New Member - Bailey and her owner Chris

[chris murphy]

Hi Everyone,
I found this site last week and have been reading as many posts as possible before I joined. There really is so much information here it's amazing. Thank you to whoever started this site.

I believe my 8 year old lab, Bailey, has Cushings. She had her regular check up earlier this month and I mentioned to my vet that she's been drinking a lot of water (more than a gallon a day), peeing a lot, and hungry all the time. She's also gained weight -haven't we all :-) Oh, and the panting! It's enough to drive one to drink (me, not her).

She has a bloated look to her (I imagine it's because she's drinking so much water!) and seems to be laying in different positions.

I'm getting off course. So at her check-up my vet took a regular blood panel and there was only one elevated level and for the life of me I can't remember what it was (it began with an A ). As a result of that, she did a urine test and said that her urine is clear and too diluted. So the next step was the blood test for Cushings. The test came back positive for the Pituitary type. (And I apologize, I don't have any of the test results). The vet has prescibed 120mg of Trilostane (she's on day 5 of the meds).

Last night she wet the bed for the first time in months. She would do this on occassion but hasn't done it recently and only does it when she is sleeping (the vet also said she's never seen a dog with a bladder as large as hers). Would a change of food help her symptoms and are there certain foods that relax the bladder (high fiber, high protein) that would cause her to have incontinence? Or would the Trilostane cause this?

Bailey is a bit high strung as it is. She seems to go a bit crazy at cats, dogs, people, etc. She is easily excited and stressed. She shakes uncontrollably at the vet, it's really hard to console her.

When I had to leave her for the day for the Cushing's test, do you think this would have affected the results? Is it possible that she's just a stressful girl and maybe needs some doggie downers as oppposed to Cushing meds? From what I understand it's the high levels of Cortisole in her system that causes Cushings but it is possible that due to her normal state of mind she creates too much anyway?

She is the last of my 3 labs (we put Bear down last July and haven't recovered from that) and she's always been in great health except for this.

Also she had Lyme disease and went through the regular course of antibiotics a few years ago. Are there lingering complication of having Lyme disease and would this affect her cortisone levels?

Sorry if some of these questions sound stupid. I'm just trying to get my head around this.

Bailey is scheduled for her ACTH test in about 9 days and I plan to get a copy of her results then. Why is the blood test for this so expensive an does this test determine her cortisone levels-- if she is a bag of stress when I take her to the vet how will this affect her results?

Thanks and so sorry for all these questions.

[frijole]

Welcome! First off please do get the copies of the test results and keep all future ones for reference - they will come in handy. It does sound like your Bailey has cushings.

No the urination is from the cushing's. Excess cortisol is produced which makes the kidneys work overtime - they actually are peeing because they need to and that causes dehydration and that is why your dog is drinking so much. I know it is backwards but do not keep water from her.

How much does your dog weigh and what is the dosage she's on?

The reason the acth tests are so expensive is because the main ingredient in the cortrysyn is like liquid gold. No getting around it. The good news is that once you get through all the originally testing and dosage tweaks you won't have to do it as often and then it's just the cost of the drugs.

Re diet - there are no diets for cush dogs except they cannot tolerate fat. So low fat/high fiber.

Here's a link to more info on trilostane and on the disease to get you started.

Kim
http://www.k9cushings.com/forum/showthread.php?t=185
http://www.k9cushings.com/forum/showthread.php?t=180

[chris murphy]

Hi Kim,
Bailey weighs 96 or 98 pounds and is taking 120 mg of Trilostane.

Chris

[frijole]

OK, that is 'in line'. Just keep a close eye on her. Dechra has changed their opinion on dosing as have most of the specialists in the field and the recommended dosing is now 1/2 of what it used to be. It is now 1 mg per pound so the dose is slightly over the recommended starting amount but she should be ok. Just read the link I gave you and keep an eye out for any symptoms - especially lethargy. When in doubt just post here! Kim

[molly muffin]

Hello and welcome from me too. :)
Kim has pretty much covered it all :) So, I'll send a big welcome to you both.
I was trying to remember and I'm sure that another one of our members, who has a black lab, switched to wet food for dry food in the evening (she is giving a twice a day dose, split) and she has reported that this has helped her lab not have accidents at night or have to go out at night like she use to. I don't know if you give any food at night, but that is something to look into.

As Kim mentioned, just keep an eye out. I know those dratted tests are very expensive, but really once you find the best dose and don't need to do any more tweaks, it is much easier and tests aren't done as much. Starting is the most expensive part.

Again, welcome!
Sharlene and Molly Muffin

[mytil]

Hi and welcome from me too. The others have started you off nicely.

I do have a comment about the Lyme. Since it has been a while since she was treated, has she recently had any testing to see the status of it? One of my girls has tested positive for Lyme - but no symptoms and blood panel is fine (no elevations) and I have a test every 6 mos to check if she is being effected internally - a urine test called a microalbuminuria test.

There is some evidence showing that the Borrelia bacteria may induce a chronic elevated secretion of stress hormones such as cortisol, but I would certainly check with my vet on this as not all dogs experience this.

Keep us posted
Terry

[chris murphy]

I have some updated information. Bailey had her ACTH test today. No results yet, but has gained more weight.

Her original blood panel shows the following abormal results:
MCV 56.0 fL (low)
ALKP 649 U/L (high)

AP_spp Positive
EC-EE, HW, Lyme, all negative

Urine Cortisol/Creatinine:
Urine Cortisol 3.0 ug/dL
Urine Creatinine 16.6 mg/dL
Urine Cortisol/creat ratio 56

Low Dos Dexamethasone Diagnostic Intervals
Pre Dexamethasone 10.1
Post 4 HR Dex 0.8
Post 8 HR Dex 1.4

She's still drinking and eating a lot. I read the brochure for the Trilostane and the dosage recommendation for her weight says 120 mg plus 60 mg. She's now weighing 101 pounds.

[labblab]

Low Dos Dexamethasone Diagnostic Intervals
Pre Dexamethasone 10.1
Post 4 HR Dex 0.8
Post 8 HR Dex 1.4

Chris, do you have the actual test result sheet in front of you? If so, can you please tell us the laboratory norms or "interpretation" for the Low Dose Dexamethasone test? Usually. the norm is such that a dog would need to register higher than 1.4 on the 8-hour blood draw to be considered "positive" for Cushing's...

Marianne

[chris murphy]

Pre Dex 10.1 Reference Range 1.0 - 6.00 ug/dL
Post 4 hr Dex 0.8 Reference Range less than 1.5 ug/dL
Post 8 hr Dex 1.4 Reference Range less than 1.5 ug/dL

There are different guidelines, described and the Vet circled the Low-Dos Dex Diagnostic Intervals section. She circled the <1.5 or <50% of baseline for the 4 hr test and >1.5 and >50% of baseline. But I don't think she's in this range? Am I reading it wrong?

[chris murphy]

And these were the results that she used to determine she has Cushing's and started her on 120 mg of Trilostane. Her ACTH results will be back on Monday.

[labblab]

Pre Dex 10.1 Reference Range 1.0 - 6.00 ug/dL
Post 4 hr Dex 0.8 Reference Range less than 1.5 ug/dL
Post 8 hr Dex 1.4 Reference Range less than 1.5 ug/dL

There are different guidelines, described and the Vet circled the Low-Dos Dex Diagnostic Intervals section. She circled the <1.5 or <50% of baseline for the 4 hr test and >1.5 and >50% of baseline. But I don't think she's in this range? Am I reading it wrong?
Chris, if you are questioning what your vet has circled, then I'm right there with you. Because the very first step in LDDS interpretation is to look at the 8-hour result to see whether or not it is higher than the reference range. If it is not (which it wasn't in Bailey's case), then the result is not consistent with Cushing's. The 4-hour result is only of interest if the dog has tested positive at the 8-hour mark.

What the reference range means is that for a dog to test "positive" for Cushing's, the 8-hour result would need to be higher than 1.5 (the "reference range" is what a normal dog's results would be). Since Bailey's 8-hour result was less than 1.5, her result was consistent with a dog who does NOT have Cushing's. Just barely, but there you have it. So suddenly I am very concerned about the accuracy of the actual Cushing's diagnosis. A "negative" result on the LDDS is typically very trustworthy. Very few dogs who actually have Cushing's will test negative on the LDDS. Here is a link that will explain interpretation of the test results in greater detail, and I will try to come back later on to talk about this more myself.

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Marianne

[goldengirl88]

Chris:
Welcome and sorry Bailey is having problems. I know you asked about a high protein diet to see if it would help. I know these dogs need protein, but my vet cautioned me on high protein diets in dogs because of the kidneys being affected. Just wanted to pass that on and hope Bailey does well on his meds. These people are wonderful and will help you and support you. God Bless
patti

[molly muffin]

I am very interested to see what the ACTH test results will be. Based on that LDDS, I agree on everything that Marianne said, it really doesn't support cushings, but perhaps they think early cushings. However, the symptoms can be in line with cushings and that might be why your vet went forward with treatment.

How have the symptoms been since beginning treatment?
On the original test, the MCV is low, does it give a range at all?

Sharlene and Molly Muffin