New - diagnose

[kc904]

Hello everyone - I found this forum doing research for Cushings Disease in old dogs.
My Phoebe (red Pitbull) was 13 years old in August and about 1 months ago I noticed that she was drinking allot and she started to pee in the house at times. My 'usual' Vet did a blood test that came back clear and stated that she is a very old dog and I may want to think about 'humane euthanasia'.
Well - I took her home with me - and on Christmas Eve she looked as she had lost hair on her side and some purple-brown spots appeared. I checked on line and found a non-profit Animal hospital that was open and took her in.
The Vet there immediately said that she want to repeat the blood test - but she suspect Chushings - and I should not worry at this time.
Phoebe's blood test came back clear again and I scheduled an all day stay at the clinic for the Chushings testing.

Now I am confused. First one of the clinic's Vets called and stated that Phoebe's test was inconclusive and it is not clear if she has a pituitary gland or some other gland tumor and I should schedule an ultra sound.
Then another Vet from the same clinic calls and said that she does not agree with the first Vets diagnosis and Phoebe definitely has Cushings due to the pituitary gland and she recommends treatment to start immediately.
Now - I have researched on-line and found that the available medications are very harsh and have frightful side effects and that one should consider a 'natural approach to the disease' that will be a permanent condition for the rest of the dogs life.

My Phoebe right now still drinks allot but I think that she also learned to deal with her condition, because she seldom has any accidents, but uses the always accessible dog door. Her coat thinned out quite a bit on both sides and she shows medium to small size spots that do not seem to bother her when touched.

She did have a skin infection with dry blister spots and received an antibiotic for it, and the blisters disappeared but the small bumps did not. The 'rash' does not seem to bother her. She pants more often but is otherwise in good spirits. Phoebe also still jumps on the sofa and my bed - well about twice - then she wants to be picked up. She weighs about 47 pounds now and has lost some weight recently - but she has never been a good eater.

The second Vet I spoke with from the clinic stated that there is no wrong solution here - due to the age of my dog, but she did not want to recommend to treat her and to forget about the side effects or not treat her at this time.
I understand that my dog is old but I want to give her the best and most comfortable life she can have - so right now I am leaning toward not treating her and watch out for infections and other signs of illness and be prepared to take her to the Vet at any time. I am afraid that the side effects will negatively impact the wellbeing of my dog and I don't know what to do.

I guess I am relying on people that have some experience with Cushings in older dogs. So - please if anyone could help me to make an informed decision if I should treat Phoebe or not - please talk to me.
Thanks
Kristina

[Harley PoMMom]

Hi Kristina,

I have manually approved your membership so now all your posts will be seen right away. Also please just disregard the validation email that was sent to you from k9cushings.

Welcome to you and Phoebe! We are sorry for the reasons that brought you here but glad you found us, and we will help in any way we can.

Cushing's is a treatable disease but success in treatment does depend on a few things; keen owner observation, a pet parent willing to educate themselves about Cushing's, and a vet/IMS that has experience treating Cushing's and is knowledgeable about the protocols for Cushing's.

It would help us if you could get copies of all tests that were done on Phoebe and post any abnormalities that are listed along with the references ranges and units of measurement...as an example.....ALT 150 U/L (5-50) Also we are especially interested in the results of the diagnostic tests that were performed to diagnose her Cushing's.

The two medications generally prescribed for canine Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane. They are strong drugs and one drug is no safer than the other, adverse effects are usually not seen unless the proper treatment protocols are not followed. Also the medications do not cure Cushing's they are given to help abate the symptoms from Cushing's.

I am including a post made from on of our staffers, Marianne, to a member who was seeking advice regarding treating her elderly dog for Cushing's:
Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

Please do not hesitate to ask all the questions you want and remember we are here for you and Phoebe.

Hugs, Lori

[kc904]

Thank you for your note - I will try to get a copy of the lab results from my lab emailed or faxed to me.
Thanks again
K

[kc904]

Here are the lab results from the tests we had done:
Phoebe
Species: Canine
Breed : Pit Bull Terrier Mix
D.O.B. : 08/12/2000
Sex FS
Color Red
Weight 47.3 lbs.

12/25/2014 Labwork 12/26/2014: Called and TTO. Per MH; We do need to test for cushings
when O can LDDS. Continue antibiotics until then. HWT neg. dm
12/25/2014 Labwork


SENIOR PROF +MG OSM TRIG HW, CHEM 27 + OSM + TRIG, MAGNESIUM, T4, CBC STANDARD,
12/24/2014 10:06 PM
Requisition # 16171902
Accession # 4100061729
Panel Name
SENIOR PROF +MG OSM TRIG HW
Panel Name
CHEM 27 + OSM + TRIG
ALP 2222HIGH 5-160 U/L
ALT 307HIGH 18-121 U/L
AST 66HIGH 16-55 U/L
CREATINE KINASE 600HIGH 10-200 U/L
GGT 24HIGH 0-13 U/L
AMYLASE 409 337-1469 U/L
LIPASE 331 138-755 U/L
ALBUMIN 3.3 2.7-3.9 g/dL
TOTAL PROTEIN 6.6 5.5-7.5 g/dL
GLOBULIN 3.3 2.4-4.0 g/dL
TOTAL BILIRUBIN 0.1 0.0-0.3 mg/dL
BILIRUBIN CONJUGATED 0.1 0.0-0.1 mg/dL
BUN 17 9-31 mg/dL
CREATININE 0.8 0.5-1.5 mg/dL
CHOLESTEROL 294 131-345 mg/dL
GLUCOSE 86 63-114 mg/dL
CALCIUM 9.5 8.8-11.2 mg/dL
PHOSPHORUS 3.9 2.5-6.1 mg/dL
TCO2 (BICARBONATE) 18 13-27 mmol/L
CHLORIDE 112 108-119 mmol/L
POTASSIUM 5.2 4.0-5.4 mmol/L
SODIUM 148 142-152 mmol/L
ALB/GLOB RATIO 1 0.7-1.5
BUN/CREATININE RATIO 21.3




BILIRUBIN UNCONJUGATED 0 0.0-0.2 mg/dL
TRIGLYCERIDE 256HIGH 20-150 mg/dL
NA/K RATIO 28 28-37
HEMOLYSIS INDEX 2
Index of N, 1+, 2+ exhibits no significant effect on chemistry values.
LIPEMIA INDEX 1
Index of N, 1+, 2+ exhibits no significant effect on chemistry values.
ANION GAP 23 11-26 mmol/L
CALCULATED OSMOLALITY 317 302-330 mOsm/kg
Panel Name
MAGNESIUM
MAGNESIUM 2.2 1.8-2.4 mg/dL
Panel Name
T4
T4 0.7LOW 1.0-4.0 ug/dL
Interpretive ranges:
<1.0 Low
1.0-4.0 Normal
>4.0 High
2.1-5.4 Therapeutic
Dogs with no clinical signs of hypothyroidism and results within the
normal reference range are likely euthyroid. Dogs with low T4
concentrations may be hypothyroid or "euthyroid sick". Occasionally,
hypothyroid dogs can have T4 concentrations that are low normal. Dogs
with clinical signs of hypothyroidism and low or low normal T4
concentrations may be evaluated further by submission of free T4 and
canine TSH. A high T4 concentration in a clinically normal dog is
likely variation of normal; however elevations may occur secondary to
thyroid autoantibodies or rarely thyroid neoplasia. For dogs on
thyroid supplement, acceptable 4-6 hour post pill total T4
concentrations generally fall within the higher end or slightly above
the reference range.
Panel Name
CBC STANDARD
WBC 10.4 4.9-17.6 K/uL
RBC 8.27 5.39-8.70 M/uL
HGB 18.7 13.4-20.7 g/dL
HCT 51.2 38.3-56.5 %
MCV 62 59-76 fL


MCH 22.6 21.9-26.1 pg
MCHC 36.5 32.6-39.2 g/dL
% RETICULOCYTE 1.2 %
RETICULOCYTE 99 10-110 K/uL
% NEUTROPHIL 82.6 %
% LYMPHOCYTE 8.6 %
% MONOCYTE 6 %
% EOSINOPHIL 2.8 %
% BASOPHIL 0 %
PLATELET 504HIGH 143-448 K/uL
REMARKS
SLIDE REVIEWED MICROSCOPICALLY.
NO PARASITES SEEN
NEUTROPHIL 8590 2940-12670 /uL
LYMPHOCYTE 894LOW 1060-4950 /uL
MONOCYTE 624 130-1150 /uL
EOSINOPHIL 291 70-1490 /uL
BASOPHIL 0 0-100 /uL
Panel Name
URINALYSIS
COLLECTION METHOD FREE-CATCH
COLOR YELLOW
CLARITY CLEAR
SPECIFIC GRAVITY 1.017
GLUCOSE NEGATIVE
BILIRUBIN NEGATIVE
KETONES NEGATIVE
BLOOD 1
PH 7
PROTEIN NEGATIVE
Protein test is performed and confirmed by the sulfosalicylic acid
test.
WBC 0-2 0-5 HPF
RBC 2-5 HPF
BACTERIA RARE (<8/HPF) HPF
EPI CELL 1+ (1-2) HPF

MUCUS NONE SEEN
CASTS NONE SEEN HPF
CRYSTALS NONE SEEN HPF
UROBILINOGEN NORMAL
Panel Name
HEARTWORM AG ELISA
HEARTWORM ANTIGEN - ELISANEGATIVE
Dec 24, 2014 Cephalexin 500 Mg 42.00
Dec 24, 2014 IDEXX 2105 Full Profile 1
Dec 24, 2014 IDEXX 2105 Full Profile BUN 1


ABNORMALITIES
eyes ok ears ok teeth fine mm pi H&L ok abd nsf skin -
mostly truncal alopecia w/ hyperpigmentation and
comedomes, thin skin lots of crusting - one area over
left shoulder looks like it could be calcinosis cutis.

PLAN
submitted senior panel, r/o endocrine alopecia
started on oral antibiotics.











DEXAMETHASONE SUPPRESSION
01/09/2015 09:48 AM
Requisition # 16313216
Accession # E4885402
Panel Name
DEXAMETHASONE SUPPRESSION
PRE DEXAMETHASONE 5.8 1.0-6.0 ug/dL
POST 4 HR DEX 2.3 ug/dL
POST 8 HR DEX 1.9 ug/dL
Low-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hours 8 hours Interpretation
----------------------------------------------------------------------
<1 1.0-1.5 1.0-1.5 Inconclusive
>1.5 and >50% >1.5 and >50% Consistent with hyperadrenocorticism
of baseline of baseline Further testing required to
differentiate adrenal tumor from
pituitary-dependent
hyperadrenocorticism (PDH)
<1.5 or 1.5 and >50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)
<1.5 or 1.5 and <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)
>1.5 or >50% >1.5 and <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)
High-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hour 8 hour Interpretation
----------------------------------------------------------------------
<1.5 or 1.5 and >50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)
>1.5 and >50% <1.5 or of baseline of baseline hyperadrenocorticism (PDH)
<1.5 or of baseline of baseline hyperadrenocorticism (PDH)
>1.5 and >50% >1.5 and >50% Further testing required to
of baseline of baseline differentiate PDH from adrenal
tumor.
Hyperadrenocorticism is a clinical disorder with clinical signs. If
the animal has no clinical signs, we do not recommend treatment.
Approximately 5% of dogs with hyperadrenocorticism will have normal
low dose dexamethasone suppression results. Conversely, some animals
with significant nonadrenal disease may fail to adequately suppress on
this test.
01/09/2015 Labwork LDDT came back consistent with HAC, but unable to distinguish between
pituitary vs. adrenal origin. Called the owner explained that US is needed
to tell us which type of HAC the patient is suffering from. AJ
TTO and explained that test results of LDDT were consistent with PDH
(4h post was less than 50% of baseline) discussed treatment with owner
for Trilostane. Owner is unsure if she wants to treat or not due to side
effects, patient age, cost, etc. I told her I recommended it but the final
decision is hers and it would not be wrong to not treat since her side
effects are minimal.
SK
Jan 08, 2015 Activyl Plus Dogs 44# to #88 Single 1
Jan 08, 2015 In-Hospital Injection- Dex Sp 1
Jan 08, 2015 IDEXX Dex Suppression (1 Pre, 2 Posts)

[momakah]

Hello Kristina,
you will get so much help and support from the wonderful people here, Im fairly new too: Harry was diagnosed late November '14.
Finding this site gave me some sense of having a friend who can guide and advise. You know your pet, you'll know what to do ,in the meantime, well done for finding K9.
Sue and Harry.

[judymaggie]

Hi, Kristina! I was reading through the lab results you posted and this jumped out at me:


mostly truncal alopecia w/ hyperpigmentation and
comedomes, thin skin lots of crusting - one area over
left shoulder looks like it could be calcinosis cutis.

There are many members who are much more familiar that I am with calcinosis cutis and I'm sure they will take a look at your thread and chime in. I expect that there are methods to specifically diagnose this aspect of Cushing's.

Hang in there and hugs to Phoebe!

[Harley PoMMom]

mostly truncal alopecia w/ hyperpigmentation and
comedomes, thin skin lots of crusting - one area over
left shoulder looks like it could be calcinosis cutis.

I'm with Judy on this, you really do need to see if Phoebe has calcinosis cutis (CC). Calcinosis cutis, in plain words, is just a nasty thing to try to get under control, and if the excess cortisol is the reason for the CC, even with treatment it can be a bugger to get the upper hand, not impossible but it does take time. A skin biopsy is one way to diagnose CC, and if this were me I would have this done first.

Those LDDS test results do indicate to the pituitary type of Cushing's, however, any kind of illness or even stress can cause the LDDS test to be a false positive result. How ws Phoebe feeling when the LDDS test was performed? Did she have the skin rash at the time of the LDDS test?

Hugs, Lori

[kc904]

Yes Phoebe had a skin rash at the time and she was not like her usual self. Phoebe is a very introverted dog and has never been outgoing to anyone but me. Phoebe is also a hermaphrodite and when she was spayed in her 2. year - I found out that she had testicles grown to her uterus - I am not sure if that is even relevant, but I have always thought it has something to do with her somewhat neurotic character.
Around Thanksgiving we had a cold spell here in Florida and one big male stray cat came in through the dog door - I kept on putting him back out - but he always comes back in through the dog door. At the same time Phoebe started to pee in the house once and a while - and I thought that she was protesting his visits. But then I noticed that she started drinking allot more water than usually.

Then on Christmas Eve she woke up with a purple-brown spot on her back and it looked as if her coat became thinner over night - so I went to the vet.

The vet prescribed antibiotics and the dry skin blisters have cleared up, but she still has one area (about 2.5 ") with skin bumps that are still there. Phoebe does not try to itch them and they do not seem to bother her. She also has stopped drinking excessively and has no longer accidents in the house. She will finish the antibiotics by this weekend.

Since Christmas she has now multiple spots - greyish-brown in different sizes - mostly on one side and back.

I am so confused what to do and I got a 2. opinion from the local Humane Society and they advised me that I should prepare for her end of life care and to just make her comfortable.

Well - right now I am still leaning towards not treating her and to avoid any harsh meds, but watch her closely and go to the vet when needed. But I am not sure if it is the right choice.

[molly muffin]

i would ask that they do a skin biopsy of one of the sore spots and find out exactly what it is and then you'll know the best treatment for her.

[Squirt's Mom]

I wouldn't put a whole lot of stock in what the Humane Society said either. ;) I would seek a vet's help with determining what the skin issue is and go from there. If it is calcinonsis cutis, it will probably not get better until the cortisol is brought back to a more normal level. But should you chose not to pursue testing, that is your choice and we will support you as much as we can regardless.