Suspected Cushings

[Diesel's Mom]

Hi there, I'm new to the site and thankful I came across it, so nice to know there are other people out there going through some of the same things! I have a boxer who is just shy of turning 10 years old. It was about a year ago give or take we started seeing some changes in him. He started doing things like tipping over our large charcoal weber grill after we had cooked on it-something he had never done in all the years we've had him, he also began begging more, also if the pantry door is left open he will start putting his muzzle up by the garbage can or his bag of food, stealing food from the kids if they set something down, and is now even eating the cat food if it is not put up-something else he's never ever done before in the almost 10 years we've had him. Aside from that we have also noticed an increase-major increase in excessive thirst, I didn't think it could get any worse than when it started a year ago but it has, he is drinking all the time, he can finish a bowl of water in 10 min...which is about 2.5 liters at a time...he drinks several of those a day and is now even drinking out of the toilet in the middle of the night so much so that he almost empties it completely if lid is left open-again in all the years we've had him he has never drank out of the toilet. We noticed last winter he always ate snow constantly when outside, and now with this summer/fall he will drink out of any crevice outside that holds any little bit of water he can get. He is having so many urine accidents in the house I'm shampooing and mopping almost daily-very frustrating to say the least! Most recently I'm just starting to notice some thinning hair/bald spots on his belly area. It was about 6/7 months ago when we first took him to the vet as his accidents in the house aren't as bad as they are now, but we knew there was something going on with him so we went in for a check up. The Dr. ordered a blood panel, and UA, we've ruled out cancer, diabetes, UTI, liver & kidney functions were normal, and a few other things that have escaped my memory-were all normal. The Dr. did say that we could do a thyroid test but she wasn't really concerned that was the issue. She felt, and still feels he has all the clinical signs of cushings. With that said we opted for the Low Dose Dex. Suppression Test. A couple days later we were informed the test was shall I say inconclusive? Now I can't remember what is numbers were at, and this was our first test which is very new to us but basically the explanation they gave me was his number was "X" if it was below "X" or above "X" that would be great, they would be able to officially diagnose him, but I guess whatever number he actually had threw a wrench into the equation. So here we are a several hundred dollars and a week later back at square one :confused: So the last 6 months we've decided to take it as it comes and as I said earlier his symptoms are much worse than I thought they could even get. Took him in again last week, and again she says she does feel he has cushings but we have to get the right numbers on this test before treatment. However what makes me nervous is how many times can this test actually take before the numbers are right? She told us they just finally diagnosed a Dalmatian after 3 years of doing this test. As much as I love my dog, I don't think I can go 3 years of these symptoms continuously getting worse and all the accidents in the house, and with a family of 7 the vet bills aren't getting any cheaper. We had actually had an apt scheduled this week to have him put down as these vet bills are taking a toll on us, the frequent accidents in the house are frustrating and from what I've heard and am learning cushings is not a very inexpensive disease to diagnose or treat. With that said, after many tears and ups and downs this week we have decided to cancel that appt to have him put down and try another Low Dose Dex. Suppression Test, he is apart of our family and we just aren't ready to let him go-I'm just hoping the test gives us the official answer this time because I don't know how much longer we can go doing testing and not getting an official diagnoses. I must add the vet clinic we go to is familiar with and does treat cushings.

[goldengirl88]

I am so sorry for all that is happening to you and your baby, but I am glad you cancelled the appointment to have him put down. Could you try some doggie diapers, or a belly band to control all the urinating in the house. That way you won't feel so frustrated with this. I would have an ACTH test, LDDS, Urine, blood and Ultra Sound. That is basically what the dogs are tested with for Cushings. You have ruled out diabetes and thyroid?? Know one thing, at least your vet knows the signs of Cushings, where so many do not, that is a plus in my book. I would want a firm diagnosis. If it comes out Cushings and you choose to treat you dog can live a good life as long as you manage the cortisol with Lysodren or Trilostane. You can purchase drugs on line typically cheaper than at your vets. Also if you are concerned about the finances you can apply for Car Credit which many vets take. It will let you pay the bill of a long extended period. If you are concerned with that apply now. I have a Care Credit card I have never used and keep it for an emergency only. It is my back up plan to help my dog in the event of something unforeseen. It is a shame, yet a blessing these dogs get this later in life. The shame is the need to live out their older years without all these problems. The blessing is your dog did not get this at age 5. So it is a double edged sword. If it were me I would get doggy bands or pants immediately, then get the proper testing, and go from there. If in your heart you are not gong to treat the testing is a mute point. You dog will eventually come around with treatment and all the urinating etc. will get under control. If you treat and use Trilostane, not matter what anyone says or tells you, start low and gradually go up with the dose if you want the best chance of having no problems. Dechra recommends 1mg per lb. Just remember to be vigilant and watch for signs of low cortisol, and have the vet give you prednisone. Hope it all works out. Blessings
Patti

[My sweet Ginger]

Hi, I sent you a private msg regarding diapers, I hope you got it. I'm new here I'm not sure that it was delivered to you. Song.

[Harley PoMMom]

Hi and welcome to you and your boy,

Could you get your hands on a copy of that LDDS test and post the results here, thanks! We have seen many times a vet wrongly interpret the results of Cushing's tests. Also, there is a small percentage, 5–8%, of dogs that have a false negative result from the LDDS test. To help better understand the tests for Cushing's try this link: Hyperadrenocorticism (http://www.merckmanuals.com/vet/endocrine_system/the_pituitary_gland/hyperadrenocorticism.html) To understand the LDDS results: ClinQuiz: Interpreting low-dose dexamethasone suppression test results (http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093)

Has an ultrasound been performed? And if so, could you post those findings too?

Cushing's can be expensive to start with because the initial expense is during the diagnostic phase, the cost of treating for Cushing's usually goes down significantly after you've got the diagnosis confirmed and the treatment underway. The two medication usually rx'd for Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane, and both can be compounded which is a cost savings.

I am sorry for the reasons that brought you to us but so glad you found your way here, and we will help in any way we can.

Hugs, Lori

[molly muffin]

Hello and welcome. Well, you've had numerous LDDS tests it looks like and have ruled out all the typical culprits like diabetes, thyroid, cancer. How is the urinalysis? all good? What about the urine specific gravity?

Lori is correct in saying that there are percentage of dogs that will never test cushings on the LDDS. I think mine is one of them. :) Maybe yours is too. However, since mine currently doesn't have any symptoms, I'm not treating. On the other hand, yours is exhibiting a large amount of symptoms and if the ACTH is consistent with high cortisol, then it might be worth it for you and your vet to consider treatment. I think I'd have the ACTH over another LDDS at this point. One thing, on the LDDS there are 3 numbers. The base, then the 4 hour and 8 hour result. It would be great if you could go by your vets or have them email the results of all cushing testing and blood work and urine test results. (it is always good to have your own copy and file anyhow). Then we can review them with you. We've seen a ton! :)

Next there are 2 types of medications for cushings. One is vetroyl and the other is lysodren. Lysodren is typically cheaper over all as you don't have to test as much, vetroyl leaves the system sooner (lysodren keeps working for 48 hours) but you test more and tweak the dosage usually more. So there are things to think about. Both will work with cushings to help control symptoms.
Both can be dangerous if not closely monitored.

Those are my initial thoughts after reading your posts. One thing that might give you some hope, is that the hunger and drinking and accidents are usually one of the first symptoms to clear up once treatment is started. Skin and any muscle weakness takes longer usually.

Welcome! You are NOT alone any longer :)

Sharlene and Molly Muffin

[Diesel's Mom]

Thank you all for your kind words and input! I didn't introduce myself in all my rambling on my first post, but my name is Kim! It is really nice to talk with people who actually understand and can relate to what we are going through.

Here are my thoughts on all of these tests for cushings.

As far as the Ultrasound that is out of the question for us, even though our vet clinic is familiar with, diagnosis and treats cushings they do not have the facilities for this ultrasound and that would require a 3 hour round trip not to mention the cost of the US.

ACTH-The way I understand this test and please correct me if I'm wrong or misinformed, it can diagnose but not differentiate between the types of cushings, it is more of a monitoring test which is great after our pooch would be diagnosed and on medication? Not to say that it wouldn't help in one way or another I guess if the LDDS tests keeps coming back inconclusive?

LDDS-This test can diagnose and differentiate between the types of cushings and upon the research I've done thus far and talking to my vet sounds like this is the "best" (for lack of a better word) test to continue to do at this point? Now according to my vet if we did the ACTH test we would still have to do the LDDS test in order to differentitate between the types of cushings and treat him? If that is indeed true or the case then I'd rather not spend extra money on the ACTH test until the LDDS test comes back conclusive.

HDDS-I have done some research on this particular test but this isn't a test the vet has actually talked to us about (that I can remember) From what I've read this test can also diagnose and differentiate cushings, so at what point should we consider doing this test and why?

Then we were informed about the Urine Cortisol test that will only tell you if your pooch does not have cushings. Personally at this point we all feel he has it so I guess I'd feel that would be a total wast of money.


As far as medications when we started down this path of tests several months ago she informed us right away she would treat with Vetoryl. Now I've been very proactive about looking online for pet meds to compare prices, but aside from 1-800 pet meds which has been on commercials for years, I'm not familiar with many other online websites and not sure which are "legitimate", so if anyone has any input on different sites to shop around please any info would be much appreciated. Being a pharmacy tech I'm also very aware that Walmart also carries a lot of pet meds, including Vetoryl, just an FYI for anyone who may not have know this.

As far as getting our test results from his previous LDDS test that is top on my list of things to do! And when I get those I will certainly post them for help interpreting them. Diesel has an appt this coming Tues for another LDDS, fingers crossed we get our diagnosis because all this testing is a huge part of this financial battle & frustration.

Thanks for listening :)

[goldengirl88]

Kim:
The reason they are wanting an Ultra Sound is to check the Adrenals to try and see what type of Cushings your dog has. Would you be able to apply for Care Credit? Most vets take it and it is small payments over a long period of time. An Ultra Sound can tell you if there is a tumor and if it has spread anywhere else. They need to see what is going on inside your dog. You will need to go somewhere where they have a high resolution machine. I know from experience. I spent a lot of money on the vet's ultra sound and it showed virtually nothing going on inside my dog. I went to the hospital only to find out she has an adrenal tumor. You must know what is going on with your dog in order to treat it correctly. You can purchase Vetoryl from many online sources that are Vipps approved pharmacies etc. lambert Veterinary supplies, Diamondback Drugs are just two. You need to get a diagnosis, and know what is going on with you dog instead of going into this blindly. Once you get the US and diagnosis, then form a plan of action on which treatment drug you will use, and the mg. I caution you to start low with Vetoryl, it will save you and your dog from potential problems. Blessings
Patti

[Diesel's Mom]

Hi Patti, and thanks for your responses :) As far as the ultrasound our vet gave that to us as an option if we would like to go that route, she hasn't pushed the ultrasound on us at all. As I said before, the trip for the ultrasound would be a 3 hour round trip drive which is out of the question at least at this time, with both my husband and I working full time and 5 kids at home, and the tests we are currently doing on Diesel we can't afford take the time off to drive that far or afford the cost of the ultrasound to be completely honest.

Regarding the Care Credit, we already have one which will be maxed out after our next LDDS test on Tues.

For the Vetoryl I'm curious, Diesel currently weighs 65lbs but he fluctuates usually between 65-70lbs, do you have an idea on what dose he would be starting out on once diagnosed? Also, once established on medication and he levels out does the dose just stay the same, decrease or increase?

Thanks! Kim

[molly muffin]

If starting on vetroyl then he should start at around 1mg/1lb. Depending on how he does, will depend on if the dose stays the same or increases or decreases.

Yes, we definitely understand how expensive this whole journey is. It goes get better eventually. The beginning of getting the dose correct and the diagnose testing is quite harrowing on the pocketbook.

It is less costly if you go with a compounded trilostane, especially since Diesel doesn't fall directly into the amounts that Dechra manufactures. Speak with your vet about that option.

Sharlene and Molly Muffin

[Diesel's Mom]

Thank you Sharlene. I'm sure am hoping and fingers crossed we have some results we can use with his next LDDS test. I will also be asking for a copy of his prior LDDS, blood panel, and UA tests on Tues, and when I get those I will post for help in deciphering them.

[My sweet Ginger]

Hi Kim,
I would like to tell you how Ginger's diagnosis came about. When I originally brought her in for excessive drinking and peeing a year ago, they didn't find anything. Early this year during her regular check up, a heart murmur was detected but nothing was done except to monitor her. Took her back in September of this year just to check on her heart murmur. Blood work and heart x rays were done and found that her heart was functioning fine but her blood test wasn't good. The vet suspected Cushings and recommended an ACTH test which was over-the-chart positive. The vet thought that maybe it was an adrenal tumor but couldn't be sure. She then recommended LDDST, as that would tell us which one more definitely.
Not enough suppression on LDDST to be pituitary dependent. By then the vet was quite sure Ginger had adrenal tumor and I was crying my eyes our for days and days. To be sure, our vet then recommended (I don't think they ever push it) an abdominal Ultrasound which CONFIRMED that Ginger had PHD, and I could breathe again at least. Without the ultrasound, we couldn't have started a treatment on Ginger because ADH and PDH are treated differently, as far as I know. We had to go to a special hospital for ultrasound and the cost wasn't cheap ($270) but we didn't see any other option if we wanted to make her feel better. It makes me shudder to think that what if we decided not to treat her thinking she has adrenal dependent since we were not going to put her through a major surgery considering her age (14 in a month) and her weak condition. I was so glad we did the ultrasound.
My point here is even if the ultrasound is neither inexpensive nor easy task for you to get there, in my mind you need ultrasound more than possibly endless LDDST at this point to put an end to this misery you two are in as quickly as possible. What he's been going through is not a way to live, not even for a dog
I would highly advise that you don't have the LDDS test this time and use that money to get the ultrasound done instead and find out which tumor Diesel has and put him on a treatment. You will see the difference rather quickly and just think about what a relief that will be for both of you. I hope this helps. Thank you. Song.

[goldengirl88]

Hoping you are able to find out what is going on with your baby. Blessings
Patti