Lillo

[Lillo]

Hello we are new to the group. Lillo has been diagnosed with Cushing's. He is a 8 year old wonderful long haired chihuahua. We currently are living in Rome, Italy but w are from London, England. Lillo has a complicated medical background. Since he was young around 3 years old he has had so many tests and misdiagnoses that I can barely list. Initially the problem started as he had some seizures. The vet in London back then had done an ECG and said that he had an enlarged heard and he would not live very long. Soon after I moved to New York and took him for thorough testing as the seizures continued. He had bloodwork done which showed some abnormalities in liver enzymes. He then had a full body ultrasound and the verdict was that his heart was an absolutely normal in size and they believed him to have a liver shunt. They wanted to do exploratory surgery but I refused as surgery for liver shunts are a highly risky surgery and can only be done on certain shunts so would be a last resort. When returning back to the UK a year later our family vet (not the one who misdiagnosed an enlarged heart) agreed that the most likely problem was to do with his liver as also her blood work results showed high lipids in his blood. Then his hair started falling out. First his tail then two patches on his shoulder blades. The vet said itwas because of his liver problem. She suspected a hormonal isses but his test results came back negative for those as did all the tests for possible skin allergies. They said he was a medical mystery and they did not know what was wrong with him and as long as he was otherwise healthy and happy to leave him be. I was not happy with this as he clearly had something wrong so when I moved to Italy last winter I registered him with a vet and asked their opinion. As soon as the vet saw him she said he absolutely has some kinid of a hormonal problem and that it is ridiculous to say that he should just be left and she said she would get to the bottom of it. He then had another full body ultrasound and everything was completely normal but his kidneys look possibly very slightly enlarged. Lillo was then tested for thyroid imbalances which was negative then cushing's which also came back negative. The vet said that even if the blood test came back negative she still strongly believed it was cushing's so she did a urine test which came back positive. because she had 2 varying results for cushing's she wasnn't 100% sure so she said she wanted to rule out that it could be a testosterone problem. She put an implant in Lillo's neck which would stop him producing testosterone. After a month there was no change in Lillo's hair and he continued to loose a lot of hair. Now again she did another urine sample and it came back positive for cushing's. She has ordered tablets for him as he is so small so she needed to get the pharmacy to make tablets in a lower dose for him. Lillo doesn't display any other symptoms of Cushing's. Aside from that his appetite has increased a bit in the last few months, not ravenous as i have seen described with other dogs with Cushing's but he now sometimes begs for food when people are eating which he never did before. Also it is in the last few months that his hair is falling out faster. He started losing hair 3 years ago but in the last few months its got much faster. He doesn't drink more and actually he doesn't pee as much as he used to. He used to pee inside the house all the time and wake me in the night to pee, but he hasn't done that even once in months. He also hasn't had a seizure in a long time more than a year at least. I think and the vet here thinks that the seizures are unrelated and he is a small nervous dog, and his seizures have been when he is stressed (before taking a bath, or in a noisy place etc.). He is due to start the cushing's meds on Thursday when the pills arrive. I don't have the information of what medicine it is yet or the results, i will ask the vet for them so I can post them here for your advice. I am so happy to have found this forum as I really don't know too much about this and we have been through so much for years and I just want my little boy to be as happy and healthy as possible. It has been so heartbreaking over the years to be told over and over wrong diagnoses and pessimistic prognosis's for his future, at least if it is Cushings we finally know what is wrong with him and we can treat it. Please let me know what you think of Lillo's story I would really appreciate all your extremely knowledgeable advices.
Kindest regards Angela and Lillo

[Harley PoMMom]

Hi and welcome to you and Lillo,

So sorry for the reasons that brought you here but glad you found us.

It sound like Lillo might of had an UC:CR (urine cortisol:creatinine ratio) test which can not rule in Cushing's but may rule it out. Dogs with Cushing's have increased excretion of cortisol in their urine. This excretion can be compared to creatinine excretion, which should be fairly constant in dogs with normal renal function. However, false positive results can happen when other non-adrenal problems are present.

If you could get copies of all tests that were done on Lillo and post any abnormal values that are listed with the reference ranges and units of measurement that would help us a lot in providing you with more meaningful feedback.

Strong clinical symptoms do play a huge part of a Cushing's diagnosis and it seems that Lillo does not have these obvious symptoms of Cushing's. Cushing's progresses at a snail's pace so if this were me I would not start any medications for Cushing's until a diagnosis can be confirmed.

Please know we will help in any way we can so do not hesitate to ask all the questions you want.

Love and hugs, Lori

[LtlBtyRam]

Sorry to hear about all the problems plaguing you and your baby but the folks around her are super PAWSOME! I'm new here too ;)
Angela

[Lillo]

Thanks Lori and Angela for your replies. I will ask the vet to give me the results for me to post to you. Is it possible for a blood test showing normal levels of cortisol to be wrong? I understand what you say about the urine test not being able to determine cushing's but showing that it wasn't ruling it out. If it is cushing's then Lillo has had it for a minimum of 3 years already and probably much longer. He first had the symmetrical hair loss 3 years ago. I'm worried it is getting worse as he has no hair left on his back or neck at all anymore and in these days clumps are falling from him. He does eat more food then he used to but he is a small dog only 1 1/2 kilos so what is more food for him is of course less then a large dog. He has almost finished a 1.5 kilo bag of dried dog food in a month and I also feed him boiled chicken and other meats with that. Definitely a lot more then before. But he hasn't put on extra weight. I noticed since he moved to Italy he was eating more and he previously would never eat when outside of the house but now he does always eat when we are out in a restaurant or at a friend for dinner. Then he comes home and eats his dried food too. This has happened only since Easter. He used to not be able to control his pee and wake me in the night, but this stopped around the same time as he started eating more around Easter. Can symptoms change like that? His tummy is a little rounder but not pot bellied. I am worried things will get worse if he doesn't start medicine as he has deteriorated so much since Easter with his coat and I worry its a sign that things are worse. I will let you know the results when I get them. Thanks again for your replies.
Angela and Lillo

[LtlBtyRam]

I'll be watching for more news of you and Lillo. Hang in there. I know it's rough.
Angela

[Harley PoMMom]

I sure do wish there was a test for Cushing's that was 100% accurate at diagnosing it but unfortunately there is not.

I'm providing this quote to another member from one of our Administrators decribing the ACTH and LDDS tests:
Welcome from me, too!


As far as which blood test to request, there are pros-and-cons to both the ACTH and the LDDS. As Kim says, a benefit of the LDDS is that a positive result can also sometimes help differentiate between the two forms of Cushing's. The ACTH cannot do that. On the other hand, the ACTH is less likely to return a "false positive" if a dog is suffering from a different illness other than Cushing's. So for a dog with questionable symptoms for whom you'd prefer to err on the side of caution before beginning treatment, the ACTH may be the preferable test. The downside, though, is that the ACTH is also more likely to miss properly identifying a dog who truly does have Cushing's. So the ACTH is the more "specific" test (less likely to give a false positive), while the LDDS is the more "sensitive" test (less likely to give a false negative). Confusing enough?? :o

For what it's worth, here's a decision-making chart that I've always found helpful in deciding which test to start off with. It is a set of testing recommendations given by Dr. Rhett Nichols (http://www.k9cushings.com/forum/showthread.php?t=210):
Marianne

Hope this helps. ;)

Love and hugs, Lori

[molly muffin]

Hello and welcome to the forum.

UC:CR definitely cannot confirm cushings. In light of the previous testing for cushings being negative and then the implant to prevent testosterone production, I wonder if this could play a part in any subsequent cortisol production which could show up in his urine.

There is a type of cushings, called Atypical Cushings, where the cortisol is NOT elevated but the other hormones could be. The only place that does the testing for this is University of Tennessee in the US.

You draw a regular ACTH and then it is sent to U of Tenn for testing. It is possible that your vet might contact them and get their opinion on the case as I am not really on board with a full cushings diagnosis without proper testing for it, LDDS or ACTH, and ultrasound of internal organs, specifically liver/adrenal glands, if that is an option for you. We might see more cushings type results in the lab results when you can get them and post. (only the abnormal high/low with range is needed and any cushings specific tests, to include urinalysis showing specific gravity, protein, etc). That would be a good place for us to start.

The hair loss does sound hormonal possibly in nature if thyroid and diabetes have been ruled out. That he is showing no cushings symptoms, is one of the things that raise a question in my mind.

Welcome to the forum!
Sharlene and Molly Muffin

[Lillo]

Hi there, the vet finally emailed me Lillo's test results. They are in PDF format, how can I post them? Sorry for not getting back to you all sooner we were away for the weekend in San Marino which Lillo loved!
all the best Angela and Lillo x

[Squirt's Mom]

If you would post only the abnormal values - too high or too low - on the CBC (the one that shows things like ALP, BUN, etc. - along with the little letters that follow each and the normal range for each. It will look something like this -

ALP 900 150-300 ug/dl

Then give all the info on any tests called LDDS, HDDS, ACTH or UC:CR plus all comments on any ultrasound she has had.

Thanks!

[Lillo]

OK here goes...it doesnt really make a lot of sence to me and its in Italian.

From what i can tell the first test seems to be for proteins listing things such as Albumina, Alfa 1, Alfa 2, Beta 1 & 2 and Gamma - he is within the range of all the results.

The next test says Hormonal at the top and tests Cortisolo at Base then post ACTH. Both in the range. 3.3 1.0-5.0 mcg/dl (Base) and 12.7 6.0-18.0 mcg/dl (post ACTH)

Next test is called Emogramma. Abnormal results as follows:

Monociti 1070.0 200-740 /ul (its a symbol not a u exactly but i don't have it on my keyboard!)

Eosinofili 107.0 150-1100 /ul

PLT 639 150-460 1000/ul
MPV 8.7 9,6-18 fL
LPLT 14 50 1000/ul

Next test is Profilo Biochimico

AST (IU/L) 71 10-45
ALT (IU/L) 202 10-60
ALP (IU/L) 164 30-130

Trigliceridi (mg/dl) 167 30-95
UREA (mg/dl) 49 15-45
Proteina C Reatt. (mg/dl) 0,36 0,01-0,35

Please let me know what you think.

Kindest Regards,

Lillo and I really appreciate all you your help and advices

[frijole]

You got me confused. If you look at the cortisol (acth) test it is NOT positive for cushings. The numbers (there are two of them) are both within the range of normal which means the cortisol is not elevated which means it is not cushings.

What test made your vet diagnose your dog as having cushings?

Also the alkp is only mildly elevated but the ALT is higher than normal. With cush dogs it is the alkphos that is high, often in the 1000's.

My take is your dog does not have cushings. Kim

[molly muffin]

I agree, not cushings, with a normal ACTH test and no symptoms of cushings, it doesn't even make sense to think that it is.

However, with the platelets raised, etc, there is something going on and I'm thinking an ultrasound if it is possible might be worthwhile to have checked out.

hugs,
Sharlene and Molly Muffin

[frijole]

Thanks Sharlene - I should have mentioned that I agree something is off with the blood results but again - it is not cushings because the acth test proves that the cortisol levels are normal which means no cushings. I'm just trying to understand why the vet said it was cushings after that test. :confused::confused::confused::confused: Kim

[molly muffin]

Probably a vet with not a lot of experience with cushings disease is my guess.

I swear cushings is the fad diagnosis these days, whether they have it or not. I think vets need to be more discerning in their diagnostic processes.

:(

yea, I know what you mean Kim, something is up, but no idea where the vet got the cushings idea. Nothing supports it.

What other options do you have Angela? Will your vet be okay to try and pursue what is really going on and leave the cushings out of the equation?

Sharlene and Molly Muffin

[Lillo]

Hi there,
I mentioned before that the vet said the blood test came back in the normal range but she said that a false negative is possible and she still suspected cushings. Then she did a urine test which came back positive in June. After this in June to rule out testosterone issues she gave him the implant to block testosterone production. As this didn't help after one month and he was also negative for a thyroid problem she said she it is cushings. She did not want to start him on medication as we were about to go to Croatia for a month and she said to wait till we returned the end of August. Whe we were away his hair fell out at a much faster rate and he has been eating more but not particularly drinking any more. He has always peed a lot so it's hard to tell. When we came back to Rome the end of August the vet did a urine test again and said it was still positive for cushings and she wanted to start the medication. She ordered a smaller dose as it had to be made up for him. It is ready tonight. I am of course extremely worried as I hope he is not being mia diagnosed. What happens if he takes the medication and he doesn't have cushings? Is it dangerous? I told my vet my concerns even back in June when she had conflicting cushings results but she insists and says she is positive it is this. I suspect as she always insisted it was hormonal and ruled out thyroid and testosterone imbalances she was left with only cushings. Are there any other hormonal issues which would make his hair fall out symmetrically, on his tail and back of his legs? He had an ultrasound already and all was notmal, she said his kidneys looked a little bigger possibly. She said he is too small to be able to see a tumor to prove cushings, he is a small dog only just over 1 1/2 kilos. He has had every test under the sun in the last 6 years. The vet never knows what's wrong with him. I just hope the vet is not just desperate to diagnose something and is getting it wrong.
So worried
Thanks for your help
Angela

[Trish]

Hi there

I am no expert on cushings but your post worries me. If the blood tests are showing normal cortisol then that would suggest to me that medication to lower his cortisol would be dangerous. I know the others more knowledgeable than me will be on later but in the meantime please do not give him the drugs until you have their opinion.

As I understand often quite a few tests are needed before a firm diagnosis of cushings can be made. I would hate for you to give this drug and your Lillo to have complications from this treatment which can be dangerous if not administered appropriately.

Has your dog been spayed? I am wondering why your vet gave him a testosterone implant? A blood test can be done to evaluate testosterone levels. Testicles make 90% of testosterone and the adrenals 10% in humans and I am presuming it is similar in dogs, but would have to google to be sure. These implants block testosterone from testicles but not the small amount the adrenals are still producing, so it is not a 100% blockade with the implant without adding other drugs. So if a dog has been spayed an implant would not do much in lowering testosterone levels. I hope your vet did not just give an implant to lower testosterone in the hope it could work. One side effect of the implant is weight gain, which could explain why he was more hungry at that time.

I do not think it is good to give cushings drugs based on a urine test that is prone to false positives PLUS a normal ACTH. If your vet still thinks it could be cushings then further testing such as LDDS should be done. I think it would be very dangerous to test her theory that he has cushings by giving these drugs in the hope it would work. Is your vet a specialist or a local GP type of vet, if it is the latter I would suggest you should consider getting a specialists advice and do not give the drugs until you and the vets are positive it is cushings you are dealing with. Good LUck and hope your cute little Lillo is feeling better soon. :)

[Lillo]

Thanks for the advice. I am going to go and see the vet again tonight and to talk to her fully about the results and to find out why she is so convinced it is cushings. He has not been neutered so this is why she wanted to try the implant. She said if his hair started to grow back with the implant then it would prove its a testosterone problem and after the implant started to ware off within a year he would have to be neutered. He has had no improvement with the implant and has not changed at all with other dogs (still persistently marks territory, growls at males etc). His appetite increased a long time before the implant so it's not that. For years they thought it was his liver, but on the ultrasound his liver is absolutely fine. I am so confused. I really want to find the cause before he deteriorates. He is seemingly otherwise fit, energetic and healthy. He loves to go outside, loves to walk but I've noticed after a strenuous day at the beach, at the lake or out somewhere for a long time he is very tired and sleeps the whole next day. I'm not sure if he is more tired than normal or not as I've been with him a lot in these months as I'm not working at the moment so as a consequence he's been out and about with me a lot which he loves but maybe it's too strenuous for him? Are Cushing dogs more prone to tiredness?
Thanks again for all your help and advice,
Love Lillo and angela

[Squirt's Mom]

AST (IU/L) 71 10-45
ALT (IU/L) 202 10-60
ALP (IU/L) 164 30-130

These are all liver values and all are elevated which would tell me the liver needs to be investigated in much more depth before I gave this drug to my baby. Liver disease is just one of MANY conditions that mimic Cushing's and cause false-positives on the tests. If Lillo has not had an abdominal ultrasound performed with a high resolution machine recently, I would have that done asap.

I add my concerned voice to those who have already spoken about your vet's Cushing's experience and understanding. This is not a disease to "guess" at and the drugs used to treat it are very powerful so to prescribe them based on a guess is irresponsible in my book.

I am not seeing where you say which drug has been prescribed but here is something you need to know - Trilostane (Vetoryl) should never, EVER be given to a pup who does not have Cushing's so if this is the drug your vet has ordered for Fang based on a guess and negative ACTH, I would get my babies records and RUN to a new vet asap.

Please know that Cushing's is not typically something that needs to be rushed to treat - it is a very slowly progressing condition so you have time to remove all doubt about this diagnosis BEFORE you ever put one bit of this drug in his system. Taking time to make sure at the beginning is much better for you and for your baby than taking a risk and finding out OOPS! he didn't have Cushing's after all. ;)

I'm glad you found us and look forward to following Fang's journey. You and Fang are family here now and we are happy to have you! You will never be alone again; we will be here every step of the way. Never hesitate to ask questions and we will do our best to answer.

Hugs,
Leslie and the gang

[Lillo]

Hi Lesley and everyone,
I have decided to make an appointment for tomorrow with the vet and discuss everything thoroughly as I agree absolutely with you and don't want to give him medicine until I am absolutely convinced it is for the correct illness! He had an ultrasound but I don't know if its the high res one that you mentioned, I will ask buy I am not sure they are as advanced here as in the states. He had an ultrasound in NY around 6 years ago and that is when they first started talking about liver shunts. They could not find one on the uptrasound so said it could be hidden behind an organ or a vesicular shunt but I didn't want to do exploratory surgery then my vet in the UK said if it is a shunt the survival rate for surgery is only 30% so it is done as a last resort. Again he has no other signs of liver damage. And the vet here said his liver looks absolutely fine on ultra sound. I really don't know what to do. I will talk to the vet tomorrow and let you all know. But I don't start mess until absolutely sure.
Thanks for your care and advice it means a lot
Angela and Lillo xxx

[Lillo]

ok so I managed to see the vet tonight. I told her my concerns and she said she was sure it was cushings as she ruled out the only other possibilities of Thyroid and Testosterone imbalances. She said even if the blood test sows a normal range of Cortisol it is not always accurate as it goes up and down depending when he was tested it could've been a low period. She said the urine test showed an extremely high cortisol count. This is true. The results are as follows:

Profilo endocrino
Cortisolo/Creatinina urinari Det. 10 Risultato 25.0 Min 2.5 Max 12.9

That seems to be a extremely high result? This test was done in 14th of June then again now at the end of August and it came back the same.

She wants to start Lillo on medication and has given me Vetoryl strength 5mg. she said this was a really low dose, but I said I had read that dogs should start 1mg per kilo in weight. Lillo is around 2 kilos. She said that it is not true for dogs who are under 3 kilos and the dose is 10mg for all dogs under 3 kilos but she has halved the amount for Lillo. Does this sound correct?

I asked her what happens if Lillo takes the medicine and he does not have Cushings. She said nothing will happen. Is this true? She said he will have a blood test in 15 days and if his base cortisol is lower then before she will take him off the medication. She said to me your dog is dying, if he is left alone he will die. His liver is already showing damage. My recommendation is to start treatment immediately. She said his Surreni (adrenal glands) are larger than normal size on the ultrasound and that she saw it was written in his notes of a previous ultrasound too. In his notes from this last ultrasound all is normal apart from his liver larger and also his adrenal glands. It says in Italian - lievemente aumentato simmetrico bilaterale delle dimensioni (6,5mm ca); morfologia conservata; parenchima leggermente disomogeneo.
the diagnosis says - "considerare accertamenti funzionali della attivita surrenalica. quadro epatico e renale compatibile con degenerazaone."
Translated roughly to:
Slightly increased bilaterally symmetrical size (6.5 mm approx); morphology preserved; parenchyma slightly uneven.
the diagnosis says - "considering practical tests of adrenal activity. framework liver and kidney compatible with degeneration.".

I just looked through all the notes I brought of Lillo"s medical history since 2005. In August 2010 was when we first took him to the vet re hair loss first his tail then by October 2010 started the symmetric alopecia on his neck. His ALT is high in his whole history.

Please tell me what you think,

We appreciate your help...

Now pretty desperate
angela and Lillo xx

[Junior's Mom]

Hi Angella, I know you are very worried about Lillo. Your vet is wrong to tell you your dog will die if you don't treat cushings immediately. The vet is also wrong to say nothing will happen if you give the medication, and Lillo doesn't have cushings.
Also, the lowest vetoryl comes in is 10mg. To get 5mg, it would have to be compounded. You cannot open and split the vetoryl capsules, so I hope your vet has not been planning on doing this.
Lillo's cortisol test showed normal levels, not cushings. If the medication is given, the levels will drop, possibly too low, causing an addisons crisis.
There seems to be something going on with Lillo, according to the symptoms you see, and the ultrasound. Maybe the testing is being done incorrectly? I'm not an expert, so I can't offer much help. Other members will answer you soon, with more more knowledge than I have.
I am wondering if a complete hormone panel should be done? It can only be done in one place in the states. They could tell your vet how. With high liver values, you could supplement with milk thistle, sam-e, hepato support etc. The vet should be able to get you this, or you could find it online.
I hope you are able to find answers soon, and get to the bottom of whats going on with your baby.

[Harley PoMMom]

Hi Angela,

In a previous post you mentioned that Lillo could have a liver shunt, was this diagnosis confirmed? Was a bile acid test performed to see how Lillo's liver is functioning?

The test that was performed on Lillo's urine, I believe was an UC:CR, and this test can be falsely elevated from any non-adrenal illness.

I believe that questions regarding Lillo's liver should be answered before any diagnosis and/or treatment for Cushing's are carried out.

Hugs, Lori

[frijole]

I'm still not sold that it is cushings. That urine test cannot diagnose cushings it can only rule it OUT. I disagree that nothing can happen if she takes the drug and doesn't have cushings. Do you have any other vets you could go to for a 2nd opinion like specialists or a teaching university vet?

I agree - I'd worry about the liver. Again, its the alk phos that is usually elevated in cush dogs. ALT is your dog's biggest issue.

Kim

[Squirt's Mom]

ok so I managed to see the vet tonight. I told her my concerns and she said she was sure it was cushings as she ruled out the only other possibilities of Thyroid and Testosterone imbalances.

This is absolutely false. There are countless things that present just like Cushing's, that cause false positives on the tests, yet are NOT Cushing's.

She said even if the blood test sows a normal range of Cortisol it is not always accurate as it goes up and down depending when he was tested it could've been a low period.

Per one of our Admins - "Dogs with adrenal tumors routinely yield false negative ACTH stim test results. It's because a sizable number of dogs with hyperadrenocorticism (Cushing's) will test negative on a stim, that the ACTH has fallen out of favor with many specialists as a diagnostic tool. Dr. Edward Feldman is one specialist who doesn't recommend it."

She said the urine test showed an extremely high cortisol count. This is true. The results are as follows:

Profilo endocrino
Cortisolo/Creatinina urinari Det. 10 Risultato 25.0 Min 2.5 Max 12.9

The UC:CR cannot diagnose Cushing's. It can only rule it out. If the UC:CR comes back abnormal, that simply means something is off and further testing is needed but it does NOT necessarily mean Cushing's.

In a cush pup, we typically see LOW results on the UC:CR, not high.

That seems to be a extremely high result? This test was done in 14th of June then again now at the end of August and it came back the same.

She wants to start Lillo on medication and has given me Vetoryl strength 5mg. she said this was a really low dose, but I said I had read that dogs should start 1mg per kilo in weight. Lillo is around 2 kilos. She said that it is not true for dogs who are under 3 kilos and the dose is 10mg for all dogs under 3 kilos but she has halved the amount for Lillo.

This is absolutely false.

Does this sound correct?

No, this is NOT correct.

I asked her what happens if Lillo takes the medicine and he does not have Cushings. She said nothing will happen. Is this true?

NO. This is not true.

She said he will have a blood test in 15 days and if his base cortisol is lower then before she will take him off the medication. She said to me your dog is dying, if he is left alone he will die.

This is cruel and unfounded based on the testing done so far.

His liver is already showing damage.

Based on the labs, the liver needs to be looked into very, very closely. Liver disease mimics Cushing's.

My recommendation is to start treatment immediately.

Her recommendation is dangerous and scary.

She said his Surreni (adrenal glands) are larger than normal size on the ultrasound and that she saw it was written in his notes of a previous ultrasound too. In his notes from this last ultrasound all is normal apart from his liver larger and also his adrenal glands.

Many, many things can cause the adrenals to enlarge that have nothing to do with Cushing's.

It says in Italian - lievemente aumentato simmetrico bilaterale delle dimensioni (6,5mm ca); morfologia conservata; parenchima leggermente disomogeneo.
the diagnosis says - "considerare accertamenti funzionali della attivita surrenalica. quadro epatico e renale compatibile con degenerazaone."
Translated roughly to:
Slightly increased bilaterally symmetrical size (6.5 mm approx); morphology preserved; parenchyma slightly uneven.
the diagnosis says - "considering practical tests of adrenal activity. framework liver and kidney compatible with degeneration.".

I just looked through all the notes I brought of Lillo"s medical history since 2005. In August 2010 was when we first took him to the vet re hair loss first his tail then by October 2010 started the symmetric alopecia on his neck. His ALT is high in his whole history.

Please tell me what you think,

I think your vet does not understand Cushing's nor the drugs used to treat it which makes this vet less than desirable.

We appreciate your help...

Now pretty desperate
angela and Lillo xx

I don't know what the availability of vets is where you are, but if you have other vets you can take your baby to see, I would be going there as fast as I could run. If you have an IMS (Internal Medicine Specialist) that is who I would get an appt with. I would take that medicine back to the vet and make them give me a refund today. There is no way under the sun I would give Trilo (or Lysodren for that matter) Lillo if she were mine, no way. The ACTH is FALSE - it says she does not have Cushing's. In spite of a confusing picture, this vet has done very little to determine the possible causes - they seem to have decided this IS Cushing's in spite of little evidence to support that theory...they seem to have developed tunnel vision, or simply do not care to learn about this disease. Lillo may actually have Cushing's but based on the testing done so far, that is not a firm conclusion and to start treatment is extremely risky in my book. In my opinion, this vet is much more scarey and dangerous than Cushing's. ;)

I'm sorry to sound so harsh but I am very concerned about the care Lillo is getting from her current vet and would strongly recommend you find another vet, preferably an IMS, asap. An IMS will be more expensive but they also have much more training and experience than a GP vet, no matter how good that GP is. ;)

Hugs,
Leslie and the gang

[Lillo]

Thank you all again for all your replies.

I have not given Lillo any medicine yet and will not until I am satisfied that he has a correct diagnoses.

I emailed his long term vet in london (also another friend's vet in London and Lillo's breeder who is very knowledgeable about chihuahua's so I thought I'd ask him too what he thought and to see if he had any experience with Cushing's as he has been breeding for over 30 years) with a full description as follows:


We have been taking Lillo to your practice most of his life. He was seeing Catherine until we moved to Italy in April. My mum said Catherine has gone away to do a masters and that she was told to tell me to email the practice with regards to Lillo. Lillo has had an undetermined illness for some time now. In your records you can see he has had a history of liver abnormalities and has had hair loss for some time. First his tail then symmetrically on his torso and the rear of his back legs since 2010. Catherine put it down to something hormonal/his liver but was never able to determine or treat the condition. Since moving to Italy in april his hair loss has continually deteriorated. His new vet here said she did not want to just leave his condition and wanted to find out and treat what he has. Blood tests were conducted first. These showed the following abnormalities:

Monociti 1070.0 200-740 /ul (its a symbol not a u exactly but i don't have it on my keyboard!)

Eosinofili 107.0 150-1100 /ul

PLT 639 150-460 1000/ul
MPV 8.7 9,6-18 fL
LPLT 14 50 1000/ul

Next test is Profilo Biochimico

AST (IU/L) 71 10-45
ALT (IU/L) 202 10-60
ALP (IU/L) 164 30-130

Trigliceridi (mg/dl) 167 30-95
UREA (mg/dl) 49 15-45
Proteina C Reatt. (mg/dl) 0,36 0,01-0,35

From what I can tell this next blood test seems to be for proteins listing things such as Albumina, Alfa 1, Alfa 2, Beta 1 & 2 and Gamma - he is within the range of all the results.

The third test says Hormonal at the top and tests Cortisolo at Base then post ACTH. Both in the range. 3.3 1.0-5.0 mcg/dl (Base) and 12.7 6.0-18.0 mcg/dl (post ACTH)

Even though the third test shows levels within the normal range of cortesol levels the Italian vet strongly believes Lillo has Cushing's Syndrome. She said she believes this because in her opinion he has to have one of three things - a thyroid problem, a testosterone problem or Cushing's Syndrome. She tested for Thyroid and it came back negative. then to rule out a testosterone problem she gave Lillo an implant to block testosterone production. There was no change in Lillo and his hair continued to fall out the following 2 months so she ruled out a testosterone problem.

He in the interim had a urine sample which showed a high level of cortesol:

Profilo endocrino
Cortisolo/Creatinina urinari Det. 10 Risultato 25.0 Min 2.5 Max 12.9

The vet also had an ultrasound done. This showed a slightly larger liver but nothing too worrisome. Then they found his adrenal glands were enlarged, thus supporting the Cushing's Syndrome suspicion. The rough translation of results as follows "Slightly increased bilaterally symmetrical size (6.5 mm approx); morphology preserved; parenchyma slightly uneven.
the diagnosis says - "considering practical tests of adrenal activity. framework liver and kidney compatible with degeneration.".

She wants to start Lillo on medication for Cushing's and has given me Vetoryl strength 5mg. She said this was a really low dose, but I said I had read that dogs should start 1mg per kilo in weight. Lillo is around 2 kilos. She said that it is not true for dogs who are under 3 kilos and the dose is 10mg for all dogs under 3 kilos but she has halved the amount for Lillo. Does this sound correct?

I asked her what happens if Lillo takes the medicine and he does not have Cushings. She said nothing will happen. Is this true? She said he will have a blood test in 15 days and if his base cortisol is lower then before she will take him off the medication.

Please give me your advise on what I should do. Should I give Lillo the medicine for Cushing's even if we are not 100% sure he has this? He doesn't have strong Cushing's symptoms. His appetite has significantly increased since around April but not "ravenous". He doesn't drink a huge amount. He has always peed a lot but has actually got better, he no longer pees in the house or wakes me up at night to pee which he used to for years. He doesn't seem to have a pot belly. He is energetic and is always up for going out for walks but I have noticed after a particularly strenuous day eg at the beach he is very tired the next day...but so am I! He has always slept a lot most chihuahuas do though when there is nothing fun happening.

The problem is that this longterm vet in London did not manage to find out what was wrong with Lillo and said he was a medical mystery and to do nothing. I am not happy with that either. Lillo has been to see so many vets in his life and ALL have proved to be useless. There is no difference in vets in Italy as far as I know..GP or the other that Lesley mentioned. I will do some research now to see what i can find out about specialist vets in Rome. I am sure that they are not as advanced here as in America though. Even the person who did his ultrasound was trained by someone who was trained in America! a bloody disaster!

I will keep you posted.

Thanks again for all of your help

All the best
Angela and Lillo

[Lillo]

Update-

Today I went to another veterinary surgery for a second opinion with all of Lillo's history and test results. The vet wants to do all of the testing again including another ultrasound. I said that I don't want to do this as it is not only extremely expensive but so stressful for Lillo and i do not want to put him unnecessarily through all the testing again. So I agreed to do first the test they suggested to see first wether or not he has Cushings. He said it is an all day test called a "dexamethasone suppression test". He is scheduled to have this test on Tuesday. They told me this will tell us for sure if he has cushings or not. Is this true? They said that the last vet did the cortisol blood test on Lillo wrong as it should be done at 8 in the morning and Lillo had it done around 11 in the morning. They said it makes a big difference. Is this true?
Then they listened to his heart and said he has a severe heart murmur and did I know this. No one has ever said this before. When I left the vet i was in floods of tears. They said this is another thing on top of Cushings if he even has Cushings and he should see their cardiologist on Thursday. Then they charged me 40 euros which I said fine, but i have never been previously charged for an initial consultation before to which the main vet was awfully rude to me. I wanted to tell him to get stuffed and walk out but I am so concerned for Lillo that I paid and didn't say anything. This vet practice is bigger, is a 24 hour vet and does everything on site-ultrusound surgery etc. But after the main vets treatment of us in an obviously stressful situation i don't know if I trust this practice. Plus I don't like that they want to repeat all the tests that we have just done it doesn't make any sense to me. God I wish there was a good vet who I trusted its such a shame i can't go to one of your vets. I'm emailing my London vet again now to see wether there is anything anywhere written about a heart murmur in Lillo's history. Have any of you heard anything about cushings causing a heart murmurs? feeling so sad, so overwhelmed and trying not to lose hope. Lillo seems so happy and healthy aside from his hair. I just don't get it.

[Lillo]

when i was crying in the car he was licking my hands as he always does if i cry. it breaks my heart....

[spdd]

Getting a good vet seems endless, and here where I am it's been almost impossible for me. I've gone through 5 now and have had to settle for a vet with over 30 yrs practice but knows nothing about Cushings. I actually tell him how to do the testing, what hours etc. either that or I get an IMS to tell him. It's stressful if you don't know if or when it's being done right. His testing came out positive, I take him 2 weeks later to an IMS and he's negative. I just shake my head and plod on.

I'll tell you the same thing I just wrote on another thread. We are all overwhelmed when we first find out, tears come so easily and their immortality rears it's ugly head. After the initial shock, and thanks to this forum, all stops are pulled out and we get the proper direction to take. I've been through the ringer with "mah boy" and cried endlessly for awhile, but it does get a bit easier and the focus on getting them treated takes over.

Keep you chin up... sit back and take a few deep breaths. The people on here know exactly what they are doing and for the life of me I can't figure out why they aren't in full time practice. ( I know they need to go to vet college ) They know far more then most vets. Their knowledge is astounding, and always right.

Remember we've been there too and know exactly how you feel....so don't worry about the tears... we have shoulders and that's what they are used for. It's precious to read about him licking your hands when you cried. Aren't pets just the be all and end all....

[molly muffin]

Awwww, no worries, we share our tears here and some days they are many and others are few. We also share our smiles and funny stories. :)

Yes, some dogs do have heart murmurs. I don't know if cushings causes it or not.

The LDDS test is what the specialist (vet you saw today) is talking about doing, and it is an 8 hour test. I've had that done a few times, and so far, even though for us, we have a positive ACTH, where you have a negative, our LDDS test has always been negative. A negative ACTH, which you already had shows that there is no excess cortisol in the body, nor is there any in reserve in the adrenal glands to be dumped out after they receive the injection. That is why we always advise not to treat with a Negative ACTH, because there is a risk of then going way to low on cortisol, if it's not there to begin with. So it is strange then that the UC:CR does show cortisol, but again, this vet said that test was done incorrectly.

Hang in there. It's not dire yet, we just keep plugging along till we find answers. One way or another.

Lillo is just so sweet. :)

hugs,
Sharlene and Molly Muffin

[Lillo]

thanks guys for your kind words. I heard back from the main vet in our family vet practice in London as my mum went to see him to discuss Lillo. I emailed him as I told you all with all the test results and description of whats been going on. He immediately said exactly what all of you said that he doesn't believe it is cushings at all based on the results and symptoms. He was furious that the vet wanted to start medicine and said that is far too high a dose anyway for Lillo's size. He said he thinks it sounds far more like a problem called "Growth Hormone-Responsive Dermatoses". Reading up on this now it really does sound more like what Lillo has. the hair loss symptoms sound similar to Cushings which is why maybe the 2 can be mixed up in diagnosis.
Baldness on both sides of the torso, neck, and insides and backs of the thighs, on the tail, on the underside of the abdomen, under the tail, and on the ears
Hair present on the head and legs
Hair easily comes out
Tufts of hair regrowth at injury or tissue sampling sites

Lillo has all of these. And I thought it was strange that he grew tufts of hair where he had a procedure carried out. For example where he had the chip for the testosterone implant put in a couple of months ago he has a huge tuft of hair.

I am waiting to receive an email from our family London vet with directions of what he thinks should be done re testing. My mum thinks maybe I should take Lillo back to London to her. I don't want to part from him so will see if I can do things from here first.

On the positive side if it is this that Lillo has it doesn't affect the health of the dog just his appearance. Then I have just to worry about this apparent heart murmur they found yesterday. It feels never ending. I feel a little more hope today. We really haven't had an easy time Lillo has been misdiagnosed throughout his life its so disappointing and terrifying. It really makes you think if vets make so many mistakes then surely doctors do too...just terrifying.
We send much love to you all xxx

[Lillo]

PS I just wanted to say that I am so glad I found you all as if I had not been reading info on this site and discussed with you all I would have been none the wiser and trusted the vets opinion and started cushings medication. The only reason we did not already start in July was because we were going to Croatia on a long vacation. Thank god I found you! really a blessing...

[frijole]

THanks, we are glad you found us too.. I had the same experience - a vet that was clueless and likewise it made me wake up and realize we have to ask the same questions of our human docs prior to blindly following their advice because mistakes happen. Do keep us posted on your progress. Kim

[Lillo]

Yes a lot of questions I think is a good idea!

My vet from the uk emailed me saying:

"Thank you for your e-mails. The situation is rather complex, and it is difficult to make a diagnosis from a distance, but I will try to offer some advice.

First of all, I don’t think that there is evidence to say that Lillo has Cushing’s syndrome. The ACTH stimulation test is giving normal results. Although it is important to run a dexamethasone suppression test at the right time in the morning, the ACTH stimulation test can be run at any time without the results being affected. There is no test that is 100% reliable for Cushings, but the ALP is not as high as I would have expected in a case of Cushings and so I would say that the result is reliable. The measurement of the adrenal size is also within our normal parameters.

It could be quite dangerous to treat with trilostane if Lillo doesn’t have Cushing’s syndrome, and even more dangerous to overdose. We would normally start a dog on 3 to 6mg/kg. The smallest capsule that we have in this country is 10mg and, as the drug can affect people, it is not safe to split a capsule at home. There are some specialist pharmacies that can reformulate medicines.

There was a previous, conflicting, history from when Lillo was in the USA about his heart, but we scanned the heart in 2006 and found no abnormalities. We have not noted any cardiac murmur, but they can develop quite quickly in small dogs.

As to the skin, our next step in diagnosis would be to take a skin biopsy under local anaesthetic. The sort of conditions it might be, provided the hypothyroidism has been excluded, would include follicular dysplasia (which is untreatable) or alopecia X (which can be treated with trilostane, but is quite rare and mainly occurs in Pomeranians). I wonder if there is a veterinary dermatologist that you could ask to see Lillo."

This means first of all the new Italian vet I went to see yesterday who told me that if the ACTH test is not done first thing in the morning its wrong was total rubbish...meaning now I have even less trust in them! The last part of Dr Young's email says it could be Alopecia X (which is what I wrote to you earlier, the condition otherwise known as growth hormone-responsive dermatosis. The really interesting thing is it is treated with Vetoryl! Well if Lillo does turn out to have Alopecia X then seeing as it is not harmful I would probably decide not to give him Vetoryl because of possible side affects.

How extremely bloody complicated this all is. I asked Dr Young if he thinks I should ask the Italian vet to carry out a skin biopsy instead of
the dexamethasone suppression test, and what he thought about Lillo seeing a cardiologist next week as recommended by the Italian vet...lets see. I wish he could see Dr Young. This is so frustrating....

[goldengirl88]

Welcome and glad you found us. Oh you are the luckiest to live in Rome. I hope the Dex test gives you some firm answers. My dog unfortunately developed a heart murmur from the Cushings. I hope you get some concrete answers. What a cute little baby in the avatar picture. Blessings
Patti

[Lillo]

Thanks Patti, ps love toppers sunglasses!

Dr Young my London vet has got back to me and said after looking at the photos I sent of Lillo and the description he thinks it is likely to be Alopecia X that he has. He said however to do cardio exams before further investigating the skin issue as a sedation will be required for the skin autopsy which would interfere with the cardio results.

He says there is non sense in doing the dexamethasone suppression test when the ACTH stimulation test has given a negative result and the scan has shown normal adrenal size. So I will go with him on that, especially as Lillo doesn't really show other Cushings signs.

Has anyone here done a skin autopsy before? How invasive is it? I am assuming they need to cut a piece of skin away as they give a local anaesthetic? that is terrifying. Poor Lillo. I wish i could do it instead of him, he has such a tiny little body :-(

Im praying for a good cardio result. Will let you all know.....

Thank you all so much for your support,

Love Angi and Lillo xxx he is fast asleep next to me on the bed...tomorrow we are going to Bologna for the weekend...he loves tortellini so he'll be in for a treat as thats what Bologna is famous for!!!

[Squirt's Mom]

My Squirt had a skin biopsy done years ago and it was no big deal. They didn't even sedate her and it didn't seem to bother her. They had this instrument that sort of pinched a very tiny section of skin off. The spot bled maybe one drop and that was it. Squirt didn't even flinch when they took the sample so I hope it goes as well for Lillo.

[Lillo]

thanks Leslie thats a huge relief to know. I was really worired about that...Lillo absolutely hates even giving blood...seems like we are trying to cut his head off!

I have been looking at all of your wonderful pictures of all of your dogs. I don't see however many dogs with much hair loss? Lillo's is really bad now. I will post the photos I just sent to my vet. Maybe you can confirm that the hair loss Lillo has doesn't even look like hair loss of a typical cushings dog? thanks guys x

[lulusmom]

Hi Angela,
I shared my life with three cushdogs, all of whom have passed and one of whom was a tiny adorable Pomeranian who spent most of her adult life with a torso as bald as a billard ball. She started losing her hair by the age of two and aside from a small improvement while treating with Lysodren, the hair loss progressed unabated. The cushing’s treatment didn’t help and her baldness was merely cosmetic.

I’ve not been active on the board lately but I have been following your thread and am just now finding the time to post. As I was going through your thread, I typed my comments as I went. Since I don’t have time to put those notes in a logical order, things may sound disjointed but hopefully you will still get a good idea of where I’m coming from.

When was Lillo’s most recent bloodwork done and did your vet put him on liver support like Adenosyl, SAMe or milk thistle? If bloodwork is more than 90 days old and Lillo is not on liver support, he needs new bloodwork done and if liver enzymes are still elevated, I’d forget about running after a cushing’s diagnosis and get him on liver support asap. My Lulu was completely void of hair on her torso for most of her adult life and treatment did nothing to remedy it. She was a follicularly challenged Pomeranian, a breed known for their alopecia X. Some Chihuahuas can also have their own follicular issues, all of which are a mystery and most of which never cause any clinical abnormalities. In the words of Dr. David Bruyette, one of our renown endocrine specialists, the best treatment for this is a sweater. My Lulu had lots of sweaters.

Lillo’s liver enzyme elevations is not the pattern we see in cushing’s. ALKP elevations are anywhere from mild to severely elevated, with mildly elevated ALT. Lillo is the opposite, plus Lillo’s AST is elevated. ALT and AST are enzymes stored in the liver cells and when there is damage to the liver that ruptures the cells, these enzymes flow out into the bloodstream. Excessive amount of cortisol which is the adrenal steroid culprit in cushing’s, doesn’t kill liver cells, it causes an over-accumulation of glycogen, enlarging the liver and making it work harder.

Abnormal urine cortisol creatinine ratios (UCCR) are not uncommon if a dog has a non adrenal illness or is an anxious or easily stressed type, which would certainly be awful for this type of dog if a urine sample were taken by cystocentesis . Was Lillo’s urine specimen taken from a free catch of the first urine of the morning? If not and your vet stuck a needle thru his gut into the bladder, I would be shocked if the results were normal. Since the liver enzyme elevations are more consistent with something other than cushing’s, I’m not convinced the high UCCR results have anything to do with cushing’s either.

Dogs with non-adrenal illness are less likely to produce false positive results on the ACTH stimulation test but conversely, a fair number of dogs with cushing’s will have false negative results. For this reason, the acth stim test has fallen out of favor with some endocrine specialists for purposes of diagnosing the disease. For instance, dogs with adrenal tumors are likely to not have an exaggerated response on stimulation. I’m not saying that Lillo could have an adrenal tumor but merely wanted to point out that false negative acth stim test results are not uncommon.

Unless I’ve missed something, it seems to me that you are bound and determined to find a reason for Lillo’s hair loss, even though he isn’t showing any outward symptoms or discomfort. Chihuahuas are a breed that are included in a few lists of breeds that are over represented in a few categories of follicular dysplasia…..color dilution alopecia is one that can affect blue and fawn chis. The onset is usually by the time of six months old so not sure that’s what’s going on Lillo but there are other forms of pattern baldness that could be the problem. Most are cosmetic in nature and pet owners are limited as to treatments and efficacy of those treatments is a crap shoot. If you want to try to grow some hair for Lillo, I would suggest that you give Melatonin a try. He would take 3mg morning and evening. Make sure it’s plain old melatonin…not fast acting or time released.

Some folks have mentioned atypical cushing’s as a possibility but I’m one who wouldn’t jump on that bandwagon right now, especially since Lillo has none of the usual symptoms that are associated with cushing’s and blood abnormalities that aren’t really consistent with typical or atypical cushing’s. Melatonin and Lignans are the first two treatments the University of Tennessee Knoxville recommends for a dog who is diagnosed with atypical cushing’s (elevated sex hormones) and if estradiol is elevated and the dog is intact, they recommend castration.

Work is once again calling me so I gotta scoot but will be back later to check in on you.

Glynda

P.S. Here is a url to a picture of my bald babies. Lulu is on the right and my sweet little foster boy, Otis is on the left. You'll notice that Lulu had hyperpigmentation as well. http://k9cushings.com/forum/album.php?albumid=11&pictureid=351 I also forgot to mention that it is quite common for dogs with alopecia to regrow hair at the site of surgical incisions. Lulu had hip surgery and she grew a long tuft of hair at her incision line....it's a very weird thing but normal in these dogs.

[Lillo]

Hi Glynda,
Thanks so much for your reply. I looked through your photos and all of your dogs were really wonderful. Lulu reminds me a lot of Lillo and i can see her little neck through her sweeter like Lillo's. The dog you rescued Jasper is just incredible, I cant believe he grew all that hair! With respects to Lillo the hair in itself is not what i'm worried about. Its what is causing it. Not knowing is the difficult part as its hard not to imagine the worst. It hs got much worse this last year. Last summer this time ha only had 2 small patches on his shoulders and his tail. It is shocking to watch and worrying that something really wrong that you don't know about could be happening.

Lillo's blood work was done in June. No he isn't and hasn't ever been on liver support. I didn't know there were any such thing. In the past when liver damage was suspected he was put on a low protein prescription diet and prescribed glucose which he hated and made him get the shakes. His blood work have often shown hight ALT levels. Sometimes high liver enzymes and high lipids and sometimes totally normal. The problem with Lillo is that his results are always inconsistent. So Lulu had Alopecia X? This is what Lillo's London vet believes he has. if his hair loss is purely cosmetic then that's great and as I said in a previous post I probably wouldn't even try to give the Vetoryl especially as I read the medication shouldn't be given to a dog with liver damage. I will ask my London vet re the liver support meds you talked about.

Lillo's urine sample was taken by me first thing in the morning. He wasn't stressed...he thought I was mad chasing him with a plastic cup down the street though...as did the porter who explained to me that in italy it is polite to pick up poop but the pee is ok haha really he thought i was trying to collect lillo's pee so he didn't dirty the street...isn't that so funny?! However, I believe as you all have explained and my vet has explained other things could have given a high cortesol result not particularly cushings.

I will follow the advice of my London vet and see what is going on with this new found issue the heart murmur first. Then take a skin biopsy to determine if he has Alopecia X or follicular dysplasia. I will ask again about the liver results as he didn't mention it al all in either of his emails.

Thanks again,

Lots of love
Angela and Lillo xx

[Trish]

Hi Angela

That cracked me up the porter thinking you were being a tidy girl collecting all Lillo's pee, kind of him to point that out :D:D:D:D

Pleased you have decided not to start the meds, and hopefully it is something simple like alopecia causing Lillo's hair loss.

Maybe the first vet has made an error regarding the heart murmur like their suggestion to start cushings medications in the absence of supporting tests!! Fingers crossed you get a good cardiac review next week :)

[FemaleK9]

Hi! I've been following Lillo's story but haven't chimed in as I didn't have any help to offer. I just have to thank you for the good laugh I got picturing you chasing Lillo down the street trying to catch pee in a cup, and the porter probably thinking "Crazy foreigner!" What we go through for our dogs!

[molly muffin]

I was rolling with laughter reading that segment about collecting the pee, such a sweet lady, doesn't dirty the street at all with her pet. :) :) :) :) :)

oh my god, that is funny.

I think your London vet sounds very sensible. :)

hugs,
Sharlene and Molly Muffin

[goldengirl88]

That was too funny following the dog with a cup, I laughed so heard reading it. They must think you are crazy over there!! You know what I do, I get a sterile sealed small plastic container from the vet and tape it to the end of a yard stick. I only remove the lid on the way out to go potty so it does not get contaminated. It works well, but probably drive my neighbors insane thinking I am a nut case following my dog with a yard stick. How long have you lived in Rome? Do you like it? I would love to see it someday. As for the skin biopsy, I think they take out a sample with a skin punch an put a few stitches in. I don't think it will be that bad. Lillo is awfully cute, and I can see why you just love him. How are the Italian vets over there? I am glad that he does not have Cushings, it is not something you want to deal with unless you have to. Blessings
Patti

[Lillo]

Yes the pee collecting was a very funny situation! I did try to do it first in the garden but every time he lifted his leg and I appeared with a cup Lillo put his leg down and wouldn't pee and literally looked at me with an expression what now?!! I know you're up to something! So I decided to take him outside as he pees on every single tree in the street. I did get more pee on my hands then in the cup for sure...and my boyfriend who was "helping" took a full photographic account so I will post them for you when I get back to Rome tomorrow! Rome is wonderful and the lifestyle, food, sun, sea, lakes and a lot more is wonderful. Lillo really loves it. He really likes that there are so many dogs, and that dogs can go everywhere...restaurants, stores, cafes...and it's fun for him as there are always other dogs to play with. Re vets...I don't know...I obviously haven't had the best experience yet with vets here. But in fairness with vets anywhere...Lillo has never been a straightforward case. He has always had something wrong many of which just sorted themselves out in the end...eg the seizures...I haven't mentioned before but he also had an inguinal hernia..but it closed up on its own when he got older. Lets see...I'm not too happy with the new vet in Italy either as he just sent me an email saying he wanted to do every test under the sun on Lillo...I just want to find and experienced good vet who knows what they're doing...
Thank you all for your wonderful support...we will keep you updated xxx

[FemaleK9]

It's understandable that they would want to run their own tests rather than rely on the results from the tests done by the previous vet; many tests are dangerously unreliable if done incorrectly, and based on the previous vet's performance, I wouldn't want to bet my dog's life that they were done correctly!

But I would have expected just one or two tests to start with, then a rethink based on the results, not a whole battery of tests right off the bat. Whenever a doctor (human or animal) wants to run lots of tests, particularly if they seem to have no bearing on the complaint, it makes me suspect that they are more interested in racking up charges than helping the patient. I'm afraid I have a nasty suspicious mind, though, and I could be totally off base in this instance.

So I will just wish you good luck, whether in getting help for Lillo with this vet or in finding a new one.

I'm looking forward to the photos!

[Lillo]

Hello everyone,

Just wanted to write to you all and give you an update on Lillo. We finally found a reall good vet here in Rome. He too believed Lillo to have alopecia x like my vet in london believed. Before we even had time to do any tests out of nowhere Lillo's hair started growing back! Totally remarkable it's almost all back! It must have been the testosterone blocker implant the old vet put in his neck before the summer. It just took a few months to start working. His heart murmur will be monitored but no treatment necessary as of yet. He has had some epileptic seizures...I am hoping it will calm down and I am just recording episodes for now. All in all he is fine...always has had issues...but generally is a happy healthy dog and that's all that's important. I particularly wanted to post this invade someone else's dog gets misdiagnosed with cushing's instead of alopecia x. Hope everyone is well,

All the best,
Angela and Lillo

[goldengirl88]

So glad to hear from you and that Lillo is doing well. Also nice that you found a good vet. Has he has these seizures before? Blessings
Patti

[FemaleK9]

So glad Lillo is doing well, and that you let us know - we love seeing good reports!

I hope the seizures are infrequent and not too severe.

[molly muffin]

I'm real glad to hear that you found a good vet there in Rome. How nice that the hair has started to grow back in too!! Awesome. Lilo will be looking slick in no time. :)

hugs,
Sharlene and Molly Muffin