Please Help

[ezdays]

My 9 year old bichon frise, Kobi, was just diagnosed with Cushings. When the Dr. told me, I asked her what was next and she said don''t treat him. All she said was, "we had anoher dog that was treated and he became very ill." I didn't even want to ask if he made it or not which I assume he didn't. I did not appreciate that answer. I am going see the owner of the hospital and get her opinion. Kobi is having surgery Monday, December 10, for bladder stones. This is his third time. I had always heard of Cushings Disease but never had one of my dogs diagnosed with it. I have done a lot of research these past several days and it sounds like it is a very hard disease to treat. Especially if on Lysodren. He's such a wonderful dog. I rescued him when he was 9 months old. He acts like he's 3 and not 9. Full of energy--even now. Would like to know if others out there were told not to treat their dog but did anyway and what the oucome was. I know the situation is different for each dog. Kobi is eating a lot now which he never did before, drinking and urinating more. He hasn't had any accidents in the house yet. Thanks for any insights you might have.

[Harley PoMMom]

Hi and welcome to you and Kobi,

Sorry for the reasons that brought you here but glad you found us. First and most important, Cushing's is NOT a death sentence for one's dog. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Trilostane/Vetoryl and Lysodren/Mitotane are the two drugs most Rx'd for a pet with Cushing's. These are strong medicines so a vet/IMS that is very knowledgeable about Cushing's and has experience treating a pet with Cushing's is vital, also an owner who educates themselves about this disease, the medications, and treatment protocols is very important.

If you could round up copies of all tests that were done on Kobi and post any abnormalities that are listed, that would really help us. Also, could you tell us what symptoms Kobi is displaying plus his weight. Is Kobi taking any other herbs/medicines/supplements? Does Kobi have any other health issues? Was diabetes and any thyroid problem ruled out? Sorry for all the questions but the more we know about sweet Kobi the better our feedback will be, ok?

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

Love and hugs,
Lori

[ezdays]

Thank you so much for the reply. I will get the test results from the Dr. and post them. The only symptoms he has are the drinking a lot of water (I always had to make him drink or put water in his food), eating a lot (he was always a very picky eater), having to urinate a lot. No skin problems, pot belly or any other signs. Just the three stated above. He had a low dose dexamethasone suppression test this past Monday and Tuesday the vet called me with the results and said he had Cushings. His liver enzymes were also high (in June they were 200 then two weeks ago they were 565). He has been on a special diet because of his bladder stones since he was 6. It's JD wet food. He does not get anything else to eat other than snap peas as a treat which he loves. I'll post the test results as soon as hey are faxed to me. Thanks.

[ezdays]

Sorry I meant to tell you his weight -- 18 lbs. They never mentioned thyroid or diabetes. She did say his sugar count was normal. He's not on any medications, herbs and the only supplement he takes is MSM for his legs -- he had two ACL surgeries.

[ezdays]

Not sure if these results will help. He hasn't had bloodwork done since June.

Urinalysis

Specific Gravity -- 1.017
pH -- 6.5
Protein -- NEG
Glucose -- NEG
Ketone -- NEG
WBC -- 2-3
RBC -- 0-1
Oxalate Crystals -- 4-10
Bacteria -- none seen
Squamous Epithelia -- 0-1

Low Dose DEX Suppression Test

Cortisol Sample 1 -- 11.3
Cortisol Sample 2 -- 2.2
Cortisol Sample 3 -- 5.1

[molly muffin]

Okay so this is the urinalysis and the LDDS test. Do they give what the normal ranges where? and indicate anything high or low? If so can you edit your post and indicate if so. Also do you have the results? Same thing, only post abnormal results high/low and range with nmol or ug (the units measured in)

It is possible that a vet would recommend to not treat if no symtoms are being displayed. However, it sounds like your vet is saying that they don't want to treat because they've only treated one dog previously and it didn't go well. In which case, I have to agree that they shouldn't be the ones treating, but that doesn't mean you shouldn't treat. That is your decision to make, but you want to do it with a vet that has experience treating cushings and using the medicines. It's just as tricky getting the right dosage and monitoring as it is diagnosing. Is there a specialist or some other vet in the area that might have experience?

Sharlene and Molly Muffin

[frijole]

I'm not sure I'd stick with a vet that won't treat because a dog got ill.. chances are it 'got ill' because they went with too high of a dose. Just a guess based on being here for close to 8 yrs now. ;) Lots of inexperience and it leads to problems sometimes.

So let's talk about your dog... I can't believe they did the LDDS before doing a regular full blood panel. You want to look at the liver enzymes. The LDDS test can rule in cushings but if other issues are going on it is known to have false positives for cushings. You don't want to take a chance and treat a dog for cushings that doesn't have it. (It happened to me)

So I'd start out with having a blood panel done, preferably at a vet's office that truly has experience with cushings. If you tell us what part of the country you are in we might be able to help.

Meanwhile start measuring the water intake so you know how much water (ounces) your dog is drinking a day. A normal dog drinks an oz per lb of weight on average. So a 16 lb dog would drink 16 oz or around 2 cups a day.

Does your dog have a ravenous appetite? Round tummy? Skin issues? FYI I've noticed a lot of dogs have stones (my cush dog did) as well as ACL issues. May or may not be related - just sharing.

Don't take the diagnosis as firm yet - get a blood panel to see what's going on and we'll help you from there ok? Kim

PS If its cushings both trilostane and lysodren are equally effective. They are equally dangerous if abused - but so is aspirin. :) So don't fret that at all... again, we'll help.

[ezdays]

I so much appreciate all of the suggestions. I was so happy to find this site when I first was told he had Cushings. I just cried all night thinking his time was up but then read other posts and feel like he can live a good quality of life if treated and monitored correctly. They did blood work because of his surgery so I will get those results faxed to me today. As soon as I get him healed from this surgery I plan to take him to an IMS. There is one close to where I live. I'm in Alexandria, VA and they are in Springfield, VA. I will also measure his water intake. He doesn't have a ravenous appetite he just eats both meals a day which he NEVER did before. He begs for food and searches to see if anything was dropped on the floor. No round tummy or skin issues. His liver enzymes were up to 565 compared to 200 in June. Again, thank you all for the list site. It really does help those of us who have never experienced this before.

[ezdays]

OK, so I got his blood work results and the only result that was high was ALK Phosphatase which was 535 (normal is 5-131). Everything else was normal. He did have 2 lows and they were Urea Nitrogen --2 (normal is 6-31) and BUN/creatinine ratio was 3 (normal is 4-27). Any ideas???? Could it be a problem with his liver and not Cushings? Now I am really wondering about this Dr. -- I called the IMS and have an appointment in 10 days - want to get him healed from the bladder surgery first. Thanks so much for the advice. You all make me feel better.

[Harley PoMMom]

Increased drinking/urination are some of the symptoms assoicated with bladder stones. Any form of non-adrenal illnesses can create false positive results on all Cushing test. Since Kobi did/does have bladder stones this could of skewed the results of the LDDS test. The bladder stones could also be the reason the ALP is elevated.

If a vet diagnoses Cushing's merely from a elevated ALP and then prescribes Cushing medication, IMO, this is totally wrong.

If I were you, I would find an IMS or vet that has more experience with Cushing disease and the treatment/diagnosing protocols.

Love and hugs,
Lori

[molly muffin]

I would definitely go to see the IMS and take all test results with you. I think that with a low BUN and Creatinine they will want to take a closer look at the liver.
They are probably going to want to do an ultrasound and I think that might be a good option especially to see what the liver and adrenal glands look like.
You're making progress, and remember, it's all baby steps.
Oh yes, we all know the fear that brought each of us to this site really well. The tears that we still shed and the worry that is always at the back of your mind.
It's helps though to share that with others going through the same thing.

hugs,
Sharlene and Molly Muffin

[apollo6]

As was suggested you should definitely change vets and get a second opinion. Try to find an Internal medicine specialists who deals with Cushings. I will have to later email the sites on specialist, more info on Cushings. Before you even think about any medication, you need to know which if any kind of Cushings your furballs has. there are three kinds. Cushing can mimic other diseases, the thyroid, sex horomones can be affected. An ultrasound would show if one or both pituitary glands are enlarged, if the organs are enlarged or any other abnormalities. It is never to late to save our babies. MY sweet Apollo was diagnosed over two years ago, was on medication and almost made it to his 14th birthday. Each case is different. And a dog can live with Cushings if treated correctly. but first you should get a second opinion and maybe from a different hospital. If you let us know where you are from,maybe someone on the forum may live in the same area and can help you. We have people all over the
United States, Canada, and as far as Europe.
HUgs Sonja and Angel Apollo

[ezdays]

I am so appreciative of the advice and am taking it. I located an IMS who deals with cushings daily and not too far from me and have an appointment on December 18. They suggested that I get his bladder stones taken care of first then come in and they will do some more tests. I will take all of my test results for him with me. Whatever they need to do to find out what this really is is what I will do. He's my best friend. After talking to a few of my family and friends they are wondering if my vet even knows if he really has cushings and saying not to treat was better than saying, "I don't know." I will definitely not be going back there. Thank you all so much for the encouragement. I will keep you posted. You are all wonderful!!!! Lynn

[Harley PoMMom]

It is great that you have been able to locate an IMS and have scheduled an appointment.

When a dog does have, and is prone to form, stones it is best if the dog is drinking and urinating more.

[acushdogsmom]

I am so appreciative of the advice and am taking it. I located an IMS who deals with cushings daily and not too far from me and have an appointment on December 18. They suggested that I get his bladder stones taken care of first then come in and they will do some more tests. I will take all of my test results for him with me. Whatever they need to do to find out what this really is is what I will do. He's my best friend. After talking to a few of my family and friends they are wondering if my vet even knows if he really has cushings and saying not to treat was better than saying, "I don't know." I will definitely not be going back there. Thank you all so much for the encouragement. I will keep you posted. You are all wonderful!!!! Lynn

Hi Lynn and welcome! I just wanted to let you know, in case it turns out that your Kobi does have Cushing's, that it *is very definitely treatable. And that dogs who are treated (by a vet who has the necessary experience and knowledge of how to treat and monitor the condition properly) do usually live out a normal lifespan for the breed with an excellent quality of life. My little Bichon was one of them. He was diagnosed at age 10 and lived happily for 6+ years after diagnosis. We placed him in the care of a terrific Internal Med Specialist after our GP Vet said pretty much the same thing that yours did - that treatment was so hard on the dog and she even suggested that we should euthanize him. But thank goodness, we didn't listen to her and we found an awesome IMS for our boy. And once we got his Cushing's under control, you never would have even been able to guess that there was anything wrong with him at all. All of his symptoms disappeared and he became playful and happy and well again.

I also wanted to say that it sounds like the IMS you found has given you very good advice. Even before I read what you said they advised, I was going to say that you might want to consider having an IMS evaluate Kobi and maybe re-test for Cushing's *after the bladder stone surgery is done and when Kobi is considered to be recovered from that surgery. Because false positive results can happen on the LDDS test (and on other Cushing's-specific testing), especially when there is concurrent non-adrenal illness or other sources of stress - and I think that bladder stones would likely qualify as a non-adrenal and stressful condition for a dog. So it's possible that Kobi doesn't even have Cushing's, even though the LDDS test result that you posted could be interpreted as positive for Cushing's. And if it does turn out that Kobi does have Cushing's, I think he'd be in *much better hands with a Specialist.

[apollo6]

this site gives an overview of cushings. Too often we are the ones who need to research this disease.
http://www.kateconnick.com/library/cushingsdisease.html
You might check if your new vet is on this list. near the bottom type in your state, if you are in the USA.
never feel that you can not question the vet, get copies of all labs done. We have some very experienced lab techs who can interrupt the lab results you get. When you do post, show what it is and the low and high range for the readings.

http://www.acvim.org/websites/acvim/index.php?p=3
HUgs Sonja and Angel Apollo

[ezdays]

Hi everyone!

Just wanted to give an update on Kobi. I went to the IMS and he is 90% sure he does NOT have cushings. Kobi may have a liver problem and ran tests. Don't have the results just yet. The Dr. feels as though the cause of the stress and pain of the bladder stones that his LDDS test was false positive. He wants me to watch him close and see if he has any other symptoms like pot belly or losing his hair. He said he may be in the very early stages but he doesn't believe he is. If it wasn't for all of you on this forum I would have taken my vets advice and not gone to a specialist. You all are great and I even told the IMS about this forum. He said many people get good advice from those that have or are going through this with their pets. I will keep you posted on the tests. Thank you again for your support.

Lynn and Kobi

[lulusmom]

Hi Lynn,

Thanks for the update. I do hope your IMS is right, that Kobi does not have cushing's. That must have been music to your ears. :) Please do keep us posted on the results of the recent bloodwork.

Glynda

[Squirt's Mom]

Hi Lynn,

Please do stay in touch and let us know what you learn with Kobi. Ya'll are family whether he has Cushing's or not. ;)

Hugs,
Leslie and the gang

[ezdays]

I will most definitely keep you updated on Kobi. I really do feel like I have found another family in all of you. I will need to keep a watchful eye on him. Even though the Dr. said no cushings I know how hard it is to detect -- he even said that. I will need to have bloodwork done more often along with urine tests and down the road he may want to do an ultrasound. Right now I am just happy with the results but I know it may be another problem with his liver but I'll handle that when I find out. I hope everyone has a Happy New Year and again I don't know waht I would have done without you.

Lynn and Kobi

[Boriss McCall]

That is GREAT news. I will keep my fingers that Cushings is not the case for Kobi. What a great New Year gift.. Happy New Year!!