Baylee (9 y/o Yorkie/Cairn mix)

[Donna]

My dog Baylee is a 9 year old Yorkie/Cairn mix. She has gone to the same vet clinic her whole life. Recently my husband took her for an ear infection and she was seen by a different vet at the same clinic who sent home literature about Cushings. She suspected Baylee has Cushings because she has a "pot belly", she also said she has "black heads" on her skin. I did notice that Baylee has somewhat of a pot belly, but felt it was odd that her vet that sees her on a routine basis never brought it up as a concern. Baylee has always had an big love of food, so I didn't feel she had any increase in her appetite, nor her drinking or urinating. She has always been intolerant to heat and pants easily. I have not noticed any change to her skin, nor has her groomer mentioned anything. I did bring Baylee in for a dex. suppression test which the vet said was "inconclusive" or "borderline". She feels she has Pituitary dependent Cushings and suggested starting her on Anipryl. My question is: how does she know it's Pituitary dependent just based on blood work? Also, should I treat her if the results were borderline or inconclusive? She said the life expectancy is about 2-4 years regardless if I choose to treat or not and that the medication relieves her symptoms. I'm not sure what she means by "symptoms". Any suggestions would be welcomed and appreciated.

[mytil]

Hi, (welcome to you and your Baylee)

I have just a sec but wanted to chime in about the 2-4 year life expectancy for Cushpups....this is incorrect. We have had dogs here who have been treated for well above these years and are doing fine. Possibly your vet was mentioning this as part of the overall life span of dogs given the age of your Baylee.

Secondly, IMO I would not start any medication until a firm diagnosis has been made and being "borderline" can mean many things.

I would contact my vet and get those actual numbers of the low dose dex and post them here so we can see and give further feedback.

Take a few minutes to read through these links - http://www.k9cushings.com/forum/showthread.php?t=180 (great reading for more on Cushing's, diagnosis and treatment options).

Keep us posted
Terry

[lulusmom]

Hi Donna and welcome to you and Baylee.

Most common symptoms associated with cushing's are excessive drinking and peeing, voracious appetite and panting. Other symptoms are intolerance to exercise, weakness, primarily in hind quarters due to muscle wasting, loss of coat and thinning skin.

If your vet suspected cushing's, he should have done a full senior screening on Baylee before doing an LDDS test. This would include a blood chemistry, complete blood count and a full urinalysis, including a culture. Were these done and if so, can you please get copies and post the abnormal values. With respect to the blood values, we need only see the highs and lows and please include the normal reference ranges. If none of these were done, your vet did a woefully inadequate job of ruling out all other causes that could be responsible for Baylee's pot belly. Cushdogs are prone to infections due to suppression of their immune system but otherwise healthy dogs get ear infections all the time. Does Baylee have chronic ear problems?

Based on the little information you have provided, it appears that your vet pursued a cushing's diagnosis based solely on a pot belly and an ear infection. Is that correct? If the LDDS test was done while Baylee had an active ear infection, that could cause a borderline LDDS test result. Can you please post the actual results of that test? We recommend that members keep a folder with all medical documents which come in very handy if Baylee ever needs to be seen by an ER vet. It is extremely helpful to ER vets to have a dog's current medical history at their fingertips. It also comes in very handy for when we nag you to post test results? :D I've had two cushdogs of my own and fostered another cushdog and many time, I referred back to those test results to track progress. Cushing's is a difficult concept to grasp but as you learn more and more about the disease, all of this will make sense.

At this point, without the benefit of your responses and test results, I'd say to put any further testing for cushing's on the back burner for now. The goal of treatment is to remedy the problematic symptoms associated with cushing's and since Baylee doesn't seem to have any of those, I personally wouldn't worry about cushing's if and until Baylee becomes symptomatic....which may be never. I had a gp vet that looked at my little Maltese and told me she suspected cushing's. He always had a thin coat due to poor breeding and he was a bit overweight. She talked me into an LDDS, which wasn't even borderline. That was money down the toilet. Symptoms are a huge component of a diagnosis and even if blood values are consistent with cushings, I personally would never start an asymptomatic dog on treatment.

As for the life expectancy with treatment, your vet hasn't a clue. My first cushdog was diagnosed at three years old and had a great quality of life for another 8 1/2 years. My second cushdog was a shelter rescue who appeared to be very senior at that time. He was under treatment for five years, with a great quality of life. Most dogs are fairly old at diagnosis so two to four year life expectancy is based on the law of averages.

I'm glad you found us and we'll do all we can to help you figure this out. The more information you can give us, the better.

Glynda

[mcdavis]

I am definitely not an expert in Cushings, especially compared to many on this board, however from what has been done so far I would be very reluctant to start treatment, especially if Baylee isn't displaying the normal Cushings symptoms.
This sounds very similar to my vet who "diagnosed" Cushings purely based on a slightly elevated ALKP reading which was subsequently reduced by liver support pills.
I would suggest posting the results of the LDDS and blood tests so that others can review.

[Trixie]

I'm kind of surprised at your vets approach with your dog. If I were you I would stop that pill right away and talk to another vet.

My dog had all the symptoms of Cushings, and they were extremely obvious-- even then my vet did a "wait and see" approach with some liver supplements before we even tested for Cushings!

Before we started any medications the vet did everything possible to be sure the dog had Cushings, including an ultrasound. Did any of your dogs blood work show abnormal results?...for Cushings the liver numbers are usually above the norm. The vet should have way more diagnostics than just a pot belly and "blackheads" before even testing let alone treating!
Meanwhile your dog has zero symptoms and treatment begins right away and with a drug that most vets don't even use for Cushings anymore. That is also really strange in my opinion.
The life expectancy is also ridiculous...there are people treating their Cushings dogs successfully for many years so that info is also quite dated. Sounds like the vet is alarming you and with little reason.

The symptoms are KEY for diagnosing and tracking the disease. When the dog starts taking the medications- Lysodren or Vetoryl--the observation of the symptoms along with the testing become an important part of treating with the drugs. Without symptoms I would not treat.
I would be very uncomfortable with this whole situation and with this vet...it just sounds all wrong.

Barbara

[kmazurak]

Hi Donna,

My Boston Terrier was diagnosed with pituitary dependent cushings in November 2013. They can suspect cushings through routine blood as generally the liver panel is elevated.

However they are not able to confirm a diagnosis until they do a lose dose dex test and then determine whether its adrenal or pituitary by doing a high dose dex test.

I would NOT start any medication until you have a firm diagnosis. Also please monitor the dog closely for anything that might resemble a seizure as they can be very common with advanced pituitary cushings and are not treated with the cushings medications.

We lost our dog from a grand mal seizure even though he was responded very well to his cushings meds and I have heard of this happening quite often. I would suggest an MRI if it is pituitary to see how large the tumor is and then determine a course of treatment.

Best of luck!

[Donna]

These are the results of Baylee's testing: pre-dex: 4.9 ug/dl, 4 hours post dex: 1.5 ug/dl, 8 hours post dex: 3.0 ug/dl. 1 week prior to her testing she had a tooth extraction and the vet said her liver enzymes were elevated, she said it may have been due to dehydration since she had nothing by mouth after midnight. I do not have those results.

[Trixie]

Donna- do you have the normal values listed on your test results?

[Donna]

Baylee has never had a problem with ear infections, that was her first one. That is the reason she went to the vet. The vet does a complete physical whenever I bring her in, but this was the first time this particular vet had seen Baylee and thought she may have Cushings. Could you tell me what are symptoms that would cause you to treat a dog with Cushings/

[Donna]

Normal values: 4 hour post dex=<1, 8 hours post dex=<1, 1.0-1.5 is inconclusive for 4 and 8 hour post dex. I hope this helps.

[Trixie]

most common symptoms:

increased thirst and urination (dog may start to have accidents in the house)
excessive drinking
insomnia
skin issues-scaly patches
pot bellied appearance
muscle weakness
episodes of panting
weight gain/obesity
fur loss
lack of energy

some dogs have many symptoms and some just a few...

[Harley PoMMom]

These are the results of Baylee's testing: pre-dex: 4.9 ug/dl, 4 hours post dex: 1.5 ug/dl, 8 hours post dex: 3.0 ug/dl. 1 week prior to her testing she had a tooth extraction and the vet said her liver enzymes were elevated, she said it may have been due to dehydration since she had nothing by mouth after midnight. I do not have those results.

These results are from a LDDS (low-dose dexamethasone suppression) test and do point to the pituitary type of Cushing's, however; since the test was performed only 1 week after Baylee had a tooth removed I am a bit concerned that this could of created a false positive result on the LDDS test. Any kind of stress or non-adrenal illness will skew the LDDS test results. It would of made me feel better about those results if the vet would of waited at least a month before any testing was done.

Dental problems, among a host of other things, can cause elevations in the ALP (liver enzyme) and should not be the cause for testing for Cushing's. Strong obvious symptoms play a huge part in the diagnosis for Cushing's and since Baylee doesn't display any clinical Cushing's symptoms I do question the diagnosis of Cushing's.

Hugs, Lori

[lulusmom]

Most common symptoms associated with cushing's are excessive drinking and peeing, voracious appetite and panting. Other symptoms are intolerance to exercise, weakness, primarily in hind quarters due to muscle wasting, loss of coat and thinning skin.

Does Baylee have any of those symptoms?

[molly muffin]

Hello and welcome to the forum.

I can tell you that we started this journey many years ago, with a similar type of situation, where the vet thought my dog looked cushings, but she didn't have any of the symptoms. This seems to be what you are saying too? No excessive drinking, urinating, eating, muscle weakness etc? (listed by Barbara and Glynda above) We didn't start treatment because there was a lack of symptoms at that time.

The tooth extraction and an ear infection would make me leery of the results on the LDDS, just because it can be inaccurate if other things are going on.

One thing is good, there is no hurry in rushing to treat cushings, it is a very slow progressing disease, if it is even a factor. What did your regular vet say about all this?

Sharlene and molly muffin

[Donna]

Could daily use of Optimmune opthalmic ointment cause symtoms of Cushings?

[molly muffin]

Does it have a steroid in it? If it does it can contribute to symptoms if used for a long period of time.

hugs
Sharlene and Molly muffin

[Donna]

It contains Cyclosporine and petroleum.

[molly muffin]

Cyclosporine, most common side effect is gastric upset (vomiting or diarrhea). It can also contribute to a UTI. Since it's an immunosuppressant, you have to be careful of any infections when using it.
The petroleum (usually a jelly) is used a lubricant base for delivery and shouldn't cause any side effects from what I can find.

Sharlene and molly muffin

[Donna]

Since my initial post, Baylee does seem to have increased thirst. She has always had a ravenous appetite, but seems to be a lot more focused on eating. We don't give her table scraps at all, she gets boiled chicken if she begs while we're eating. For as interested as she is in food, she only grazes at her food dish. I have not taken her back to the vet to start her on any medication. My vet would like to start her on Anipryl. Would that be beneficial to her? Also, it seems like her respiratory rate is faster than it has been. Is that common in Cushings dogs?

[Donna]

Is Anipryl effective treatment for dogs with Pituitary dependent Cushings and if so, how?

[jxeno13]

Hi there Donna and welcome! I'm sorry for the reasons you are here for your Baylee. But, you came to the right place. I don't know anything about Anipryl . The IMS I saw said they only used Vetoryl/Trilostane for the pituitary dependent Cushing's. But, the others on this forum should be along shortly and can give you a wealth of information!

Some use Lysodren/mitotane.....but my IMS doesn't, at least not for PDH

Again.....welcome! :)

Hugs, Jo Ann and Eli

[molly muffin]

Hello, some think there is a small percentage of dogs that will respond to Anipryl. I don't remember the exact statistic but I think it is like 20%. The tumor I believe has to be in the correct spot for it to work. Some vets, I think Dr. Feldman at Univ Davis is one, says straight out, it doesn't work for cushings.

Yes, panting can be increase, heart rate BP should be checked if you think it is raised. Hypertension being a risk.

Sharlene and molly muffin

[labblab]

Hi Donna, you'll see that I've merged your newest post into your original thread. We find it's much easier for our members to follow along with thoughts and suggestions when all the conversation about each individual dog remains consolidated in one spot.

Thanks!
Marianne