Ketoconazole

[jessebelle13]

My 12 year old yellow lab has just been diagnosed pre cushings. The symptoms are typical....he started drinking excessively, urinating in the house, and panting. First vet did urinalysis.....which indicated dilute urine. He presumed it was his kidneys. Went for second opinion. Second vet did complete bloodwork and x-rays. Creatinine and BUN levels were normal. But Alk Phosphatase very high and Lipase was high. The x-rays showed slightly enlarged liver and some lymph nodes that were swollen. So, Vet decided that he was probably pre cushings and put him on Ketoconazole (200 mg....twice a day). Winston goes in for a recheck in two weeks. This is such a frustrating situation. Winston is a senior....but still enjoys walks and is fairly energetic when he is outdoors. We have carpeting throughout our house and we must keep him in hallway (which is tiled), due to the accidents. I am wondering if anybody has used Ketoconazole successfully? Vet said it would take about a month to see if it works. So frustrating. From what I read, 20% of dogs do not responde to this med. Ugh. I have already called a flooring guy to get an estimate on ceramic tile flooring!!!!

[Squirt's Mom]

MODERATOR NOTE:

I have moved your post concerning Ketoconazole into the Discussion thread where more members will see it and respond to it. We keep all posts concerning each baby in their own thread under the Questions and Discussion section. This way it is easy to track the history and respond to your posts more easily.

If you would like the title of your baby's thread changed, just let one of the mods know.

[molly muffin]

Hello and welcome to the forum. Most dogs with cushings end up on either vetroyl or lysoderm treatment, as those seem to have the most consistent and best results.
I see the Lipase was high, has a bile acid test been done to check for liver disease?
Usually if it is cushings, with proper treatment, you will see a decline in the drinking and urinating as the cortisol lowers.
One thing to be aware of is as the cortisol comes down then things that have not been bothersome before due to the higher levels of cortisol can rear it's ugly head, such as arthritis.
Has an LDDS or ACTH been done yet? If so could you post those results?
I'm really glad you found us. Here you will get a lot of support from others who have gone through or are going through the same things.

Sharlene and Molly Muffin

[Harley PoMMom]

Hi and welcome to you and your boy,

Ketoconazole is hard on the liver so it is usually not prescribed for a dog that has Cushing's disease. A dog with Cushing's has excessive cortisol running through its body and this excessive cortisol puts a strain on the liver.

Trilostane/Vetoryl and Lysodren/Mitotane are the two drugs that are most recommended, so I would ask your vet about trying one of these instead of the ketoconazole.

I was wondering if you could tell us a bit more about your boy. What symptoms did your boy display that lead you or your vet to test for Cushing's? How much does he weigh? Does your boy have any other health issues? Is he taking any other herbs/medicines/supplements?

Could you get copies of all the tests that were done and post any abnormalities that are listed, we would especially be interested in any results from Cushing tests such as an ACTH stimulation test, LSSD test, or UC:CR test.

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

Love and hugs,
Lori

[Rural doggie]

Hi- We just tried our 90 lb lab mix on Ketoconozole for 3 weeks with results that were mixed, at best. His water consumption and urinating did not go down. His appetite definitely decreased, to the point where he would spit out any dry food he was given and wouldn't accept dry treats. His back legs also started shaking more and sometimes he'd shake all over right after eating. No idea what that was about, unless his stomach was just so upset that it was traumatic to eat. The ACTH stim test we did after 10 days did show a slight decline in cortisol, but we were not happy enough with the results to keep trying. Maybe we ended too soon, but it does sound like trilostane is the preferred drug. We will start trying that next.

I know how you are feeling. Our dog is doing really well for his age aside from the drinking and urinating, as well, which is frustrating in its own way.

[SoggyDoggy]

Second vet did complete bloodwork and x-rays. Creatinine and BUN levels were normal. But Alk Phosphatase very high and Lipase was high. The x-rays showed slightly enlarged liver and some lymph nodes that were swollen.

I'm just wondering if the second vet tried to aspirate any lymph nodes or did any further investigation on these? I ask as when my boy went to a specialist, she also found some enlarged nodes and said she wanted to check them out just to make sure she hadn't missed a potential cancer. Luckily for me (and him) they were nothing (just a bit of fat), but their presence was a worry for her until investigated.

As for the flooring, having just enquired myself (for completely different reasons though) I would say hold off until you get the Cushing's under control. When you get onto the right drug/when it takes effect, you will notice water intake decrease in less than a week (we took 3 days which was really quick) and therefor you Lab will be less accident prone. Other than that, if you are worried about the carpet, buy yourself a carpet shampooer, a lot less cost than re-flooring your house and they work brilliantly.

[jessebelle13]

Vet number three finally gave us the diagnosis which we expected for Winston, our 12 year old yellow lab. Cushings. Liver enzymes 1114, urine ratio 55. All other counts are normal. He started having problems about two months ago urinating in the house and drinking excessively. Now we have to make a decision regarding treatment. Winston is 105 pounds.....I found a compounding pharmacy in Arizona called Diamondback. I could get 180 mg of Vetoryl for $113.40 a month. This is REASONABLE, compared to traditional pharmacies. I am curious to hear other experiences with Vetoryl. My vet actually tried to discourage me from pursuing treatment, given Winston's age and arthritis problems. However, after reading various posts and reviews of Vetoryl, it seems like it could produce great results. I know there are no guarantees with Cushings...but if we could give Winston a good quality life for even one year, it would be worth it. Thanks

[frijole]

:D Vet number 3. We understand. It is often not diagnosed and it is often misdiagnosed so can we trust that you ruled out diabetes and hypothyroidism? I ask because we like to make sure before recommending treatment. Do you have copies of test results that confirmed cushings? Which test and what were the numbers? Did you do an ultrasound?

The liver enzymes are in line with a cush dog but not a definite dx. The urine test is done to rule out cushings and in this case they did not but it is not by itself a dx either. So we just want to be sure. If you don't have the cushing test results please get them. did other vets do cushing tests with results that were not positive or did they just not bother to do the tests?

I had one dog that did have it and another that had 7 false positives so I learned the hard way even with experience dang it! :)

Have you measure the water intake? If not you should do so before beginning trilostane/vetoryl so you can measure it daily and know the difference. What I did was mark a bowl with tape and fill it every day and at the end of the day measure intake. Faster that way.

Many here have used Diamondback and found them to be a good compounder. THey are not all good.

What dose is your vet recommending and what does your dog weigh? Given his age and the arthritis you definitely want to start off low. If he is feeling arthritis with his cushings not treated he will be in increased pain once treated. (cortisol in the cushings masks pain - a natural treatment so to speak) You might consider giving him some form of treatment for the pain prior to starting so he doesn't have such a big shock as trilo will lower the cortisol pretty quickly.

I'm sure others will have thoughts. Here is a link that should be helpful in answering questions on the drug. Kim
http://www.k9cushings.com/forum/showthread.php?t=185

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about a "definitive diagnosis" into Winston's original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[frijole]

Thanks Leslie - that helped. I see you had bloodwork done and an ultrasound. I still don't see any cushings test results so I'm hoping vet 3 did them. :) Kim

[jessebelle13]

Winston is 105 pounds (normally he is between 110 and 115). At our prevous appointment (before the lab results came back) we were conjecturing about treatment. She said for his weight, he would need 180 mg per day. And yes...they did rule out diabetes and thyroid concerns.

I think that our vet was trying to give us a realistic picture of Winston's future. She said that without treatment, he would have one year, at best. With treatment, she said there are no guarantees. We could have six months, one year, or more. She said if we do not treat Winston, that she would administer liver medication to him, as well as treat his arthritis with injections. Originally, when she gave us a price quote from petmeds for Vetoryl......it was exorbitant....almost 300.00 per month for 180 mg. At that rate, I could not afford treatment, especially with the followup bloodwork which is necesary. However, I was thrilled when I recieved a quote from Diamondback for $113.00 (which I can do). From what you told me, Winston's arthritis will be worse, due to the lack of cortisone. Can he still recieve injections and anti inflamitory meds with the Vetoryl? Also, if we do treat with Vetoryl, we he still need the liver medication (I left the name of it in the car...I believe it begins with a "D"). So many questions. Do you think that with Vetoryl, Winston could have decent quality of life....for perhaps more than a year? I know that there are no guarantees, but I would like to hear other experiences with the drug. Thanks so much. This has been a tough time. Oh...by the way....Vet number three does not like Ketoconazole. Said it has a low succes rate. She discontinued it, immediately.

[jessebelle13]

We just recieved the results via the telphone today (Saturday). I do not have a printed copy. Vet number 2 did x rays, which did not show anything of significance. No ultrasound.

[jessebelle13]

To Rural Doggie: Vet number three discontinued Ketoconazole. We noticed the same things.....drinking and urination continued to be excessive. We also noticed the occasional shaking, which Winston has never done before.

To Soggy Doggie: We did not investigate the lymphs. Vets said it probably is a result of the Cushings issues. Winston is 12.....I can only do so much. I think that the best line of treatment seems to be Vetoryl. The flooring is a huge issue to me!!! We both work, and winston is confined to our ceramic tile hallway. When we are home for the evening, I want to enjoy time with our boy....without worrying. You may laugh, but a purchased large tarps from Home depot for the living area (putting a large blanket on top, for comfort.) That way we can enjoy quality time together!!!

[frijole]

First off I want to clarify something and that is that cushing's is not a death sentence and there is no one year or two year life span. Most of our dogs died of old age unrelated to cushings. Perhaps your vet is guestimating your dog's life expectancy based on other things but don't do it based on the cushing's because they lead normal lives.

You could probably not treat the cushings and have a happy life with the exception of the urination in the house and that is the only reason I'd treat if I were in your shoes.

There are different schools of thoughts on dosing but most vets are now starting at 1 mg per pound of weight so in your case I would have gone with 100 mgs vs 180 mgs. Please keep a very close eye on him to make sure he isn't having any symptoms (see the link I gave you for details). Did your vet give you prednisone to give in case of emergency?

Yes you can give the anti inflammatory drugs - trust me we all had to. Denamarin is probably the liver drug you were given.

I am still concerned that I am not seeing any actual tests for Cushings'. You said vet 2 did xrays and not an ultrasound. Xrays cannot diagnose cushings disease. What were they looking for? Curious.

YOu should have done a two hour blood test called the acth test and/or a low dose dex suppression test (LDDS) which is an 8 hr blood test. They send them off and you wait for results usually 2 days. Did this happen? If it did not - regardless of how sure you are of the diagnosis you cannot give the trilostane as you are risking your dog's life. I've seen it about 3 times on this board the last 2 nights so I am going to be very honest to make sure you know I am not lying! ;) Watching dogs go thru pain and die for no reason is about to kill me.

There are other things that could be causing the urination including kidney issues, SARDS, diabetes insipidus (a different type then what glucose measures). High liver enzymes can be caused by almost any illness so that isn't good enough. You MUST do at Least one cushings test.

I hope you are just missing my question on the test and that an acth test or LDDS test was done. Please confirm. If the answer is no don't give the trilostane. If you haven't ordered the drug from Diamond Back I would ask if you could get an rx for a lower dose. It will save you money AND I believe it is a much safer starting point. You always start as low as you can and tweek upwards if need be (don't buy many pills until you know it's working).

I'm sure others will chime in with their thoughts. Sending warm thoughts your way. Good luck! Kim

[jessebelle13]

No we have not done the low dex test yet. I am sorry.....I missed this. Yes, our vet did recommend it.....if the urinalysis and lab work pointed to a Cushings Diagnosis. AND as of today (with the phone call from the vet), the tests did point to Cushings. Sooooo, from your comment, it is essential that we do the low dex test to recieve a better diagnosis. If, in fact, this test gives us a more definitive Cushings diagnosis, than I will mention the 100 mg of Vetoryl to my vet. I would rather be safe than sorry. All of this is so new to me. I was relieved to find Diamondback, since it provides an affordable option (if in fact, he is Cushings). To recap, if Winston is Cushings AND we pursue Vetoryl, is he given the Denamarin, as well? Vet said that Denamarin is around $50.00 a month. I hope that Diamondback can provide us with Denamarin at a deep discount. We have spent about $1000.00 in the past month and a half on vet bills. Also, Winston seems more particular about food, except for lunch meat, double cheeseburgers, and Mac-n-cheese. He will not eat the expensive dry that I buy him (salmon and sweet potato), even if I mix it with tuna. AND, he only will eat small amounts of the expensive canned food, which I have tried. I fear that his appetite is dwindling. I was thinking about buying 15 double cheeseburgers from Burger King for the week....and mixing it with canned food. I don't want him to lose more weight : (

[frijole]

I don't mean to scare you but now I am really questioning the diagnosis. Cush dogs don't have picky appetites. cush dogs live to eat. They do not chew food. I am serious they inhale it. And they've been known to eat rocks, dirt and you name it too.

Have you had an acth test? That's the other one that can test for cushings. If you haven't then seriously your vet #3 should be fired for even thinking about giving you trilostane to give your dog because you have symptoms not a diagnosis.

I had a dog (Annie) that we thought had cushings but she didn't and she too was losing weight and I couldn't get her to eat anything at times. I understand it is the scariest thing ever. Here is what I'd like you to do and it is to save your sanity and your wallet ok?

Take a step back from the whole cushings thing. Go to all 3 vets and get photocopies of all labworks and tests that have been done. You paid for them so you own them. Put them in order of tests and type up each one chronologically just type the name of the test and the resutls along with 'normal ranges' where applicable.

Until then, please start at the beginning and tell us the entire story as much as you can remember. I don't want to miss something important. When did this start, what did you notice first etc?

Meanwhile just an fyi - cush dogs cannot tolerate fatty foods - they vomit it up and it makes them very sick. My Annie who we thought for a while had cushings sometimes would only eat lunch meat and burgers so I understand. I know you only give it when nothing else will do. No onions on those burgers - very bad for them ok? :)

OK...write it all up and we will all take a very close look. You are no longer alone on this journey ok. So deep breaths. We'll help as best we can. Sending hugs, Kim

[frijole]

oops.. almost forgot.. I bought Denamarin online from Amazon.com of all places - best prices. You do not need an rx for it so you can save there. Another option is milk thistle which is great for the liver. (at least it worked on my dogs!) You can buy it at health food stores OR even Walmart! It comes in capsules and you put it/pour it over the food. I'd be afraid your dog wouldn't eat the denamarin tablets - that's what happened to me anyway. Kim

[jessebelle13]

Thank you so much for all of your concern. I will obtain all results from Vet 2 and Vet 3 (Vet 1 did not get lab work). And I will attempt to give you a timeline, as best as I can. This means so much to us. Winston has been a joy his entire life. We do not have children and Winston used to go to work with me everyday (I work for an attorney....the clients love him). This entire saga is so confusing. Thank you from the bottom of my heart. Jessica

[frijole]

Glad to help. I've been down a very similar path with vets, throwing thousands away and still no answers. It is an awful feeling. Looking forward to the write up. :) Go give him a hug. Kim

[lulusmom]

Hi and a belated welcome to you and Winston.

Kim has done her usual good job of covering all the bases but I'd like to make a few observations. To make it easier for me to remember everything I thought of when I read your thread, I'm typing my comments in blue within the body of your posts below:


My 12 year old yellow lab has just been diagnosed pre cushings. The symptoms are typical....he started drinking excessively, urinating in the house, and panting. First vet did urinalysis.....which indicated dilute urine. He presumed it was his kidneys.

Granted that symptoms and dilute urine would lead you to think kidney issues but without a full blood chemistry and cbc, no presumption should be made.

Went for second opinion. Second vet did complete bloodwork and x-rays. Creatinine and BUN levels were normal. But Alk Phosphatase very high and Lipase was high. The x-rays showed slightly enlarged liver and some lymph nodes that were swollen.

Creatinine, BUN and Lipase elevations are all what you would expect with kidney dysfunction, not cushing's. Unless a dog has an underlying infection due to severely compromised immune system, swollen lymph nodes are not an abnormality seen with cushing's.

So, Vet decided that he was probably pre cushings and put him on Ketoconazole (200 mg....twice a day).

I have no idea what your vet used to declare that Winston is pre-cushing's but if vet #2 did not determine that Winston's cortisol was elevated by way of an acth stimulation test or low dose dex suppression test, prescribing ketoconazole would be completely irresponsible. It is not a benign drug and it is rarely used for cushing's any longer due to it's lack of efficacy and it's adverse effect on the liver.

Winston goes in for a recheck in two weeks. This is such a frustrating situation. Winston is a senior....but still enjoys walks and is fairly energetic when he is outdoors. We have carpeting throughout our house and we must keep him in hallway (which is tiled), due to the accidents. I am wondering if anybody has used Ketoconazole successfully? Vet said it would take about a month to see if it works. So frustrating. From what I read, 20% of dogs do not responde to this med. Ugh. I have already called a flooring guy to get an estimate on ceramic tile flooring!!!!

The percentage of dogs who don't respond is closer to 30% to 35%. Some dogs simply don't absorb it into the GI tract. Efficacy for Winston should be a non issue because vet #2 doesn't even know if Winston has elevated cortisol. There is absolutely no other reason to prescribe this drug to a dog. To do it based on a really uneducated guess is simply unacceptable.



Winston is 105 pounds (normally he is between 110 and 115). At our prevous appointment (before the lab results came back) we were conjecturing about treatment. She said for his weight, he would need 180 mg per day. And yes...they did rule out diabetes and thyroid concerns.

Kim has already mentioned that while the packaging insert for Vetoryl may indicate that 180mg is an appropriate dose for Winston, they have told one of our administrators, Marianne, that they recommend starting at 1 mg per pound. This is also what UC Davis recommends based on their extensive experience with the drug. Every dog is different and what we've learned in the years since Vetoryl was FDA approved is that the manufacturer's dosing recommendations are too aggressive.


I think that our vet was trying to give us a realistic picture of Winston's future. She said that without treatment, he would have one year, at best. With treatment, she said there are no guarantees. We could have six months, one year, or more.

A realistic picture of Winston's future is contingent upon whether he actually has cushing's. If he does have cushing's and he has no other complicating issues, with treatment, he can live out his normal life expectancy with a pretty good quality of life. An exception to this would be if a dog has severe arthritis. Cortisol is the body's natural steroidal anti-inflammatory so once treatment reduces cortisol, the arthritis flares. Winston is at the upper end of his life expectancy for his breed so a one year prognosis without treatment would be a safe guess for your vet. I personally rescued a 19 year old lab who almost made it to see his 20th birthday so Winston could have lots of good years ahead of him.

She said if we do not treat Winston, that she would administer liver medication to him, as well as treat his arthritis with injections.

If Winston has uncontrolled cushing's, your vet shouldn't have to give him arthritis injections as he would be self medicating with the high cortisol. If he does have elevated cortisol, it's also highly unlikely that liver support would reduce alkaline phosphatase. That's not to say that it isn't a good idea to give liver support anyway because it will help the liver.

Originally, when she gave us a price quote from petmeds for Vetoryl......it was exorbitant....almost 300.00 per month for 180 mg. At that rate, I could not afford treatment, especially with the followup bloodwork which is necesary. However, I was thrilled when I recieved a quote from Diamondback for $113.00 (which I can do). From what you told me, Winston's arthritis will be worse, due to the lack of cortisone. Can he still recieve injections and anti inflamitory meds with the Vetoryl? Also, if we do treat with Vetoryl, we he still need the liver medication (I left the name of it in the car...I believe it begins with a "D").

It's called Denamarin or Denosyl. I have done business with Diamondback Drugs for years. As my cushdogs were tiny, I had to have their trilostane and lysodren compounded. Diamondback saved me lots of money and they never let me down on their delivery or quality.

So many questions. Do you think that with Vetoryl, Winston could have decent quality of life....for perhaps more than a year? I know that there are no guarantees, but I would like to hear other experiences with the drug. Thanks so much. This has been a tough time. Oh...by the way....Vet number three does not like Ketoconazole. Said it has a low succes rate. She discontinued it, immediately.

Yes, I do believe Winston can have a good quality of life with treatment. We have hundreds of threads that prove it.

Please round up all the tests that were done to diagnose Winston and post the results here so we can help you get Winston back on the right track.



Glynda

[frijole]

I just wanted to post so anyone following along isn't confused... Glynda when you made your comments in the last post you said you were glad an acth test was done but the person you were quoting was not this poster. I do not believe an acth test was done. We will see when we get all of the test results. Just wanted to clarify that. Kim

Note added by Glynda (lulusmom): Well duh! I just deleted Rural doggie's quote which I included in error as Jessebelle13's. Thanks for catching my mistake, Kim.

[molly muffin]

I second that cushings is the hardest thing in the world to get a clear diagnosis on. I've been trying to get a definitive diagnosis of yes or no for awhile now. Our vet was convinced she had cushings, based on pot belly, and high ALP and ALT tests. So, finally in 2011 we did an LDDS test and it showed negative for cushings. Then this year, again, same thing so they did an ACTH test, which did show high cortisol levels. We went to see a specialist and did an ultrasound. The ultrasound again was consistent, with a mildly enlarged liver, adrenal glands, lymph nodes. However, keep in mind, any cause of high cortisol is hard on the liver and adrenals, even if not caused by cushings. Due to this the specialist ordered an LDDS to be sure it was in fact cushings and not something else. End result was full suppression for 8 hours, and negative for cushings. We still don't know what is causing the high cortisol results.

I'd get an LDDS test done, then if that was positive, I'd follow up with an ACTH test. You want to know the ACTH before you start treating with vetroyl.

Anyway, that is my experience. We're still trying to figure it all out and it's been awhile I have to say.
You don't want to give vetroyl unless you know it's cushings. Which is my our specialist said not to start anything until we get a positive LDDS showing cushings. So, I actually did another LDDS test in December to see if there had been any changes, and she is still suppressing.

I can't remember if a culture was done to check for UTI? If not that is a possibility to check out. Go with culture if the urine is dilute at all.

I do understand that the carpet urination has become a very big problem for your families life. If in fact this is cushings, then yes, I agree with Kim that you will want to treat to try and get rid of that symptom specifically.

It is true that in the last couple days we have had dogs on here that have had very bad results from being treated when they didn't have cushings and in fact had another problem. That has been very hard I think on all of us and is heart breaking to see. This in no way reflects on you and your Winston, just we are really sensitive to that issue around here and we worry all the time. We worry about the furbabies and we worry about the people who all go through such trials in their lives.

I would try to copys of all testing done so far, so you can look at it, review, discuss not only with us, but with your family. It will be good as you go further to have those results to refer to when needed too.

Think of yourselves as Winstons advocate. You are his voice. We know none of this is easy and it's bloody expensive too. It's that sort of disease unfortunately. So anything we know of that would help we will let you know and we'll be there every step of the way too. :)

Sharlene and Molly Muffin

[jessebelle13]

The kindness and information shared on this website is amazing. I think that am going to print various replies and take them to Vet #3. I am beyond saving face, at this point. We have to get to the bottom of this and I am willing to go the extra mile for my dear sweet boy, who has given us a lifetime of joy. Vet #3 actually owned a Blue Healer who had Cushings....so at least she is familiar. And she said that Endroconology is her specialty. We will certainly get the dex test done...and perhaps the other, based on the findings.

Winston is a big yellow lab who unfortunately has pretty bad arthritis....especially in the hind quarters. He also is lumpy and bumpy. Throughout his life, he has had numerous fatty "tumours" removed, all of them proving benign. Vet number three asked if any were biopsied.....and the answer was no. The two vets who had removed the lumps said they were clearly benign...and did not send them off for testing. Over the past two years, these lumps have sprouted up everywhere....with one particularly large mass on his side. Vet 3 palpated it.....there was no obvious pain for Winston. At his age, we have made the decision to quit removing them, since previous ones were apparently benign. Other than this, no medical problems.

We noticed this past summer that he was really slowing down. I attributed it to old age and the intense heat which we experienced in the Northeast. He did not seem to want to walk or swim very much. And he panted heavily when exercising. Again, I attributed it to the 100 degree plus weather. I suppose little things started happening in August and September. He no longer wanted to sleep with us in the bed. In the past, he would use an ottoman to jump up. Gradually, he stopped trying. He also stopped getting on the sofa. General lethargy increased through the fall. Than the first obvious symptom began in the beginning of December. I all of the sudden noticed that he had urinated in the house, which has not happened since puppyhood. Went to Vet Number one, who has been Winston's primary doctor since 6 weeks of age. To be truthful, Vet # 1 has horrible bedside manner and is more of a country vet. He is reasonable ....but no bells and whistles. In his 50s (his father was also a vet....so I assumed he was knowledgable). ANYWAY, we used him until this point because Winston had no real issues, aside from orthopadic. Told Vet 1 about the "accidents" and he immediately put him on an incontinence pill (pro con??...I think). Initially, it seemed to work. December rolled along and over Christmas we went away. My mother stayed with Winston in our condo. Upon return, it was OBVIOUS that Winston had multiple accidents. Went back to Vet 1......Technician did preliminary "dipstick" urinalysis to check for UTIs, etc. No evidence of infection. We left....she scheduled a return visit for Winston (when the vet would be in the office). Went back. Vet 1 did a blood test in the office and I collected urine for him to analyse. I think he was checking the blood for diabetes and other things. The urine, however, showed an extremely low gravity. Vet 1 said that Winston's kidneys were probably beginning to fail. He said that he could send blood away for analysis....but he said that he would bet that his numbers would be normal. Told me that nothing could be done for the kidneys...and could not predict what would happen. That was that. I was devastated.

Went to the Pet Smart to try to find special food for kidney issues. When I was there, I told an employee about my situation and she suggested that I see Vet 2. It was a Saturday, but she told me to stop in. That he was extremely compassionate and could help us. So that is what I did. Winston subsequently saw Vet 2.....he did blood work to send off. Did not do a urine culture (?) to send away. Took four x-rays. On return visit, he said the blood work could indicate pre-cushings (I will share that with you tomorrow....the data is at my office). He said that his kidneys were fine. He also said the x rays showed no obvious issues. A few lymphs were enlarged and I believe that his liver was a bit enlarged. He said this could be consistent with cushings. SO....he put him on Keto. and told me to return in two weeks.

Well....we noticed that Winston was not responding well to Keto. Symptoms still apparent. And he began to shake a bit. At the end of two weeks, I decided to cancel my return appointment with Vet 2 and seek Vet 3 (who is conveniently located near my home). It is a brand new practice and she is a recent grad from Purdue (I believe). Anyway, she told me that Vet 2's bloodwork was insufficient....and ordered a new panel. They also did some kind of urinalysis......which was also sent off. She said that the results of these tests could either rule out or verify a POSSIBLE Cushings diagnosis. So TODAY....I recieved the call from Vet 3's husband.....giving me the verbal information...which confirmed a preliminary Cushings diagnosis. I remember during my appointment with vet 3 that additional tests (the dex test and another test) would be done if we want to pursue treatment.

So that is it, in a nutshell. I will get specific results to you tomorrow from Vet 2 and Monday from Vet 1. Sorry for the prolonged post. Actually, I am waiting for my husband at the Apple store....so I had time on my hands. Thanks again for your kindness.

[frijole]

Thank you for that. So you don't really have a cushings diagnosis. I think her husband mis-spoke. The urine analysis that was done could not rule out cushings. (just means it is highly dilute) It could be cushings and it could be something else. Only the two tests we discussed can diagnose it.

I am relieved and already Vet 3 is clearly your best option. :) Country docs are great when you don't have any major issues. Vet 2 should go to jail for giving you Keto without a diagnosis of cushings.

The entire story does sound like a cush dog BUT BUT BUT the weight loss and lack of appetite screams NO NO NO. Perhaps it is cushings and something else OR just something else. I had the same thing happening and I am going to be real specific about my recommendation because I had to drive 5 hrs each way to the closest Internal Med Specialist to get answers (after having spent enough to buy a used car)...

I would NOT start out with the LDDS test. It is usually the golden standard to diagnose HOWEVER if something else is going on it often can have false positives (happened to me). I would recommend an ultrasound on a high resolution machine (they may not have one - most local vets don't so you have to go elsewhere)... I want them to look at the abdominal organs in great detail for any tumors/bumps they can find. Make sure they get shots of BOTH adrenal glands.

The reason for this recommendation is that they can tell from the size of the adrenals if its cushings. If they are normal chances are it is not or it is PRE PRE PRE cushings. If they are equal in size and enlarged then it is most likely pituitary type cushings and if one is enlarged it is most likely adrenal cushings (tumor on the adrenal glands). If there are tumors on other organs this could be why you are seeing cushings like symptoms - we've had dogs before that were misdiagnosed with tumors on the spleen. Remove them and no more issues. Big bang for the buck with the ultrasound.

If you were to do a test for cushings I would do the ACTH test. My dog that I told you about that was misdiagnosed for cushings and had all the false tests and loss of appetite had a pheochromocytoma. All of her ACTH tests came back positive EXCEPT for the one that was sent to Michigan State Univ. I do not know why but since we have similarities with the eating ask the vet if they can send it to MSU. I assume you are close to there if she's a Purdue grad. ;)

If I could only afford one - for now I'd do the ultrasound because I really am not sold on cushings.

Also I would get copies of all tests and your write up to vet 3. It makes their life so much easier if they can look at things over time and rule out things. Plus it'll save you money.

Whew... hope this helped. Kim

[Squirt's Mom]

I wonder if the urine test Vet #3 did wasn't the UC:CR? That can rule Cushing's out but cannot diagnose it. If it is abnormal, that simply means something is going on but does not confirm Cushing's. You will need to have further testing to help determine that like the LDDS and ACTH at the minimum. I would also suggest an ultrasound, abdominal ultrasound performed on a high resolution machine.

Hugs,
Leslie and the gang