New here (11 y/oWestie)

[Patrick's Mom]

My 11 year old Westie was just diagnosed with Cushings--
He had the ACTH test yesterday.
Other than a big appetite, he does not seem to have many symptoms, although he did have a bad skin infection a few months ago.
The regular vet does not think that he needs to go on medication yet, because she mentioned many side effects.
She is recommending that we do an ultrsound--
His blood work showed high ALK phos (313- range10-150)
and a high potassium and a low Na/K ratio
I would appreciate any and all information--
Thanks so much

[Simba's Mom]

Welcome to the family, this forum is awesome, full of info and tlc!

[addy]

Hi Patrick's Mom!!!!

Welcome !!! If you could post any and all test results for Cushings that would be great, you only need to list the abnormal ones with the normal ranges given by the lab.

A big part of diagnosing Cushings is history and symptoms. Cushings is seldom an emergency and we have had a few pups misdiagnosed. One of the reasons we like to ask for test results;);)

I waited a year to start treating my pup, her symptoms were mild and she had other health issues I needed to work on first.

Here's a link to read through:

http://veterinarynews.dvm360.com/dvm/Medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663

and another:
http://endocrinevet.blogspot.com/2011/02/diagnosing-hyperadrenocorticism.html


I would be nervous getting a diagnosis based on one ACTH test and no overt symptoms. What were the test results?

Hang in there and tell us more and if you can list the test results, that would be great!!!:):):)

[NoonelovesmelikeNorman]

Hello Patrick's Mom - I am too new to decifer any tests so I will leave that to the others. I just wanted to say welcome, your in good hands with this site.

Sharon and Norman

[frijole]

Interesting. I am wondering why your vet even did the acth test for cushings. With no strong symptoms and a very LOW alk phos reading that could be caused by a variety of illnesses/stress.. Is there more to the story?

Cush dogs have alk phos readings in the range more of 800 to 2000. Could be your dog is in the early stages. Or not as this disease is very very often misdiagnosed which is why this site exists frankly. ;)

I too would like to see the results of the acth test. (there are two numbers on it that we need)

Normally I would recommend an ultrasound too but since there are no strong symptoms and the alk phos is so low and I presume the cortisol reading in the acth test will be low too... not sure it's time for an ultrasound if she is saying not to treat unless she thinks it could be something else.

Know this - if it is cushings - this disease is not a death sentence. With treatment they lead normal very happy lives. Also there is no rush to treat. When a dog has no symptoms you absolutely don't need to treat.

Don't believe what you hear about the drugs being bad - they are wonderful. Bad things happen with any drug that isn't administered properly.

Glad you found us! Kim

[Patrick's Mom]

Thank you so much-
I am waiting for the vet to mail the ACTH results and will post it and his blood test information as soon as I get it--
I am so happy that I found you!

[mytil]

Hi and welcome from me too. We are happy you joined us.

Looking forward to the ACTH test results as well.

In the meantime, here is a thread that has some great links to Cushing's, the symptoms, and treatments - http://www.k9cushings.com/forum/showthread.php?t=180.

Terry

[molly muffin]

Hello and welcome. Cushings is so tricky.

My dog had high ACTH results and little to no symptoms, an LDDS test came back negative and the adrenal glands aren't showing a mass on any one. That was a year ago. We're still thinking possible early cushings, with a pituitary that is still suppressing. We aren't treating yet either. It really is hard to figure this disease out.

Have you notice an increase in water consumption? Any accidents in the house? Rear leg weakness, not wanting to jump up on the couch for instance?
Those would be the kind of things that you would be watching for with cushings, in addition to the ravenous appetite.

You mentioned a skin infection. Can you tell us a little about that? What was it diagnosed as?

I know this is a lot of questions, so I hope we aren't overwhelming you. Westies are so cute. My neighbor has one (one of my dogs best buds, they have play dates together. :) ) In fact, they actually have Westie days at a local park in the summers and tons of westies and their owners show up for a walk through the park. I hear it is great fun. :)

Sharlene and Molly muffin

[milosmom]

welcome patricks' mom !!! you have found the best place for info,love,support and tons of worriers....we are all here to share knowledge,stories and help for all at this forum.just wanted to say hello and watch for your postings.....wishing you peace,xoxox patty(milo)meka

[Patrick's Mom]

Thank you for the lovely welcome.
I am still waiting for the results of the test and will post it as soon as I get it.
He has not increased his drinking and does not have accidents in the house, but he does have back leg weakness--At first we thought it was/is arthritis--but now I'm not sure. It has been going on for quite some time-at at times he limped a bit. Because I've been pretty careful making sure he doesn't "over do it"he hasn't limped in a almost a year. He can still jump on the couch, but we carry him up and down the stairs.
He has seasonal allergies and licks his paws and scratches. This past fall he got really itchy and the skin got infected, so he went on antibotics to get rid of the infection. The rash then turned 'yeasty'-like a malassezia so he went on ketaconozole. He just stopped taking it (a few days before the ACTH.)
He had his blood work in November (before the ketaconozole) and then again in January (during the ketaconozole.)
I think the ACTH test was done to check for Addison's--because his ALK Phos. went from 207 in Nov. to 313 in Jan.
His Potassium is also high; it was 6.6 and then 6.3 (range 4.0-5.6) and his NA/K ratio is low; it went from 22 to 23 (ref. range 27-40.)
I'm not sure what all this means--
Thanks
Mara and Patrick

[mytil]

Hi again Patrick and Mara,

It is my understanding that Keto can stay in the system for several days and I am not sure if it may have skewed the ACTH results - you may want to ask your vet as well.

Terry

[Patrick's Mom]

These are the results of the ACTH test along with a little more information about Patrick:

These are the results of Patrick's ACTH test:

Pre-ACTH Cortisol--8.9 (Ref. range 2-6)

Post ACTH Cortisol--27.1 (Ref. range 6-18)

(Equivocal post ACTH cortisol ref range is 18-22; Post ACTH cortisol consistent with hyperadrenocorticism is >22)


Patrick has an enlarged heart and had heart surgery when he was seven (balloon valvuloplasty). He takes 10mg of popranolol daily.
He also has 'kidney issues':somewhat low urine specific gravity (1.016) and slight protein in the urine.

He had his bloodwork done in November 2012 and January 2013 which led to the recommendation that he take the ACTH test.

The results of those tests showed high ALK Phos, High Potassium and Low NA/K ratio:

AlkPhos 207 (Nov.) 313 (Jan.) (Ref. range (10-150)

Potassium 6.6000 in Nov. 6.3000 in Jan. ( ref. range-4.0-5.6)

NA/K ratio 22 in November 23 in January (ref range 27-40)


So do you think the next step is an ultrasound or a low dose dexamethasone suppression test?
My vet recommended the ultrasound--
I'm not sure if I should see a IMS specialist.


I didn't think that Patrick had many symptoms, until I read up on Cushings.
He has a great appetite and has some rear back weakness---but he has always had a great appetite and he does have some arthritis.
He had a bad skin rash and yeast infection, but the hair is growing back nicely now.
He also has some possible neurological issue-he occasionally will shudder for a second or less.
The neurologist suggested an MRI, but I didn't want to put Patrick through it.

So now I am trying to figure out what to do and appreciate all of your thoughts--
Thank you
Mara from NY with Patrick

[frijole]

Mara, I would do an ultrasound over the low dose dex supp test. The LDDS is prone to false positives when other illnesses are present and with the heart and kidney issues I'd feel better if you did the ultrasound. It also can provide you with a good looksy at what is going on with other organs.

My Annie had shivers like you described and ends up she didn't have cushings - it was a very rare tumor on the adrenal glands called a pheochromocytoma. Only the ultrasound showed it. We never would have figured this out had I not gone to a specialist (K State Univ Vet Hospital) and used their high tech machines.

Others here have had tumors on spleens that presented as cushing's. So you see the ultrasound can help prevent a wrong diagnosis. Plus your vet can get a feel for the condition of the heart and kidneys.

Not sure the type of equipment your vet's office has but most refer to specialists that have better (high resolution) machines and people trained at reading the film.

If you tell us where you live perhaps we can recommend a specialist. No pressure though.

Kim

[labblab]

Hello and welcome from me, too!

And I want to say that I agree with Kim's recommendation re: the ultrasound as the best next step. ;)

Marianne

[mytil]

I too would agree about the ultrasound given the other conditions Patrick currently has.

Keep us posted
Terry

[Patrick's Mom]

Thank you all for the replies. I think our next step is to find a specialist and do the ultrasound and then maybe the low dose dex sup test.
I live in Rockland County New York--it is @ 30 miles north of New York City-near the NY/NJ border. I would appreciate any IMS recommendations. Patrick sees a cardiologist and gets echocardiagrams at the Oradell Animmal Hospital, so I will check and see if they have an advanced high resolution ultrasound.
I am so thankful for all of your information.
~Mara

[frijole]

Well you are close to one of the best in the world:

http://www.drmarkepeterson.com/

Google and you'll learn more about him.

Kim

[Patrick's Mom]

Yes- thanks-so much
I called his office and was told that they do not do ultrasounds there and the first consultation is @ $450.00--
so I think I should first get the ultrasound and a bit more information--

[milosmom]

hey kim,good answer for patricks'mom mara.i actually had an appt with him on dec 24th but unfortunately milo couldn't stick around for that appt.his sescretary is very nice and will do all she can to get you in for an appt.good luck we will all be watching anxiuosly...patty(milo)meka xoxox

[lulusmom]

I called his office and was told that they do not do ultrasounds there and the first consultation is @ $450.00--

$450? Wow! I have a great deal of respect for Dr. Peterson but honestly, that's absolutely ridiculous! I did a little research and there is a facility called Blue Pearl in NYC which has awesome reviews on Yelp. You just don't get those kind of ratings easily so a near perfect score is very impressive. A consult with an internal medicine specialist there is $170.50 and they have state of the art imaging so the ultrasound can be done there.

[frijole]

Good job Glynda! Yeah Dr P is great but holy cow.. and you can't even get the ultrasound done there. Kim

[Patrick's Mom]

Thank you-Blue Pearl does look very impressive and I will call them for more information. My only concern is that it can take a while to get into the city in traffic and after reading the posts and messages, I think I may be better off finding a vet who is closer. I know I am getting ahead of things, but I am a little nervous about treatments because Patrick has so many health issues and he has had bad reactions to other medications--He got violently ill after taking Enalapril and ended up in the ER --
I'm also going to call Oradell Animal Hospital (another animal specialty and emergency hospital )in NJ where Patrick goes to see a cardiologist.
They have three board certified internal medical specialists and it is closer than Blue Pearl.
I know to ask about high resolution imaging--Is there anything else I should ask about?
Thanks so much!
Meanwhile-Patrick seems perfectly fine--
Mara and Patrick

[Harley PoMMom]

They have three board certified internal medical specialists and it is closer than Blue Pearl.
I know to ask about high resolution imaging--Is there anything else I should ask about?
Thanks so much!
Meanwhile-Patrick seems perfectly fine--
Mara and Patrick

IMS' usually do have more knowledge and experience treating dog's with multiple health issues but I would still ask them how many dogs that they are treating for Cushing's and what their choice of treatment is and why.

I would, also, read up on the treatment protocols of Lysodren and Vetoryl and ask questions pertaining to that, such as their regime for the ACTH stim test and their dosage scale.

Here are links to info about Lysodren and Vetoryl: Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
) and Lysodren loading Instructions and related tips. (http://www.k9cushings.com/forum/showthread.php?t=181)

The best of luck to you both, please do keep us updated!

Love and hugs,
Lori

[frijole]

Just do a write up (as a cheat sheet :D) chronologically on everything that has happened. Testing/results, symptoms etc.

Be sure to mention anything that might be important. Copies of tests are helpful as well.

Having an executive summary will really help the specialist and save you time and money.

I looked at the Oradell website and it is huge! They should have the right equipment they have so many specialists under one roof. I'd google the 3 internal med specialists and pick a favorite if you can find one that has specialized in endocrinology. :D

Can't wait to hear how it goes. Kim

[Patrick's Mom]

Thank you so much--
I'm definitely going to see and IMS and have the ultrasound/LDDS test as well if recommended--and discuss Patrick with the vet--
But I have another question and I'd like your opinions:

Is it always necessary to treat Cushings based on test results--or do I treat him based on how he appears?

Some people have told me that untreated Cushings is dangerous and others have told me that the medications are dangerous--especially because he has heart and kidney issues--so naturally I am scared about making the right decision.

The regular vet said we can wait a bit--but I'n not sure about this--

I don't think I'm being unrealistic--but
Patrick really seems fine--his skin condition has cleared up and based on what I read, I do not think it was related to the Cushings--
He does not drink a lot, does not have accicents--he is actually on a very good potty schedule and goes out 3-4 times a day
His only 'symptoms' are that he likes to eat--but again it idoes not seem out of the ordinary as he always loved to eat--he now eats twice a day @ 1-1/4 cup of food total daily

Sorry for asking so much--but I'd really like your thoughts-
Mara and Patrick

[frijole]

Mara, Your questions are good ones. A specialist truly is required because of the other complications - as I think i mentioned earlier I am not sure your babe has cushing's. I would have them do the ultrasound first because if they find something else you would save the money by skipping the ldds test. The ultrasound I'd do either way so that's why I'd do them in that order.

If it is cushing's the experts in the field say don't treat until the symptoms are there. I would certainly rely on the specialist for thoughts on how the meds might affect the other issues. Hope this helps. Kim

[Patrick's Mom]

Thanks so much--next step is the IMS---and then I am sure I will have lots more questions--
Thanks again~
Mara

[Patrick's Mom]

Thank you so much for all of your advice and suggestions.
Patrick saw an Internal Medical Specialist last week. She is supposedly a Cushings/Addisons 'expert.' (I found a number of articles that she has written.)
Patrick had an ultrasound and more blood tests.
The ultrasound indicated some kidney and liver problems--his adrenals were normal. He also has hypertension.
So for now the IMS suggests that we treat these other problems, and hold off on any Cushings treatments for now--
He still remains pretty symptom free--(even his skin has cleared up and the fur has grown back.)
Thanks again for all of the advice and suggestions-
Mara and Patrick 11.5 year old Westie from NY

[milosmom]

hi mara looks like your litl lad patrick is keeping you busy...will keep watching your story to see how things are going.all the best !!! patty(milo)meka xoxox

[molly muffin]

Oh yay, so glad you found a specialist in cushings to take a look at Patrick! What a great find. You're doing awesome. great that you are treating other things that might be going on first. Always a good idea to eliminate other potential problems!
Sharlene and Molly Muffin

[Patrick's Mom]

~Thank you-- I will keep you posted--
Mara and Patrick 11.5 year old Westie from NY

[milosmom]

just checking in mara...good night to you and patrick ...patty(milo)meka xoxox

[Simba's Mom]

Sending hugs your way!