New member trying to sort through it all (Dixie) 8 y/o Kooikerhondje)

[SuperErth]

Hello,

I just got back from Dixie's (my 8-year old Kooikerhondje) ACTH vet visit. We've known something was up with her for about 3 months now. She shows the apparently classic signs of excessive thirst/urination/appetite, increased panting, decreased willingness to engage in activity, weight gain, and so on. Interestingly no hair loss though. Anyways, in that time I've been reading as much as I can on the subject of Cushing's trying to get a handle on it and came across this site. While reading some of the posts, my interest was peaked by the numerous mentions of SARDS/IMR. Dixie still has her sight, but was diagnosed with KCS (dry eye) about 4 years ago and has been on several different eye drops and ointments ever since. Our vet doesn't believe she has Iatrogenic cushings since none of her drops have been steroid based. However, I am intrigued and even will go so far to say I feel prompted to investigate further any possible connection with her eye problems and possible Cushings/SARDS/IMR. While I do have the drive to research every piece of literature I can get my hands on and intend to do so. I don't always have the stamina or the time. I wanted to ask your for your experience and insights on the possible connections between these diseases.

How do tell the difference between Cushings and SARDS/IMR?
Do you treat them differently?
How do you treat them?
How do you diagnose them?

Also, in the meantime, while I work with my vet to diagnose Dixie's condition, I can tell she's uncomfortable. It breaks my heart and want to do everything I can for her. She shows her discomfort through a sort of tight-chested, audible grunt when she exhales. I can tell she feels a high level of anxiety. We keep her inside with her bed and water bowl nearby. Also, I sit beside her often and give rub downs. Any other suggestions on helping her feel more comfortable?

[mytil]

Hi and welcome to our site, I am sorry you and your girl are having to go through this.

Firstly, post the actual numbers when you receive them, of the ACTH test. We can see more from the numeric results. Were there any additional tests performed? One test actually does not diagnose Cushing's I am afraid. (even with all the symptoms she has).

Here is a great link to information on diagnosing and the treatment of SARDS. http://www.k9cushings.com/forum/showthread.php?t=213. SARDS may be associated with Cushing's but not always.

Have any other conditions been ruled out? - Thyroid problems, liver issues, diabetes? Has a complete blood panel been done?

Keep us posted.
Terry

[addy]

Hi and Welcome,

High cortisol can cause problems with other parts of the body. My pup developed many eye problems while we were treating her Cushings unrelated to Sards. At one point she was on 12 different eye drops which eventually were cut back to five administered 3-4 times a day.

The testing process for Cushings is very important as well as history. It is a very difficult disease to properly diagnose.

You can read more about Sards and other eye issues here

http://www.dvm360.com/veterinary/search/solrSearchResults.jsp?searchType=defLink&qgeneral=sards&q=&tabid=&search.x=34&search.y=16

I am glad you found us.

[Squirt's Mom]

Hi and welcome to you and Dixie! :)

I had to look up "Kooikerhondje" - a gorgeous breed and reminds me of the Duck Toller! A friend used to have a DT and that pup would spend all day retrieving his "ducks" from the pond if you let him. You could see the pure joy on his face the whole time!

The first term in SARDS is "Sudden" - and that is how this condition manifests....very quickly. The pup can see today and is blind tomorrow. SARDS pups will often display cushing's signs at first but most adjust and the signs go away. I would think the dry eye can be seen as a separate issue and not connected to SARDS. ;) Can you tell us the names of the drops she has used?

Cushing's is tested for via the UC:CR (which can rule Cushing's OUT but cannot diagnose it), the LDDS, the ACTH, and the abdominal ultrasound. A general health screen to look at organ function as well as a CBC provide additional clues. A pup doesn't have to have all of these but as many as you can afford will give you the best idea of 1) anything else that might be going on and 2) provide a solid confirmation for Cushing's. Additional tests that may be used are the HDDS (rarely used these days) and the full adrenal panel from the University of TN - the UTK panel (used when all other tests are negative but cush signs persist). This is one of, if not THE, most difficult of canine diseases to correctly diagnose because so many other conditions share the same signs AND can cause false positives on the cush tests. So the more thorough we can be in the initial testing phase, the better. ;) There is rarely a need to rush into treatment - Cushing's is a very slowly progressing condition, typically taking years to cause permanent damage.

As for comfort now, try to keep her area as cool as possible - cush pups don't handle heat well at all. I've been known to wear sweaters and shiver so Squirt can be cooler. :rolleyes::D ALWAYS provide access to fresh water - a cush pup can become dehydrated quickly if water is withheld. If she is displaying constant hunger, try some fresh or frozen (not canned) veggies like green beans or carrots, fruits like apples, bananas, oranges for treats to help her feel a bit fuller yet not add weight like normal treats do. Exercise as she can tolerate but don't overdo as cush pups are prone to ligament tears while the cortisol is uncontrolled. Be with her as much as you can, keep her routine as close to normal as possible, and keep loving her as you do. If this is Cushing's, you will start to see more of your old girl once treatment starts and the cortisol is brought back to a more normal range.

The proven treatments for Cushing's are via 2 drugs called Lysodren (Mitotane) and Vetoryl (Trilostane). As for which drug is best for Dixie, that is something you and your vet will need to discuss. Both are very powerful drugs, both carry the same risks factors, both are life-savers for our babies.

One thing to keep in mind - Cushing's is not a death sentence. It means some changes for both of you but cush pups can and do live out their normal life span and beyond. So keep your chin up and know you and Dixie are now part of a stupendous family here at K9C.

Hugs,
Leslie and the gang

[goldengirl88]

Hello and welcome to you and your baby. I take my dog to an opthalmologist and dry eye can be a result of Cushing's. As far as your dog being uncomfortable. My dog makes noises too. With Cushing's the fat in their bodies is redistributed and a lot ends up in their abdomens. It can shift other organs around. Also the liver may become enlarged and put pressure on other things, thus making them uncomfortable. When you get the testing done, please always get copies for yourself. You will want to post the abnormal results, along with the labs scale of normal ranges as all labs are different. We can look at the numbers then and better help you. The thing you said about reading everything you can on this disease is the very best thing you could do for your dog. You will
Be the only advocate for your dog so educating yourself is the best way to go. Is you vet experienced in treating Cushing's? That is really important also. Blessings
Patti

[flynnandian]

welcome. kooikerhondjes are a dutch breed, i know them very well. i did not know they do breed them in the usa? or are you from europe too?

[SuperErth]

Just wanted to log on and post a quick update on Dixie. But first, I wanted to thank everyone for your well wishes, insights, and support! Dixie's latest vet visit went OK. She's definitely responding to the Vetoryl, which she's been on for about 3 weeks now. She is drinking more like normal and she seems to be getting fuller, more comfortable rest. She has, however, gain a couple of pounds now putting her at about 20lbs overweight. I'm sorry I can't be more specific, it's for the same reason I said her latest vet visit was just OK.

Dixie IS doing better, I am just growing unhappy with her veterinarian. (WARNING: RANT ALERT!) Dixie's been going to the same doctor for the last two years. A doctor it took great pains to find because I only wanted the best in the area we live for my little girl, naturally. He is still great, however, he is nearing retirement age and grossly overbooked. He recently hired a very green, straight out of vet school girl doc to help him out. When I first became concerned about Dixie's drinking levels I reached out to the vet's office and they set me up with the new doc because she had an opening before Dixie's regular doctor. I wanted to get her seen about ASAP and I trusted the old doc's judgement in hiring her, so this wasn't a problem. After three months, however, it has become one. She seems competent and nice enough, but she doesn't communicate well. For example, there have been several occasions in which I've called, been put on hold for several minutes, asked to be called back, only to have to call back myself the next day. Furthermore, I've probably spent somewhere around five-hundred dollars for tests and visits since being put with her and she hasn't really told me anything I couldn't read online or can see myself by just looking at my dog. Like the the other day, she calls back with Dixie's first follow up test result after starting Vetoryl. She basically just says "So, it looks like Dixie's doing better." "Just keep her on the trilostane and we'll check back in 6 months." Seriously, I just spent $200 on a test and all I get is "She seems to be doing better."?! I could have told myself that for free! How about some specific lab results and recommendations? I inquired about Dixie's high cholesterol (it showed high on her original cushing's urine screen, or so they say, I never got an actual result on that either). She just said "Well high cholesterol is typical for cushing's and although we didn't check that this time around her cholesterol levels should return to normal while on the Vetoryl." "We can check when you bring her back in six months." I'm thinking, OK what if it doesn't return to normal in six months? Six months to a dog is like 3.5 years. What happens to a person who has high cholesterol for 3.5 years?! So anyway, I say all that to say I think she's basically worthless as a veterinarian, or at least Dixie's veterinarian. I tried getting back with Dixie's old doc without addressing any of the above, only talking with him about Dixie's condition, trying to get him updated on her situation. He just seems tired and overworked. Also, he couldn't find certain bits of info in her file the other doc was supposed to have written down (another communication issue).

At this point, I think (and please give feedback on this) I'm going to call and request old doc meet with me to air out my concerns and more importantly go over all of Dixie's test results for the past 3 months. And two, I want to find a great ophthalmologist, preferably in the DFW area (nearest large metro to where I live) to meet Dixie, screen her for SARDS/IMR and check her dry eye. What do you all think? Sound like a plan?

Again, Dixie and I want to thank you for all the support! It's great to have an active, caring community to go to. I look forward to hearing what y'all have to say about this latest update. Sorry it was a bit (alot) ranty. If anyone near DFW or just in Texas knows a good eye doc, please let me know. Also, where's the cheapest place to get Vetoryl? Til next time!

[SuperErth]

P.S. Dixie is a shelter rescue. She was probably 3 months when I got her. I have no idea if Kooiker breeding is widespread in the US, but I've since seen two or three others since I got her.

[Trixie]

I would most definitely speak to the more senior vet! Cushings can be hard to manage and having a really good competent vet who knows the disease and who you trust is half the battle.
I get Vetoryl from LambertVetSupply.com Depending on your dog's dose the price range for a 30 count box is $41.95-$67.95.
If you decide to go for the compounded version of Trilostane which is more economical, many people here on the board use Diamondback Drugs.
Really happy to hear Dixie is already showing improvement, that's great news. :)

Barbara

[molly muffin]

Okay, first off, hello. :) Welcome to you and Dixie. I don't think I posted before, so was playing catch up. Kooikerhondje, what a gorgeous breed.
I've noticed that we see this a lot with the new vets, that aren't as "seasoned" in both communication and actual working, treating cushings along with the meds.
If there is one thing I would definitely recommend, it is that you go to the vets office and ask for copies of all of Dixie's test going back 2 years. That way you can see the progression yourself and keep track of what the numbers are and areas of concern. Just tell them you want your own file. This is what I did for my dog.
Then tell them you would like a referral to an IMS and an Ophamologist. (get a good clinic that has them both if possible, less trips and file in one place) Then if need be, find a new vet, maybe the IMS can recommend one experienced in cushings to work with them.
I'm also concerned about this 6 months follow up. Where the heck did that vet go to school at because they obviously have not a clue about cushings, the medications used, or proper protocols.
She started medication in January, should have had a couple ACTH since that time and be on an every 3 month regime until at least feeling very comfortable that she is stable. Then I'd think maybe 6 months Might be doable unless signs are otherwise seen.
I agree, you want the numbers, and a "good enough or doing okay" doesn't cut it in my book and I'll tell you why. We have way too many vets that use a normal from the lab results to think the dog is doing fine, when in reality, those numbers change when they are on medication and it could be they are Not within range at all. You don't know unless you see the numbers.

Okay, that is my recommendation. I would think that there would be some very good vets and specialty hospitals in the DFW area.

Sharlene and Molly muffin

[Renee]

Hey there, and welcome from me too!

First, the least expensive place I have found for the vetoryl is California Pet Pharmacy. A box of 30ct 10mg is just under $42. They do free shipping when you spend over $100, so I always order 3 boxes at a time. You do need a script from your vet, but they allow refills, so my vet just wrote me an unlimited refill script for a year.

I definitely second Sharlene in asking to get copies of your dog's records from the vet clinic. Since this cushings started for my pug, I started getting copies of everything. You'll want to have those records so you can track things yourself as well.

I am so sorry your inexperienced vet is doing such a bad job. I must have the exception to that rule, because my vet is rather inexperienced with cushings, but she has been nothing but amazing. It may be worth your while to meet with the old vet and air your concerns... but, bottom line, regardless of what you say to him, it is time to move on quickly and get with a vet that you can communicate with, that respects you and your dog, and knows what they are doing when it comes to cushings. It is sad but true that a lot of vets do not welcome involved / active pet owners when it comes to veterinary medicine. It baffles me why, but clearly it is an issue.

I think your plan on seeing an IMS and opthamologist is an excellent idea. Being near DFW, I bet you'll have many options!

[goldengirl88]

I just had a few thoughts. Is this vet saying that after starting Vetoryl that the next check would be 6 months?? If so that is not right at all. Also these Cush dogs have a lot of fat mobilized in their systems. That is why they have really high cholesterol and triglycerides. I am using very good fish oilmtomget my Tipper's numbers down. After about 2 months hers came down to one half of what it was. This vet has a very cavalier attitude towards all these descending things. I get copies of anything done to my Tipper. that way I keep track of everything myself and if you want to go to another vet you already have the file.I would be either advising this vet of proper protocol or going else where.Blessings
Patti

[flynnandian]

P.S. Dixie is a shelter rescue. She was probably 3 months when I got her. I have no idea if Kooiker breeding is widespread in the US, but I've since seen two or three others since I got her.

i am from the netherlands and it is a dutch breed so i was curious about her. even overhere there are not very much kooikerhondjes.
i hope she will do fine on the vetoryl and that you will get your old vet back.

[goldengirl88]

All of you have peaked my interest, and I have to look online to see this breed!!