9 yr. Doxie just diagnosed with Cushing's Disease

[mbloss20]

Hi all! I'm so happy to find this group. I have a 9 yr old male dachshund named Oscar. He had a Low-Dex test last Friday, and we just got the results that he does have Cushing's Disease. Now I have to figure out what to do.

First, a little of his history. Oscar started having seizures when he was about 3 1/2 yrs old. The vet checked him out and said to keep a journal, but if they rarely occurred, not to worry. Over the course of the next year, the seizures came more frequently. After he had a bout of 4 seizures back to back one day, I sought a different vet for treatment who I was told had a lot of knowledge in this area of animal medicine. The vet determined to treat Oscar with phenobarbital. Of course, I went home and did my research. I decided that this was not a drug I wanted my dog on long-term, and asked for more tests to be sure. It turned out that his thyroid levels were very low. I also learned a lot about how very bad dog food is. Since he started the thryoid meds and we changed to a much better, high-quality dog food, he has had 2 seizures in about 4 years.

Fast forward to the past couple of months. Oscar has always been a little chunky. I moved to Los Angeles in October, and have a new vet that I like. We decided to put more effort into his weight loss and cut back his food intake and increased his exercise. However, I noticed that he was gaining quite a bit of excess belly fat. After 2 months of this strict regime, he gained yet another pound. I also noticed he was having hind leg weakness, the pot-bellied appearance, and just seemed to look at me like he was trying to tell me he didn't feel good, oh, and he has a voracious appetite. Otherwise, he didn't have the other more tell-tell symptoms. He actually does not drink a lot of water, and no frequent urination. But, I just knew there was something going on. My vet did a Low-Dex test last Friday, and today (Tuesday) we got the results that he did test positive for Cushing's Disease. I will get his charts next trip to the vet so I can give you all the numbers.

Next step?? My vet recommends that we do the ultrasound, so we can determine if it's adrenal or pituitary. From there, we decide on treatment. I am so incredibly worried, because I kind of live paycheck to paycheck. It seems that trilostane is the preferred treatment, based on other people's advice from Facebook pages and here, but can be expensive with the medicine and continued testing. Of course, I will find a way to make it work....but I want to be sure that I'm making the best choice for my dog. I don't want to pursue a treatment that will destroy his organs or ruin his quality of life. Of course, most of you have very positive things to say about the treatments, and that makes me feel so much better. Honestly, if it's adrenal and surgery is an option, I think that's the choice I would make. Otherwise, we choose a medicinal form of treatment.

It's very early in our journey, and I'm reading through the different posts for encouragement and advice. As we progress, I will keep you all posted. At 9 yrs old, I still feel like my little boy has so much life left to live and want to give him the best chance for that!

Thank you!!

Michelle & Oscar

[addy]

Hi,

Welcome and I am so glad you found us. Sounds like quite a few things are going on with your doxie.

Are you still giving his thyroid medication? When you can, please post the results of his low dose dex test. Has any blood work been done, like a super chem panel? I'm glad to hear you will be having an ultra sound done because no one test is perfect to diagnosis Cushings. You can get false positives as well as negatives. It is a very hard disease to diagnose and a big part of getting a diagnosis goes to history and symptoms.

Cushings is seldom if ever an emergency to start treatment. We waited a year to start my pup.

It can get to be expensive when you first start treatment. Not all dogs are controlled right away and there can be some back and forth with dosing and more ACTH tests.

Let us know the results of the ultra sound and please try to post the low dose dex test results as well.

[mbloss20]

Thanks for the welcome! And yes, my sweet boy has had a time with medical things!

He is on the thyroid meds. .01mg twice a day. It's the same dose he's been on since he started it. We test him every year to be sure the dosage is correct. In fact, my first intro to my new vet was to test him in October before we could refill his prescription. All looked well on that front.

In January, I knew his teeth were in bad shape (though his previous cleaning was in September 2011). They ran a full blood panel prior to the cleaning. He had high levels of something regarding his liver (I don't have my notes on me...but will get all of this in later). The vet suggested Denamarin, but upon another person's recommendation asked if I could try Milk Thistle. She said that was fine, and we could re-test to see if that helped. Also, having his teeth cleaned and the bacteria out of his mouth would help (he lost 8 teeth!). When we went for the pre-op blood tests, we weighed Oscar and learned he'd gained more weight. I decided that after he healed from the dental cleaning/surgery I would have him tested for the Cushing's.

A mother knows best, right? The vet said I was right to have him tested since I felt something wasn't right, although he wasn't displaying the more common symptoms. This is where it gets tricky. She called me a couple hours ago with the news. She said she has never see a test that doesn't show any signs of which one it could be (pituitary or adrenal). She says it is completely inconclusive as to which one it is, but the levels do clearly indicate Cushings. This is another reason why I will do the ultrasound before rushing to treatment.

She also did suggest that I could take some time before starting treatment. She said that Cushing's itself is not deadly, but it could lead to other infections or high platelet levels that could be fatal. If this is something that is treatable and will improve his quality of life without being fatal, then I am all for it! I will actually give them a call to see if they can email or fax the results to me in the next day or two. I'm still in that "processing" mode, but tend to be a pro-active person, so I want to learn as much as I can and be informed as I can to start considering my options.

Thanks you so much!

Michelle

[molly muffin]

Hello Michelle and Oscar and welcome.
You are certainly on the right track, in that knowledge is the best thing you can have to be an advocate for Oscar and make informed decisions.
Your vet is right. Cushings is not a rush to treatment disease and is largely based upon symptoms and how he is doing over all.
So, depending on what type he has, will of course determine treatment. If you end up deciding to go with Trilostane (vetroyl), then you can get it in a compounded form if you choose not to use the brand name. Just make sure you go with a well regarded compounding pharmacy, but that might keep the cost down. Also is your vet would freeze the medicine for the ACTH test that would help keep cost down too. (all things to check into)
Again, welcome to the forum, you can also check out our resource section and do some background reading there.
http://www.k9cushings.com/forum/forumdisplay.php?f=10
Sharlene and Molly Muffin

[mbloss20]

Thank you for the advice! I've just called my vet's office to request the results of his test be faxed to me. I have to wait for the vet to call me back (which I think is weird, b/c usually the employees will send any records you request). However, I should have his results to post sometime today.

I will also definitely ask about the compounding treatments and all that you suggest. And freezing the test medicine. I am going to compile a list of all the things I'd like to ask and talk to her about when we go see her next. It's easy to forget half of what you want to know when you're in the moment and dealing with a dog that now hates going to the vet to get poked and prodded! Most importantly, based on what many have posted, is to be sure that she has experience and knowledge about treating Cushings. She seems really great, and I'm sure she will, but it is only fair to Oscar to be sure he is getting the best treatment possible.

I think I'd like to proceed with the ultrasound next month. Mainly because I hope to have my tax refunds by then, and as soon as I get the ultrasound results I just know that I will want to start pursuing treatment. So, I want to learn as much as I can before we start this journey.

Thank you all so much!!!!

Michelle

[mbloss20]

Oscar's Results from Low-Dex Test:
(as copied from form vet sent)


DEXAMETHASONE SUPPRESSION

PRE DEXAMETHASONE: 5.9 1.0-6.0 ug/dL

POST 4 HR DEX: 16.2 ug/dL

POST 8 HR DEX: 14.5 ug/dL

Low-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hours 8 hours Interpretation 1

<1 <1 Normal
1.0-1.5 Inconclusive

>1.5 and >50% >1.5 and >50% Consistent with hyperadrenocorticism
of baseline of baseline Further testing required to
differentiate adrenal tumor from
pituitary-dependent
hyperadrenooorticism (PDH)

<1 .5 or <50% .5 and >50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)

<15 or >1.5 and <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)

.5 or >50% .5 and <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDi-i)


High-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hour 8 hour Interpretation

<1 .5 or <50% >1.5 and >50% Consistent with pituitary-dependent
of baseiine of baseline hyperadrenocolticism (PDH)

>1.5 and >50% <1.5 or <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (FDH)

<1.5 Or <50% <1.5 Or <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism

>1.5 and >50% >1.5 and >50% Further testing required to differentiate PDI-l from adrenal tumor.

Hyperadrenocorticzism is a clinical disorder with clinical signs. If
the animal has no clinical signs, we do not recommend treatment.
Approximately 5% of dogs with hyperadrenooorticism will have normal low dose dexamethasone suppression results. Conversely, some animals with significant nonadrenal disease may fail to adequately suppress on this test.

[mbloss20]

Also, the vet did say his platelet levels looked good, and his cholesterol is in normal range (in Jan. blood test). He only has the high liver enzyme levels. After reading/research, is it also possible that he could have another illness other than Cushings? He does seems to be hungry all the time (but has always enjoyed food), has the potbelly with excess fat hanging (this has come about in last 6 months), and seems to have some hind-leg muscle weakness (or it could just be he wants me to carry him up the stairs b/c he's spoiled :) I just want to be sure there aren't any other things to consider, should the abdominal ultrasound not show anything for adrenal Cushings. Before we just start treating, I want to be sure there aren't other tests we should run. I guess we could do a MRI or CT scan of brain - do they do that to be sure it's the pituitary Cushings, or just base it on LDDS test results and start treating? What do you all think?

Thanks!

Michelle

[molly muffin]

Well an LDDS could be positive if something else is going on. Since liver is the only thing elevated, and the thyroid appears to be controlled with medicine, if you've ruled out diabetes and kidney, then you could have the ACTH test, which also tests for cushings, but could also have a false positive. There is the U of T test for checking other hormones, and is the only thing that can diagnose Atypical cushings, which is where the cortisol is at a normal level but the other hormones are elevated.
Otherwise, it's a matter of waiting to see what the ultrasound would show. If any other liver values than ALT and ALP are risen, then you could do a bile test for liver. Those are just ideas and there are some others on here that are much more knowledgeable than myself on these matters. (years of experience will do that)
So I'm just throwing ideas out of possibilities. However, the LDDS does show no suppression, but then again, no one test can ever really diagnose cushings.
I wouldn't get an MRI or CT which are both very, very expensive, until or unless needed after an ultrasound. Usually you do that when you are suspicious of a macrotumor of the pituitary gland and you'd be seeing probable neurological signs if that was the case.

Sharlene and Molly Muffin

[mbloss20]

As far as I know, he hasn't had any kidney or liver tests performed, only what's been seen on his blood tests. Is this something I should ask the vet to do, just to rule those out?

Thanks!

Michelle

[molly muffin]

Well with kidney has he had any sort of urinalysis done? What about the UC:CR urine test for cushings? Had he been checked for a UTI? What about protein in the urine that sort of thing? You'd probably see that if they faxed you all his recent tests results.
In fact, that is what I would suggest first off, before deciding what to do next, is rounding up all test results. You're going to want to keep your own folder of test results anyhow. It comes in handy at the most unexpected of times and you can then easily refer back to it when you want to compare something. (whatever you do going forward, you will be looking at comparisons :) ) take my word for that one. :)
Also, a journal of anything you notice can help you. Some like to be able to refer to it when speaking with their vets. Notes of what you want to ask, answers given, that sort of thing can all be included in it.
This thread which is all yours is another great way to keep track of things.

So, lets see, tests results first for everything, post the results here showing any abnormal tests, unit of measure (ug or nmol) and normal range. That is a start, then we'll see what has been done and what can still be done, test wise and you'll be able to make some informed decisions on what you want to do.

Hang in there This is a long journey. :)
hugs,
Sharlene and Molly Muffin

[mbloss20]

I am certain that they have not done any form of urinalysis on Oscar. The only tests they've performed on him was a blood panel in October to ensure he was still on the right dosage of thyroid med, a blood panel in January to be sure he was okay to go under for dental cleaning, then the LDDS test last Friday to test for Cushings. Do you recommend a urine analysis before the ultrasound?? I feel really sure about wanting the ultrasound because his abdomen is rather large and I also kind of want to be sure there's nothing else going on in there...

Thanks!!

Michelle

[Harley PoMMom]

I would definitely want an urine analysis done. If a dog has an UTI or stones, which both can be painful, all tests for Cushing's can be skewed.

If this were me, I would have an urine analysis done first.

Love and hugs,
Lori

[mbloss20]

He doesn't seem to be in any sort of pain....but this is something I will definitely speak with my vet about and get it taken care of. Thanks for the advice!!!

[mbloss20]

So, I think I've decided to move forward with doing an ultrasound. In the past couple weeks, Oscar's almost doubled his water intake, and seems like he definitely has to go potty much more frequently. The part of his rear abdomen that hangs really low seems to be more "full" looking. I'm freaking out that it's not fat that's hanging, but something much worse going on in there. They have a specialist that comes in on certain days for the ultrasound, and I will have to leave him all day. Because these vet visits stress him out so bad, I figured I might try to do all the tests at one time that you've recommended. I thought I'd do the ultrasound, then look into the urinalysis and workup of his kidney and livers to see how those are doing. Anyway, I'll keep you posted. I spend my days working and my nights cuddling my buddy and giving him all the love I can. He just looks at me like I'm crazy half the time. Haha. So, hope to have this all done in the next couple of weeks and will post results.

Thanks for being here!

Michelle & Oscar

[molly muffin]

I think going with the ultrasound is a good call. It's definitely another step on the path of trying to figure things out. Definitely get that urinalysis with a "culture". If the urine is dilute at all, only a culture will show if there is a UTI. Molly never showed pain from the UTI's she's had, but they were there unfortunately and now I know that at the least thing off to get her in and get her checked for one. She's prone to them with the crystal issues.

You're doing great. :) I can think of worse ways to spend a night than cuddling with my best friend. :)

hugs,
Sharlene and Molly Muffin