Recently Diagnosed...Concerned

[Roxy's mamma]

Hi all! I just received a diagnosis of Cushing's for my dog Roxy 2 days ago. I have cried and cried over this reading all of the worst possible scenarios on the internet. I see the lifespan is 20-30 months once diagnosed and that scares me. I am clueless to this disease and i'm a bit upset with my vet. The tech called and left a message regarding the results and it seems as though I am bothering them with all of my questions. I want to talk to the VET himself, not a tech who responds with "well, i'm not really sure."

Anyways a bit of a background. My baby Roxy was rescued off of death row by a rescue group. I adopted her and am unsure of her breed. (Will post a picture soon, but I am at work) To give you a despcription she looks lke a little red fox with the floppy ears and feathery curled tail. I took her in last week for her shots and routine physical. I causally mentioned to the doctor that she was shaved about 8 months ago and her fur has not grown in. He said it was possible that because she is a triple coat dog and she was shaved it wouldn't come back. However, given her "waistline" he recommended doing a full blood panel with a thyroid test. Thyroid came back fine and wanted to perform the ACTH Stim test. Did that and was told the results were "consistent with Cushing's." Before I could turn around they had sent the prescription in and here I am left with a million questions and unable to get answers to any of them.

1) Many of you talk about an IMS, how do you go about locating one and what are the signs of a Cushing's savy vet?

2) After reading some of these posts, I'm wondering about a misdiagnosis? The vet prescribed her 63mg of Trilostane and from what I have found online it is recommended to start with 1mg/kg? She weighs 25 lbs.

3) I feed her Blue Buffalo with shredded boiled chicken, any change to her diet need to be done?

4) I have read a lot regarding herbs/supplements..any recommendations to take to my vet?

5) Side affect is high blood pressure and UTI, how often do you check for those?

BTW, the only symptoms that I have noticed is lack of fur growth and excessive panting....her thirst is average for the weather and although she could eat all day, it isn't excessive as what I have read on here. She is appx. 7 yrs. old and still hops and jumps around like a puppy. She loooves her long walks, so hind leg weakness doesn't appear to be a factor. Her urine is yellow and is not frequent. She has no accidents either.
Here are the following results for her tests:

Alk. Phosphate - 423 (Range: 10-150 U/L)
Albumin - 4.2 (Range: 2.5-4.0 g/dl)
BUN - 29 (Range: 7-27 mg/dl)
B/C Ration - 41.4 (Range is unspecified, but they noted it is high)
HGB - 18.8 (Range: 12-18 g/dl)
HCT - 56.3 (Range: 37-55%)
Neutrophil SEG - 82 (Range: 60-77%)
Lymphocytes - 11 (Range: 12-30%)

T4 test results:
1.6 (Range: 1.0-4.0 ug/dl)

ACTH STIMULATION:
Pre-ACTH cortisol - 12.3 (Range: 2-6 ug/dl)
Post ACTH cortisol - 34.7 (Range: 6-18 ug/dl)

I have gone to this vet for years, but my gut is telling me to find another one for the Tx of this disease/second opinion. Supposedly this clinic is actively treating over 100 dogs with this disease, however, I have concerns about lack of communication as well as the sudden desire to put my dog on what seems to be a pretty high dose to begin.
Any suggestions or information would be greatly appreciated! I am so lost and just feel that I MUST advocate for my dog. She is so healthy and happy right now, I just want that to continue. Thanks!

[Jenny & Judi in MN]

welcome, hang in there. The receptionist at my vet's office has a dog who has lived with Cushings for something like 7 years. This is not a death sentence.

I'm sure the experts will be along but here is a link to a thread where you can look for a specialist: http://www.k9cushings.com/forum/showthread.php?t=182

I think your instincts are right. Lots of misdiagnosed dogs around here and all Cushing's drugs do is treat symptoms, they don't cure the disease so when in doubt, if your dog isn't miserable, wait.

The ACTH measures cortisol levels and a dogs cortisol levels increase if they are stressed so a lot of other medical conditions can raise their cortisol levels resulting in a false positive.

This is a great forum and people are very helpful. Try not to stress ok? you can do this! Judi

[jmac]

Hi there, and welcome to you and Roxy!

I am sorry for what brought you here, but so glad you found us! First, Cushing's is not a death sentence. I felt the same way when my dog was diagnosed just over a year ago. I was devastated and crying. I was a nervous wreck and read everything I could on the internet, and was also really scared about the things I found. This site was a lifesaver! After a few days of reading, I realized that I could relax and that most dogs with Cushing's die from something else.

There are tons of knowledgeable people here who will help you out with everything along the way. Judi has already posted the link to find and internal medicine vet in your area. I would definitely recommend consulting with one, as they specialize in this area, while our regular vets do not. Also, it sounds like Roxy has some mild symptoms, so you by no means need to rush into treatment. I still have not started treating my Hannah because she also only has some mild symptoms. Take your time to get advice and seek the answers to your questions.

Thanks for all of the info. you already posted. It will be helpful to "the experts" who will be along soon to advise you. Cushing's is often misdiagnosed, and there are other issues that can have similar symptoms. Usually, more than one test is used to confirm a diagnosis. Has Roxy had an ultrasound done? That will allow a vet to see her adrenal glands (to determine whether or not there is a tumor there) and to see if anything else looks suspicious.

Many of us have our dogs on a liver supplement, since Cush-pups frequently have elevated Alk Phosphate levels. My dog is on Denamarin and it has significantly reduced her liver value. At the point of her diagnosis, it was over 1700 and in April it was 200. That might be something to consider, regardless of whether or not she has Cushing's or you pursue treatment.

I am not an expert on Trilostane, but I do know that it is recommended to start at a very low dose. Someone will be along soon to give input about her dosage and to tell you things to watch for that would indicate her cortisol has dropped too low. Did your vet happen to give you prednisone in case of an emergency? That is also recommended.

Please know that if Roxy does have Cushing's, there is no truth to the "living 2-3 years" thing. There is excellent information in the resources section of this forum, so please look it over and continue to ask us questions.

I know it's hard, but take a deep breath, and just gather information, ask us questions, and take your time making decisions for Roxy. You are already doing the right thing by seeking out information, joining this forum, and asking your vet questions. So good work! :) Again, you have found a wonderful place, with caring, helpful, kind people, and we will be here to support you however we can.

Sincerely,
Julie & Hannah

[Roxy's mamma]

Thank you so much for the responses. This website has put my mind at ease..a little. No, Roxy has not had an ultrasound and not until a bit ago when I talked to the vet tech did she say that the doctor doesn't feel like i'm completely convinced that she has Cushing's so he recommends I see a specialist. Yeah, I was already one step ahead of them. :D I am now going to make an appointment to have one scheduled. According to the tech she has the adrenal Cushing's, how she found that out is unknown to me, because Roxy has not had the ultrasound yet, but the tech says that is the type of Cushing's she has. Makes me even more skeptical about the knowledge this vet has with this disease. NO, there has been no mention of Prednisone for my dog, in fact I was not aware of that until you just mentioned it. I did ask the vet about supplements and again, because I brought the topic up, he did recommend that same liver supplement. Glad to see someone recommends it on this forum as well. I will definately be obtaining a bottle for her. Again, thank you so much for your advice. I am beyond grateful!

~Jessica & Roxy

[StarDeb55]

Jessica, welcome to you & Roxy! After reading your initial posts, I'm glad to hear that you will be seeking a second opinion from a specialist. First of all, you absolutely can't diagnose adrenal Cushing's based on only an ACTH. Quite often, the results of a low dose dex test will indicate whether the type is adrenal or pituitary, but an abdominal ultrasound is used to confirm any positive on a low dose test. Cushing's is absolutely the most difficult canine disease to diagnose as there is no one test that will give you a 100% diagnosis. The low dose test that I mentioned is considered to be the "gold standard", but you can have false positives on this test in the presence of non-adrenal illness. This is why it's critical to confirm a positive low dose with a second test such as an ultrasound.

We are here to help in any way we can.

Debbie

[molly muffin]

Hi Jessica, how is Roxy doing? Where you able to get in to see an IMS?

Hope things are well.

Sharlene

[Roxy's mamma]

Hi there!

Roxy is doing GREAT! I have switched general vets and found one that works closely with a specialist at a nearby university. The vet said that because she really does not exhibit any of the typical cushings symptoms (other than the fur regrowth and panting) the prior vet jumped the gun a little by diagnosing her with only one test. She is going in for an ultrasound next month to see if a clearer diagnosis cannot be determined as well as a urinalysis. The vet did recommend against treating her right now because she said that you don't want to medicate a dog with the medication without knowing for sure that is the diagnosis.
I'm just so happy that I follwed by instinct with the last vet....Thanks for asking how all is going!

~Jessica

[molly muffin]

Oh I'm so glad to hear that they will do more testing before making any determination. I'm in the same situation with molly. First they scared me to death, now they say not yet, but maybe soon, who knows. I'm holding off treatment for now too.

I'm Thrilled that Roxy is doing great!

Hugs,
Sharlene and Molly muffin

[Roxy's mamma]

It's been such an emotional rollercoaster. The worst part is not knowing. Fingers crossed everything turns out great with your baby! At least I know now that IF it is Cushings that she has that she can still ive a long, normal, healthy life. Take Care!

~Jessica