it's adverse affect on the liver. Has Noah been on any other medications besides these two drugs in the last six months?

Hypothyroidism and cushing's have overlapping symptoms and most of the symptoms you mentioned are definitely associated with hypothyroidism. After seeing the low results of the acth stimulation test, I doubt that Noah has an increased appetite as a result of excess cortisol and with no current urine testing, even if Noah is drinking more water, there is no way to know whether it's due to the hot weather or his need to stay hydrated because his kidneys are not concentrating his urine. When is the last time Noah's thyroid levels were checked to make certain that the current dose of .8mg twice daily is effective?

The recommended starting dose of thyroxine is .1mg per 10 pounds of body weight twice daily and if you do the math, .8mg would be for a dog weighing 80 pounds. I have a friend who used to show Newfies and his male was more than twice that at 165 pounds. I remember when he and his sibling, a 155 lb female, pinned me on the sofa with their full 320 lbs. My friend was upstairs changing clothes and came running when I screamed for help because I literally could not get them off of me. I am not a little women and I'm not a weakling but I was helpless under that weight. They were big sweeties who thought they were lap dogs and wow, they brought an all new meaning to the words sloppy wet kisses. I had globby slobbers from head to toe. I went directly home, put my clothes in the washer and hopped in the shower. That was a long time ago but I still smile whenever I think about it. :D

Sorry for digressing but what was I was getting at is .8mg could be a woefully inadequate dose but on the flip side, it could be too much, if Noah doesn't really have hypothyroidism. Was he diagnosed while in rescue and if so, can you get copies of the bloodwork from them? I'm a rescuer and can easily get copies of bloodwork for our adopters if needed, so I think the rescue organization should be happy to provide you with whatever information they have.

Glynda

[Chris]

Hi Glynda:

Noah hasn't been on any other medication in the last 6 months other than Atopica, Ketoconazole and Thyro-Tabs. His last known dose of Prednisone, which was tapered, was July 2011. He has not received any Prednisone since then. We don't have any other history before coming into rescue.

After speaking with his IMS, we are doing water monitoring starting today and from there will move forward with labwork. It looks like it will be a process of elimination to see what is going on.

Thank you everyone for your support and ideas through this.

Chris

[lulusmom]

Hi Chris,

Do you know when Noah's thyroid levels were checked last and what the results were at that time? If Noah was started on the thyroxine by the rescue do you know if they ever did a recheck to see if the current dose of .8 is adequate?

[Chris]

He had a T3/T4 done, but it's been about 8 months since it has been rechecked. I am going to get him in the first part of the week to have it checked again. I hope we can get all of this figured out soon.

[Chris]

Noah is going in tomorrow to have blood drawn for an adrenal panel from the University of Tennessee and to check thyroid levels.

I am praying this will give us some answers.

Chris

[lulusmom]

Hi Chris,

Do you make sure that Noah gets his Thyro Tabs on an empty stomach one hour before meals? Make sure they do the blood draw 4 to 6 hours after his morning dose.

I'll be looking forward to seeing the results of the full UTK adrenal panel.

Glynda

[molly muffin]

Good luck tomorrow Chris. Hope the tests provided the needed answers. :)

Crossing fingers and toes.

[molly muffin]

Hi Chris, I thought of you and Noah today as I was walking Molly and met my neighbor who just got a new newfoundland puppy. (they lost their dog in Dec to kidney disease) The puppy is just adorable.

Noah's test results seem pretty good. I'm taking molly for her ultrasound in about 1/2 an hour. Hope the ACTH tests come back negative and you don't end up having to deal with cushings.

Sharlene