New to the forum- 8 year old maltipoo just diagnosed

[kaitlinns]

Hi everyone,

My eight year old maltipoo, Ricky, was just officially diagnosed yesterday with Cushings (with a strong probability of being pituitary dependent). For the last few weeks, he had been having acidents frequently in the house. Knowing that it wasn't normal behavior, I took him to the vet (the accidents started about 3 weeks before we took him to the vet. Ricky hates going out in the rain and also hates fireworks and the accidents started during a week and a half of strong rain and thunderstorms and then 4th of July-- so we shrugged it off. I then came to the conclusion that there was no way this was normal.) We did a urinalysis and a blood test. The only abnormality in the urine was that it was very dilute. The blood test showed elevated liver enzymes. We followed up with the HDDS test (started at 7.8, after 4 hours he was down to 1.0 and after 8 hours, he was back to 4.8 indicating-- as you'll all probably know-- pituitary dependent cushings).

The next step for us is to get the abdomen ultrasound to completely rule out adrenal dependency and then to start medication.

My family and I are kind of struggling in deciding whether or not to treat him. Ricky's ONLY symptom is the frequent urination and drinking more. There's no hair loss, lack of energy-- nothing. I recognize that those symptoms probably will come and maybe in the fairly close future.

Our first thought-- he's not in any pain, he'll be 9 in January so he's getting pretty old so are we doing more harm than good by medicating him when the symptoms are really only an inconvenience to us (I should not that he hasn't had an accident in over a week because we've changed our behaviors to take him outside more freqently. He's never had an accident while we're all away at work during the day-- I'll attribute that to him sleeping all day and he doesn't eat or drink during the day when we're gone-- this could obviously change with the cushings symptoms.)

As I've been reading more, it sounds like the symptoms of cushings disease really are just an inconvenience to the owner but the presence of cushings disease can cause some pretty bad conditions (high blood pressure, organ damage, etc).

My family doesn't have a lot of money. Between my parents, my sister and I (we all share ownership of him since I live at home and he really is a family dog), I'm in the best position to pay for it all (and I'm happy to). I would be lying if I told you that I would prefer to not have the expense of all the medicines and tests for the rest of his life. From what I've read, I should budget for about $2500 for the first year and around $700 a year after that to account for medicines and tests? Does that seem accurate?

I know this is really hard question to answer about life expectancy-- I've read 2 years but I also recognize the flaws in the data. Is 8 1/2 years old considered to be the young side of senior? I thought it seemed old until I was reading stories about 15 year old dogs. It sounds like my otherwise healthy Ricky could have many good years left.

I'll talk more about options with our vet this week, I just wanted to be armed with information to make the best decision for Ricky.

Our vet likened the medications to chemotherapy. Should I expect him to become low energy, sickly on the medications? I do not want to give him something that will make him worse in any way just to be more convenient for my life.

When push comes to shove, I'm going to do what is best for Ricky-- regardless of cost. I could just use some thoughts on really what would be best. He's both like my baby and my little brother and I just want to make the best choice for him.

Thanks so much for all your help and support. I was so glad to find this site and already, reading your stories have been so helpful.

-Kate

[frijole]

Hi Kate. I can tell you have been reading up as you have a solid understanding of things for a first time poster! :) First off - ignore the 2 yr baloney. I don't know where that came from other than the fact that alot of dogs are diagnosed when very old so of course they won't live long. My Haley (schnauzer) was diagnosed at 12 and she was treated with lysodren for 4 1/2 yrs and died of old age (not cushings) at 16 1/2. Yes the drugs are chemo drugs but she led a very normal and happy life. So once the symptoms are controlled you are fine and on auto pilot. (at least in my case!) BTW 8 yrs is a youngster in our eyes. :D

You are wise to do additional testing as the LDDS test that you had done can have false positives for cushings when other illnesses are present - we see it alot (my Annie was misdiagnosed as having pituitary cushings) Never rush to treat - get it right as the drugs aren't meant for dogs with normal cortisol.

Other than the drinking/urination does Ricky eat like a pig? As in inhales, does not chew and spends all day in search of a crumb on the floor? That is a cush dog. :) What happens is that pituitary tumor (tiny little thing) sends false signals to the adrenal glands to produce cortisol that is not needed. It makes the dog think they are starved when in fact they are not.

It also causes the kidneys to work overtime. That results in the frequent urination. Believe it or not but the drinking is because he needs it because he is peeing so much. So when one elects not to treat that kidney (and other organs) are working overtime and that is what leads to problems up the road. (heart, liver, kidney, diabetes)

Costs will vary depending on what you pay for tests. Find out what your vet charges for the acth test. That and the drug would be the main costs. You'll have several acth tests the first year and one or two annually after that (typically). You can save money on the acth tests if your vet freezes the very expensive cortrysyn and reuses it for your dog. Here's a quote from our Glynda on how that works:



Most vets use a stimulating agent called Cortrosyn but we call it liquid gold because it's that little vial that dictates the cost. The vial is .25mg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5mcg per kg is all that's needed. Since there are 250mcg in one vial, your vet can get two stim tests out of one vial. This has saved members a lot of money, especially those of us with teeny dogs who can get five and six stims out of one vial. Formula for Rascal's weight in pounds converted to kg is 39 divided by 2.2 = 17.73 x 5mcg = 89mcg. Your vet can round that off to half a vial or 125 mcg.

Some vets are not aware of this so we always provide the url to Dr. Mark Peterson's blog which instructs vets on how to dilute and store cortrosyn for future use.



http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html
You have nothing to lose and everything to gain by printing this out or providing the URL to your vet and asking if s/he will please split the vial.


That example is for a dog weighing 39 lbs. So if your dog weighs 20 lbs you can get twice as many tests! Re the drugs - you can save money by not buying from the vet but we can discuss that later when you know what drug your vet wants and the dosage etc.

You are obviously a great advocate for your dog. That is key Kate because not all vets are up to speed and what is critical is that you pay close attention to instructions and speak up if you feel the vet is wrong or inexperienced. I have no reason to doubt your vet but just a warning that you can waste time and money with someone practicing on your dog.

We'll help you along the way so don't worry about being new to this. Keep us posted on the test results and ask questions. If you go to our resource section you will see info for beginners, how to diagnose, how each drug works etc. Glad you found us! Kim

[kaitlinns]

Thanks so much for your reply, Kim.

Ricky's appetite is totally not a fair judge of cushing's for him. He's always been obsessed with food (he was the food bully of his litter) and we nicknamed him sharky because he'd circle the perimeter of our kitchen looking for any sort of crumb and pounces when anything is dropped. So not a good judge for him. I haven't noticed any additional hunger in him since his diagnosis though.

Thank you for the tip about the cortrosyn. Ricky is 21 lbs so hopefully that'll help with the costs! I am really confident in our vet team's experience but even still, I'm a researcher at heart so I want to make sure I have any and all questions answered and that I know what questions I SHOULD be asking. I was reassured when my vet encouraged me to continue researching and gave me some suggestions on where to look. He let me know that if I had any questions, read conflicting information or needed clarification that I should call in and they'd talk me through everything and help to explain.

I talked to my sister today and we think we're going to go forward with the extra tests and then treatment (after it is verified cushings with the abdominal ultrasound) and I feel good about that choice.

I would still love to hear others opinions if people wish to share. I was pretty scared when I got the diagnosis and started reading about everything and a community like this is so helpful and reassuring. Trust that I'll be a regular!

Thanks so much again, Kim!

[Squirt's Mom]

Hi and welcome to you and Ricky!


Ricky's appetite is totally not a fair judge of cushing's for him. He's always been obsessed with food (he was the food bully of his litter) and we nicknamed him sharky because he'd circle the perimeter of our kitchen looking for any sort of crumb and pounces when anything is dropped. So not a good judge for him. I haven't noticed any additional hunger in him since his diagnosis though.

You almost quoted me when Squirt and I started this journey! :) Her nickname is Miss Piggy and she'd eat anything, anytime! She once ate ammonia nitrate I was putting out on weeds (before I had sense :o) so the idea that appetite could ever be a trustworthy sign for her was unbelievable...until I saw the cushing's appetite take her over. She didn't just display an increased interest in food, she became literally obsessed with it. She would wolf down her food, try to run the others off their food with aggression, she wanted out and would hunt for something to eat on the ground, then want back in and hunt on the floors and furniture and make the round of all the bowls. She couldn't rest or sleep for the need to find something to eat...she was up and down all night long. She would look at me with pain and hurt in her eyes that I was starving her to death, because that is exactly what she felt like - that she was literally starving to death 24/7. I don't think I will ever forget that haunting pleading look in her eyes. Once you see the cush hunger, you will never forget it nor ever confuse it with a pup who really, really loves to eat. ;) It is something to behold! :p

You are doing a good job of researching and asking questions....and pursuing additional testing. The ultrasound is one test I cannot recommend highly enough - it saved Squirt's life by finding a tumor on her spleen. Her cortisol was high and she tested positive on all tests for PDH. But once that tumor was out, her cortisol returned to normal and remained within range for several more years. Be as thorough in the testing as you can possibly be to rule out other causes for the signs and elevated cortisol. Cushing's is one of, if not THE, most difficult canine disease to diagnose because so many other things share the same signs and other conditions can cause elevated cortisol. So take your time and be very comfortable with the diagnosis before starting treatment. Once treatment is started, we will be here to help you along if needed.

I'm glad you found us and look forward to keeping up with Ricky's story.
Hugs,
Leslie and the gang

[molly muffin]

Hello and welcome from me too. :)
9 1/2 isn't something I consider to be very old for a small dog. Ricky could have quite a few more years ahead of him, happy, healthy ones in fact. :) As we have had plenty of success stories on here.

If it is cushings, then I personally like to start at the 1lb/1mg dosage for trilostane (vetoryl). Start low and move up as needed.
You either do once a day dosing, of around 20mg or twice a day, 10mg morning and evening, about 12 hours apart. You give with a bit of food, like cheese or something or just breakfast. When you do your follow up ACTH test, which is at the 10-14 day mark, then at the 30 day mark (if no dosage change is needed) then about every 3 months after that. You always give him his morning medicine on the day of the ACTH test and then the test should be about 4-6 hours (4 is preferable) after the dosage.

Those are the important things to know about treatment if you go down that road.
If you do decide on treatment, then we'll let you know what the range should be for a dog treated with trilostane before your first ACTH. It's important for you to know as sometimes the vets can get it wrong, by just reading the normal non cushing range.

At 9 1/2 and if I felt sure that it was cushings, and it was me and if I could afford it, then yes I would treat. That's what I would do and then hope I don't have to make too many dosage changes going forward.

Hope that helps,
Sharlene and Molly Muffin

[Budsters Mom]

Hello and welcome 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. We will do all we can to help, but be ready for lots of questions! So again, welcome to you and Ricky. Hugs,

[kaitlinns]

Thanks so much for your help, everyone. The support is so very needed and welcome. I am going to call the vet today about having the ultrasound and at that time, I am going to ask them any/all questions I have. I'll keep you posted!

[goldengirl88]

Kate:
Hi welcome to the group. Before I forget please look at my posting under redlight40 as there are some good pointers on there you can use also. The first thing I want to tell everyone is the biggest lesson I learned and that is if using Vetoryl start low on the dose. You can always go up. You are educating yourself and asking a lot of good questions. Keep doing that as that will help you a lot. I can tell you from my experience that my Tipper could not have made it this far without treatment. Her symptoms were severe, and they are controlled now. I was scared to death to give her these drugs as she is allergic to everything. It all worked out and we are a year into it. If you keep a close watch there is no reason your dog will not live out it's life. Good Luck to you and God Bless you and your baby.
Patti