Cushings diagnosis, low level after 2 years course of treatment question

[Lactosetheintolerant]

My dog is a 7 , almost 8 year old chihuahua. She was diagnosed 2 years ago with cushings. She also was diagnosed with heartworm. It is actually my parents dog. They were devistated by the news. They were not actually offered a solution or treatment for the cushings. I think the vet was more concerned about the heartworm. So my parents put the dog on the slow kill method, figuring with the cushings, they did not want to press their luck giving her the poison. Well, this year she had a clean heartworm test. My parents had given her the heartworm treatment faithfully since the moment she was old enough to have it and that is all we did to "cure" it. We got the negative test results when we inquired about puting her on Doxicycline as we had not heard about that before. So, when we found out she was negative, We got a second opinion on the Cushings test. It was confirmed this week she DOES have cushings, but her levels are VERY low for a cushings positive dog. And this is after 2 years of no treatment. My parents are on a fixed income and can not afford to keep having the cushings tests done as they are 400 a pop here. Plus the medication which is 60 dollars a month.

I find it VERY curious that her levels are still so low after not being treated for 2 years. I am wondering if she can do without the medication, or actually my parents were wondering.

She is not displaying many of the symptoms of cushings. No increased water intake or urination, no thin skin etc. The only symptoms she has is she is an 18 lb chihuahua and she grunts a little when she walks around. So her quality of life is good. She is spoiled and is a rather sedate dog. But she does not seem lethargic either. She is a happy dog and is not experiencing weakness that we are aware of in her legs.

She also has an underactive thyroid. This was discovered about a month ago and seems to be the only health symptom she is experiencing from it. She is currently on thyroid medicine and will continue that as it is not too costly.

So I guess I say all of that to ask, what do you think we should do? My parents dont want to spend thousands of dollars that they dont have if it is only going to extend her life a little while. They also feel since her levels are still so low after being left untreated, that the disease is not progressing. It may be, if a tumor is causing it, no longer growing so the problem may not get any worse. I dont know if they even did an ultrasound to see if the cause was a tumor. They didnt even suggest it.

These are all questions they asked me. I am going to call the vet tomorrow and explain that my parents felt uncomfortable asking these questions when they got the call and see if they will discuss it with me. I dont know if they will.

Any suggestions would be helpful.

[doxiesrock912]

Most vets don't think that it's necessary to give meds for Cushing's until a dog shows clinical signs. Every dog is different so it is a good idea for you to speak with the vet.

With the levels being so low, I would ask how they determined that she has Cushings in the first place?

If they did do a specific test, please get the results and post them here for others to see and comment.

It will work out, if she has Cushings and this is the early stage - that's a good sign.

One note, get that dog exercising because being fit goes a long way, especially for a Cushings dog :)

[Budsters Mom]

Hello and Welcome,:)

First of all, would you please share your name as well as your fur baby's. We are a family and like to address each other as such.;)
I am so glad you found us, but I am sorry for the reason that brought you here.
You have come to the right place! There are many K9Cushings angels to help answer your questions and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. The more they know, the more they will be able help you. We understand all about the expenses associated with treating a Cush dog. You are not alone. Many of us struggle with that issue.

Hugs,
Kathy and Buddy

[Harley PoMMom]

Hi and welcome to you and your parent's chihuahua,

Experts in the field of Cushing's state that if there are no obvious symptoms that are bothersome to the dog or owner that treatment is not necessary.

Could you round up the copies of all tests that were done on your parent's furbaby and post any abnormalities that are listed, we are especially interested in the results of tests done to diagnose the Cushing's, these tests might be called a LDDS, ACTH, or an UC:CR.

Cushing's is not a death sentence for a dog and is very treatable. If and when the time comes and your parents do decide to seek treatment we can pass along some ways to save costs on the tests and medication for Cushing's.

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

Love and hugs,
Lori

[Lactosetheintolerant]

Most vets don't think that it's necessary to give meds for Cushing's until a dog shows clinical signs. Every dog is different so it is a good idea for you to speak with the vet.

With the levels being so low, I would ask how they determined that she has Cushings in the first place They did a test, not sure which one, but they did one and I guess the cortizone levels were elevated enough to indicate cushings, but very low on the cushings scale.?

If they did do a specific test, please get the results and post them here for others to see and comment. I will get the results from them and post it, hopefully tomorrow. I have asked my dad to call them in case they wont release them to me.

It will work out, if she has Cushings and this is the early stage - that's a good sign.

One note, get that dog exercising because being fit goes a long way, especially for a Cushings dog :)As for exercise, I fuss at my dad for that all of the time. He treats her like a princess as I think he had extreme guilt over losing her sister at 6 months old. So ever since her sister passed ( they adopted them together) he has coddled her. I cant even explain how much. I dont think you would believe me. He does everything short of chew her food for her. ;-/ I bring the dogs I foster over and he partitions her down in his room (where she hides most of the day anyway) and does not make her/let her socialize. It drives my mother and I crazy how much he coddles her. He has fallen a few times because he built a ramp for her so she does not have to jump on to the bed and he had fallen over it. So he coddles her so much he puts his own health at risk.

Mother takes her out to walk every now and again. But for the most part she stays on my dads bed. He surrounds her with pillows every day before he leaves to make her comfy in the "doggie donut".

[Lactosetheintolerant]

[QUOTE=Budster's Mom;102648]Hello and Welcome,:)

First of all, would you please share your name as well as your fur baby's. We are a family and like to address each other as such.;)
I am so glad you found us, but I am sorry for the reason that brought you here.



Hi Kathy and Buddy. My name is Cindy and my parents Chihuahua is Dozer.

Just a little history. Dozer came from an unexpected litter of puppies my Chihuahua gave birth to when her spay was delayed due to an infection. Cinnamon gave birth to 6 chihuahua puppies and then died 24 hours later of a uterine infection. I managed to get them all to 8 weeks old by bottle feeding them. In the course of this time, my parents fell in love with Dozer and Doobie. I kept the littlest one because there was several times I didnt think she was going to make it. The other three found homes with close friends, so it all worked out. Well, my parents adopted Dozer and Doobie. Right after thier six month "birthday" Doobie was discovered deceased in her bed. We have no idea what from, she was just gone and had been acting fine only an hour before she was discovered. This caused my father great anquish. I think he cried more for her passing than his own fathers passing. So since then he has coddled her. Cooked her food daily. He wont go on vacation unless he can take her. Crazy obsessed with her. He buys her very expensive food (wilderness Blue Buffalo) and makes sure she is well taken care of.

A little about me. Since the experience with my Cinnamon passing after giving birth, I am a strong advocate for spay neuter. I was before, but even more so now. I foster for 5 local shelters. I have 7 Furbabies of my own and currently have 7 fosters. I am very in touch with my animals. I limit myself to this many animals but as soon as I can rehabilitate my fosters I try to get new ones as there is SUCH a need out there.

Cindy and her furbabies:
Cujo (chihuaha, daddy of Dozer, Doobie and Gizmo)
Gizmo (Chihuahua)
Pebbles (Terrier mix former foster)
Midnight (Terrier Mix former foster)
Termite(Chihuahua former foster)
Sophie (Yorkie former foster)
Roxie (Sophie daughter former foster)

Fosters currently
Forrest (socialization foster had since October fearful)
Priscilla (heartworm foster had since October)
Momma (Pregnancy foster since February, delivered 6 pups)
Natasha ( Mommas daugher)
Socks (Mommas Daughter)
Scrappy Doo (Bottle baby fostered since early april)
And lastly Sabrina ( foster for weight gain and heartworm treatment since April).

[Lactosetheintolerant]

Hi and welcome to you and your parent's chihuahua,

Experts in the field of Cushing's state that if there are no obvious symptoms that are bothersome to the dog or owner that treatment is not necessary.

Could you round up the copies of all tests that were done on your parent's furbaby and post any abnormalities that are listed, we are especially interested in the results of tests done to diagnose the Cushing's, these tests might be called a LDDS, ACTH, or an UC:CR.

Cushing's is not a death sentence for a dog and is very treatable. If and when the time comes and your parents do decide to seek treatment we can pass along some ways to save costs on the tests and medication for Cushing's.

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

Love and hugs,
Lori

Thanks Lori. I have asked my father to get copies of the test that was just done. I dont think we can get the ones that were done two years ago as my parents former vet has HORRIBLE record keeping and did not give them to us when we asked for her records when we were changing vets. So I am assuming they do not have them or can not find them. His record keeping was a matter of writing treatments and diagnosis on these little index like cards that were updated with each visit. We found several errors in these recently which prompted my parents to lose faith in the vet.

I will post the results on this thread as soon as I can get them.

[Lactosetheintolerant]

Ok. Sorry about the many replies you guys. Thank you ALL SO MUCH for all of your help so far.

Apparently I came to the right place. :) I will get answers to as many of your questions as I can as soon as possible. I really appreciate all of the help. I think I can put my fathers mind at ease a little as he has been worried since the day she was diagnosed that he was going to come home and find her deceased. I think this will put his mind at ease that it is not a death sentence. She may still have many years in front of her.

[Budsters Mom]

Cindy,
I'd like to officially welcome you, Dozer and all your fur babies. thank you so much for fostering so many pets in need.:) Please let your dad know that we'll do all we can to help all of you. I was feeling very much like you dad before stumbling upon this mighty group of angels. I know now that there is hope and plenty of support from others who either have or have had Cush pups of their own. So please, gather as many facts as you can and post them, so our experts can go to work and do their magic.
Hugs,
Kathy and Buddy:cool:

[doxiesrock912]

Cindy,

you have a regular zoo :) Mega kudos on the fostering!!!!

I understand your father's pain. He sounds a lot like my father who doesn't listen to me either when it comes to what is best for our furlets in comparison to what he thinks that they want. It got to the point where I forbid him to feed Daisy at all unless I left a plastic baggy and then she was ONLY to have what was in that bag.

Cushings is VERY treatable, but the overall health of a dog will play a huge part in how well they do. Many dogs go years without having to give meds :)

15% of dogs have Cushings of the adrenal glands which is often operable. Obesity can delay recovery, put undue strain on the heart, and lead to diabetes. All of these conditions can affect a dog adversely and more-so when the dog has Cushings.

Also, dogs thrive on exercise. They LOVE it:)

I know that you know all of this - If you have a relationship with the vet, maybe they can convince your father of the importance?

Good luck:)

[Lactosetheintolerant]

Ok... Picked up the results. Her PRE-ATCH WAS 5.1, which is normal. Her POST-ATCH IS 22.6 with it looks like less than 22 is normal. Her T4 is 3.0 (or so it appears). Hard to tell as it is a bar scale. Her CHOL is 258, but again a bar scale so I don't know if I am reading it right. Those were the only labs they have me. I think that is all they did that day.

Again, keep in mind that this is 2 years after the initial diagnosis. So, to me it would appear the disease is VERY MILD in her case and or not progressing.

[Harley PoMMom]

She is not displaying many of the symptoms of cushings. No increased water intake or urination, no thin skin etc. The only symptoms she has is she is an 18 lb chihuahua and she grunts a little when she walks around. So her quality of life is good. She is spoiled and is a rather sedate dog. But she does not seem lethargic either. She is a happy dog and is not experiencing weakness that we are aware of in her legs.



Ok... Picked up the results. Her PRE-ATCH WAS 5.1, which is normal. Her POST-ATCH IS 22.6 with it looks like less than 22 is normal.

Since she displays no symptoms of Cushing's and her post ACTH stim result was only a smidgen over the high normal limit, I would not pursue any treatment at this time.

Love and hugs,
Lori

[lulusmom]

Hi Cindy and a belated welcome to you and your crew.
Love the user name but loathe being lactose intolerant myself. Actually at this mature age, my stomach doesn’t tolerate too much anymore. I see my gastroenterologist more than my gynecologist these days. :D:o:D

14 dogs under one roof. Yikes! Bless your heart for fostering so many. You must have amazing stamina and hopefully some extra hands on deck to properly care for 14 dogs. Just wow! I’m a special needs small dog rescuer with my own senior and special needs dogs and even with my husband’s help, we can only effectively treat and rehabilitate five or six at a time. Hopefully most of your fosters are healthy. My hat is off to you.

It’s too bad that you can’t get your hands on copies of the original testing that was done because I’m not convinced that Dozer was properly tested and diagnosed. Symptoms are a huge component of a diagnosis so if Dozer had no overt symptoms commonly associated with cushing’s, I don’t believe any experienced vet would confirm a diagnosis. Do you remember what was going on with Dozer back then that made the vet think cushing’s was involved? To launch into cushing’s testing on a dog with no symptoms and active heartworm infestation is misguided at best and a total waste of money at worst.
So now you have a second vet who has done testing on Dozer, who is still asymptomatic, yet this new vet reconfirmed a diagnosis based on nothing but a borderline acth stimulation test. My mom is much like your dad in that she has coddled her dog and has not socialized her. As a result, her dog is a nervous wreck going anywhere and a total basket case at the vet’s office. I suspect that Dozer may be the same way in which case, you would expect that the acth stim test would have been a bit higher than normal. If a post stimulated cortisol of a bit over 22 ug/dl and a grunt when Dozer walks is the lump sum total of your vet’s diagnosis, I’d say that diagnosis is extremely suspect. I agree with the others that you may be throwing good money after bad to pursue any further testing until Dozer lets you know it’s time. If and when it’s time, Dozer will most likely be acting like he is starveing, drinking and peeing buckets, will have some degree of hair funk going on, maybe panting, maybe seeking out cool spots to sack out on, less active and maybe some hind end weakness. Do you see any of that going on now?

Have you had Dozer’s thyroid rechecked since going on supplementation to make sure the dose is adequate?

Glynda

[Lactosetheintolerant]

Hi Glynda.

Luckily most of the fosters I have are easy care special needs. Like heartworm. That just requires medication daily. My most challenging are my socialization fosters, so I keep those numbers low. A good majority of what I tend to get are bottle babies. Once I get them to gruel, they are easy to handle, aside from the constant poop patrol. :-).

As for Dozer, the first vets suspicions were due to her size. She is a BIG chihuahua. Almost as wide as she is long. Her hair is gorgeous and thick. We shave her during the summer to help keep her cool. She is a long haired chihuahua. So no hair issues. She does pant a bit, but I suspect that is because it can't be easy to move 18 lbs on those stubby little legs. I wish I could put a picture on here that would show you her size. And she eats very little. My parents give her about 1/4 cup of blue buffalo duck formula food. They mix it with a little hot water, a fish oil tablet and a small amount of the nightly lean protein that they eat for dinner. This is once a day. No treats in between. She scarfs it down and would probably eat more if allowed, but due to her size we don't allow her more. She eats quickly. Now, admittedly, my parents dogs are all overweight. But none to the extent that she is. And the vet also knows my Gizmo, Dozers sister, is all of 4 lbs. And while everyone knows that families can run the gamete in size, the difference is pretty extreme. Of course, Gizmo is a bit more active. Not much, but she does get a little more exercise. So I think that is what caused him to suspect cushings because he said at the time her thyroid levels were not bad. Mom lost confidence in the office staff when we found incorrectly dated testing. She actually still kind of liked the vet himself, but how do you tell the vet that his wife is messing up as it was his wife that was doing the data errors.

Normally this vet had been fantastic, giving me his cell to call when one of my fosters was close to delivering and I feared she may have trouble birthing them. He told me to call any time day or night if she was in distress. So we kind of hated to leave him because of her but felt we kinda had to. Well, he is still my vet, but my parents don't go there anymore.

Well, when we switched to this new vet, the first thing they did was the thyroid and immediately put her on thyrotabs. This test that was posted above is a month after beginning treatment. She had taken her medicine at 6:30 the morning the test was done and it appears to still be on the high side of normal.

Praise God that her heartworm test has come back negative. My mother is freakishly faithful about giving her pets the heartworm medicine monthly. She didn't understand how it is possible she got it at all. But I explained, like any vaccine, it helps prevent it, but it is still possible to get a disease you have been vaccinated against.

I told my dad to focus on regulating her thyroid right now. Get that under control and let Dozer indicate if she needs further treatment based on symptoms.

My dad was concerned this new vet was just trying to take in extra profit. He found it very unusual, as did I, that the vet called 2 days BEFORE her cushings test to ask for payment for it. My father was afraid that they saw dollar signs when he came in. I personally found it suspicious too and that they want to run this test repeatedly and frequently until it is "under control". But with the normal PRE levels and the only slightly elevated post levels, it seems controlled to me. I wonder if the stress from being in unfamiliar surroundings, locked in a cage, could have caused the slightly elevated post levels.

I did tell him he needs to get her up and moving a bit more to prevent other co-morbidities like diabetes that may worsen the problem. He said "yeah right, like that is going to happen" and I told him, she needs it. Even if for the first month it is only down the street and back. Or a once a week trip to the park to just walk. I think my mother will have more luck or be more compliant with that recommendation.

Ok. Time to go inside to my brood and fix dinner. Yay domesticity!!!! Thanks again for yours and everyone else's responses. I think it put my dads mind at ease. I will continue to answer questions and post updates and help out with the limited knowledge I have. No better way to learn to help other than by learning yourself, right?
Thanks you guys, Cindy.