Possible Cushings dx in Boston Terrier, need advice please

[CookietheBoston]

Hi all. We have received a possible dx of Cushing's dx in our 12 year old female Boston Terrier, Cookie.
Here is some background:
approximately 1 1/2 years ago she started wetting the bed when she slept during the day while we were at work. During night she did start increasing the need to go out to 1 to 2 times a night. The vet did a urine test, came back normal, so he put her on Proin, thinking it was due to weakening due to age. I removed her from Proin soon after due to side effects of increased nervousness, edgy, etc.
The bed wetting during day has been on and off and night awakenings to go out have increased.
January 2013 she ruptured her ACL and PCL in her hind leg. We did not know why, came home to her limping. She had surgery. At this time, she had lab work done and it was normal, except her BUN was a little elevated at 33.
Her hair took a very long time to grow back and then she still has a bald spot, hair not growing back.
Back in May she had an episode where she had bad diarrhea (orange in color) and no appetite. She became dehydrated and was put on antibiotic.
Now at present time, she really started drinking tons of water, waking me up every 90 minutes to 2 hours during night to go out and having accidents around house, not just while sleeping. I also noticed she started panting more during our walks I took her to vet, they did a urinalysis and found that her urine was very diluted with high protein. The results say 2.8 ( i was told .5 or lower was normal). The lab work showed the following: ( i only know what i was told over phone, i do not have a copy) I will compare January to now if I have it.

Creatinine (WNL) January 1.2, August 1.2
BUN January 33, August 27 (now WNL)
ALT elevated January 84, August 250 (told normal is 100 or less
ALK 118 August (was told normal)
Bilirubin .5 August (normal)
GGT elevated 26

She had abdominal ultrasound that indicated she had enlarged adrenal glands (both of them). She also had X-ray which showed slight kidney infection. They said everything else was normal.

Her BP was taken and it was 240, they said normal is 160. I asked since she hates the vet and being confined if that was cause for elevation but they said it is still too high.

So meds: now she is on Zeniquin 50mg for 30 days for infection of kidney, Benazepril 5mg daily for high Blood pressure
and Amlopidine Besylate 1.25mg daily for high Blood pressure.

She is scheduled for a Dex Cortisone test next week. I will be picking her up and dropping her at the intervals as not to keep her at vet all day to decrease anxiety.

So my questions are this:
Does this sound like Cushings? is there something else we should rule out? The vet mentioned lyme disease and leptospirosis also could cause kidney issues but she has been lyme vaccinated and they seem unlikely, esp since she has weak hair growth, panting, thirst, diluted urine, increased peeing, accidents, enlarged adrenal glands, weak hind legs (shakes now but idk if that is from surgery or a symptom) and she also had skin growths; however i do not know what growths for cushings look like.

2nd, if it is, what medication do you recommend? It is likely pituitary based since both adrenal glands were enlarged.

3rd, are there any other tests I should demand before medicating?
I have spent over 1100 to date and next week will likely be 2 to 300 more dollars. Cookie is my fur baby and I will find money if need be, but soon I will be borrowing the money for these treatments, etc so I only want to run additional tests if it is absolutely necessary and there is a strong belief it is needed.

Thank you for reading this lengthy post. I appreciate whatever advice can be given. I am devastated and hoping this does not mean she will pass soon or have a poor quality of life. She has already begun to lose her hearing and also has cataract and uveal cysts so her vision is patchy. I still want her to enjoy life.
Thanks again!

[spdd]

Hi and welcome to the forum. Just want you to know that there are experts on here that will help you through this.

They are working with me, so somebody will be along shortly to probably ask you all kinds of questions.

Good luck with your furbaby. We really do love them.

[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! Others will be dropping in shortly to welcome you also! So again, welcome to you and Cookie.

[molly muffin]

Hello and welcome.

I'm glad you stopped the Proin as we have discovered it has some very adverse side effects. So, good job on that, it can also cause Proteinuria and Hypertension. I'm not sure if Cookie would have been on it long enough for it to contribute to these two issues for Cookie. Do you have any comparison about the urine protein? Some protein can be caused by cushings, but with a kidney infection that could also be contributing.

First off, I wouldn't get the LDDS test done next week. I wouldn't get it done until the kidney infection is cleared up, so that you won't risk the results being invalid due to something else going on. LDDS and other cushings tests can be false positive if there is another problem going on. If a UTI can mess with it, a Kidney infection sure could. It's just not worth throwing money out the window.

As for what medication to use, the two most often used is vetroyl (trilostane) and lysodren. It depends on what your vet is most comfortable with and has the most experience with. The two work in different ways and I would refer you to the Resource section http://www.k9cushings.com/forum/forumdisplay.php?f=10 to do some reading up on both medications.

We've had success on the forum with both types of drugs. Both can also be dangerous, so you need to have a vet who knows what they are doing, has used the drugs before and follows testing protocols.

This isn't a death sentence, and with successful treatment, they can live out their normal lifespan and have a good quality of life.

I would probably, prior to medicating, have an ACTH test done. Once you start medicating, this is the only test that you will be using to gauge how well the medication is working. So, having an idea of where Cookies cortisol was before treatment (a baseline) would be a good idea in my opinion.

Others will be along to welcome you too soon. Don't worry, you have found a good place with very supportive people who will be right there with you. You can pop in most any time and ask a question and find someone around. :)

Welcome
Sharlene and Molly Muffin

[CookietheBoston]

Thanks for the responses so far. Question then based on your suggestion to hold off on the dex test, should i be concerned that the vet wants to run the dex test while she does have the kidney infection and also while on the Zeniquin? she wants her on that a month though so would waiting a month be bad with her issues?

A coworker had a Boston terrier who had similar symptoms and her vet swore it was Cushings also and the ACTH (sorry not sure if that is it but that expensive test) ended up concluding it was not Cushings. But yet her cousin had a Boston with same symptoms and it had confirmed Cushings so it is really weird how this all works and I do fear if they are wrong or not. Would a thryoid panel be based on a normal blood test I wonder? I didn't pay extra for one and that concerns me as well. They already think I am crazy because my dog was at vet all day waiting for the ultrasound vet to come and since she was so upset and blood shot eyes, high BP etc, I told them I did not want her all day for dex test, so I literally will be driving to the vet with her multiple times that day for the blood draws, as opposed to having her wait there all day in the kennel. They will probably hate me if I question holding off on the test. ugh....I had to call them yesterday again because she had diarrhea in house and it as runny and I think it was due to the antibiotic. This disease is very confusing. How do you know if the vet truly knows it or not. She did say last week it was weird that her ALK phosphate was normal but then when ultrasound showed the enlarged adrenal glands, she said the ALK didn't have to be elevated in order to diagnose Cushings. She does seem to have many of the symptoms though, as I listed above, don't you agree?

Luckily I did not keep her on the Proin very long at all. I didn't even finish the bottle. I noticed the neurotic behavior and stopped in soon after so i don't think that did it. But that does remind me, since she was wetting when sleeping I did put her on an herbal medicine, Id say 3 months ago, it was a Bladder Support pill. I read some of the root ingredients etc and they are kidney and liver herbs so now i wonder if that triggered something. So confused. I don't want to do the wrong thing and I do have to keep some type of hold on the finances and not go too crazy testing for everything. I am in NJ. Should I be going to NY?

[Squirt's Mom]

Hi and welcome to you and Cookie! :)

I'm with Sharlene - I would hold off on the cush testing until this infection is cleared up....including the possible intestinal infection with the reappearance of the diarrhea. ;)

Here's is a little tidbit to keep in mind - cortisol is the body's normal response to stress of any kind, internal or external. It is one of the fight or flight hormones. Any time there is an illness present, the cortisol can be elevated as a natural response - NOT always because of Cushing's. These tests can only tell us if the cortisol is elevated but not why there is excess cortisol present. So anytime our babies are ill or have other conditions present it is best to hold off on testing during the diagnostic phase in order to try to get as clear a picture as possible. Point in case - my Squirt tested positive for PDH on five tests but it turned out she had a tumor on her spleen causing the elevated cortisol (found via ultrasounds) and once it was removed, the cortisol returned to normal.

Because so many other conditions share signs with Cushing's, this is another reason to rule out conditions like diabetes and thyroid problems especially - both can be looked at via blood work and urine - and may have already been ruled out. We will know more about that when we see those values. On the lab work Cookie had done that showed the ALT, ALP, etc. do you see something like GLU and T4 listed? Liver and kidney disease can also mimic Cushing's so it is important to check these out if values are elevated before confirming a Cushing's diagnosis and starting treatment.

So take a break from the vet for a bit and let's get Cookie's infections under control then we can do the cush testing. And don't panic about the wait - Cushing's moves at a snail's pace, taking years and years to do any real damage. So a short wait for her to get better won't hurt where the Cushing's is concerned. ;)

I want to tell you that I wish I had had the insight you did about Proin. My Sweet Bebe was put on it last Sept. and I noticed things about her changing and her having some difficulties she hadn't had before. But she was almost 15 so I put it down to aging. In March she had a seizure from the Proin and almost didn't make it. Squirt's much better today but has some apparent permanent damage from the seizure. So I am very, very proud of you for stopping this drug....AND that tells me that if your sweet girl does have Cushing's, you already have two of the most critical factors under control - 1) loving that sweet girl to pieces and 2) knowing her well enough and watching her closely enough to know when something is "off". Diligent parents are as important as the treatments...if not more so. ;)

I'm glad you found us and look forward to learning more as time passes. Never hesitate to ask questions or talk to us about anything. You and Cookie are part of our family here now and we will be with you all the way.

Hugs,
Leslie and the gang

[BostonLover]

Welcome! You have come to the right place! I have a 9yr old Boston Terrier (we think, she was rescued from an amish puppy mill) with Cushing's and coming here was the best thing I did!

They will ask you TONS of questions, and give you invaluable advice!

[goldengirl88]

Hi
Welcome to the forum. Sorry your furbaby is having troubles. I would wait until the infection is cleared for the testing as you don't want false readings and wasting money you don't have to. I would then do the LDDS and the ACTH. Please take Leslies advise about the Proin. She knows all about it from experience. It will be really helpful to keep copies of all testing, and post the results on here for help. Keep a doggy diary, you will refer back to it many times over. To save, time, money and heartache get a vet that is thoroughly experienced with Cushings, as most are not. Ask questions and educate yourself as much as possible. You will be your dogs best advocate through this journey. If you watch them diligently your dog should do fine on the drugs. If using Trilostane/Vetoryl always start low and work up no matter what!!!! That is my best advise for anyone starting their dog on those drugs. Lysodren is a different drug and I can't speak to that dosing as I don't use it, but many on here do. Everything will be ok, just be vigilant. Blessings
Patti

[lulusmom]

Hi and welcome to you and Cookie.

I'm sorry for the circumstances that brought you to us but I'm glad that you found us. Getting the dreaded diagnosis is a scarey proposition but I promise that once you have a greater understanding of the disease and the effective treatments, you'll come to realize that there are any number of diagnoses that are much, much worse than cushing's. It's an expensive disease to diagnose but once diagnosed and stabilized on treatment, the expenses are much, much more manageable.

Please see my further comments in blue below.


Hi all. We have received a possible dx of Cushing's dx in our 12 year old female Boston Terrier, Cookie.
Here is some background:
approximately 1 1/2 years ago she started wetting the bed when she slept during the day while we were at work. During night she did start increasing the need to go out to 1 to 2 times a night. The vet did a urine test, came back normal, so he put her on Proin, thinking it was due to weakening due to age. I removed her from Proin soon after due to side effects of increased nervousness, edgy, etc.
The bed wetting during day has been on and off and night awakenings to go out have increased.

Without knowing which urine tests your vet did, I'll have to lapse into my Monday morning quarterback chair and makes some calls. :D If a dog is waking their owner up at night to go out, I wouldn't automatically assume this is the onset or worsening of an incontinence problem unless a urine culture comes back clean and urine specific gravity is normal. If your vet only did a dipstick urine test, s/he fell short of doing a comprehensive analysis needed to determine the root of Cookie's problem. It would be great if you could ask your vet for copies of all urine tests and post the results here. Actually, please ask for copies of all of Cookie's tests. We would be most interested in seeing any high and low values on the bloodwork, including the normal reference ranges.

January 2013 she ruptured her ACL and PCL in her hind leg. We did not know why, came home to her limping. She had surgery.

Cruciate ligament injuries are common in cushing's due to the catabolic effect of steroids; however, these same injuries are seen in healthy dogs as well. This is just one more piece of the big puzzle that vets have to include when trying to confirm a cushing's diagnosis.

At this time, she had lab work done and it was normal, except her BUN was a little elevated at 33.
Her hair took a very long time to grow back and then she still has a bald spot, hair not growing back.

High BUN and coat issues are definitely associated with cushing's but it is strange that the hair would grow back at all without effectively reducing cortisol with treatment.

Back in May she had an episode where she had bad diarrhea (orange in color) and no appetite. She became dehydrated and was put on antibiotic.

Based on my own experience, this sounds like pancreatitis, a condition that cushingoid dogs are definitely at higher risk. Do you recall if your vet did a special test to rule out pancreatitis or did s/he figure that antibiotics would address whatever the problem was?

Now at present time, she really started drinking tons of water, waking me up every 90 minutes to 2 hours during night to go out and having accidents around house, not just while sleeping. I also noticed she started panting more during our walks I took her to vet, they did a urinalysis and found that her urine was very diluted with high protein. The results say 2.8 ( i was told .5 or lower was normal). The lab work showed the following: ( i only know what i was told over phone, i do not have a copy) I will compare January to now if I have it.

Creatinine (WNL) January 1.2, August 1.2
BUN January 33, August 27 (now WNL)
ALT elevated January 84, August 250 (told normal is 100 or less
ALK 118 August (was told normal)
Bilirubin .5 August (normal)
GGT elevated 26

She had abdominal ultrasound that indicated she had enlarged adrenal glands (both of them). She also had X-ray which showed slight kidney infection. They said everything else was normal.

Her BP was taken and it was 240, they said normal is 160. I asked since she hates the vet and being confined if that was cause for elevation but they said it is still too high.

So meds: now she is on Zeniquin 50mg for 30 days for infection of kidney, Benazepril 5mg daily for high Blood pressure
and Amlopidine Besylate 1.25mg daily for high Blood pressure.

Hypertension and Proteinuria are quite common in cushing's and it's a crap shoot as to whether one or both will resolve with treatment. One of my cushdogs had persistent 2+ protein in her urine and her kidney values were still normal seven years post diagnosis. I've included a url to a blog on the subject by renown endocrine expert, Dr. Mark Peterson.

http://endocrinevet.blogspot.com/2012/06/hypertension-and-proteinuria-frequent.html

She is scheduled for a Dex Cortisone test next week. I will be picking her up and dropping her at the intervals as not to keep her at vet all day to decrease anxiety.

If Cookie does, in fact, have a kidney infection, I would not recommend doing a low dose dex test just yet as the likelihood of a false positive result is great in the face of non adrenal illness or severe stress. There are certain urine and blood abnormalities that are usually present with a kidney infection but I don't see them. I've never heard of diagnosing a kidney infection solely with an xray so I'd be interested to learn what it is that a vet would see on imaging that would confirm an infection. Is it possible that your vet diagnosed a kidney infection based on the proteinuria and hypertension as opposed to the xray? If so, then I think doing the LDDS now would probably be okay because a good many of our own dogs had these same abnormalities when they had blood drawn for the LDDS test.
So my questions are this:
Does this sound like Cushings? is there something else we should rule out? The vet mentioned lyme disease and leptospirosis also could cause kidney issues but she has been lyme vaccinated and they seem unlikely, esp since she has weak hair growth, panting, thirst, diluted urine, increased peeing, accidents, enlarged adrenal glands, weak hind legs (shakes now but idk if that is from surgery or a symptom) and she also had skin growths; however i do not know what growths for cushings look like.

Yep, it sure sounds like Cookie is a cushingoid dog based on everything you've posted so it will be interesting to see if the results of the LDDS are consistent with cushing's.

2nd, if it is, what medication do you recommend? It is likely pituitary based since both adrenal glands were enlarged.

Both Vetoryl (Trilostane) or Lysodren (Mitotane) are very effective in the treatment of pituitary dependent cushing's. Both are serious drugs so it would behoove you to learn everything you can about which treatment you ultimately opt for. As long as Cookie's symptoms aren't driving you up a wall, you have plenty of time to research both before making the decision. Hopefully your vet is familiar with both drugs but that can always be remedied with some continuing education on his/her part. I lost both of my cushdogs in the last year and a half but they treated with both Mitotane and Trilsotane and did quite well on both. Of course they didn't take these together.....I switched them at different times after an appropriate washout period. Unfortunately neither grew hair for my little Pom and neither cured my other Pom's polyuria/polydipsia.

3rd, are there any other tests I should demand before medicating?
I have spent over 1100 to date and next week will likely be 2 to 300 more dollars. Cookie is my fur baby and I will find money if need be, but soon I will be borrowing the money for these treatments, etc so I only want to run additional tests if it is absolutely necessary and there is a strong belief it is needed.

If you can afford an acth stimulation test before starting treatment, that's the one I'd recommend as it 1) will validate a positive LDDS and 2) gives you a baseline cortisol to use in assessing the post treatment acth stimulation tests. You can save money on the acth stimulation tests if your vet is open to cooperating. There is no reason why s/he shouldn't so make sure you talk to him/her about splitting the vial of cortrosyn, which is the stimulating agent used in the acth stim test. It is the cost of this agent that makes the stim test so darned expensive. Those members with small dogs can capitalize on this savings. You and your vet can read about this on another Dr. Mark Peterson's blog found here: http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Thank you for reading this lengthy post. I appreciate whatever advice can be given. I am devastated and hoping this does not mean she will pass soon or have a poor quality of life. She has already begun to lose her hearing and also has cataract and uveal cysts so her vision is patchy. I still want her to enjoy life.
Thanks again!

If Cookie is ultimately diagnosed with cushing's, there is every reason to believe that with treatment, barring complications of an expanding pituitary tumor, she can enjoy a good quality of life and live out her expected life span for her breed. I will tell you though that Boston Terriers are a breed that seems to be more at risk for large pituitary tumors and sometimes treatment can hasten growth of these tumors which cause neurological signs.


I'll be looking forward to hearing more about your precious girl.

Glynda

[CookietheBoston]

Thanks everyone for all the kind words and advice. I will definitely try to get my hands on all the lab work and tests, etc. I think I may them to discuss putting off the test until the antibiotics are finished in 1 month. I still question her pills to begin with, as she was put on 2 BP pills and this antibiotic all at once and now she is not eating much and seems tired. I don't know which one is doing it now! I also wonder if she needs 2 BP pills as I know she had high anxiety in the office and wonder if 1 BP pill would be enough for when she is home. These vet places get so big sometimes that you think the little details and thoughts get overlooked. Since my dog is older I am thinking of switching to a smaller more intimate office where they let you visit often when they are hospitalized, let them have their bedding, etc, however I do love the one vet at the group we are at now, he watched her since she was a puppy! The issue is we can't always get him when she is sick, etc. Decisions decisions. i will post more when I get the reports, etc and decide about when to do this Dex test.

Glynda, I dont know if the labs showed infection of kidney as I recall the week prior she told me bloodwork did not show infection so I think they are basing this on Xray and utlrasound shadow of kidney....?

[Trish]

Hi not much help on the cushings side of things but I am on hypertension!!

My vets, local and IMS have both commented that it is unusual for a dog to have primary hypertension such as we humans can get. There is usually something else going on that causes high BP.

My dog has high BP, he was found to have an adrenal tumour. I note you have had an ultrasound done that showed both adrenals to be enlarged. So were Flynn's. But he was found to have a pheochromocytoma which has high BP as one of it's main presenting symptoms. His was up over 200 too.

He has since had surgery to remove this tumour, unfortunately BP has not totally come back to normal which it usually does. His vets think it is because it was so high for so long. So he is on the same meds as Cookie. But benzapril slightly lower at 2.5mg daily and same dose of Amlodipine. It is definitely doing the trick and we monitor it monthly. He is a stressy dog at the vets too, so he has to stay for the day to get it checked a few times so they can average it out which is how they hopefully remove the stress effect from his readings. From what I can tell, he does not have any side effects from these drugs

As Glynda says it could be the cushings causing this BP trouble, but that is pretty high so I would be wanting them to take a very hard look at his adrenals to make sure there is no tumour in there that could be causing this problem. :)

[CookietheBoston]

Hi not much help on the cushings side of things but I am on hypertension!!

My vets, local and IMS have both commented that it is unusual for a dog to have primary hypertension such as we humans can get. There is usually something else going on that causes high BP.

My dog has high BP, he was found to have an adrenal tumour. I note you have had an ultrasound done that showed both adrenals to be enlarged. So were Flynn's. But he was found to have a pheochromocytoma which has high BP as one of it's main presenting symptoms. His was up over 200 too.

He has since had surgery to remove this tumour, unfortunately BP has not totally come back to normal which it usually does. His vets think it is because it was so high for so long. So he is on the same meds as Cookie. But benzapril slightly lower at 2.5mg daily and same dose of Amlodipine. It is definitely doing the trick and we monitor it monthly. He is a stressy dog at the vets too, so he has to stay for the day to get it checked a few times so they can average it out which is how they hopefully remove the stress effect from his readings. From what I can tell, he does not have any side effects from these drugs

As Glynda says it could be the cushings causing this BP trouble, but that is pretty high so I would be wanting them to take a very hard look at his adrenals to make sure there is no tumour in there that could be causing this problem. :)

Trish, thanks for the info. How did Flynn get diagnosed with that definitively? Did they do a CT scan? She had Xray and ultrasound and they only said both were enlarged but that was it. I will also get a copy to see how enlarged. Also, did Flynn have the other cushings symptoms that made them think it was Cushings at first?

Thanks for sharing. I am grateful for this board!

[Trish]

Hi
He had a few cushings symptoms but not the most major ones of drinking, hunger and peeing excessively. He had surgery for liver cancer the previous year so we were monitoring him with scans. His symptoms had never fully resolved, so we also did LDDS which were negative. I think he had 3 ultrasounds over 2012. They finally found it on the one in November 2012 and he had adrenalectomy in December. They said with the benefit of hindsight they could see it very very faintly on his CT before liver surgery Nov 2011. Which is why I suggest they have a very close look at the scans as they can be missed. Flynn's adrenal tumour would have been there on the two earlier ultrasounds and they obviously did not see it because it was so small. But I guess if they had seen it before his liver resection they may well not have done the surgery, so it turned out lucky for us!! His BP had never settled down fully over 2012, kept getting higher and higher which turned out to be the adrenal tumour he had. If it was me, I would get your dog's BP checked soon to make sure it is coming down. If it did happen to be the type of tumour Flynn had, pheochromocytoma then they need a different medication called phenoxybenzamine to get good BP control. He also had protein in his urine, caused by the high BP and its' effect on kidneys, it has righted itself somewhat since we have good BP control now. He also had bulging veins in back of his eyes caused by BP, so get those checked as well. They have also resolved since BP stabilised. Just trying to think of anything that will help on the BP front! Hope that helps :)

[CookietheBoston]

Hi all. We are still in the process of finding out if in fact Cookie has cushings or not. The Low Dose came back normal so now we will be getting a 2nd test, a more detailed ACTH test to see if it is possible Atypical cushings. In the meantime, i am teacher and going back to work next week. I know Cookie cannot make the day without the need to pee, so I was looking on Amazon at the options. The ratings are mixed. I wanted to see if anyone here has had success either with a particular product or building their own makeshift dog pee area. It is too much urine to simply use a wee wee pad so I know I need something more designed for this. I was considering sod in a tray but I live in NJ, so it won't be easy to get this winter. The one that looked best to me on Amazon is "Tinkle Turf" but I am open to feedback or suggestions on what to make. Thank you so much!

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about indoor potty options into Cookie’s 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!

If it has been a while since you logged in here, you may need to search back a few pages to find your original thread.