Possible Cushing's diagnosis, blood levels listed

[Cheddar]

So happy to find this forum. My eleven year old Sheltie had a routine CBC prior to his teeth cleaning. The vet informed me that the lab reports were consistent with Cushings and suggested he return the next day for a LDDST. I am awaiting the results and should hear something today.

Levels in the high range:

Alkp 800 u/l. 2.5-4.0
Chol 687 mg/dl. 112-328
GGT 15 ul. 0-14
Lipa 824 ul. 100-750
Ck 265 ul. 10-200
Chloride LOW 103 mEq/l. 105-115

His lab repot with levels in the normal-high range are as follows:

Eos 8.8. 2-10
Hgb18.1. 12-18
Platelets 599 k/ul. 164-510

T4 0.8 ug/dl LOW

Chedder also had a normal abdomen ultrasound. I have no report, but will request ultrasound and LDDST report when I talk to the vet today.

Of course, I am very worried. Chedder is not exhibiting the classic signs....drinking or urinating excessively. His skin and fur look good, no pot belly. Panting is the only noticeable symptom and it is occasional, not all day. I noticed panting after his evening walk last night, but that could have been the heat. He has always enjoyed napping on top of the a/c vents. He wil randomly start panting, but it is not every day and it is brief...maybe a few minutes max.

He is sleeping and eating well with an occasional VERY early Morning outing (2-4:00) defecate and/or urinate. I attributed this to late day, early evening treats aNd fresh veggies...romaine lettuce, tomatoes, cucumbers, and dog treats. I have minimized his early evening snacks and the early morning excursions have subsided.

He is still enjoying his walks, but is not walking as far, but I attribute this to his older age. It is inconsistent, though, with some walks a good 20-30 minutes. Other days he is ready to turn around after ten minutes or less.

Ok, I have probably shared more than you need to know, but thought it best to share as much information to help you get a good picture of dear Cheddar! Just FYI, cheddar did not undergo the teeth cleaning and I would expect he will not if he has Cushings, correct? My vet does anesthetize for teeth cleaning.

I will post as soon as I hear from my vet, but any thoughts or suggestions on what to ask the vet, other than treatment and certainty of any diagnosis, are appreciated.

Thanks to all!

[Budsters Mom]

Hello and welcome:)
I am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help 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. We will do all we can to help. Others will be popping in to welcome you also. So again welcome to you and Your sweet little fur baby.

Hugs,
Kathy

[Cheddar]

Thank you, Kathy! I am keeping busy today, but cannot help but worry until I get the LDDST results and if Cheddar has Cushings disease.

[Budsters Mom]

We would love to know you and your fur baby's name. You have just joined our family and we would like to call you by name because it is more personal. We have many Cushngs expects who would be glad to answer all of your questions. They will be coming along shortly. I know you're scared. We all are. Know that knowledge is power. As you learn, it because easier to make the best decisions for you fur baby. You are not alone in this. We will be with you every step of your journey.

Hugs,
Kathy

[Cheddar]

just received voice mail from Vet. cushings confirmed. will send mire info after talk to Vet but wants to put him vitoryl, spelling ? i want to ask if he is absolutely certain that this is the correct diagnosis. will write later after talkto Vet. very sad but hopefully the meds will work and he will continue with a good quality of life.

[molly muffin]

Hello and welcome from me too.
Giving you a big hug.
First thing, cushings is Not a death sentence. Many dogs live out full, normal lifespans with a good vet and a vigilant owner working together as a team.
So, don't go down that scary path okay :)
Next, if you have copies of lab reports, can you post the range next to the abnormal in your previous post, with unit of measurement. Just click edit to do so.
Also, yes we would like to know what the actual ultrasound report says, such as does it mention adrenal glands, liver, and other organs, any enlargement, etc.
As for the LDDS test, did the vet give you the actual numbers? There should be a base, a 4 hour and an 8 hour result.
Has the vet mentioned wanting to do an ACTH test prior to beginning treatment, as this is the test that will be used to monitor during treatment.
Which medication does your vet prefer to use, vetoryl or lysodren?
A couple things you'll also want to find out is, how many cushings dogs has he treated and what have the results been?

So, I know that is a lot of information. One thing that we have all found to be important is knowledge. It is your greatest asset in dealing with cushings. The more you know, the better you'll be able to adjust and advocate for your precious furbaby.

If there is anything that we can answer for you or help you with, do not be afraid to ask. It is why we are here and there is no such thing as too much information.
Oh I almost forgot to mention. Get copies of all lab results and keep your own file. It really comes in handy.

Welcome again

Sharlene and Molly Muffin

[Cheddar]

Sharlene, they left a voice mail, as indicated in previous post. I am waiting to talk the vet. He wants to put Cheddar on vestroyl. I will post the lab norms later when I get home. Thanks for the encouraging words and suggested questions. I do want to be sure the diagnosis is accurate.

I have always keep records of Cheddars blood work, all lab reports, etc. thus fAr, he has been extremely healthy, so I only have results for titers. I have titers every year to check his antibody levels. I do not vaccinate yearly. I also had the blood results from last week and will be requesting the ultrasound and LDSST test today.

I will post updates when I speak to the Vet. thanks to everyone!!M:)

[Trixie]

Sorry you got the positive Cushings diagnosis for Cheddar. I was right where you are just a few months ago. You found this board so you are already ahead of the game! You will got tons of help and advice by the experts on this board...I'm not kidding, they know their stuff..more than average vets. Post all those test numbers and the knowledgeable ones will be able to advise, the rest of us will chime in too. :o
My dog (9years old) is on Trilostane/Vetoryl since April. In the last couple of weeks I am starting to see a diminishing of drinking, panting etc.
She is still herself...barking at noises, wanting to go for walks and pretty much behaving normally. We are still tweaking the dosage but things are better than before we started the medication.
Everyone here has gone through what you're going through so we all "get it"! Try not to worry too much (easier said than done!) you've got a bunch of people here ready to help!!
Barbara

[KennyJ]

This is a wonderful group.

[molly muffin]

We're here to help. I do want to say since vetoryl is the drug of choice for your vet that current dosing recommendations is starting on the low end and going up if needed at 1mg/1lb. I know some vets like to start higher, but we've seen way too many dogs end up in trouble by starting too high and it is impossible to know how any given dog will react to the medication. Some are very sensitive and others are not, so until you know, it's best to stick to the 1mg/1 lb ratio for beginning dosage.

Sounds like things have been really great for him health wise so far and that is wonderful. :) Being healthy certainly helps I think :)

Ta
Sharlene and Molly Muffin

[Cheddar]

First, allow me to introduce myself since i neglected to do so earlier. I am Lori and my 11-year old Sheltie is Cheddar.

I did not talk to the vet today as I had hoped. When i called him again,he was gone for the day. He left a voice mail earlier confirming the diagnosis of Cushings disease and said he wanted to start cheddar on 60 mg of Vetoryl trilosane, 60 mg/day, once a day for 30 days and then repeat the chemistry, I have so many questions, but will have to wait unti Friday when he returns. I told the tech I would not be starting the meds until I talked to the vet.

I did have the LDST results fax'ed to me...
Pre. Dexa 3.9 ref range 1.0-6.0
Post 4-hour 0.5 ref range less than 1.5 ug/dl
Post 8 hour 2.5 ref range less than 1.5 ug/dl

Four hours...More than 1.5 and more than 50% of baseline
Eight hours...more than 1.5 and more than 50% of baseline

Interpretation:

Consistent with hyperadrenocorticisn. Further testing required to differentiate adrenal tumor from pituitary-dependent hyperadrenocorticism ( pdh)

Can anyone explain these numbers to me? I just don't feel good about starting this med until the vet answers my questions about the. certainty of the diagnosis, how many dogs with Cushings does he treat in his practice, any shelties, side effects to the drug, is his pituitary or adrenal dependent?

Any light you can shed on the latest results is much appreciated.

Again, THANK YOU, everyone for your kind words, encouragement, and responding in a timely manner, heartfelt hugs to all! Forgive my typos. My desktop died the other day and I cannot type well on this Ipad. Cannot get used to the touch.

I will post updates as soon as I talk to the vet Friday. I am hoping to talk to the other vet who did the ultrasound tomorrow since the office would not fax that report. They would only fax the blood-lab results.

Thanks.

[molly muffin]

Hi Lori, I'll let the others answer the question on the LDDS results. It does seem to point to their not being adequate suppression at the 8 hr draw.
How much does Cheddar weigh? My vet had tried to start Molly on 30mg and she weighs 19lbs. The IMS that I saw, thought that would be too much and recommended a lower dose to start with.
The other thing I notice is that he didn't follow the recommended follow up testing as protocol dictates.
You always have a follow up ACTH at 10 - 14 days to make sure they are on the right dose. The next test if all is well is at the 30 day (4 week mark). If that is good, you can go to about every 3 months.
This is the protocol set out by the makers of vetoryl and has been consistently recommeneded by the top endocrinologist in the country.
Definitely ask him how much experience he has with cushings and testing. My vet told me she had plenty experience. I wasn't nearly as convinced after much studying and a consult with the IMS, that seem to also tick her off, but what can you do. I like her and everything, but it's got to be about what is best for Molly at this point, not her feelings.
You have to do what is most comfortable for you and Cheddar, no one knows him better than you.
My Molly too doesn't display the classic cushings symptoms. I have not yet started treatment, since while her ACTH was high, her LDDS was negative. (suppressed at both 4 and 8 hr)
This is a very tricky disease to diagnose. So, thyroid, diabetes can show the same results.
You could elect to monitor and treat if/when symptoms appear. You could elect to treat, but definitely start at a smaller dose, based on weight.
I know this just gives you more questions and certainly every dog is different, so my molly is not exactly the same as your Cheddar will be.

Sharlene and Molly Muffin

[Cheddar]

Someone asked me to post the lab"s normal ranges. I tried to edit my original post and add the ranges, but was not sure how to repost, so I am responding with a new post.

Levels in the high range...to the right of the results is the reference range:

Alkp 800 u/l. 2.5-4.0
Chol 687 mg/dl. 112-328
GGT 15 ul. 0-14
Lipa 824 ul. 100-750
Ck 265 ul. 10-200
Chloride LOW 103 mEq/l. 105-115

His lab repot with levels in the normal-high range are as follows:

Eos 8.8. 2-10
Hgb18.1. 12-18
Platelets 599 k/ul. 164-510

T4 0.8 ug/dl LOW

[frijole]

OK I'll say it - with absolutely zero symptoms of cushings I wouldn't think of starting treatment yet. The test you had done is fantastic except when other things are going on it can result in false positives - it happened to me and many others here.

I would have an abdominal ultrasound done or the acth test. Basically you want to confirm the dx.

I am no blood panel expert but what caught my eye is:

T4 0.8 ug/dl LOW

Have you ruled out hypothyroidism? the symptoms mimic cushings disease. Again if you don't have symptoms you will have an awful time knowing how to tell if the drug is working (tweaking the dosage).

It could be you caught it early but I would do more testing before starting on the trilostane. Also check with us re the dosage because there have been changes in the manufacturer's recommended amount that not all vets are aware of.

Lastly - yes you can certainly get your dog's teeth cleaned. That's how my Haley discovered cushing's as well. There is no danger in cleaning a cush dog's teeth unless the heart or other organs are compromised for some reason.

This is not a death sentence should it be cushings. Read this link re the symptoms and tell us if your dog has any of them please! Kim
http://www.k9cushings.com/forum/showthread.php?t=180

[Cheddar]

The only noticeable symptom is panting, but it is not chronic. It is not daily. It is random. No excessive thirst or urination, pot belly. Perhaps he is in the very early stages. I am hoping to hear from the other vet who did the abdomen ultrasound, which my vet said was normal. I am requesting they fax the report to me.

After reading comments, I am perplexed and am not going to start the meds until talking to my vet. In your experience, do the results of the LDST test strongly point to Cushings?

I need to educate myself on this LDST and how to interpret the results. So anything under 1.5 is normal? How likely is this reading a false positive in view of other lab levels-results? Is it likely for a dog to exhibit no clinical signs?

Any additional questions I should ask the vet who did the ultrasound?

So much going on in my life right now it is hard for me to figure this out and do what is best for my dog, especially having no medical background or knowledge of these tests. Thank you.

[goldengirl88]

Hello :
Welcome to the group. These people will help and support you thru your Cushings journey. I just want to say from the experience with my Tipper, start low on the dosage and err on the side of caution, make sure you have a Vet that has a good track record/understanding of Cushings- as most do not, and be vigilant watching your baby after you start treatment. You are the most important factor in whether or not your dog will get through the treatment process, with the least amount of problems. Any time you see something different happening, please get on here and get help. Make a diary of your dogs daily happenings, and call Dechra and get a file on your dog started, they make the Vetoryl and have a Vet there to help and guide you and your vet. They keep a file on your dog, which will help you, and other that follow in your path after you. This is important as we need to get research started on this disease, as it plagues too many dogs. The number is 866-933-2472 God Bless you and good luck.
Patti

[Cheddar]

Thank you, Tipper. I have that question listed and agree we should start on the lower dose and err on the side if caution. As indicated previously, the only noticeable symptoms are the occasional panting (nothing today and panting toward the end if the day yesterday) and his bushy tail is just a tad thinner. I have maintained his weight at 30 pounds for years.

Still waiting to hear from the vet who did the ultrasound. My vet wont return until tomorrow.

[molly muffin]

Hi, did you get a chance to have a chat with your vet?

Sharlene and molly muffin

[Cheddar]

Yes, molly. We finally connected last night and after much reading and perusing the web, and I will cut to the chase, I have opted out of treating cheddar. He is not exhibiting symptoms...intermittent panting that is very random. Hs tail feels just a tad less bushy, but who knows if that is a result if the cushings. so for now, i hAve opted out of treating him with the Vetroyl. If he shows any changes in behavior or quality of ife, I will revisit. Many concerns...one being the side effects...just the unknown. To start him on this drug requires monitoring and regular blood work.i really hate to put him thru this and if he is not exhibiting symptoms, from my reading, it is best not to treat. I have noticed today he is not drinking much...maybe because he is getting blueberries and had yogurt todAy which might be enough hydration. he has been sitting on top of the ac vents keeping as cool as a cucumber. We have been walking in the evenings since it hAs been so hot in our neck of the woods!!

Thank you for checking in.my desktop crashed so using this ipad is not fun for long typing. Too many mistakes on my part!!!

I continue to check this forum and will definitely report back with any changes and updates!!

[molly muffin]

That's okay. I'm not treating for cushing either. I'm giving liver supplements at the current time. I don't know for sure if my dog does or doesn't have cushings, but she doesn't exhibit the symptoms either. I just retest blood work and monitor and adapt as I go along.
This forum is made up of many people with various issues and treating in various ways. Just know that we are all here to support you no matter what is going on.
I would probably do the same as you are doing in the same situation.

Sharlene and molly muffin

[Trish]

As others have said it makes sense not to treat if there are only very minimal symptoms, I think you are doing the right thing too!! Go Cheddar hope it is not too hot and you get your walk tomorrow :)