15 year old Chihuahua just diagnosed with Cushing's. Expectations?

[Jdeet]

I have a 15 year old Chihuahua named “CC” that has been diagnosed with Cushing’s as of yesterday. I took her into the vet Monday because she started wetting in the floor and it was huge volumes. She also drinks a lot of water. When I dropped her off I told the gal at the desk I think she has Cushing’s. I told her about the wetting the floor and drinking and she also had some bruising on her belly. One other weird thing she was doing and may not be related is she spends an hour every morning licking the carpet. That stopped for the last 3 days and she has not wanted to get out of her bed in the mornings to go out. When she does go out she comes in and goes right back to bed which is out of character, but she could just be cold and may mean nothing else.
The house accidents have only been going on about 4 weeks.
She was never one to mess up on the floor before. I put it off as old age but...and this will sound crazy…I had a dream Saturday (& I rarely remember my dreams) that she and I were falling through the sky and she was below me and I was trying to reach down and catch her before she hit the ground. When I woke up the dream stayed vivid with me all day & really bothered me. I came to the conclusion that something was wrong with my dog and I needed to get her to the vet fast.
I left her at the vet all day Monday and they did blood work looking for a kidney issue or bladder infection. When I picked her up he said both test showed nothing but that her urine was very diluted. So I had to take her back the next day to do the Cushing test... and they also cultured her urine.
The vet called me late yesterday and said she had Cushing’s and he is going to start her on Trilostane but it has to be ordered and will take until Monday or Tuesday until it comes in. He said the drug was hard to get the correct dosage and she would have to be tested later to make sure the dosage was right.
I am really cutting out a lot of details here as what I really wanted to know is since my dog is 15 what can I expect? My vet has long told me my dog doesn’t look 15 but that doesn’t mean she isn’t. I have had her since she was about 6 weeks old so that is a long time. Everyone that’s a dog person, and loves their dog, thinks they love their dog more than any other person could possibly love a dog.. I am no exception. She’s been at my side everyday for 15 years. She is part of who I am. So I am frightened and scared. Someone told me yesterday that I was “lucky” because their vet told them that their dog that has Cushing’s was given a year and half to live. At first that shocked me but then I thought well in a year and a half my dog will be pushing 17. So….
I looked through the forum for anyone with a 15 year old dog that had Cushing’s but I didn’t find anything. So if anyone out there has a pretty old dog with Cushing’s I would like to hear what I can expect.
It wasn’t that long ago she showed signs of arthritis in her back leg.. that just went away. I fear when she goes on the drug and the steroid is lowered in her body all kinds of things are going to appear that have been masked. Appreciate any comments.

[addy]

Hi and Welcome,

It is hard to know what to expect once we start treatment. The goal of treatment is to give our dogs a quality of life and address symptoms that bother them and concern and our worrisome to us. Treatment does not cure the disease.

Yes, it possible to uncover issues we did not know they had when we lower their cortisol as some dogs are self medicating with higher cortisol which acts like prednisone for them. My Zoe uncovered allergies and arthritis and eye issues. We take each issue and address it and try to balance everything. Key word there....balance

What dose will you be starting on? Has an ACTH stim been scheduled for 10-14 days after start date?

Each dog is different. You have to see how it goes. One thing is for sure, we will be holding your hand every step of the way. So ask lots of questions, vent, whatever you need.

Others will be by to welcome you. I'll let them ask our 20 questions!!!

So glad you found us.

[Jdeet]

Thank you for your reply! To answer your questions.. I don't know yet what dose she will be on. He did state that's going to be difficult to figure out what dose will work for her & may take time. He did say she would have the ACTH Stim test later but he didn't say when.
My vet went out of town but he told me he would call me when he got the results which he did.. so over the phone I didn't get into a lot of detail... He did mention the chances of it being cancerous were only about 5%... so that was good to hear.
She has begun to develop cataracts but they are not terrible yet. She has lost all of her hearing though but we get by on signing.
I'm just scared the drugs are going to be difficult and hard on her. But I don't know what other choice I have. He told me it was not curable but if not treated she would develop all kinds of other issues.
She doesn't seem to be suffering now. Just more tired in the mornings. She's not eating a lot nor acting starving like I have read Cushing's does to some dogs.
I never mentioned to my vet I thought it was Cushing's as I wanted him to tell me what was wrong with her.. and I know the lady at the desk didn't mention to him that I thought that's what it might be.
Before the test he said he didn't really think it was Cushing's as she didn't have all the symptoms. Then he called and said it was.. I wasn't surprised. When I get her dosage I will post it... and thanks again!

[lulusmom]

Hi and welcome to the forum.

Cushing's is one of the most difficult canine disease to diagnose which makes it one of the most misdiagnosed. I am therefore a bit worried that CC's diagnosis is correct as she has few symptoms associated with cushing's. Aside from sudden lethargy and the excessive drinking and peeing, are there any other symptoms that you have noticed? Can you ask your vet for copies of all tests done and post the results here. With respect to bloodwork, you need only post the highs and lows and please include the normal reference ranges. Have you gotten back the results of the urine culture yet and if so was bacteria found? A good majority of dogs with cushing's will have a urinary tract infection at the time of diagnosis.

Since most of the diagnostic tests are less than reliable, especially if a dog is stressed or has a non-adrenal illness, it's pretty important that all other possible causes for CC's symptoms are ruled out. Any non-adrenal illness or serious stress can cause false positive results on all of the diagnostic tests. If your vet has not determined what form of cushing's CC has, that also is a concern. Doing an abdominal ultrasound to take a look see at the adrenal glands and surrounding organs is the best way to validate the low dose dexamethasone or an acth stimulation test as well as differentiate between adrenal and pituitary cushing's.

You can't provide too much information about your girl because the more we know the better able we will be to provide meaningful feedback. We're here to help in any way we can to get both you and CC through this in accordance with proper protocol. We are real stickler's for protocol because if not followed, the risks to our dogs increase. These are not benign drugs so it is important that we as pet owners educate ourselves so that we can be active participants in our dogs' care. You would be surprised how many people place blind faith in their vets at their dog's expense. I'm one of those people and I wish that I had found this forum when I was searching for answers for my first cushdog. Unlike CC, my dog was diagnosed at the young age of three. She is currently 11 and doing great.

I'm sorry for the circumstances that brought you here but I'm glad you found us. You're both family now and we'll be walking down that familiar road with you, holding your hand and keeping CC's welfare foremost in our minds.

Glynda

[molly muffin]

Hello and welcome. So what dose are they thinking of starting CC at? I go with the start low and go up as needed till the right dose is hit.
It's true what Glynda has said, cushings is hard to diagnose. I'd want a thorough battery of testing, blood, LDDS, urine and ultrasound, to be positive and then if you are comfortable with the diagnosis, start slow and adjust as needed.
I know that people say on the net a year or so to live with Cusings, but this forum with soooo many members having gone through this, have proven that to be wrong over and over. They can live out their normal lifespan. My sister's chihuahua lives to be somewhere around 19 years old. She was pretty feeble by that time though.

I don't know about how many dogs are diagnosed at 15, so can't answer that. So many seem to be diagnosed around the 9 - 12 years, but I think that is just a generalization. It can be younger and it can be older.

We have some very experienced people here who can tell you what to expect and watch out for every step of the way.

Right now you are terrified. This is your baby. One thing that you can count on us knowing, is that no one can possibly love CC more than you do. That is how we are all and here, we do believe that every owner loves their dogs just as much as the next person loves theirs. We know this to be a fact because if they didn't, they would never have shown up here.

Ask anything you want. Vent as needed, laugh and cry.

Sharlene and Molly Muffin

[apollo6]

Dear Jdeet
the love you have for your baby shows. YOur picture says it all. she is your baby, you know more than anyone else what is wrong with her. Before you even think about Trilostane please read up about Cushing. there are three different kinds of cushiness- adrenal,pituitary, and asy(forgot the correct spelling) Cushings is a very complicated disease. Other diseases can mimic it,thyroid, etc.
You are right on being cautious. The signs of Cushings are many, the excess urination, pot belly, hair loss. Also doing the right dosage is very important as to weight. MY baby weighed 10 lbs and was only on 10 mg of Trilostane. so before you even start the medication give us some more info.
The test for Cushings is a full blood panel showing elevated readings, an ACHT Stim test showing elevated cortisol readings and an stomach ultrasound showing enlarged adrenal glands , one may be larger than the other, and enlarged organs.
So, don 't rush into the medication until you are sure. You can go the the manufacturer s site- DEchra and read up about Cushing and the drug vertroyl/Trilostane.
too many vets are really not the familiar with Trilostane and just go by the directions instead of the patient.
Each case is different, and there are different treatments.
Don't listen to what they say. each case is different and don 't focus on the life numbers. Just like cancer some patients can live with it for years, others are not so lucky.
enjoy each day with your angel, try to focus on the now.
I lost my baby in September, he almost made it to 14. There is always hope. We are hear to support, guide and help you.
Hugs Sonja and Angel Apollo

[Jdeet]

Thank you everyone for your support! I don't have her labs but will get this week. Just over the weekend she's started throwing up. No warning or gagging or anything. Just comes up very quick and it's thin and watery. She's eating more too and hanging around her food bowl. Other than that and the potty issues she's seems okay. My husband noted she sits and stares more than usual. Anyway will call the vet tomorrow and see what info. I can gleam and keep yall posted and I really appreciate everyone's input!!!

[Jdeet]

I have received the labs from my vet and copied below. Since I had to retype all this if something looks off lmk and I will verify I have typed it correctly!
As of last night she wouldn't get out of her bed. I got her out and held her and she was very not herself. She just sort of fell over to the side instead of loving on me as usual. She got back in her bed. Later I tried to give her a treat which is just a tiny piece of bread. My other old dog Chloe takes meds and I always put her pills in a tiny piece of bread to get her to eat them. So CC always gets a bit of bread too. Last night she wouldn't catch it so I droped it in front of her. She picked it up and spit it right back out and left it on the floor and went back to bed. In her entire life she has never turned her nose up at anything edible. So this was a huge cue to me something is bad wrong. I did get her to eat it later but she seemed to struggle to get it down. Just a tiny bit of soft bread.
I am waiting to see if her meds come in today and when they do I will know what the dose is and post it.
She got up this morning okay and went out. She didn't poop as usual. My husband said when he took her out last night her poop looked funny. Very thin he said.
After she came back in this morning she went right back to bed.
I am concerned about her not eating. She is drinking a lot though and hangs her head out of her bed to the water dish when she wants a drink.
Just a side note that I have had a dog that was diabetic and sadly is gone now so I have treated a severly diabtic dog before and CC acts nothing like my other dog did when she was diabtic so I am ruling that out. Appreciate any thoughts or input!!!

Cortisol Serial 3 (DEX)
Time 1 8:30
Time 2 12:30
Time 3 4:30
Coritsol Sample 1 1.4
Cortisol Sample 2 Dex <0.7
Result verified
Cortisol Sample 3 Dex 1.8

Low dose- dexamethasone suppression test: Normal: Cortisol level less than 1.4 ug/dl 8 hrs post-dex
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs post-dex.

If the 8 hr post dex. Cortisol level is greater than 1.4 ug/dl, the following can be used to differentiate pituitary dependent less than 1.4 ug/dl 4 hrs post-dex is consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.
(Samples taken at 2 or 6 hrs are interpreted the same way as a 4 hr sample)

If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.

Urine MIC Culture
No growth after 24 hours.
No growth after 48 hours

CBC
Test Results Ref. Range
WBC 9.1 4.0-15.5
RBC 7.23 4.8-9.3
Hemoglobin 16.9 12.1-20.3
Hematocrit 52.3 36-60
MCV 72 58-79
MCH 23.4 19-28
MCHC 32.3 30-38
Platelet Count 704 (HIGH) 170-400
Platelet EST increased Adequate
Differential Absolute %
Neutrophils 7007 77 2060-10600
Bands 0 0 0-300
Lymphocytes 1274 14 690-4500
Monocytes 546 6 0-840
Eosinophils 273 3 0-1200
Basophile 0 0 0-150

RENAL CHEMISTRY Results Ref. Range
Total Protein 7.3 5.0-7.4
Albumin 3.7 2.7-4.4
Globulin 3.6 1.6-3.6
A/G Ratio 1.0 0.8-2.0
Urea Nitrogen 13 6-31
Creatinine 1.0 0.5-1.6
BUN/Creatinine Ratio 13 4-27
Phosphorus 5.3 2.5-6.0
Calcium 10.8 8.9-11.4
Sodium 153 139-154
Potassium 4.8 3.6-5.5
Na/K Ratio 32

URINALYSIS
Collection Method
Cystocentesis
Color Light Yellow Ref. Range
Appearance Slightly Hazy Clear
Specific Gravity 1.010 (LOW) 1.015-1.050
pH 5.5 5.5-7.0
Protein Negative Neg
Glucose Negative Neg
Ketone Negative Neg
Bilirubin Negative Neg to 1+
Blood Negative Neg
WBC None 0-3
RBC None 0-3
Casts None Seen
CA Oxaltate Dihydrate Crystals 0-1
Bacteria None Seen None
Squamous Epithelia 0-1 0-3

URINE MICROALBUMIN
Microalbuminuria 2.2 <2.5

[lulusmom]

Thank you for posting the test results. Considering her age, those values look really good but unfortunately, it appears your vet did not do a complete senior panel which would include liver values, cholesterol, glucose, triglycerides, etc. Some or all of these values are elevated to some extent if a dog has cushing's so to have this missing is unfortunate. Given her limited symptoms, missing blood chemistry and no validating or differentiating test for the LDDS, if CC were my dog, I would not start treatment until I was absolutely sure she has cushing's.

I can tell you right now that even if CC was a walking poster dog for cushing's, I would not start treatment now because whatever is going on with her has nothing to do with cushing's. Pancreatitis would definitely be a suspect and at CC's age, liver issues could also be at play. If she does not start coming around and eating and/or she continues to have loose stool, I would recommend that you get her to the vet to determine exactly what is going on. Cushing's needs to go on the back burner and if and when you need to address cushing's, your vet needs to do an abdominal ultrasound at the very least.

Glynda

[Jdeet]

Thank you so much Glynda! I am going to put a call into the vet today. I am just so ignorant here. Your help and input is so much appreciated! I am at work and I can't tell you what I fear when I get home ...:(

Joanna

[labblab]

I am so sorry that CC is feeling so poorly and I agree 100% with Glynda's advice. The LDDS blood test as a diagnostic for Cushing's is especially vulnerable to being skewed by other, nonadrenal illness. In other words, a dog can test "positive" on the LDDS if there is instead something else going on. The dog may not actually have Cushing's at all.


It has been shown that the LDDS is more sensitive with fewer false negatives, but less specific with more false positives than the ACTH stimulation test in dogs with significant non-adrenal illness, especially liver disease.

http://www.veterinarypracticenews.com/vet-practice-news-columns/abstract/acth-stimulation-testing.aspx

CC sounds like an acutely ill little girl right now. Even if she does have Cushing's as an underlying condition, I would want to get to the bottom of her inappetance and lethargy before starting any medication.

Marianne

[molly muffin]

I hope that CC was doing okay when you got home. Definitely get her in to see your vet. If you have to and you think she is getting worse, then take her to the Vet ER.
I agree, she needs to have a senior panel run, to show liver values, etc. But at the moment, everything else aside, she needs to have whatever is going on found out and treated.

Hugs, I know you are scared to death.
Sharlene

[molly muffin]

How is CC?

Sharlene