Here goes....(10-12 y/o Brittany)

[meteorologist]

I have a 10-12 year old Brittany that we rescued 7 years ago. To say that she has been a challenging dog would be an understatement. Anxiety issues, extremely dominant, constantly escaping or digging out whenever she can.

Shortly after we got her, we had her tested for hypothyroidism and she's been on meds for years now. A few years later, we noticed that she would drink so much that she would urinate in her sleep. We brought her to the vet, and we were told that it was probably female incontinence that many dogs have with age. It seemed like these symptoms would come and go over the years, and she would go through long stretches without an accident. She does exhibit other symptoms of the disease such as voracious appetite (stealing food from plates, going in the garbage can), and a pot bellied appearance. She has had seizures in the past, but they were few and very infrequent. I don't think she's had one in the past 3 years.

Unfortunately over the past few months things have gotten much worse. She's had accidents all over the house, both awake and asleep and we took her to the vet. They did a battery of tests and the vet told me that they suspected Cushings. The vet wants to perform a test for several hundred dollars to attempt to confirm Cushings. Just from some scanning on this site, it just doesn't sound like it's that easy to diagnose or treat.

Can someone please give me some advice on what to do next? What test should we have done if we can only afford one? Are there other diseases that this might be? I asked about diabetes, but the vet didn't seem to concerned based on the results. She did mention that her cholesterol and triglycerides were high along with some other key values that I can't remember at this late hour. She put her on 50 mg of proin twice a day for incontinence and we are not noticing any changes.

Things cannot continue on like this in our house. Should we keep her crated all the time? I've seen some suggestions for pee pads. I have already gleaned that I should not be restricting her water. She has been drinking out of the toilets if we don't keep the bathroom doors closed.

We are not at a point in our lives that we can afford hundreds of dollars of tests, followed by thousands of dollars of treatments, that may only extend her life by a few years. Not to mention the cost of cleaning the carpet and furniture frequently.

I have never had to put an animal down, so I feel like I would be some kind of monster if I didn't fight this. But at the same time, we're very tired of this situation and we have so many other commitments in our lives right now I just can't justify these expenses. I know that you all have made faced these tough decisions and would really appreciate your feedback.

Best,

Jason

[labblab]

Dear Jason,

I am so sorry that your girl is having these problems, and I'm also sorry that I don't have much time right now to reply. But I do want to welcome you and let you know that others will soon be speaking with you, too.

First and foremost, if you could get a copy of her actual test numbers and post any abnormal values here (along with the "normal" reference range) that would be a great help to us. In addition to physical symptoms, a big part of Cushing's diagnostics are the presence of certain lab abnormalities and the absence of others. If, in fact, she is already receiving appropriate thyroid supplementation and such things as diabetes and kidney dysfunction have been ruled out, then it does sound as though Cushing's could certainly be the issue. The symptom profile you describe is pretty classic.

One simple test by which you could begin is a urine test called a UC:CR (urine cortisol/creatinine ratio). You would collect a sample of her first pee of the day at home (where she is not stressed), and take it in to the vet for analysis. If this test is "normal," Cushing's most likely can be ruled out. If it is "positive," it does not diagnose Cushing's definitively but lets you know you should move on to other testing.

In the absence of any other known health issues, the LDDS is probably the preferred diagnostic blood test for Cushing's. This is because it is the least likely to "miss" making the diagnosis in a dog who truly has the disease. Also, depending on the pattern of the results, you can sometimes tell whether or not the dog has the pituitary form of the disease (as opposed to the adrenal).

As for handling things in the meantime, no, I would never keep a Cushpup locked in a crate for an extended period. As you already now know, the dog must have access to water at all times. And since the need to urinate also becomes uncontrollable, you do not want to trap the dog in an area where she has no option other than to totally soil her confined space and herself. Pee pads have indeed been an answer for many of our members when they are away from home. If there is any tiled or noncarpeted area of your house, hopefully you can gate it off or set up a large exercise pen which can include both water and an area of pee pads. If you have no areas that will work other than carpeted ones, you can also try putting down a large tarp or plasticized tablecloth/s, etc. upon which you erect an exercise pen. The pen can restrain you girl but with more freedom of movement than a crate, hold the tarp in place, and also keep the carpet clean and dry below the pee pads.

I am sorry to hear that she has been put on proin, because we have recently heard some very scary things about that drug. I'm hoping some of our members with first-hand knowledge about that will soon be stopping by.

OK, gotta close and run for now. But please do get ahold of those test results, OK?

Marianne

[goldengirl88]

Sorry you are having so many problems with your baby. Like Marianne suggested the LDDS test would be what I would do. Could you try and put some doggie pants on your dog?. It would stop the peeing all over the house and lessen your work and frustration. That is right about the water. Do not restrict it as Cush dogs use more water, and pee more often. Once the cortisol is controlled your dog will probably not be peeing in the house. I would keep a doggie diary daily of my dog. There are 2 treatments Lysodren, and Trilostane. My dog has been of the Trilostane ( Vetoryl) for a year now. Her symptoms were so severe she had to be treated or I feel she would not be here. Make sure your vet is experienced in treating Cushings, as it will save time, money and heartache. Most vets are not. Get as educated as possible on here and research everything. The more you know the better off your dog will be. If you decide to treat your dog with Trilostane, I caution you to start at a low dose, no matter what anyone says. The dog will adjust to the drug and you can increase it if necessary. There have been instances of vets that are not experienced with this drug that give the dogs a high dose and then there is trouble, so beware. If you aren't sure about something come her and ask, as these people know a lot more than any vet about this disease. Please post the numbers from your dogs test to get help. Keep copies of all test done and post all results on here. It's not as bad as you may think right now. I was scared too, but as long as you are vigilant about watching for signs of trouble your dog should do fine. Also get some prednisone from the vet. You may need it if your dogs cortisol goes too low. Blessings
Patti

[Squirt's Mom]

Hi Jason and welcome to you and your baby girl! :)

I am one with Proin knowledge and all I can say is do NOT give this drug to your baby. My Squirt was put on it last Sept. and she started having problems with respiration, sleep, appetite, digestion and a whole host more that culminated in a seizure. It took about 3 months to get her stabilized and almost back to normal. She does seem to have some permanent damage since her mouth hasn't worked right since. Here is some info on Proin that your vet probably didn't tell you about and probably doesn't even know about. The FDA is collecting info on this drug and it has already been banned in some countries for humans and animals.


http://www.fda.gov/downloads/AnimalV.../UCM296349.pdf


Table 6: Adverse reactions in the 28-day placebo-controlled clinical study
Adverse Reactions
PROIN
-
treated (N=123) (first number)
Placebo (N=61) (second number)

Emesis 20.3% 8.2%
Hypertension (≥ 160 mm Hg) 19.5% 14.7%
Anorexia 16.3% 3.3%
Body weight loss (≥5%) 16.1% 6.8%
Proteinuria 13.0% 8.2%
Anxiety/aggression/behavior change 9.7% 3.2%
Diarrhea 7.3% 9.8%
Polydipsia 6.5% 9.8%
Lethargy 5.7% 1.6%
Musculoskeletal disorder .2% 1.6%
Insomnia/sleep disorder 2.5% 0.0%

Squirt displayed nearly all of these signs but I didn't connect them to Proin. :( I failed to research this drug before giving it to her and my Sweet Bebe paid dearly for my failure.


http://www.livestrong.com/article/25...ects-of-proin/


Allergic Reaction

Dogs that are allergic to phenylpropanolamine or any of the components of Prion should not be treated with this medication. Improper use of Proin by hypersensitive dogs may induce a severe and potentially life-threatening allergic reaction. Symptoms of a hypersensitive reaction in dogs include weakness, seizures, pale gums, facial swelling and difficulty breathing. Dogs who exhibit any of these side effects after taking a dose of Prion should be transported to an emergency veterinarian clinic immediately.

Since your baby girl has had seizures in the past, I would be that much more afraid to give this drug to her. Invest in diapers instead. ;)

Odd thing....Squirt had some leaking is why we started Proin. After the seizure (the vet nor I had made the connection at this point) we stopped all her meds. Squirt started peeing LAKES, not leaking but peeing huge amounts as if she had lost all control of her bladder. In ignorance, I put her back on the Proin at a lower dose to help control this flooding for a short while. After being told by a dear friend how dangerous Proin was, I threw it out and contacted our vet. After stopping that Proin for good, she had a short period of minor leaking again, no flooding tho. I started giving her some Stinging Nettle, dried herb, in her feed and she has had no more leaking. In my research, there is very little to support the feeling that the Nettle is behind this improvement...but I can't deny what my eyes see. ;) There are other herb protocols for incontinence that do have research to support the benefits. You might find a Holistic vet in your area to help you with this.

Has an UTI been ruled out? Surely it has....

As for expenses - yes, the diagnostic phase can be expensive but there are things that may help. Check out CreditCare - a credit card for pet care that has lower interest rates...and in some cases no interest depending on your balance and how soon you can pay it off. Many vets us CreditCare. I've been known to sweep floors, walk dogs, clean cages and so on to go against my vet bills in the past and am more than willing to do so again. Some vets are more than happy to help you help your baby if you just talk to them. Here is a link to our Helpful Resource section on financial help -

Financial resources
http://www.k9cushings.com/forum/showthread.php?t=212

Once treatment starts, the costs go down. Of the two drugs used to treat Cushing's, Trilostane (Vetoryl) can be the more expensive one to use as often pups require several dose adjustments and with each dose change, the ACTH testing schedule starts all over - meaning more ACTHs are often required when using Trilo that when using Lysodren (Mitotane). BUT we are not at this point yet...and based on what you have said so far, you may never reach the point of diagnosis and treatment. ;)

If you choose not to pursue the diagnosis and treatment, you need to be aware of what your baby girl faces. Here is a link that tells a little bit about what happens with an untreated cush pup -

Complications from untreated Cushing’s –
http://www.k9cushings.com/forum/showthread.php?t=195

Please don't take this to mean that we think you MUST treat - she is your baby and we will support you regardless of the path you choose. Short of cruelty, we ain't gonna yell at you. ;) It is your choice alone and we will help you in any way we can no matter what you decide to do about the apparent Cushing's. We will be with you all the way. Please don't hesitate to ask questions and we will do our best to give you beneficial feedback.

Hugs,
Leslie and the gang

PS. Throw that PROIN in the garbage where it belongs! ;)

[spdd]

Hi Jason and welcome to the forum. I had absolutely no idea that there was such a thing as Cushings in dogs until my vet mentioned it. Obviously I knew nothing, but after looking for information I came across this forum. They have been a wealth of information to me, and I've listened to everything they have said. I'm even in the process now thanks to this forum in educating my vet even more.
Pay attention to the advice here... it is gold.
Good luck with your pup, and everyone here understands your situation.

[meteorologist]

Thanks everyone for the support!

I went by and got Missy's lab results this morning. Here's what we know so far. Maybe some of you can help me interpret all of this info!

Total Protein: 6.8 Range 5.0-7.4
Albumin 3.9 Range 2.7-4.4
Globulin 2.9 Range 1.6-3.6
A/G Ratio 1.3 Range 0.8-2.0
AST (SGOT) 27 Range 15-66
ALT (SGPT) 200 *HIGH Range 12-118
Alk Phosphatase 358 HIGH Range 5-131
GGTP 5 Range 1-12
Total Bilirubin 0.1 Range 0.1-0.3
Urea Nitrogen 15 Range 6-31
Creatinine 0.6 Range 0.5-1.6
BUN/Creatinine Ratio 25 Range 4-27
Phosphorous 4.2 Range 2.5-6.0
Glucose 106 Range 70-138
Calcium 10.7 Range 8.9-11.4
Magnesium 1.7 Range 1.5-2.5
Sodium 144 Range 139-154
Potassium 4.5 Range 3.6-5.5
Na/K Ratio 32
Chloride 110 Range 102-120
Cholesterol 384 *HIGH Range 92-324
Triglycerides 386 *HIGH Range 29-291
Amylase 321 Range 290-1125
Lipase 311 Range 77-695
CPK 110 Range 59-895
WBC 7.8 Range 4.0-15.5
RBC 6.0 Range 4.8-9.3
Hemoglobin 14.7 Range 12.1-20.3
Hematocrit 43 Range 36-60
MCV 72 Range 58-79
MCH 24.5 Range 19-28
MCHC 34.2 Range 30-38
Platelet Count 255 Range 170-400
Platelet EST - Adequate Range Adequate

Differential Absolute % Range
Neutrophils 5538 71 2060-10600
Bands 0 0 0-300
Lymphocytes 1950 25 690-4500
Monocytes 234 3 0-840
Eosinophils 78 1 0-1200
Basophils 0 0 0-150

Comments: Hemolysis 2+, Lipemia 2+, No significant interference.

Total T4 2.3 Range 0.8-3.5

Urinalysis Results

Leukocytes - Negative
Nitrates - Negative
Urobilinogen - Normal
Protein - Negative
PH - 7.0
Blood - Negative
Specific Gravity -1.014
Ketones - Negative
Bilirubin - Negative
Glucose - Negative

I told the vet that we are not noticing improvements with the proin, so I told them that we would not be giving it to her anymore. She takes 0.3 mg or Soloxin for her thyroid daily.

I went ahead and scheduled LDDS for Wednesday AM. I talked with some of my dog loving neighbors this morning and they recommended a specialist hospital that is about an hour away if the diagnosis is Cushings.

[Squirt's Mom]

Good for you! If you haven't had her thyroid checked lately you might want to make sure that dose is still doing its job, too. Hypothyroid signs and cush signs are shared so be sure the thyroid is within range and not behind the issues you are seeing.

Let us know how things go and know we are here any time!
Hugs,
Leslie and the gang

[meteorologist]

We had Missy's LDDS done yesterday.

The vet called to tell us that she has Cushings. She said that her levels (I'm assuming cortisol?) were 5.4 for the baseline, then 4.3 four hours after the injection, and 4.3 eight hours after the injection.

I don't have a copy of the full results yet, but will pick them up tonight.

The vet wants to treat with medicine, but I didn't ask what type.

Curious what you guys think.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about Brittany's test into her original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[lulusmom]

When was the blood chemistry done that you posted on 8/5? Was Missy fasted for that test and was she given her thyroid supplementation three or four hours before the blood was drawn?

[meteorologist]

I am not sure what time my wife took her in. I know that she did not fast, and unless my wife took her by 9AM (unlikely) it would have been longer than 4 hours since her thyroid meds.

[Squirt's Mom]

Do you know the date the lab work was done?

[meteorologist]

Yes. It was 07/18/13.

[meteorologist]

Just reaching out again since I haven't gotten many responses...

The information that the vet provided suggested that it was adrenal because the levels stayed so high for so long.

I need to know if this is the case. She has not had an accident in the house in a while now, but is still drinking a ton of water. We're just more diligent about waking her up and taking her out. She's still shaky, her nose is dry, her belly is big and her coat feels more coarse than usual. She still goes on walks and runs with me every day (usually not more than 3 miles and always in the morning or evening) and has no trouble keeping up.

If we do decide for treatment which medication should we use?

[Junior's Mom]

Was a urine culture ever done on her to rule out a bacterial infection? Which drug is your vet recommending for cushings? How much experience does your vet have with cushings? In order to properly monitor your dog, there needs to be symptoms you can see a change in after starting medication. Is your dog starving all the time, and drinking buckets of water a day?
I notice on her lab work that the urine was not dilute (specific gravity). Cush dogs have very dilute urine-pretty much clear without treatment.
Cushings is a very slow progressing disease, so there is no rush to treat without a lot of symptoms showing. Have you read through the resources section to familiarize yourself with the treatment options, and what to watch for?

[molly muffin]

Hi. Without an ultrasound it is iffy to know for sure if you are dealing with pituitary or adrenal tumor when it comes to cushings.

I know we currently have a member with a dog with an adrenal tumor who is being treated with lysodren. We're hoping for some success in both control symptoms and the growth of the tumor itself. This was confirmed via an ultrasound though.
Waly's thread is located here and you might want to read through it.
http://www.k9cushings.com/forum/showthread.php?t=5412&highlight=waly

Sharlene and Molly Muffin

[lulusmom]

Just reaching out again since I haven't gotten many responses...

The information that the vet provided suggested that it was adrenal because the levels stayed so high for so long.

I need to know if this is the case. She has not had an accident in the house in a while now, but is still drinking a ton of water. We're just more diligent about waking her up and taking her out. She's still shaky, her nose is dry, her belly is big and her coat feels more coarse than usual. She still goes on walks and runs with me every day (usually not more than 3 miles and always in the morning or evening) and has no trouble keeping up.

If we do decide for treatment which medication should we use?

I'm so sorry that you had to rattle our cage to get a response. I assure you that that is not the norm here. We are usually quite good at responding quickly. In any event, I'd like to share some information with you. Firstly, the bloodwork abnormalities you posted are quite common in cushing's. I asked about the timing of the Soloxine dosing and the test because if the test is not done within 4 to 6 hours of dosing, you aren't testing during the peak effectiveness of Soloxine so theoretically T4 could be much higher than reflected on the test results. If the dose of Soloxine is too high, excessive drinking and peeing are the usual symptoms. Per Dr. Jean Dodd:
The sample should be taken 4-6 hours after the morning dosage and optimum results will show thyroid values in the upper third of normal ranges at the peak time of absorption. Missy's T4 was definitely in the upper third of normal but if the test was done more tha n six hours after dosing, I wonder how much higher it would have been. Whether it would be high enough to cause problems for Missy and account for the incontinence, I don't know. My little cushdog, Lulu, was diagnosed with hypothyroidism and the more learned about the disorder and the treatment, the more I realized that many vets are clueless about how to properly monitor treatment. Most vets also don't know that Soloxine (Levothyroxin) is best absorbed on an empty stomach at least 1/2 hour prior to a meal.


We had Missy's LDDS done yesterday.

The vet called to tell us that she has Cushings. She said that her levels (I'm assuming cortisol?) were 5.4 for the baseline, then 4.3 four hours after the injection, and 4.3 eight hours after the injection.

I don't have a copy of the full results yet, but will pick them up tonight.

The vet wants to treat with medicine, but I didn't ask what type.

Curious what you guys think.

Those results are consistent with cushing's but don't tell you whether it is pituitary dependent or an adrenal tumor. If I could afford it, I would want to do an abdominal ultrasound before starting treatment just so I knew what I was dealing with. If Missy had an adrenal tumor, would you consider surgery as an option if she were an acceptable candidate? If yes, then an ultrasound is a must.

I believe one of your posts mentions that your vet thinks these results are more indicative of adrenal tumor. That's not really true. Dogs with adrenal tumors most often don't suppress at all at 4 and 8 hours. Missy suppressed. It wasn't much but she did. If I go with the law of averages instead of proof via additional testing, my money would be on pituitary.

Glynda

[meteorologist]

Thanks so much the replies you guys!

Some answers:

@Junior's Mom: Is a urine culture a different procedure than a urinalysis? We have had a urinalysis done and they did rule out a UTI.
My vet has not made a recommendation on treatment because I have not told them I am ready to treat yet. I wanted to work with you guys to get a read on what medicine would probably be the best. Unfortunately our vet has moved on and was replaced with someone that is 1 year out of school. The other partner at the vet is much more experienced, but honestly I doubt they have much experience with Cushings (though I could be wrong). Missy is starving all the time and drinks a crazy amount of water every day. Here is where I get aggravated. I have brought this dog to the vet at least 3 times when she was having accidents in the house (almost always while asleep). They would test for UTI, come back negative, and they never mentioned Cushings as a possibility. So we are looking at a situation that has been going on for years now, and as long as I was good about letting her out, no accidents in the house. Her belly is so big right now, and I can feel a fatty tumor on her breastbone, and what feels like another fatty tumor over her stomach. She pants alot and is shaky to the point that her teeth chatter if I have food that she wants to steal.

I'm kind of surprised about the urine dilute, because she almost always pees clear anytime I let her out.

I have read through several of the great links to resources from this site. It's a lot to absorb!

@Sharlene: I figured an ultrasound would be a next step, but seems so expensive. If I'm pursuing treatment, I would probably have my vet send her records to a specialist that is about an hour away. I think they would have the expertise to address this correctly.

@Glynda

That's great info about the Soloxine. I'll start giving it 1/2 hr before food from now on. I really need to find out when the blood was drawn. If it was before 11 am (which it probably was) it was within the 6 hour window. We had her diagnosed as part of a study and she was originally on a higher dose per the vet's recommendation. She acted "drugged" and we cut back by half. We have experimented with taking her off of the meds and all the hypothyroidism symptoms come roaring back.

As previously mentioned an ultrasound seems expensive and if it were an adrenal tumor we would probably not operate. I would want to treat with medication to make her as comfortable as possible as I understand the adrenal cush dogs don't usually live very long after diagnosis.