Ellie

[Susieanna]

Hello everyone, I am writing to you from Australia where my little Ellie has just been diagnosed with Cushings on Sunday 25th August. Since then I have been doing a lot of research on the disease and your blog has been so helpful and informative.
Ellie is a toy poodle cross and my baby. I have very mixed emotions by the news because Ellie has had such a rough time for the last 18 months. It all started when she had to have luxating patella repair surgery on the right leg and then 4 weeks later on the left leg. Both surgeries had problems which resulted in modification surgery on both right and left knees, which for a little dog weighing just 5 kg. was very traumatic.....not to mention myself, looking after her, 4 surgeries, worrying she would never walk again........feeling guilty at putting her through all this.! Anyway it was during this time that she started having muscle spasms in her legs. The vet told me these spasms were probably related to pain and should get better over time as she got stronger and recovered from surgery. She has been on Meloxicam and Zydac injections. She also was on Tramal for pain.
I have been back to the vet for regular check ups continually complaining that Ellie still has muscle spasms and the vet has continually dismissed the issue saying Ellie has low pain tolerance and the spasms were a pain response because she hasn't built up muscle mass to support her knees and needed physio and exercise.
I am sorry to make this a long story. I feel frustrated as I write all this, it seems to have been going on forever ..... the end result being Ellie having more spasms and clearly something else going on and my insistence on investigation. That's when Cushings was first mentioned and she has had the 8 hour test resulting in a positive diagnosis.
I am not allowing this vet to treat her and have asked him to give me a copy of all her records and blood test which I am collecting on Thursday.
I have an appointment with a specialist next Monday
Can anyone please help me with questions to ask?? I have read here that even the 8 hour test could give an incorrect positive result. Should I request a scan??
Symptoms are ravenous, yes yes! But I do not see that she is excessively thirsty and she has not peed in the house. She does have thinning hair around her tummy and it is extended. She has no panting and enjoys her walks. She does not jump up on the sofa as she used to but I put that down to the knee surgery. I also think there has been some muscle wasting.
Thank you all for just being here and I look forward to any info as Ellie and I start deciding what to do next.....
Susan and Ellie

[frijole]

Interesting.. muscle spasms really aren't indicative of cushings. If it were cushings I would think they would have caught it via regular blood panel done prior to surgery and perhaps would not have even done the surgery.

The 8 hr test is called the LDDS and it is prone to false positives when other illnesses are present. Certainly your dog trying to heal from those surgeries could cause it. Do you have results from a recent blood panel? Were the liver enzymes high? (ie alk phos and alt?)

I have to run to work but others will chime in. Glad you found us. Kim

[goldengirl88]

Susieanna:
Sorry to hear about your Ellie. Can you post the results of all the tests you have done? My Tipper gets these muscle contractions also. Also you should try and keep a doggie diary as you will need it to refer back to, and keep copies of all of your tests. There is an ACTH test and a urine test also you can do, and they do an Ultra Sound. If your dog is confirmed to have Cushings find a good vet that has a lot of experience treating it as it will save you time, money and heartache. I wish the best for you and your sweet Ellie. Blessings
Patti

[Junior's Mom]

I hope Ellie is doing well. We will be glad to see those test results you are getting tomorrow.
As this is a difficult disease to diagnose, it is always best to rule out everything else possible first.

[lulusmom]

Hi Susan and welcome to you and Ellie.

I do agree with Kim that muscle spasms aren't on the list of symptoms that are associated with cushing's so i find it a bit odd that it was this this symptom that prompted your vet to pursue a cushing's diagnosis. It's usually the obvious overt symptoms like excessive drinking and peeing, a huge appetite and the usual abnormal values on blood and urine tests. Exactly where is the spasming happening and how does your vet know it's a spasm? One of my cushdogs was a shelter rescue with severe muscle wasting. I don't know what his history was so not sure if prior surgeries would make a difference but he never had muscle spasms as a result of the muscle wasting. He tremored constantly until he regained some muscle mass after being stabilized on treatment. I've had plenty of muscle spasms and they are quite painful. Is Ellie in obvious pain when she is hit with a spasm? Is she on any medication for the pain?

It's a bit difficult to provide a list of questions for you to ask the specialist on Monday because we don't have a clear picture of what's been going on with Ellie. Test results will definitely help but until you can get your hands on those on Thursday, can you tell us if your vet told you if Ellie has pituitary or adrenal dependent cushing's and did he do an abdominal ultrasound?

Glynda

[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! It looks like you're off to a great start! So again, welcome to you and Ellie.:)

[spdd]

Welcome to the forum. If you are looking for answers you've come to the right place. I am not knowledgeable enough to give you any, but I sure have taken direction from people here and as far as I'm concerned it so far has kept "mah boy" from an almost euthanasia.

I don't have all my answers yet and everyone here is helping me much more then I ever expected especially from complete strangers, but they are coming and I'd take direction first from more experienced people on here then most vets. I have now gone through 5 vets until I found someone very experienced with Cushings. The only reason for that is that with the knowledge I gained here, I was telling vets more then what they knew.

The jury is still out on whether my dog really does have it.

I've learned soooooo much and am more grateful to the people on here then any words could ever express.

So, post your test results and you are guaranteed people here will analyze them for you and tell you what they think should be done next.

Good luck with Ellie... give her a belly rub from all of us.

[Susieanna]

Thanks so so much everyone. I am off to the vets today to get Ellie's records and will post later. Susan and Ellie woof wood

[Susieanna]

Hello again to everyone and many thanks for sharing experiences and
interest in little Ellie and her Cushings diagnosis. I have just returned from my regular vet and when I asked him what type of Cushings did she have, he replied that it didn't really matter because the treatment was the same??? If I had stayed with this vet, her treatment would have been Trilostane 5mg capsules, once daily. This vet did think he was going to treat her and he would have started on these meds without a scan!!!! Since I have been on your forum, I have become a
little more informative on the disease and asked him about why he wasn't going to request one be done for her. He was a little vague saying that "Cushings was the most over diagnosed disease in Australia but easily treatable". That is not what I have read here....Anyway, I told him that I wanted Ellie to see a specialist and I have an appointment next Monday.
Her LDDS results are:

Cortisol resting 72
Cortisol 1st post <28
Cortisol 2nd post 99
1st Post Dose
Time 4
2nd Post Dose
Time 8

That was the only test done.

Her medical history does not show a blood test was done prior to her luxating patella surgeries.

She is on Meloxicam daily for pain associated with the muscle spasms which occur in her bicep femoris muscles. The symptoms are a severe contraction of these muscles which I can feel. Relief comes when I massage her little legs! She has seen at least 5-6 vets and no one took these symptoms as anything serious but due to pain response after her 4 surgeries. Maybe since the spasms are getting worse but the vet has
told me that there is no movement in her patella and he feels the surgery was successful, then the question has to be why are her spasms getting worse if the knee surgery has healed. Maybe because she hasn't been able to build up her muscle mass due to the onset of Cushings?? She definitely has muscle shrinkage.

Please forgive me if I have not answered all questions asked from those people who have responded to me. I am not quite sure how to use this forum yet...

Meanwhile I hope that I can get some thoughts on the test results before I go to the specialist on Monday.

Bye for now from Ellie and her mum Susan.

[goldengirl88]

Ellie:
I know I read some where on here that someone thought the spasms were a side effect of the Vetoryl, so if your girl is not yet diagnosed and on Trilostane it can't be coming from that. I was glad to hear you are going to a specialist. Hope everything turns out well. Blessings
Patti

[Susieanna]

Hi Patti thank you for your comment but Ellie was only diagnosed last Sunday based on the 8 day test and so spasms cannot be a response to coming off any meds. Vet said she is a complicated case! Susan

[frijole]

I am glad you are going to a specialist for a 2nd opinion. I don't have time to check/convert the ldds test results but given the 'symptoms' you provided I'm still not sold on cushings and really you don't need to rush into treating it if it is cushing's so... do the tests/ultrasound and get it right. There's nothing that you described to me that sounds 'complicated'... perhaps the vet is just not sure... ??? Anyway you are doing a great job of advocating for your girl. Keep it up. Kim

[goldengirl88]

Ellie:
You are doing a wonderful job on behalf of your baby, keep up the good work. Blessings
Patti

[Squirt's Mom]

Her LDDS results are:

Cortisol resting 72
Cortisol 1st post <28
Cortisol 2nd post 99

I'm not as familiar with all the different units of measurement labs use to know what they are by the numbers alone. So if you would edit this LDDS to include the little letters that follow the numbers (like Mnol/L, etc) I'll be glad to convert it to the units we are used to seeing (ug/dl).

I can tell you that second number looks quite odd to me - it seems to be saying it is below the normal range. IF that is so, then with the post shooting up to 99 something is certainly indicative of a failure to suppress - which is what the LDDS looks for. HOWEVER, the LDDS is notorious for false-positives when there are other conditions present. So you cannot count on this test alone since Ellie is displaying some signs that are not associated with Cushing's like the spasms. Cortisol is the bodies natural response to stress of any kind, including pain, so elevated cortisol does not always mean Cushing's and these other issues can skew the testing. The tests can only tell us that excess cortisol is present, not WHY it's present.

From what I read you need first and foremost a complete blood work up on Ellie - not testing for Cushing's but looking at all other factors like liver and kidney function, thyroid function, BG levels, cholesterol, triglycerides, etc. Then I would definitely want the abdominal ultrasound on a high resolution machine to get a look at the internal organs. This will go a long way toward a diagnosis and provide valuable information regardless of what the diagnosis turns out to be.

Your vet is right in that both forms of true Cushing's are treated the same as far as drugs go. However in ADH, when the tumor is on the adrenal gland, removing the tumor and gland can effect a cure. Adrenal tumors can and are treated via both Lysodren and Vetoryl (Trilostane) as well. There are two other forms that are treated differently. 1) Iatrogenic - which is caused by the use of steroids and is treated by slowly weaning the pup off the steroids if possible, and 2) Atypical - which is a form that does NOT involve elevated cortisol but involves elevations in the intermediate (or sex) hormones and it initially treated via melatonin and lignans, with the possible addition of Lysodren as a maintenance dose only. I would want to know what type my baby had but some don't see that as important.

Keep in mind - this is YOUR baby and YOUR money. You have every right to guide the investigation into what is going on and to refuse anything your vet wants to use or do if you feel it is not the right thing for Ellie. We always say "you know your baby better than anyone else so trust your gut." ;) You have the right to insist certain tests are done and done correctly. You have the right to the copies of those tests every time. The ideal set up is a team that is composed of you, your vet and any specialists that may become involved. And, of course, us! :D

How is Ellie feeling today? Hope you both are able to find some moments of joy in each day.
Hugs,
Leslie and the gang

[goldengirl88]

Just checking in to see how you and your baby are doing? Hope all is well. Blessings
Patti

[Susieanna]

Just checking in to see how you and your baby are doing? Hope all is well. Blessings
Patti

Thank you Patti for checking in on Ellie and I. We are both doing well and enjoying our weekend with Ellie's two rescue sisters. I am taking her to see a specialist tomorrow to see what we need to do next and I will definitely let,you know,outcome. Susan and Ellie woof woof

[goldengirl88]

Ellie:
Great to hear you are going to a specialist. I hope you get some answers and that all turns out well. Blessings
Patti