Punkie is testing for Cushings :0(

[Stac&Punks Maui]

Aloha,

My Punkers is in the middle of the low-dose Dexamethasone test. He has been drinking a lot over the last two years. In the past 6 months he has gained a pot belly, hungry, hair thinning, snorts, lazy, doesn't want to play with is daughter Cookie anymore :0( I have mentioned the obsessive water drinking to my vet over the past couple of years.... They weren't concerned.

He had his dental done last July of 2012. I asked for a blood test for a bill of health and he was cleared. Just recently gathered his records and that blood test had been handled wrong and all results were "chemically" wrong. This made me sad because I wanted to compare his blood work. Also, I lost faith in my Vet...

Recent blood test came back normal within all proper ranges. Alk Phosphatase 77 (5-131)

Urinalysis showed high PH 7.5 (5.5-7.0)
Proteins 2+
Blood 2+
Ca Oxalate Dihydrate 11-20
Microalbumin >30 (<2.5mg/dL)

Due to signs doc decided to check Cushings...results will be in Wednesday. I'm very up on the details of the disease and have done my research. My issue is finding a Vet in Maui that specialized in treating a Cushing dog :0(

I have calls into other Vets and an appointment with a Vet who is treating her own dog with the disease...

I guess I could be looking at an inflamed glomerular of Kidneys is no Cushings...

My poor lil guy.

Stacey & Punkers

[labblab]

Hi Stacey,

Welcome to you and Punkers, although I am sorry for the reasons that have brought you to us. I have only a moment to post right now, but I do believe you would want to perform further kidney diagnostics prior to launching into Cushing's treatment regardless of the results on the LDDS. The fact that Punkers' urinalysis revealed loss of protein, blood, and elevated microalbumin are all "red flags" that need further exploration (as you may already realize from what you've written). For instance, some of the urinalysis results reflect only "dipstick" measurement which can be skewed significantly by several factors. If I were you, I'd want more specific and sensitive microscopic analysis of Punkie's urine.

The LDDS can give a "false positive" for Cushing's when other underlying illnesses are at play. Plus, it is somewhat surprising that Punkie's Alk Phos is normal -- we typically see elevation in Cushpups. It is true that Cushing's can affect the kidneys, so this is not to say that Punkie does not have the disease. But before starting medical treatment for Cushing's, I would want to have more extensive evaluation of Punkie's kidney function in order to better assess the extent and most likely cause of any damage. For instance, one of the medicines used to treat Cushing's (trilostane) is contraindicated for dogs who have significant renal impairment.

Marianne

[Harley PoMMom]

Hi Stacey,

Welcome to you and Punkie from me as well! So sorry for the circumstances that brought you to us but so glad you found your way here.

The finding of calcium oxalate dihydrate in Punkie's urine is a great concern to me. Bladder/kidney stones will cause a dog to drink and/or urinate more and can sometimes be very painful. Has your vet mentioned having a x-ray or an ultrasound done to see the stones?

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

Love and hugs,
Lori

[NoonelovesmelikeNorman]

Hello Stacey, Just stopping in to welcome you and Punkie. Wising you the best with his recent testing. You have found a great site, with very informed, compassionate, experienced cushings moms and dads.

Peace, Sharon - Norman (Cushings Doxie) and Millie(mini, yorkie-pooh)

[Stac&Punks Maui]

Aloha,

Thank you for all of your detailed information. I am currently in the middle of a Vet search. I have 3 consultations this week to hopefully make the right decision. I'm happy to hear about other tests that anyone recommends. I'm working on collecting three samples of Punkie's urine to have it tested for the more detailed analysis due to the concerning protein...etc. The insight you all provide helps me feel one step ahead of my current Vets recommendations. I agree waiting on any treatment for Cushings prior to discovering all issues. That makes since to me :0)

We don't have many options on the island and hope I can find a Vet that offers a more wholistic approach...

What can be done for stones? Is this treatable? I don't know much about that. Would the PC Ratio help aid in the diagnosis? Is that a Kidney disease issue?

Thank you, Stac & Punkers

[NoonelovesmelikeNorman]

Bring along a list of questions...ask about the cost of ACTH testing, if they will freeze the vial so they can get several doses out of one vial...ACTH testing is quite costly. Also, would they be will to write a script for Punkies meds froma compounding company...Others can help with other questions...you will also get a feel of how compassionate they appear to be...Good Luck....You're a great mom! Punkie is so lucky to have you.

Peace, Sharon

[Harley PoMMom]

Dogs that are prone to calcium oxalate stones are usually given potassium citrate. Also it is very important that the dog is hydrated so, usually, a dry dog-food only diet is not recommended, canned food contains water which is good for dogs that are prone to kidney stones.

There is no diet that I know of that will dissolve calcium oxalate stones, they are mostly removed via surgery.

In light of Punkie's issues on his urinalysis an UPC ratio should not be done, as sediment and/or stones can cause false positive results. If this were me, I would urge the vet to do a x-ray to see the stones.

[molly muffin]

Aloha :) Welcome Stacey and Punkers. How freakin cute is that name!

Do you have a vet ER on the island? If so they should have an IMS specialist (Internal Medicine, small animal) that might be worthy of going to.
You want to ask, have you treated cushings, what kind of results have you seen with treatment, what treatment do you use. Then ask about the kidney disease, you want a vet who knows it all. One reason I suggest an IMS if possible.
I agree, the protein of 2+ and other factors would make me really go to town on that kidney issue.
I would be worried about the cushing test results right now, if stones are present, since that really can skewer the results.
You're a few steps ahead of the game already. Our motto is always that knowledge is power and you are the voice for Punkers. You're way ahead on that already.

Welcome again

Sharlene and Molly Muffin

[Stac&Punks Maui]

Aloha,

Punkers is eating Honest Kitchen-force. Dehydrated food with all natural ingredients that I add water to. Along with green bean as a treat and recently started adding bits of raw chicken..

X-ray seems like the way to go. So it seems like if there are stones it could throw any test. Good to know!

I have an appointment on Friday march 15th with an ER Dr. Unfortunately there are not any IMS on the island of Maui :0( For a small fortune of $250 I can fly to Oahu to see an IMS with a referral from my future Vet.... I have made contact with her office and have her information if I have to travel that path.

I also have an appointment with a Vet that receives aid from an IMS, not sure if that's the same as seeing and IMS. I called the licensing school and there are only like 144 in the US and two reside on the islands....

Thanks for helping with a list of questions :0))

So far when I have asked Vets on island their experience with Cushing patients... It's one or two, or they don't have follow up them, or one experienced Vet who is selling her practice & leaving mid April .... Ugg :0(

I'm not going to ever give up searching. I'll do whatever I have to for Punkers.

Stacey
16lbs, 9yrs
Dachshund

[molly muffin]

Oh that is really crummy that the experienced vet is leaving. :( Did she by any chance have a recommendation for which vet she might think would be good for treaing cushings? Maybe there is a vet she has worked with or knows of that she thinks would be good, very diligent sort. If you have to go with only semi experienced, go with one who is willing to work with you and to learn and not afraid to pick up the phone and call anyone they need to in search of the correct answers. If you can't have one thing, then search for the next best thing.

I suppose bribery to stay on Maui wouldn't work either:D

Sharlene and Molly Muffin

[Squirt's Mom]

Hi and a belated welcome to you and Punkie! :)

I returned to my home state in 2010 and started interviewing vets to take over Squirt's care. I think I talked to every vet in town and was not satisfied with any of them, even tho several of them claimed to have experience treating Cushing's. They all said things while talking that let me know they were more the type of doc that has to have total control and not the type to work as a team. Several told me straight up they would change her treatment immediately - a treatment plan that was working beautifully for her but they either didn't believe in that approach or thought another drug was better. I ended up choosing a vet who point blank told me he knew next to nothing about Cushing's and had never treated it. Why choose such a vet over those who said they had experience? Because there was none of the arrogance or narrow-mindedness I felt from the others; because he was honest; because he listened; because he was willing to learn. Doc B has been treating all my babies ever since and has done good by them. Squirt scares him to pieces at times :D but it is out of concern that he will make a mistake, causing her to lose ground, ground he is simply amazed she is standing on at the ripe old age of 15. ;) Doc has now diagnosed several cases of Cushing's as well as Addison's and his confidence with these polar opposite conditions has grown.

There were times in the beginning that I had the clear image of Squirt and I dragging Doc kicking and screaming into the cush world but I am very glad I chose him. He has never hesitated to tell me he doesn't know but will find out; he has put us in touch with a great IMS he works well with and they consult when Doc has questions; he treats me with respect; and he loves my babies, the whole staff does. So in spite of his inexperience 3 years ago, he has done very well by my cush baby, as well as the others who all have their own health issues.

So talk to the vets, listen with your Heart for one who will work with you and listen to you. Finding a vet who will let you be part of the team and who is willing to learn is very important and from that point, much can be built. ;)

Hugs,
Leslie and the gang

[Stac&Punks Maui]

Low-dose Dexamethazone test results

1st drawl: 2.5
2nd drawl: 1.7
3rd drawl: 2.1

He wants to do a UTI test.
Wants to then treat Cushings with Trialstane (spelling). He thinks he is PDH... But was said its not technically confirmed.

I would like to wait and do more tests to rule out the Kidney disease first. What's the best first step after these results? Should it be the X-ray to check stones? My brain is racing, I need some steps help please.

Thanks, stacey

[Stac&Punks Maui]

Leslie, what a great post you wrote to me. I really appreciate you sharing your journey to find a Vet. It means a lot. You gave me some new in site and that's all I want, someone to work with me as a team. I've been spoken to very fast with a lot of information thrown at me by my current Vet. He is pointing me in one direction. I'm seeing that there are options by the research I have done.

If I hadn't done research,... We would be starting Cushing treatment based on the one low-dose Dex test and and high protein urine analysis and a perfect blood test.

The more questions regarding further tests to confirm and check other organs before starting the meds for Cushings, the more I see my Vet admitting that there is more to discover. I want to know about that... Not just be handed drugs and sent out the door 15minutes later :0(

Stacey

[Stac&Punks Maui]

March 13, 2013
I requested an X-ray: No Kidney stones, no bladder stones, larger liver than normal, normal looking kidneys, breakfast in belly, poop in intestines, spine looks good!, 1 degenerating rear hip (Ouch!... no wonder he skips) :0)

Current Doc ordered: Steril Urine taken for PCR (my request) and culture (UTI test-doc request).

He said blood in urine could be from bladder infection and hopes to see UTI to show where protein is coming from.

An Ultra Sound tech comes from the Big Island every three months, she just happens to be arriving next week! $400 for an Ultra Sound!?! Doc says we can get a good look at his Adrenals for both to be swollen or just one. I don't know which one I would rather see.... uggg!

I have to say, after all the doubts and concerns with my current Vet... I think I lit a fire under him. I had a really good meeting with him yesterday. He spent more time speaking with me Vs. rushing me out the door. He said he appreciates that he can speak to me knowing I understand more than most. I know people make mistakes....At least now I have learned to pay closer attention. I think maybe they get used to people not knowing anything and making all their decisions for them. Or maybe just get used to people going along with everything they decide. I want to be apart of the decisions and have my options presented to me. I think my Vet see's that now :0) I told him I just want us to be a team for Punkie's best interest.....

So, I am still going to visit the next two vets to REALLY make sure this IS the right fit before any treatment.

Second opinion Vet suggests: Look deep into the Thyroid, due to Low end T4 (1.0 Ref range 0.8-3.5), wants to make nutrition plan to gear up for monitoring food intake, start measuring water intake, ultra sound ($140-in house and WAY cheaper than current vet, although old equiptment and it would be a floppy disk-he thinks)...hmmm. Also, he wants to do a ACTH Stim, he thinks this is a better teast(although he seemed iffy on the test making it to Irvine, CA in a needed frozen state). Great guy, and he said I could call or email him every day, or use him as a second vet for second opinions (his vet office is being sold and he isn't sure of his future employment).

Today is the second, second opinion vet. This I hear is a great Vet.

The least I can do is shop around for an Ultra Sound! $400????? Yikes!

All of these vets so far offer 24 hours emergency on call services.....is this the same as ER?

Stacey-Punkers

[molly muffin]

Hi Stacey, no on call service isn't the same as a Vet Er Hospital. An ER is just like a people ER, it is staffed with a vet and staff, 24 hours a day, so that in case of emergency you can go right in and someone can see your pet.
If an ER isn't available on the island in your area then a 24 hour on call is better than nothing. Usually that means you can contact them and get someone to meet you at the vet office right away.
The $140, sound better than the $400, but often with the older equipment you don't get a clear view of the adrenal glands and other organs that you need to see, compared to the Hi Res equipment. ACTH test have to be sent to California lab? Yikes. Nothing on Oahu even? You absolutely have to use ACTH to monitor when treating cushings with either vetroyl or lysodren.
It does sound you lit up your vet. Glad he is talking to you now. You might have to train him though. :)
When do the UTI results and urinalysis results come in?

hugs,
Sharlene and Molly Muffin

[Simba's Mom]

Welcome to you and Punkie, is she a Doxie? Maybe I got it wrong, but if she is, that's way cool, I have a Doxie too. I know right now you are feeling very overwhelmed, but just remember we are here for you!

[Stac&Punks Maui]

Punkie had an ultra sound on March 22, 2013 and was found to have his left Adrenal to be swollen. His right adrenal is shrinking and very small.

What are the next tests to find out if he is a candidate for an adrenalectomy? I spent a lot of time understanding PDH because I heard that ADH was rare. I don't know the next step....

Or is it better to just treat with Lysodren? Has anyone treated with Trilastan instead?

Thanks, Stacey

[molly muffin]

I'm hoping Trish sees this and stops in, she just went through an adrenalectomy with her baby, Flynn. You can read her thread here: http://www.k9cushings.com/forum/showthread.php?t=4242

ADH is rare compared to the PDH, but we see it all on here. :)

check out Trish's thread and it will give you a lot more information.

hugs,
Sharlene and Molly Muffin

[Trish]

Hi Stacey
I think you need to get Punkie to a specialist, I know that is hard where you live. But if adrenalectomy is to be the answer you need someone who is very experienced in this type of surgery as it can be tricky.

My boy had an adrenalectomy 3 1/2 months ago now, his was not an adrenocortical tumour though so he did not have the obvious cushings symptoms. His tumour was a pheochromocytoma, arising from the medulla of the adrenal gland and his did not interfere with cortisol production (some do though). But the more common type of adrenal tumour does so they can be treated with cushings meds if surgery is not an option. Flynn's tumour really affected his BP, it was very high so he did need medication for that. Get them to check his BP if they haven't already.

We first saw an IMS after the ultrasound, she got his BP under control and referred us to a surgeon who wanted a CT scan to clearly see the tumour. To decide if it was operable they also looked to see if there was any visible spread of the tumour including to his lungs - they did this during the same CT.

I think it is important to remember that with a diagnosis of adrenal tumour you can potentially get a complete cure with surgery from cushing symptoms. The surgery is risky though, so you need to work with your specialist to decide if this is the best option for your Punkie.

I hope you can find a specialist soon to help you, very happy to answer any other questions.

Trish :)

[Stac&Punks Maui]

Aloha Trish,

I practically read your whole story. I felt like I was watching your whole experience. I felt like we had some differences, you made them clear. Thank you. Punkie has normal to lower blood pressure. I figured from reading your post that the CT was most likely the next step. My main problem is we don't have an IMS on Maui. We do have two on the next island of Oahu. I am trying to decide if I should fly to the mainland to CA or try Oahu. I am looking into the options on island before considering the long trip to CA. I am going to look into UC Davis, there is a hospital that is located in San Diego that is apart of US Davis. My mom lives in San Diego. This would be a good option.

Only downside is it takes 3 months to prep Punkie to legally fly Punkie to and from the mainland. I think I am going to ask the Vet to start that process.

Could you imagine flying 5.5 hours after your pups surgery? What do you think is a reasonable timeframe to do so? Based on your surgery experience. I do have a GREAT ER Vet on the island.....

Thank you for sharing your story, it gives me hope. This has been very stressful and a sad time for me :(