Cushings...maybe

[nisamoht]

Hello,
My Golden Retriever, Cosmo is 13. Our vet thinks that he probably has cushings. Cosmo has always been a dog of two modes. Rambunctious puppy or asleep. He loves to swim and will do so for hours until he is exhausted. Now Cosmo has gotten older and is slowing down but still shows plenty of energy on walks etc. etc.
About 2 years ago we moved after 10 years in the same house. Cosmo found this very stressful and lost a lot of his coat. He looked quite blotchy, like a nasty old carpet, his skin got very dry and fragile and panted like crazy for about a month. We moved in the city but still have a place in the country. When we were in the country the panting stopped and returned when we came back to the city.
When we took him to the vet he said Hypothyroid (Cosmo has had a slightly under active thyroid since puppyhood). He ran some tests said he felt the thyroxin level was low enough to warrant meds and put him on appropriate levels of thyroxin. There was no outward change in the dogs behavior or appearance. But now his thyroxin levels test in the "normal" range.
A couple years go by panting stopped after he settled into the new place but coat never got any better and he developed a tiny pot belly,(he is not overweight), also he has lost some of the muscle in his hips. He can no longer jump into the back of the SUV but he has no issue with stairs or hills or running in the woods. But still his coat is not pretty he has some patches that are very thin.
A few weeks ago he developed a nail bed tumor on a back toe he had damaged years ago. When we took him to the vet they they took one look at him and said they thought he had cushings and wanted to run a LDDS test. We said ok. The test came back from IDEXX;
cortisol (0hr)94 (normal range 15-120 pmol/L)
cortisol (4hr Dex) 28 (normal range 0-10 pmol/L)
cortisol (8hr Dex) 32 (normal range 0-10 pmol/L)
Free T4 32 (normal range 7.7-47.6 pmol/L)
So we had his toe amputated, the tumor was large, and the Vet says that he thinks Cosmo's tumor developed because he had reduced immune function because he is on the edge of cushings and that we should have him tested every 4 months or so because the levels (40 seems to be the magic number for diagnosis) are so close he probably has it.
I'm a sceptic. Cosmo's blood tests are all excellent. Aside from the skin & coat issues (which have improved slightly since we started giving him omega oils and goat yogurt and squash) and a tiny pot belly he has none of the other symptoms. No excessive drinking, no excessive peeing. His hips are a little weaker than when he was young but he is 13.
I am reluctant to put him through regular tests. He hates being at the vet all day. He suffers a bit from separation anxiety. I work from home and for the last 13 years we've been together pretty much 24/7. I'll just say he's very well bonded.
Although I like my vet sometimes I think he's maybe a little too enthusiastic.
Cosmo is 13 so I won't put him through any major surgery but I would like to keep him happy and active as long as I can.
I'm thinking of trying Cushex or maybe some other liver cleanser.I'd like to try to keep things in check with a natural diet rather than be too quick to medicate. He is certainly enjoying the natural food diet.
Any suggestions or opinions?

[Dodie]

I am quite new to this also, but the members here are always more than happy to assist in any way they can. I know how you feel, my Shih Tzu Molly has been diagnosed, then treated for 9 days, then stopped now maybe not Cushings. Somebody will answer you about the Cushex. I remember reading something about that and I'm not sure if it was a good product or not. Many good wshes to you both!

[nisamoht]

Thanks Dodie,
Cosmo's liver enzyme levels, ALT ALP are all well within the normal range and I wonder if the tumor on his toe and his high stress level from being at the vet's all day, not to mention missing breakfast, could have raised his costisol levels. I hope someone has an answer.

[molly muffin]

Hello and welcome to the forum.

So if I understand this, the only abnormal blood test is the ALKP which is high? I need to figure out a way to convert the pmol to ug, which is what we are more use to seeing on here.

The only symptoms seems to be coat and panting, both of which showed up during a stressful time (during a move) and then the panting went away. Muscle weakness in the back legs.

So I can see why excessive testing would be stressful to Cosmo and could actually contribute to his symptoms. You aren't actually looking to treat him with either of the traditional medicines for cushings, which are vetoryl or lysodren? The only way forward, at this point would be with further testing to actually try and get an accurate cushings disagnosis. This would be ultrasound, ACTH and or LDDS.

As far as cushex goes, that isn't one that we can recommend. I believe this is one of the ones that we've had our administrators in touch with the manufactures of to ask for testing to support their claims on the websites and they did respond but to tell us that there was no backup testing, so we don't recommend either it or sugarplan which I think is now marketed under a different name.

However, there are some supplements that one of our members is trying along with vetoryl. Her thread is located here: http://www.k9cushings.com/forum/showpost.php?p=94435&postcount=227

You could also try talking with a canine nutritionist and working out diet for Cosmos that might help. One of our members is trying this method and so far having some good results.

I know when you have an older dog is hard to know what you want to do as far as pursuing testing and medicating. If Cosmos has arthritis in his rear legs then a higher cortisol could actually be beneficial to him.

This is sort of get you started and a welcome post too. :) Some of the others will be along soon to comment and welcome you too.

:)
Sharlene and Molly Muffin

[nisamoht]

Thanks for you response. Cosmo had a LDDS test and And it came back high but not positive (listed in original post). His ALKP levels are normal 62 U/L (normal range 23-212). My vet just seems convinced that we should give another LDDS test every 4 months until it comes back positive. The vet says that Cosmo does not have any arthritis symptoms. I agree. The back of our SUV is high and he is 13. He still runs and frollicks outside like a puppy.

[molly muffin]

At this point, I don't think that cushings is something you need to look into treating. You can retest of course when and if you start to see some symptoms that you would like addressed. Without the symptoms and based on these test results then it's just not there for you yet. Which is a good thing! :)

You could just consider giving him a liver supplement that you can get from the vet. In the USA I think it is Denamarin and in Canada it is Hepato Support, which is what I give my dog.

Cosmos is beautiful btw. Is he a white golden? My golden was very blonde, but he looks almost pure white.

Sharlene and Molly Muffn

[nisamoht]

Thanks for that. You're confirming what I was thinking and I really appreciate it.
Cosmo is a white Golden. His parents were from England. He's a real tank and a work horse. The fur on his back (when it's at it's best) is really curly near his tail, way less silky than the American Goldens which have Irish Setter in them.

Thanks again

[lulusmom]

Hi and a belated welcome to you and Cosmo.

First let me say that Cosmo is beautiful. I'm not sure I've ever seen a Golden quite so white and if he looks this beautiful in a little avatar, I can only imagine how striking he is in person.

Lori has been spot on in her feedback so my primary reason for posting is to validate what she has already told you but would like to add a few of my own comments. I completely agree that testing for cushing's at this point would be premature but want to add that contrary to what your vet told you, the results of the LDDS that was done is not borderline but rather consistent with pituitary dependent cushing's. We are used to seeing these numbers in ug/dl so I've converted those values belows:

Pre 9.4 ug/dl
4 hour 2.8 ug/dl
8 hour 3.2 ug/dl

Both the four and eight hour draws show more than 50% suppression of the pre blood draw, which is consistent with pituitary dependent disease. However, any type of major stress or non-adrenal illness can cause false positives so if this is the only test that was done and with the lack of the more common symptoms like excessive drinking & peeing and huge appetite, I wouldn't spend my money right now on additional testing. I'd keep an eye out for worsening symptoms and hopefully, Cosmo will live out the rest of his life with just a funky coat here and there. Your vet mentioned that 40 is the magic number for diagnosing cushing's and I am confused because as I mentioned previously, the LDDS is already consistent with pituitary dependent hyperadrenocorticism. The lab interpretation for diagnosing hyperadrenocorticism should be included on the results of the LDDS. If you have a copy, can you post those. If you don't have a copy, your vet should be happy to provide a copy. Can you also confirm that the normal reference range for the Cortisol (0 hour) is 15 - 120.00 pmol. 120.00 pmol is twice the normal for resting cortisol on the tests results we see in ug/dl. The high end is 6.00 ug/dl which would equate to 60.00 in pmol. I was never great in math so it's possible I screwed it up but I don't think so. pmol is one of the easiest to convert as you just move the decimal point one position to the left. I'm hoping that members who aced math in school will be by to check my work. :D

The distended abdomen in cushdogs is usually caused by a number of factors; enlarged liver, muscle wasting and redistribution of fat caused by the catabolic effects of high cortisol. Did your vet recommend doing an abdominal ultrasound to check the liver as well as the adrenals and surrounding organs? I see that Cosmo has normal liver values. While this is very uncommon in a cushdog, it is not completely rare. Canines are the only species in the world who have a steroid activated alkaline phosphatase isoenzyme but a very small percentage of dogs are missing this genetic marker. Therefore, some dogs with cushing's will have normal liver values. Were there any blood and/or urine abnormalities? Your vet mentioned that Cosmo's immune function is impaired. Do you happen to know what he is basing this on?

I am the administrator who wrote to Native Remedies, the manufacturer or distributor of Cushex. They admitted that they have done no testing that proves the efficacy of safety of their product. We have had a number of members join who saw what they thought were improvements in symptoms but in the end, they came here and ultimately decided on conventional treatment as symptoms had become problematic.

Glynda

[Simba's Mom]

Welcome to you and Cosmo, what a beautiful pup you have! You have found the right place for info and encouragement, take care and settle in, we are here for you and Cosmo too!

[nisamoht]

"Your vet mentioned that 40 is the magic number for diagnosing cushing's and I am confused because as I mentioned previously, the LDDS is already consistent with pituitary dependent hyperadrenocorticism. The lab interpretation for diagnosing hyperadrenocorticism should be included on the results of the LDDS. If you have a copy, can you post those. If you don't have a copy, your vet should be happy to provide a copy. Can you also confirm that the normal reference range for the Cortisol (0 hour) is 15 - 120.00 pmol. 120.00 pmol is twice the normal for resting cortisol on the tests results we see in ug/dl. The high end is 6.00 ug/dl which would equate to 60.00 in pmol. "

They sent the lab report to me but it didn't come with an "interpretation" unless I'm misinterpreting what an interpretation is:). My regular vet was out of town at the time of the testing and the vet that Cosmo saw spoke with the lab and told me that Cosmo definitely had neither regular Cushings nor Atypical Cushing. Which is why I was so surprised by what my regular vet had to say.
In the Endocrinology report that I did get it says that the normal range for (0hr) is 15-120 Pmol/L so I guess that would be 1.5-12ug/dl. But I'm guessing. But if the normal for resting is higher than is would suggest that the other numbers could be higher and still in the "normal" range.

"Your vet mentioned that Cosmo's immune function is impaired. Do you happen to know what he is basing this on? "

He was basing it on the sudden growth of the nail bed tumor. (it got very big very fast) Other than that Cosmo is healthy, no infections or anything.

I read the ingredients in CUSHEX and mainly they are natural herbal liver cleansers detoxifiers (burdock & dandilion) skin health, nerve calmers and other such remedies. I doubt that it would really help a dog that had cushings for any length of time but I could see how it could help reduce symptoms in the early stages.

Thank you for your feedback and your compliments for my handsome pup. I will keep a close eye on Cosmo for any new symptoms.

[nisamoht]

So I mad a mistake in my units. The fax copy wasn't very clear. The units are not pmol/L they are nmol/l so the conversion if I am correct is to divide by 27.55 which would give me:
(0hr) 3.4
(4hr)1.01
(8hr)1.16
but on the side of the report the little arrows next to the 4 & 8 hr results point up and are in bold suggesting that they are high. They seem to want them to be below 0.36.
Does any of that make sense? I got my conversion rates on line.
Thanks

[molly muffin]

Every lab has different ranges, which is why usually you want to check what the interpretation says. For instance, my lab, prefers under <27.59 nmol for normal suppression at 4 and 8 hours.

This test looks to me to be just outside the range of normal and is consistent with what I mentioned earlier about not really treating unless there are some symptoms to go along with it.

I don't think a liver supplement would hurt though as strengthening the liver is never a bad option when the potential is there that something could affect it.

Glynda will probably be by in a bit to comment too.

hugs,
Sharlene and Molly Muffin

[lulusmom]

Thanks for the correction. Now that you've clarified, I understand where your vet is coming from. Most labs have the 4 and 8 hour cut off for suppression at 1.4 to 1.5 ug/dl so Cosmo's results are not consistent with cushing's. I am hoping that you never see any of the usual symtoms associated with cushing's. No matter what, I do hope you stay with us and keep us posted on his progress.

Glynda

[nisamoht]

Thanks for all your feedback. You have helped me feel more confident in my choice to wait for more symptoms before putting him through additional tests. In the mean time I will take extra care with his liver.

[Budsters Mom]

Hi and welcome to you and Cosmo,:)
You have come to the right place. You will find knowledgeable and compassionate help here. It is a place to voice your fears and frustrations and well as share your triumphs. Questions are welcome and encouraged. I know, I asked what seems like hundreds of them!

Kathy and Buddy:)