Lucy - 11 y/o just diagnosed with Cushing's

[maureen0789]

Hello, my name is Maureen and my dog Lucy, a Husky/Border Collie (?) mix, was just diagnosed with Cushing's 3 days ago. I also have a female Border Collie/Corgi mix, Blackie, and they adore each other. Lucy came in to the SPCA where I work in 2003, skinny and missing most of her hair. Blackie (and her puppies) were taken on a cruelty case in 2004, and they haven't left each other's side since they met.

They had a senior checkup in November and bloodwork came back fine. In March Lucy suddenly started acting very strange, the first thing I noticed was that she was panting so much in the middle of the night that it woke me up. The next day (Saturday) she seemed like she just couldn't get comfortable, and she had a bloated belly. I didn't take my eyes off her all day and was ready to hop in the car and get her checked for bloat at any moment, luckily I live literally 2 minutes away from their vet, but honestly as soon as I looked at her I suspected Cushing's (also, she had no other signs of bloat and was eating and pooping just fine). After a bit she settled down, and her belly didn't look as big. She appeared to be back to normal, and the next day I asked my roommate to check on her for me while I was at work and she seemed ok. When I got home she was her normal happy self, but after I fed them dinner she seemed 'off' again for a few hours. I barely slept all night, and slept with my head against her so I would feel if she started getting agitated. I called the vet first thing in the morning on Monday and got her in that day (one good thing about working at the SPCA - no one questions you when you call off because your dog is sick) and they did bloodwork and an ultrasound which showed no tumors or fluid build-up, which was reassuring enough for me to go to work the next day. They called with the bloodwork results and said a couple things were slightly elevated but nothing really to be too concerned about, but if she were to start acting strange again to have her tested for Cushing's. She was back to normal so I thought, as the vet also said, it may have just been nothing. I kept an eye on her and other than an occasional episode of drinking a bit more than usual, which could have been due to warmer weather as well, she seemed 100% fine.

A couple weeks ago, out of nowhere, she had diarrhea all over my room as I slept - and she's one of those that walks while they poop. I wasn't too concerned until it lasted into the next day (luckily she made it outside the other times) and I started to see blood in it. Back to the vet for medicine, and while I was there I asked about whether it could be Cushing's related. We scheduled a test for last Thursday and they called me the next day to tell me she did indeed have it. Her medicine, Trilostane 60mg once a day, arrived today.

Now all I have to do is learn everything I can about Cushing's. I know vets can make mistakes like anyone else, so I'm always trying to be aware and thinking ahead and questioning everything. I'm sure I'll be reading more of this site tomorrow, and asking plenty of questions, but for now it's late and I have a doctor's appointment of my own in the morning... Lucy's snoring away at my feet as I type, or should I say at my knees since she takes up half the bed. Her and Blackie are my life, I don't have much money but I'm more than happy to spend whatever it takes to keep them healthy and happy. They've been with me since high school, and we've been through a lot together since then... I'll be perfectly okay with it if they both live to be 20 :)

Maureen

[Trish]

Hi Maureen

Welcome to the forum to you and Lucy and Blackie! Hopefully we can help you get a good understanding of Cushings. There is a lot of information for new members here http://www.k9cushings.com/forum/forumdisplay.php?f=10

The others will be around in a while, but hopefully you can answer a few questions for us that will help us give better replies to Lucy's case :)

Great to hear the ultrasound showed nothing too untoward. But it would be really helpful if you type in the actual report. Also for the blood tests she has had if you could type in just the abnormal results plus add in the laboratory reference ranges next to them, as labs can be different. Especially the tests they did for cushings, if you do not have the results ask your vet to get you copies. Then keep them all together in a folder.

How much does Lucy weigh, 60mg sounds a hefty dose but she is a husky/border collie so her weight may require her to have that much. Usual starting dose of Vetoryl is 1mg/pound.

If it was me, I would hold off starting her on it until the experts here can have a look over her lab tests. We have seen in the past dogs getting started on drugs at a too high dose or sometimes with a diagnosis that is dodgy.

Cushings pups are usually drinking gallons, peeing for Africa and hunting out food as if their life depended on it. They don't usually present with bloody diarrhea so there could be something else going on with her too to cause that. Is she on any other meds or supplements?

Also another rule is, never to give Vetoryl to a dog that is sick. It always pays to get to the bottom of why they are sick before giving the drug, as it could make them worse. I also hope your vet has given you Prednisone and told you what to do in case her cortisol drops too low with the Vetoryl and put an appropriate followup testing plan in place.

Sorry to hit you with all these questions, but as cushings is a slowly progressing disease there is no real hurry to start the vetoryl until you are really sure it is for the best. So if you could gather up this info we can all help you wade through the cushings maze.

Trish :)

[addy]

Hi and Welcome from me as well,

Cushings is a very difficult disease to diagnose and history is a huge part of making a correct diagnosis. I realize it is hard to come here and write everything down, especially when we are upset about the diagnosis in the first place as we all are when we first get the news.

Reading your first post, I am bothered by the "sudden swollen belly" and panting and followed by bloody stools as to me this is not generally a sign of Cushings. I speak of it as my own Cush pup struggled with inflammatory bowel disease which is what we opted to treat first, waiting a year for that to be well controlled before we treated her Cushings.

If you could give us the results of the tests that were done to diagnose Cushings, it would help us give you more feedback.

It may turn out that Lucy indeed has Cushings but I am concerned something else is going on

[goldengirl88]

Welcome to you and your baby. I wanted to ask about the ultra sound. Was is done on a high definition machine? If not you will want to do that. What if anything did they tell you about her adrenal glands form the ultra sound? Did they see any problems with any other organs, enlarged liver, spleen, any gallbladder debris? You will want to know the answers to those questions. What testing was done to diagnose Cushings? Would you please get us the abnormal results and the reference guide from the lab showing normal as they are all different? that way we can get a good picture of what is happening. Was there a urine test done. Blood panel? We will need those abnormal results too. have you ever had your dog tested for thyroid or diabetes? They do share some of the Cushings symptoms. Cushings is one of the hardest diseases to diagnose so you want to be sure you are dealing with Cushings before using the drugs to manage it. Could you give a brief medial history? How much does your dog weigh? The starting dose is 1mg per pound. Above that can bring trouble at first. Also you said your dog had bloody diarrhea. What did the vet say the cause for this was? If your dog was tested for Cushings and was having the diarrhea, the test numbers could be skewed, and give a false positive. I would be checking with the vet if this was not addressed. Was the dog fasted or not before testing? How many hours was the test? There is a certain protocol that must be followed with these tests. I am concerned of you giving Vetoryl to a sick dog, that is something that is never done, and you vet should have known this and told you, moreover he should have addressed the diarrhea issue before testing your dog for Cushings. If your dog still has the diarrhea please stop the Vetoryl now. Your vet or you can call Dechra for help if need be as I am not sure your vet has experience with Cushings which can be very bad unless he gets some guidance from Dechra 866-307-0789 Blessings
Patti

[maureen0789]

Hi Trish, questions are quite welcome! I don't have the actual reports but I will try to stop by my vet's office today and see about getting them. Wasn't even thinking about that, I have copies of my own medical reports, why not theirs?

I thought 60mg sounded like a lot to start off with too, but she weighs 55 pounds. She has been gaining a bit of weight since her appointment in November, I believe she was around 49 pounds then. But I was hoping for someone to tell me whether the dosage sounded right, as I had no idea what it should be.

I've been holding off on giving it to her for exactly those reasons, and no my vet hasn't given me anything else or told me anything other than that she needs to be rechecked (appointment July 3). The vet I go to is one of the best in this area, and to be honest that's a little scary to think about. Which is why I try to be on top of things rather than just doing what the vet says.

Lucy hasn't had diarrhea since the day I took her to the vet, just that first day and then the next day there was just barely enough blood in it to be noticeable, and since then she's been fine. That was her only symptom at the time too, no lethargy or vomiting or not wanting to eat or fever or anything. While I was at the vet with her I asked about the Cushing's test and they said it would be a good idea based on her history but they didn't say the two were related. I was unclear about that - I just asked about the test as a 'while I'm here' sort of thing. It had been on my mind since the beginning so I wanted to get it done if for no other reason than to ease my mind that she didn't have Cushing's. I've heard about dogs having signs of it for months before the owner realized what was going on so since she seemed to be in the very early stages I wasn't overly concerned.

She's not on any other medicine now, I would like to get her on a joint supplement soon tho. She's been drinking more water lately, not all the time but every so often she'll empty the bowl for no particular reason. And she does pant a lot at times, and she's always been food obsessed. I don't notice her peeing excessively tho. Her belly looks slightly bloated but not anything major.

I haven't been in a huge hurry to start the meds, mostly because she doesn't have any serious symptoms at the moment (she's still rather active and happy and doesn't seem uncomfortable or in distress) and because I feel like we caught it early so it hasn't been going on for a long time untreated. I've heard about Cushing's plenty of times but I don't know much about it, of course half the time when I tell someone she has it they go off about how their dog had it and how horrible it was and how it was so sad to watch them die from it, so I've basically stopped telling people. I don't think it's particularly pleasant to watch any dog get old and eventually die, and I don't see why Cushing's should make it any different. All dogs die from something, all you can do is help them out with whatever they need before that.

But I'm going to be late for my appointment so I better rush off - I'll definitely try to get Lucy's records today and feel free to ask as many questions as you want! No better way to learn what information I should have...

Maureen

[maureen0789]

Wow, more replies since I read the first one! I will read and respond when I get home, if I don't leave right now I'm going to be late for my own appointment. Thanks everyone!

Maureen

[Harley PoMMom]

Hi Maureen,

I am so glad you found us and we will help in any way we can.

As Trish mentioned, Cushing's is a slow progressing disease, it moves at a snail's pace, which does give a person time to get a confirmed diagnosis for their furbaby.

Cushing's symptoms do not just pop up nor do they wax and wane.
Some dogs with Cushing's go years before a confirmed diagnosis of Cushing's is made. Previously housebroken dogs may begin to have accidents in the house because their bodies are producing excessive amounts of cortisol which makes a dog urinate lakes and drink buckets and buckets of water. Dogs with Cushing's counter surf for any morsel of food because they have ravenous appetites, they tend to have a pot-bellied appearance due to an enlarged liver, distribution of fat, and muscle atrophy.

Strong symptoms do play a huge part in the diagnosis of Cushing's, which it seems that Lucy does not have. Although dogs with Cushing's do pant, panting also can be attributed to pain or discomfort so I think Lucy's symptoms fit better with a gastro problem, maybe even pancreatitis. When a non-adrenal illness is present, false positive results can be created on all tests for Cushing's.

If you could get copies of all tests that were done on Lucy and post any abnormal values here, that would be helpful. Also could you include the reference ranges and units of measurement for those values? We are especially interested in the results of all tests for Cushing's...thanks! Does Lucy take any other herb/supplements/medications? Any other health issues?

I'm sorry for all those questions but the more we know about Lucy the better our feedback can be ok? Welcome to the forum and remember we are here for you both.

Hugs, Lori

[jxeno13]

Hi Maureen, Lucy and Blackie! Welcome! I'm sorry for the reasons you're here, but glad you found this forum. These senior members are the best ever! :D Symptoms can actually show up in some little things with Cushing's as well, as long ago as 1-6 years ago ......as it did with my Eli. Then after a few weeks (slowly escalating) after a small surgery of a benign tumor..and BAM! it seemed he was full blown! So, you'll find it's really a tricky disease. But, can be controlled. :)

Anyway....welcome! Here's a good read too!

http://www.kateconnick.com/library/cushingsdisease.html

[molly muffin]

Well, I'm board with the others. Bloody diarrhea, you wouldn't give medicine anyhow, but that isn't a cushings presenting symptom. It is though as Lori said possible with gastro intestinal bacteria, which could cause the bloating look, the discomfort and panting and the bloody diarrhea. My dog is quite prone to it and usually you want to use a probiotic like florifora and an antibiotic like Metronidazole is commonly prescribed. My molly has had those exact symptoms and that is what helped her. Others on here have been through the same thing. You do want to rule out pancreatis too. Any hunch back, pain symtpoms? vomiting? Check on the lab results for any increase in lipase, etc.

I would get Lucy started on those two things I mentioned though right away if it was me and yes, Patti is right, with those things going on, cushing test results might be skewered.

This needs to be taken care of then reevaluate if you still think she is possibly cushings. Don't worry, we are with you ever step of the way and will answer any questions or worry you might have

Sharlene and molly muffin

[goldengirl88]

Just checking in to see how things are going? Hope you got some information on the diarrhea? Blessings
Patti

[maureen0789]

Sorry it took me so long to respond, this week has been ridiculous. I did get Lucy's records from the vet tho. I'll try to interpret the results as best I can but I have no idea what I'm doing so let me know if I'm missing anything.

Some medical history: she came to the SPCA in September 2003 at around a year or so old, emaciated and missing most of her hair. Spayed as soon as she was well enough. Has a strip of missing hair on her back where it never grew back but it's not itchy or flaky. History of ear infections (yeast) and has been prescribed Mometamax, Miconazole/Dex, and Ketoconazole. On 12-12-13 she was at the vet for a senior checkup/bloodwork and weighed 49.7 lbs. On 6-5-14 she weighed 55.8 lbs with no change of diet/exercise. Treated for Lyme in January. On 3-24-14 I took her to the vet with concern about the swollen belly/panting (which wasn't occurring during the vet visit) and they did bloodwork which showed a slight increase in a couple things which could potentially indicate Cushings or pancreatitis but said as long as she was acting ok not to worry about it - if she started acting strange again bring her in and have her tested. Since then she's had nothing but an occasional bout of excessive drinking, and the diarrhea.

The diarrhea started on a Wednesday, when it continued into Thursday (5-29) with just a barely noticeable amount of blood in it I took her to the vet. They couldn't tell me the cause but gave me Metronidazole and said if it didn't clear up in a day or two to call back. It stopped on its own later that day. She had no fever or other symptoms, and hasn't had diarrhea all year before or since those two days. While at the vet I asked about the Cushings test.

She had the Low-Dose Dexamethasone Suppression test done 6-5 and they called with results the next day. I have an ACTH stim test scheduled for 7-3 but I haven't been giving her the medicine yet so I can always reschedule that if needed. The test she had done took 8 hours, and she was not fasted before - the vet never mentioned anything about it.

Ultrasound done 3-24, "ultrasound of abdomen is relatively normal - no free fluid, moderate amt of gas in intestines - liver has one discrete small area that may be an area of past pathology - also one kidney has what appears to be an area of previous infarction - this appears to be "old" lesions that do not appear active". It doesn't mention whether it was done on a high-definition machine or not.

Lucy is food obsessed, but I don't think it's any different now from how she was 10 years ago. She does have some muscle atrophy in the back end, and she's very large in the front. I've been telling her for about a year now that she's "old lady shaped" because I've seen so many old female dogs shaped like her. She's got a lot of fat in the chest/shoulders area. When we moved to where we are now about a year and a half ago she could jump up on the bed on her own most of the time, but now she needs help every time. We go on walks at least 2-3 times a week tho and she walks a mile or more just fine, and often wants to go on but I have to make her stop so she doesn't overheat.

I'm going to post the test results in another message, that way if I fall asleep on my computer at least this much is here for now. I'm so exhausted and overwhelmed and all I'm seeing is a bunch of numbers and words swimming around each other. If I don't get the test results on here tonight I will definitely do it tomorrow, it's my day off so I SHOULD have time I hope.

Thanks again to everyone, if I've missed anything remind me, I've been working with dogs for over 13 years but this is the first time I've ever had to deal with something like this so I'm all confused. You think you know all there is to know and then you realize how little you really know...

Maureen

[maureen0789]

Ok, sorry I didn't get this on here last night. Hopefully I'll be able to make some sense of this.

3-25 results from blood test after she was taken in regarding the swollen belly:
ALKP=309 (5-160) up from 225 last time
AST=10 (16-55)
Chol=471 (131-345) up from 373
Lipase=905 (138-755)
Amylase=533 (337-1469) normal
Total protein=7.7 (5.5-7.5)
Glob=4.2 (2.4-4.0)
increases in ALKP and chol is suggestive of Cushings, possible pancreatic influence, but cannot conclude pancreatitis
-if worsens, rec to do Low Dose Dex Supp Test

In addition, the test results show low sodium (141, normal is 142-152), and chloride (107, normal is 108-119). Also NA/K RATIO is 26, normal is 28-37.

She then had the LDDS test done on 6-5 but I'm not sure how to interpret those results on here. What should I be looking for with those?

Thanks again!

Maureen

[Harley PoMMom]

She then had the LDDS test done on 6-5 but I'm not sure how to interpret those results on here. What should I be looking for with those?

Thanks again!

Maureen

For the LDDS test there should be 3 numbers; a pre/baseline, a 4 hour blood draw and a 8 hour blood draw. It will look like this: pre/baseline = 5.3 ug/dl, 4 hour = 3.5 ug/dl, 8 hour = 2.5 ug/dl (numbers are random).

[goldengirl88]

Yes I can see that the Lipase is high so I would be checking about the pancreatitis. Not extremely high ALKP for what Cush dogs normally have in the thousands. Sodium is just a tad low right now. I would want to look into a possible bowel disease too. Blessings
Patti

[maureen0789]

The LDDS test results are:

Pre-2.0
4 hour-3.3
8 hour-2.2

and then a bunch of stuff that says "consistent with pituitary-dependent hyperadrenocorticism" or "further testing required to differentiate PDH from adrenal tumor".

So should I have further testing done to be sure of Cushings? Should I have her tested for pancreatitis? I'll do whatever I have to do, but I don't have a whole lot of money to be spending on unnecessary tests/medications. As it is right now, she's not acting strange or in distress or anything like that, we went for a 1.3 mile walk earlier today, she's eating and pooping just fine, there's really nothing RIGHT NOW that's worrying me too much. But I don't want to let something go until it's a bigger problem than it has to be either...

[maureen0789]

Also her ALKP result in December was 225, in March it was 309. There's nothing here about what it was this month, could it possibly have gone up more since then? Even if not, does it mean anything that it's out of the normal range of 5-160?

[goldengirl88]

I think you are missing a number on the LDDS test. The ALKP is not really high for a Cushings dog they come in the thousands some times. Look on you sheet and please find the third number from your test. Blessings
Patti

[Harley PoMMom]

The LDDS test results are:

Pre-2.0
4 hour-3.3
8 hour-2.2

and then a bunch of stuff that says "consistent with pituitary-dependent hyperadrenocorticism" or "further testing required to differentiate PDH from adrenal tumor".

So should I have further testing done to be sure of Cushings? Should I have her tested for pancreatitis? I'll do whatever I have to do, but I don't have a whole lot of money to be spending on unnecessary tests/medications. As it is right now, she's not acting strange or in distress or anything like that, we went for a 1.3 mile walk earlier today, she's eating and pooping just fine, there's really nothing RIGHT NOW that's worrying me too much. But I don't want to let something go until it's a bigger problem than it has to be either...

Lucy's LDDS test results do point to Cushing's but do not differentiate between ADH or PDH. When interpreting LDDS test results the 8 hour mark is looked at first and if it is above the reference range, which is usually 1.4 ug/dl or 1.5 ug/dl, than the dog probably has Cushing's However, strong symptoms do play a huge part in the diagnosis of Cushing's, and treatment for Cushing's is to help alleviate the bothersome symptoms of Cushing's disease. Since Lucy is not exhibiting any obvious clinical signs of Cushing's, if this were me, I would not start any treatment.

Cushing's is a slow progressive disease and moves at a snail's pace, so if this was me, I would not pursue any more tests for Cushing's.

Hugs, Lori

[maureen0789]

Her records say the normal range for the LDDS test is 1.0 to 6.0.

So should I just keep an eye on things for now and watch out for symptoms of Cushings developing in the future? I guess I can cancel her ACTH stim test then too. I so wish I could find a vet that I can really trust, I'm not a huge fan of the place where I go but working at the SPCA gives you a good idea of how the vets in your area operate and this literally is the best vet in the county. I just feel like they're not really 'with it' or paying all that much attention to what they're doing, and not just with this but with other things too. Of course I have to drive through 2 counties to get to a decent doctor for myself so maybe I'll have to start looking elsewhere for a vet...

[Harley PoMMom]

The elevations in the ALP can be attributed to a gut issue, like IBD, IBS, or even pancreatitis.

Cortisol fluctuates throughout the day, and any non-adrenal illness, and even stress, will cause an increase in cortisol production.

If this were me, I would withhold treatment until Lucy started showing obvious Cushing's symptoms such as a ravenous appetite, and major increases in drinking/urinating.

Hugs, Lori

[maureen0789]

Well I can imagine she was probably good and stressed being at the vet for 8 hours. She's never away from home without me, and never apart from Blackie. Plus she's somewhat of a nervous dog in certain situations, so I have no doubt she was stressed just from being around unfamiliar people. She reminds me of a little kid who hides behind their mom's legs when someone talks to them.

Right now she's acting fine, no problems at all. If she starts anything I'll definitely get her checked out but as it is she seems normal and content and that's all that matters. I just wanted to be on top of things as the vet said Cushings was a possibility, I had kind of thought that if you caught it early and started treatment right away you could prevent other problems such as hair loss/excessive drinking/etc., but now I see that's not really how it works. Definitely glad I found out before I started the medication.

Thanks so much everyone for your help and advice! It's truly appreciated, I feel much better now that I know a bit more about Cushings. Lucy says thanks too!

http://www.k9cushings.com/forum/picture.php?albumid=891&pictureid=6812

[goldengirl88]

You are right in a way, it does not stop the peeing and need to drink, right away, but it will help with the muscle loss and weakness. I would just keep observing like you have been. Blessings
Patti