New member-Dazi's mom (Tibetan Spaniel) almost 16 y/o

[Barb B]

Hi all. I have a Tibetan Spaniel named Dazi who is almost 16 years old, who has recently been diagnosed with Cushings. We started her on Trilostane a few weeks ago, but I took her off after 4 days of it due to her not eating and just acting like she was drugged. After that, she returned to her normal happy self. She was only on 1 mL twice daily in liquid form. (she weighs 10 pounds) She also has chronic kidney failure and started in last month not wanting to eat and having strange labs, with a high BUN, but creatinine and phosphorus not that high. I had an ultrasound done of her kidneys because she didn't act like she felt as bad as a dog suffering from kidney failure acts and from this we discovered the strange adrenal glands and did the 8 hour Cushings test. I have had questions of whether this test was correct, because she never had any issues with excessive drinking, peeing, or appetite. The one thing she does that I wondered if other dogs do, is that she will walk and walk and walk; like last night she did this 2 hours straight and finally went to lay down after walking through the house that long. And she will no longer sleep on the bed with us at night. She is very wobbly, but then again, she is almost 16 yrs old and 8 years ago had a ruptured disc in her neck that made her paralyzed in her back end until she had surgery to remove the disc, so ever since then she has had a few issues with gait so I don't know if the Cushings is involved with this, or just what to think.

I am leery of starting the Trilostane again, but am also wondering about the pituitary tumor having something to do with her "wandering" for such a long time.

Any thoughts?? :confused:

Barb B

[Simba's Mom]

Hello and welcome, wow 16 years, thats awesome..I'm so glad you found this site, its a wealth of information and encouragement too....settle in and read some threads, you can learn a lot...

[Trixie]

Hi Barb,
Sorry to hear about what's going on with Dazi. I'm pretty new here myself so I can't offer up too much advice but there are many experts here who will post soon I'm sure.
My dog is on Triolstane but not the liquid so I'm unfamiliar with the dosage on the liquid type.
Since Dazi hasn't had any symptoms I would also question Cushings as a diagnosis too, most dogs would have at least one or two of the classic Cushing's symptoms. If you could post all your test numbers along with the normal parameters the knowledgeable ones on this forum will be able to provide more insight.
Welcome to the board, you'll find a lot of helpful support here.
Barbara

[labblab]

Hi Barb and Dazi,

I'm so sorry Dazi is having these problems. I would first like to ask whether Dazi is having any symptoms that are consistent with Cushing's, or whether the decision to test was based solely on the enlarged adrenal glands and kidney issues. It is true that Cushing's can cause some renal abnormalities, but treatment for Cushing's can be a double-edged sword if kidney dysfunction is significant because trilostane will not be cleared properly from the body. Since issues other than Cushing's can cause enlarged adrenals and a "false positive" on the 8-hour LDDS test, you really want to be looking for other confirmatory symptoms of the disease.

To add yet one more thing to the mix, yes, it is possible for an enlarging pituitary tumor to cause neurological problems such as endless pacing or wandering. And if that is the case, treatment with trilostane can actually hasten the tumor's growth. So an owner might choose not to treat unless the Cushing's symptoms are making the dog visibly uncomfortable. The only way a macrotumor can be diagnosed, though, is through expensive MRI or CT imaging of the head.

For me, quality of life would be the bottom line issue for a 16-year-old dog. I would be less concerned about slower accumulating effects of Cushing's and more concerned about day-to-day comfort. So if Dazi looks happier and better off the trilostane than on it, I probably would opt out of treatment even if I knew for certain she had Cushing's. But that is just my own personal opinion.

Marianne

[goldengirl88]

Hi Barb:
Welcome and sorry to hear Dazy is experiencing problems. This is one of my favorite breeds. I commend you on her 16 years and still going. Cushings can mimic so many other diseases, you need a definite diagnosis. The drugs used are very powerful and you don't want to use them on a dog that doesn't have Cushings. Not to scare you as these drugs help to manage their symptoms therefore keeping them alive, so they do good also. I hope you can get clarification in the form of test results as the members will want to see them in order to best help you. God Bless
Patti

[Budsters Mom]

Hello and welcome to from me too:) 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. So again welcome Barb and Dazi.

Hugs,
Kathy

[Barb B]

Thank you everyone for your kind words. I am going to be getting copies of Dazi's test results tomorrow, so I will post them then. I have a very close relationship with Dazi and can tell what her little head is thinking, and me doubting this Cushings is very strong. But like I said, I will get her results and get them posted and see what you guys think about them since I am clueless as to labs to do with this disease. Kidney disease labs I am all too familiar with, unfortunately, but Cushings is a new one for me.

Thank you for making us feel so welcome!!:p:)

Barb

[Budsters Mom]

Our experts can decipher those test results far better than I can. You are in excellent hands! ;):) Their advice is been invaluable to me! Don't be afraid to ask questions. I've asked hundreds of them and they haven't kicked me out yet! :D;)
Hugs,
Kathy

[Barb B]

I have the results of Dazi's Dexamethasone suppression test. I hope someone can explain this to me, because I'm a little confused. My usual vet wasn't in today to really go into detail about the results. Here goes:

Time 1: 8:30--8.3
Time 2: 12:30--5.8
Time 3: 4:30--5.3

Then it says:

Interpretation of the dexamethasone suppression tests:
Low dose dexamethasone supression test: Normal Cortisol level less than 1.4 ug/dL 8 hours post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dL 8 hours post-dex.

If the 8 hours post dex cortisol level is greater than 1.4 , the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor.
1. Cortisol level less than 1.4 ug/dL 4 hours post dex is consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8 hours post dex is consistent with PDH.
(Samples taken at 2 or 6 hours are interpreted the same way as a 4 hr sample).

If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.

NOTE: Approx 5% of dogs with PDH have normal results. False positives may occure with stress/nonadrenal illness.

What confuses me is are they saying the numbers need to be under the 1.4 to be considered pituitary, but the numbers way above that ands considered pituitary? The wording on this confuses me. Her other numbers were:
Urine prot/creat ratio-0.2-normal.
Urine total protein-17-normal.
Urine creat-77-not established.

Her diagnosis from her ultrasound was Left adrenomegaly. Differential diagnoses were
Glomerulnephritis.
Renal disease, chronic.
Pyelonephritis.
Protein losing enteropathy.

At the vet her BUN was down from 163 to 69, creatinine from 3.3 to 3.1 and phos up from 5.6 to 6. Glucose was 113. ALB was low at 2.3. Those were the only ones out of range that day, the day she had her other test on June 1.

What started all this going was the fact that Dazi's normally good appetite had dwindled down to almost nothing. We just assumed the kidney values had risen dramatically, but what had risen so high was just her BUN, clear up to 163! It had been in the 50s. Then we started some subq fluids on her, and famotadine. One day she'd act great, the next like she had crashed. I felt there was something else going on other then kidney disease and that's when we went for the ultrasound. Then all hell broke loose, so to speak.

So, even with these numbers for her cortisol test, she really had no ravenous appetite, water drinking, urinating, hair loss, or skin issues. She does have a wobbly hind end and she will do some wandering from time to time. The other big change in her is the fact that she doesn't want to sleep on our bed with us anymore. She will lay for about 2 minutes, then want up. Don't know if she is hot or what. What are the opinions out there?

Sorry this is so long. Hope it will all go through!

[lisamak]

Hi Barb and Dazi. I'm relatively new to the "cushing's" scene but do agree that without any/many of the typical symptoms and her reaction to the meds I'd hold off until you can have a good talk with your vet (perhaps referral to a specialist).

At her age however, it does sound a little like what you're looking at may be CDS (cognitive disfunction syndrome = alzheimer's). My Vince just turned 15 and was dx'd with cushing's, but 3 years ago we dx'd him as CDS. He was restless, wandering, couldn't be settled/consoled, and started having accidents in the house. We did tests for everything (including cushing's) at the time and nothing came back so our only answer left was alzheimer's. The good news is the one medicine for alzheimer's (selegeline) is also a medicine used for cushing's. So when he was dx'd with cushing's we chose to just up his medicine dose (cushings takes 2x as much as alzheimer's)...so far, so good.

Maybe discuss CDS with your vet. Not many vets have gone thru a dx and most aren't familiar with the meds to treat (as most people just think "oh well, dog is getting old").

Also wanted to comment on your kidney concerns. When looking at kidney function as they age its the CREA that's important...not the BUN. BUN will be high if your dog is on a high protein diet and also can be affected by the time the last meal was eaten (in relation to the test). So if you're looking at the kidneys focus on the CREA...giving sub-q fluids at home (very easy) can help big time for any senior animal, but will be especially good for a dog who's kidneys are starting to slow down (happens to us all as we age).

Hope that helped (not confused) things a little bit!

~~Lisa and Vince

[Harley PoMMom]

Time 1: 8:30--8.3
Time 2: 12:30--5.8
Time 3: 4:30--5.3

Then it says:

Interpretation of the dexamethasone suppression tests:
Low dose dexamethasone supression test: Normal Cortisol level less than 1.4 ug/dL 8 hours post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dL 8 hours post-dex.

If the 8 hours post dex cortisol level is greater than 1.4 , the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor.
1. Cortisol level less than 1.4 ug/dL 4 hours post dex is consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8 hours post dex is consistent with PDH.
(Samples taken at 2 or 6 hours are interpreted the same way as a 4 hr sample).
If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.

NOTE: Approx 5% of dogs with PDH have normal results. False positives may occure with stress/nonadrenal illness.

What confuses me is are they saying the numbers need to be under the 1.4 to be considered pituitary, but the numbers way above that ands considered pituitary? The wording on this confuses me.

When interpreting the LDDS test, one first looks at the 8 hour draw, in Dazi's test that would be the 5.3, if this number is greater than the lab's cut off number which is 1.4, than this says that Dazi probably has Cushing's. To differentiate between adrenal or pituitary, one needs to look at the 4 hour draw and baseline, which in Dazi's test is 5.8 and 8.3 respectively, to see if cortisol suppression occurred during the 8 hours. If at least 50% cortisol suppression is present at the four- or eight-hour time points, the diagnosis is PDH, but Dazi does not have 50% suppression at those time points so further testing is needed to diagnose if the Cushing's is adrenal or pituitary based.

However; the LDDS test can have a false positive result if any non-adrenal illness is present, and the kidney issue Dazi has could of created a false positive result on the LDDS test.



Her other numbers were:
Urine prot/creat ratio-0.2-normal.
Urine total protein-17-normal.
Urine creat-77-not established.

Her diagnosis from her ultrasound was Left adrenomegaly. Differential diagnoses were
Glomerulnephritis.
Renal disease, chronic.
Pyelonephritis.
Protein losing enteropathy.

At the vet her BUN was down from 163 to 69, creatinine from 3.3 to 3.1 and phos up from 5.6 to 6. Glucose was 113. ALB was low at 2.3. Those were the only ones out of range that day, the day she had her other test on June 1.

What started all this going was the fact that Dazi's normally good appetite had dwindled down to almost nothing. We just assumed the kidney values had risen dramatically, but what had risen so high was just her BUN, clear up to 163! It had been in the 50s. Then we started some subq fluids on her, and famotadine. One day she'd act great, the next like she had crashed. I felt there was something else going on other then kidney disease and that's when we went for the ultrasound. Then all hell broke loose, so to speak.

So, even with these numbers for her cortisol test, she really had no ravenous appetite, water drinking, urinating, hair loss, or skin issues. She does have a wobbly hind end and she will do some wandering from time to time. The other big change in her is the fact that she doesn't want to sleep on our bed with us anymore. She will lay for about 2 minutes, then want up. Don't know if she is hot or what. What are the opinions out there?

Sorry this is so long. Hope it will all go through!

An elevated phosphorus can make a dog feel nauseated and a binder might be needed.

I agree with Marianne in that if Dazi is feeling better being off the Trilostane and there are no Cushing's symptoms, I would stop using the Trilostane...just my 2 cents worth ;)

Love and hugs, Lori

[Barb B]

Lori, thank you for explaining this to me so I can understand it. Yes, I need to talk to my vet further about this. After having the reaction to the Trilostane, I told him I would prefer to just treat her kidney disease. Her phosphorus level isn't above the borderline yet, which is why I was shocked she had not wanted to eat. She was even tested for pancreatitis at that time, which was negative. I do give her subq fluids twice a week right now to help the kidneys. I had asked about a binder too, but the vet didn't feel we needed it at this time.

Lisa, I had also asked the vet about CDS, and we did talk about treatment for it. He said he hadn't seen very impressive results with Selegeline. At that time I was still dealing with her kidney levels being higher, and didn't want to add a new drug to the list, so we just put it on the back burner for the time being.

I do so appreciate hearing everyone's opinions and I have a very open mind about any and all treatment, when it is in Dazi's best interest.

This is a great group with very caring and very knowledgeable people!:D

[frijole]

What Lori and Marianne said is correct. My Annie had false positives on this test multiple times. She didn't have cushing's. And we had been using lysodren. When in doubt, particularly if there aren't symptoms then do not treat. I doubt your baby has cushings based on what you have shared. Kim

[labblab]

Barb, I see the ultrasound indicated enlargement of the left adrenal gland but there is no mention of the right one. Do you know whether or not the right adrenal gland was able to be seen on the imaging?

Marianne

[Barb B]

The right one was normal size Marianne.

Barb