Chloe most likely has Cushing's and I need as much help as I can get!

[KristinT]

A little background; Chloe is 8 years old spayed shih tzu. She's had seizures all her life but not frequent enough to justify medication, thank goodness.

In early Nov. 2014 she was diagnosed with an UTI and prescribed Baytril for 3 weeks along with changing her to Science Diet CD canned food. I've fed her Wellness brand food all her life. While I was in Knoxville, TN for Thanksgiving she got a bad eye infection and started showing signs of the UTI again so I took her to the University of Tennessee Veterinary Hospital. They treated her eye infection with Neomycin ointment and sent her urine to the lab. The next morning she vomited several times so I took her back in and asked them to do a full exam, x-rays, full blood work, everything. I was concerned something serious was going on.

She did have another UTI so they gave her 2 week supply of Clavamox. Her x-rays showed everything was normal. According to the records they gave me:
• Her blood showed mildly elevated neutrophil count and total protein
• Her platelet count was significantly elevated
• She had an elevated alkaline phosphatase enzyme
• An increased anion gap
• Decreased phosphate level

There were no signs of why she was vomiting and they suggested she may have eaten food dropped on the floor since we visited several different houses with small kids during Thanksgiving. The Vet also said she had all the tell-tell signs of Cushing's Syndrome (excessive thirst, frequent urination, extreme hunger all the time, frequent panting and a pot-belly appearance) and recommended I have her tested when I return home. I started reading as much literature as I could on the subject.

When I returned to Tampa, I took her to my Vet and gave him all the paperwork from UT Vet Hospital. He checked her urine and she still showed bacteria present so he started her back on the Clavamox. He recommended Episioplasty surgery because she has a recessed vulva. He said she will more than likely continue to get UTIs because the excess folds of skin are a perfect breeding ground for bacteria. I agreed to the surgery and scheduled it for Friday, Jan. 16th. The night before the surgery I had a bad gut feeling about going through with it. I took her to the vet Friday morning and ask him to please do a full exam and blood work before he begins the surgery because I’m concerned she’s not healthy enough to go through surgery right now. I told him I was concerned about her blood work results from UT and that she has Cushing’s. He cancelled the surgery and tested her blood in his office and said her liver proteins were very high and wanted to send her blood to an outside lab for a full analysis. He called this morning (Saturday, Jan 17th) and said there were a lot of discrepancies with her blood results and wants me to bring her in Monday morning to go over everything with me. I want to be prepared for what to look for with Cushing’s.
• What specific levels will out of range with Cushing’s?
• What are some questions I should ask the Vet?

I searched the ACVIM site and the closest Internal Medicine Specialist is in Miami. I’m not sure if my vet is experienced with Cushing’s or knows how to treat her. Anything you can recommend will be greatly appreciated.

Chloe is my baby and my first concern is that she’s not in pain. I’ve cried myself to sleep so many nights lately wishing I had seen the signs earlier and feeling so guilty that she’s been suffering for so long and I didn’t know it.

Forever grateful that I found this wonderful site!
Kristin :)

[judymaggie]

Welcome to you and Chloe (although I'm sure you would rather not have to be here)! We are neighbors ...I live in Riverview. :D. I am the parent of my second Cush pup, Abbie--an almost 12 beagle. My first Cush pup, Maggie, was also a beagle. As an aside, when she was about 4 years old, she underwent an episiotomy--it was a very major surgery. I think your instincts re holding off on surgery was a good call.

Others with a lot more experience will be along but I wanted to give you the good news that there is an excellent group of internists at Blue Pearl Veterinary Hospital on Busch Boulevard. I have used the same internist for both Maggie and Abbie, Dr. Erick Mears. He is now the medical director so do not know if he is accepting new patients but you could definitely get a suggestion from him as to whom would be best for Chloe to see. You will need a referral from your vet which shouldn't be an issue. If I were in your shoes, I would hold off on any more testing with your vet and have the IMS decide what route to take. That said, the evaluations and tests at Blue Pearl are pretty pricey but they were very thorough and I always felt like my dogs were getting great care.

One thing you can get started with here is to post all the abnormal lab test results by typing the test, the result and the range, I.e., ALP 160 (50-100).

Don't beat yourself up--I think you sound like a great Mom!

[labblab]

Hello and welcome from me, too! I'm so glad Judy could help you with some referral information. I'm afraid I only have a moment to post right now, but wanted to give you this excellent summary of typical abnormal blood results that are commonly associated with Cushing's that was posted earlier this week by another one of our staffers, Lori:



Approximately 80% or 90% of dogs have a steroid induced isoenzyme of ALKP so if one of those dogs has cushing's, you are gonna see anywhere from a mild to severe increase in ALKP and usually there are only mild elevations in the ALT. The other abnormalities generally seen on a chemistry panel are increased levels in cholesterol, triglycerides, and a low BUN, on the CBC it might show an increase in the number of red blood cells (RBC’s) and/or an increase in platelets, there is also white blood cell abnormalitie which is called a "stress leukogram"

As far as a urinalysis, urine is often very dilute with low specific gravity. And yes, Cushpups frequently suffer from chronic UTIs that are difficult to eradicate. I'll check back again when I have more time to post!

Marianne

[Renee]

Welcome from me too.

Two things I wanted to say:

Firstly, I do hope your vet is running culture and sensitivity testing for the UTI's? I say this because when you just do the urinalysis, they are *guessing* as to the correct antibiotics. If they are wrong, then you won't get rid of the UTI. Doing the culture and sensitivity is much better because a lab grows the bacteria and then determines the specific abx to kill it.

Secondly - experienced vet or inexperienced vet, I cannot urge you enough to educate yourself thoroughly about cushings, including the diagnostic phase and then the treatment and management phase. Your level of knowledge will directly impact the success of failure in properly treating this disease.

You are doing great so far!! I think you were absolutely right to hold off on the surgery. It may be that cushings is contributing to the UTI's and not a recessed vulva.

[Lola]

Hi Kristin, and welcome from me too.

I lived in Tampa for years, then Riverview before I moved to Southern California a few years ago.
JudyMaggie is right, Blue Pearl is one of the best specialty vet hospitals, they have I believe 3 locations. I used their Ulmerton Rd location in Clearwater years a go for ultrasounds when Lola was still a puppy. My regular vet was Dr Levengood at the Dale Mabry Animal Hospital in South Tampa, he's one of the best in the area.
please do not hesitate to ask any questions, we're all here to help and share our experiences


Nadia

[KristinT]

Thanks everyone for all your replies!! You have no idea how thankful I am to have found such a knowledgeable support group.

Judy - I'm so glad we're neighbors! That's great news! Thanks for letting me know about Blue Pearl, it's so good to hear from someone with firsthand knowledge. :)

Marianne - Thanks for the info on the blood tests. I'm going to read everything I can find on this site before Monday. :)

Renee - Thanks for your insight; I will definitely educate myself and not just depend on what one vet says. After all, they are only human and can easily make mistakes like everyone else. :)

Nadia - Thanks for the info on Dr. Levengood; it's good to know I can go to a vet in the area with experience on Cushing's. I took Chloe to the Vet Medical Clinic on Henderson in South Tampa up until she was 4, then I moved to Carrollwood and transferred her to Keene Vet Hospital since they were right down the street. I think I'm going to rethink that decision now as convenience isn't top priority, my baby's health is. :)

Again, thanks everyone for your warm welcomes and great information. I'm so grateful to you all.

Kristin

[Lola]

Kristin,
Dr Levengood is a great vet general practitioner, I honestly don't know if he has a great experience with Cushings as Lola wasn't diagnosed until we moved to California, but he is still great, he was always spot on, also being an older doctor I'm sure he has a lot of experience under his belt.
I personally don't like to change vets, I find a good one and stick with them :) my current vet is 45 min away, and the IMS is one hour away, and I don't mind the drive at all as long as I know that my baby will be in good hands, but again this is california, everything is one hour away :) even when I lived there, I moved several times but always took Lola to the same vet.

Good luck to you and your baby

Nadia

[Harley PoMMom]

Marianne - Thanks for the info on the blood tests. I'm going to read everything I can find on this site before Monday. :)
Kristin

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.

When a pet parent educates them-self about Cushing's and understands the treatments and protocols this disease become less scary. So kudos to you for wanting to do that. Knowledge is power!! And since we are the only voice and advocate for our furbaby getting completely involved in their treatment is so very important.

Here's a handy link to our Resource Forum: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Hugs, Lori

[Cris]

Hi Kristin! My 14 year old Bichon, Maggie was recently diagnosed with Cushing's. I live in Naples… just south of you and we have specialty hospitals in the Naples and Lee County area. HOWEVER, I prefer a wonderful doctor who has a clinic in Sarasota. Her name is Dr. Heidi Ward, and she is an internist/oncologist. She is a no nonsense, straight to the point vet who my general vet (who I have been with for over 20 years) trusts very much. Dr. Ward is also affordable and keeps her emphasis on the medical care of the pets she provides as oppose to inflating costs as a specialty vet. Dr. Ward comes down to the Naples area on a weekly basis to provide ultrasound and medical advice to some of the local vets in southwest Florida when needed. She provides the ultrasound and shares medical advice with Maggie's vet. Here's her website: http://www.gulfcoastvetoncology.com/index.php

[KristinT]

Thanks for the link Lori. Wow, so much information to absorb. I feel like I'm back in school with my pen and paper taking notes and all. :) I'm not complaining though, I'm super, super grateful so much information is available. I know I'm showing my age, but I remember when we had to go to the library and check out tons of books to get this kind of information. Can you believe we got anything done before the internet. ;)

Thanks Cris, I greatly appreciate your sharing. I feel very relieved knowing such great doctors are so close by. Whew, first hurdle complete. :)

I see her vet today at 12:40pm to go over the blood test results he ran on Friday. I hope he is open to giving me a referral to see an internist so I can get Chloe an appointment for definitive testing as soon as possible. She just lays around and sleeps all the time; I can see it in her eyes that she doesn't feel good. Of course, this could also be due to her current UTI as well. The ONLY thing that perks her up is when there's food around and then she's right back in her bed. :( It breaks my heart; I only want my baby to feel better. I hate seeing her so sad.

I've done a tremendous amount of reading over the weekend but I'm unclear on the best test to determine that she definitely has Cushing's. I read that the ACTH stimulation test was usually the first test of choice but I also read that the Low-dose dexamethasone suppression test was better.

• Is this something I can choose or does it depend on the internist which test is run?
• Once it is determined she definitely has Cushing's is an Ultrasound to rule out Adrenal tumors the next step or is there a better test to differentiate which she has?
• Which medication is best for pituitary dependent Cushings?
• Does anyone recommended a sequence of tests/testing that's best to follow?

I may be too presumptuous but I believe she has pituitary dependent Cushing's; given she's had two x-rays in the last two months and they didn't see anything unusual. That is, if an x-ray can even detect adrenal tumors. It may be that an Ultrasound is the best or preferred method of detecting adrenal tumors.

I'll report back after I see the vet today.

Many thanks to Everyone!!!
Kristin

[Barb]

Hi Kristin! My 14 year old Bichon, Maggie was recently diagnosed with Cushing's. I live in Naples… just south of you and we have specialty hospitals in the Naples and Lee County area. HOWEVER, I prefer a wonderful doctor who has a clinic in Sarasota. Her name is Dr. Heidi Ward, and she is an internist/oncologist. She is a no nonsense, straight to the point vet who my general vet (who I have been with for over 20 years) trusts very much. Dr. Ward is also affordable and keeps her emphasis on the medical care of the pets she provides as oppose to inflating costs as a specialty vet. Dr. Ward comes down to the Naples area on a weekly basis to provide ultrasound and medical advice to some of the local vets in southwest Florida when needed. She provides the ultrasound and shares medical advice with Maggie's vet. Here's her website: http://www.gulfcoastvetoncology.com/index.php

I could not agree more on Dr. Ward. She is wonderful. A right to the point lady. I have been taking my Chloe to her for bladder cancer. We live in Sarasota.
You can not go wrong with her. Bedside manner could be better but being an oncologist is hard. She does know her stuff and does not overcharge.

Good luck.

[Harley PoMMom]

Hi Kristin,

The LDDS ( Low-dose dexamethasone suppression) is the preferred test to diagnose Cushing's. This test does have the capability to differentiate between the pituitary and adrenal form of Cushing's. If the LDDS test does point to Cushing's but is inconclusive to which kind than an ultrasound can be performed and hopefully the adrenal glands are visualized.

Since there isn't one test that is 100% accurate at diagnosing Cushing's multiple tests should be done to confirm a Cushing's diagnosis. Other tests that can be performed are the ACTH stimulation, and/or an ultrasound.

Those ultrasounds are expensive, however, any abnormalities with the internal organs may be seen. With my boy, Harley, his first ultrasound showed that he had prior bouts of pancreatitis. Harley never displayed symptoms of pancreatitis and a spec cPL test later confirmed the ultrasound findings. Our motto here is you get a lot of bang for your buck with an ultrasound. However not ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it.

I'm providing a link to Dr Peterson's blog which discusses what test is best to diagnose Cushing's, just so ya know :) Dr Peterson is a renown Cushing's expert and also is a contributor to Dechra's continuing education site. Now here is that link: Diagnosing Cushing's Syndrome in Dogs: When Should I Test? What's the Best Test to Use? (http://endocrinevet.blogspot.com/2011/02/diagnosing-hyperadrenocorticism.html)

Both Vetoryl/Trilostane and Lysodren/Mitotane can be used for either type of Cushing's. One drug is no safer than the other, and if the proper protocols are not followed with either drug adverse side effects can be seen. The best advice I can give you in deciding which drug to use is: making sure the vet is knowledgeable and has experience with Cushing's, meaning that s/he has a through understanding about the medications for Cushing's and the treatment protocols for either drug. Also it is imperative that the pet owner educates them self in all aspects of Cushing's so that they can make educated decisions for their furbaby.

Hope this helps.

Hugs, Lori

[KristinT]

Ok, I just read something very disturbing. I was on the "Insights into Veterinary Endocrinology" site http://endocrinevet.blogspot.com/2011/07/q-pituitary-macrotumor-in-dog-with.html

It says that the pituitary tumor in dogs with pituitary-dependent hyperadrenocorticism (PDH) will continue to grow and 10% to 25% of dogs will eventually develop neurologic signs caused by expansion of their pituitary tumor. My Chloe has been having seizures since she was a puppy; could this mean her seizures will become more frequent as the tumor grows and her quality of life will continue to decline?

If this is the case, has anyone here had or heard firsthand of successful results from external radiation therapy? Is this something I may be faced with?

Maybe I'm jumping to conclusions and I need to step back and take one thing at a time....it's just hard not to fear the worse. I go from having hope to feeling desperately sad. And right now I'm feeling desperately sad.

I just posted a picture of her I took 5 minutes ago. She looks so pitiful.

:(

[Renee]

Yep - take a step back and go with one thing at a time.

When I was in the diagnostic phase, I ran both an ACTH and LDDS and a skin biopsy on what turned out to be the dreaded CC. This was enough for us to diagnose and start treatment. After my wallet recovered for a bit, then we did a CT scan (rather than ultrasound). This was about 2 months into treatment.

As for the possibility of a tumor on the pituitary gland causing seizures or neurological symptoms, that is a possibility if your girl ends up having a macro. I believe the only true way to know if she has a macro is with imaging (MRI or CT). If you find the thread for Buttercup, you can see how she went through radiation to treat hers. Dawn (owner) has not been real active lately, but her thread has good information on the radiation.

I really do think you need to focus on one thing at a time though. But, given her history of seizures, imaging of her head is not a terrible idea.

[labblab]

I totally agree with Renee that I would try to just take one step at a time. Since Chloe's history of seizures dates from such an early age, it is most likely that she has epilepsy. If so, I don't think it is any more or less likely that she might ultimately develop worsening problems from an enlarging pituitary tumor. This is because the mechanisms causing the seizures in the two situations are likely very different. So I don't think her previous seizure history will have a direct bearing at all as to the rate or amount of pituitary tumor growth.

Marianne

[My sweet Ginger]

Although we left our GP vet to see an IMS soon after the treatment I tend to agree with her chronological order of diagnostic Cushings tests and I think all three were necessary as not one test alone can confirm Cushings.
First we did an ACTH stimulation test followed by LDDST (inconclusive) and then ultrasound which determined my pup having PDH and a nodule on her spleen.

[KristinT]

You all are a Godsend to me!!! You have no idea how much I appreciate your helping me and answering my questions! I just returned from the Vet, he wants to perform the ACTH test tomorrow. Her blood tests were as follows:

Total Protein: 6.9 [range 5.0-7.4 g/dL]
Albumin: 4.5 (HIGH) [range 2.7-4.4 g/dL]
Globulin: 2.4 [range 1.6-3.6 g/dL]
A/G Ratio: 1.9 [range 0.8-2.0 Ratio]
AST (SGOT): 36 [range 15-66 U/L]
ALT (SGPT): 28 [range 12-118 U/L]
Alk Phosphastase: 542 (HIGH) [range 5-131 U/L]
GGTP: 24 (HIGH) [range 1-12 U/L]
Total Bilirubin: 0.3 [range 0.1-0.3 mg/dL]
Urea Nitrogen: 7 [range 6-31 mg/dL]
Creatinine: 0.6 [range 0.5-1.6 mg/dL]
BUN/Creatinine Ratio: 12 [range 4-27 Ratio]
Phosphorus: 2.0 (LOW) [range 2.5-6.0 mg/dL]
Glucose: 89 [range 70-138 mg/dL]
Calcium: 10.7 [range 8.9-11.4 mg/dL]
Magnesium: 2.7 (HIGH) [range 1.5-2.5 mEq/L]
Sodium: 142 [range 139-154 mEq/L]
Potassium: 4.5 [range 3.6-5.5 mEq/L]
Na/K Ratio: 32
Chloride: 106 [range 102-120 mEq/L]
Cholesterol: 332 (HIGH) [range 92-324 mg/dL]
Triglycerides: 995 (HIGH) [range 29-291 mg/dL]
Results verified.
Amylase: 364 [range 290-1125 U/L]
Lipase: 340 [range 77-695 U/L]
CPK: 183 [range 59-895 U/L]
Comment: Hemolysis 2+, Lipemia 3+ No significant interference.
T4: 2.7 [range 0.8-3.5 ug/dL]
WBC: 12.9 [range 4.0-15.5 103µL]
RBC: 6.7 [range 4.8-9.3 106µL]
Hemoglobin: 17.5 [range 12.1-20.3 g/dL]
Hematocrit: 46 [range 36-60 %]
MCV: 69 [range 58-79 fL]
MCH: 26.1 [range 19-28 pg]
MCHC: 38.0 [range 30-38 g/dL]
Platelet Count: 508 (HIGH) [range 170-400 103µL]
Platelet EST: Increased [range Adequate]

I’ll post her ACTH test results later this week once I receive them.

One more thing; the vet said once we know for sure it is Cushing’s he can get her started on medication. Should I let him administer the meds or ask him for a referral and take her to an Internist at that point? I told him I wanted to have an ultrasound or MRI to determine what kind of Cushing’s she has and he didn’t act like that was necessary. Is this a red flag?

Kristin

[Squirt's Mom]

Not a red flag to me; he's probably trying to save you some money and it is not a necessary test. However I recommend the ultrasound because that test saved my Squirt's life by finding a tumor on her spleen during the diagnostics. It is the one test that gives the biggest bang for the buck because not only can it go a long way in determining which form she has it will let them see many other organs and how they are doing. ;)

[My sweet Ginger]

Like have been mentioned previously, let's try to take one step at a time. Let's wait for the results of ACTH and see which way your vet wants to take you and Chloe if her ACTH comes back positive. At that point you can do both LDDS and US but if I have to pick one I'd choose US as you can also check other organs as well on top of determining which type of Cushings she may have.
Most of times US is used for Cushings diagnosis rather than MRI at this point and it is also a lot cheaper. ;)

[KristinT]

Thanks again everyone! You've given me a treasure-trove of information and I think it's finally starting to sink in. I've read and re-read this forum at least 10 times since Friday. :) I do believe I will take the recommendation and have an Ultrasound next as I want to determine which type of Cushing's she has but I also like the fact that other abnormalities can potentially be caught with an Ultrasound. So, I'm back to reading thanks to all the great information on this site. :) Kristin

[Dixie'sMom]

Hey Kristen and Chloe! It sounds like you're getting some great information and are off to a great start. It's also a huge blessing to hear that you have lots of great vets around you. You've already got half the battle whipped with that. :)

Educating yourself will go a long way towards finding some peace with this crazy disease and taking a lot of the fear away, so kudos to you for that. You are also correct in that the experts on this forum are real life savers for those of us still learning.

My doxie has been under treatment for 4 months now and is doing very well. I think Chloe will do very well also if it is determined that she does have Cushings. I am just thankful that there is treatment available for these sweet pups.

Chloe is a beauty. :) I hope she will get to feeling better soon.

[KristinT]

Thanks Suzie, I'm so grateful to you all. It really makes a huge difference knowing I have so many caring and knowledgeable animal lovers willing to give their time so selflessly.

I'm anxiously awaiting a call from the vet to hear the results of Chloe's ACTH test. I want to get her ultrasound scheduled as soon as possible so I can get her on medicine and feeling better.

She has 2 more days of Clavamox for her UTI. I really hope it's finally gone but judging by the way she's acting, I don't think it is. The cultures have come back as E. coli and Clavamox is supposed to be a good antibiotic for that type of bacteria. I really hope I'm wrong and the UTI is finally gone.

She still sleeps constantly and when she's not sleeping, she begs for food and water. I don't remember the last time she didn't wake me up in the middle of the night to go out to potty. I haven't seen her spunky and playful in such a long time. :(

I'll check-in tomorrow with her test results.

Thanks everyone!
Kristin

[judymaggie]

Kristin--will be interesting to see ACTH numbers. Where have you decided to take Chloe for the ultrasound? If you decide to have it done at Blue Pearl, your vet can call and ask for a consult (and, hopefully, Dr. Mears would be available). The consult would include a review of all tests done (your vet would provide what he has done), a meeting with Dr. Mears' assistant, a meeting with Dr. Mears and then the ultrasound. Then you would meet with Dr. Mears to talk about the ultrasound results. If the ultrasound supports a Cushing's diagnosis, this is also is a good opportunity ask questions about treatment (I had my list ...). The whole process took about 2 1/2 hours.

[KristinT]

Well, I'm bummed. The vet called this morning and apparently the lab broke one of Chloe's blood vials so she has to fast and go back in Monday morning for another ACTH test. :( I want to get some resolution so I can get her feeling better soon.

Judy - I'm definitely going with Blue Pearl and I'll keep my fingers crossed that Dr. Mears is available to work with Chloe. I'm not sure when I'll be able to get an appointment though, I didn't realize it was going to take this long to get the ACTH results. It feels like I'm waiting and waiting while my poor baby suffers.

It also looks like her eye infection is coming back. She is starting to hold her left eye closed which is a sign. She was diagnosed with Dry Eye 2 years ago by Dr. Wolfe (Vet Ophthalmologist) and I give her eye drops at least 5 times a day. The Tacrolimus drops help produce tears and the GenTeal keep her eyes lubricated. I'm not sure what could be causing the eye infections to come back but if she continues to squint I'm going to make an appt. with Dr. Wolfe next week.

[Harley PoMMom]

Dang those labs!! :mad: Results for the ACTH stimulation tests generally do take a couple days. The waiting is so frustrating!!

Unfortunately that elevated cortisol can cause cush dogs to be more prone to infections because the excess cortisol suppresses their immune system.

Just wanted you to be aware that fasting is ok for a diagnostic ACTH stimulation test, however, when monitoring with the ACTH stimulation test for treatment the medication has to be given with food.

Hugs, Lori

[KristinT]

Ah, that is good to know Lori. I wasn't aware of that and could very easily have fasted her before her maintenance ACTH stim tests which would have caused the results to be skewed. :eek:

I've made up my mind, I'm going to post to this forum EVERY step of the way. The feedback on here is second to none and I feel very confident that Chloe and I will not go it alone. :p

[molly muffin]

No fasting for an ACTH test!!!

you give them their meds with food as normal, then test 4 - 6 hours later. (some vets do 2 - 3 hours later) Mine does 4 - 5 but that is the window.
Fasting ACTH aren't accurate and the manufacturer specifically says to give with food (meal) and then test.

Gads, sorry to hear the eye infection might be coming back! Hope it isn't and it was just a dry day for her. Cross fingers for that.

[KristinT]

I was reviewing chloe's recent blood work and her triglycerides are 995. :eek:

Is that typical for cushing's pups? I currently feed her science diet cd, recently prescribed by my vet because of her recurrent UTIs. Before that I fed her Wellness ocean blend because I thought she may have allergies to chicken or grain because she was always scratching. Before the ocean formula I fed her Wellness adult formula.

She no longer scratches as much but I think that could be because I bathe her in an antibacterial, antifungal shampoo approximately once a week. I believe it was yeast on her skin causing the itching and the shampoo has helped control it's growth. So I'm rambling now, my question is about her diet.

What food regimens and/or supplements have you guys had success with for cushing's? Is a home cooked meal a good solution? Will she get all the vitamins and minerals she needs if I prepare her meals? I'm willing to do anything if it will help.

She already has two growths under her skin, one is on her neck and the other is on her back. The one on her neck is very soft and moves under her skin. The vet told me it was fat deposits and nothing to worry about. Has anyone ever heard of these? Are they really harmless? What can I do to keep them from growing or more from forming? The one on her back is more like a lump, it's not visible to the eye but I can feel it when I run my hand down her back. There's a slight lump and it's flat and firm, not like the one on her neck. I noticed them about 2 years ago and the vet told me to keep an eye on them but not to worry. I check them constantly and they don't appear to be getting larger. Again, I'm rambling. I'm curious if anyone knows anything or has experienced the same thing.

Kristin and Chloe :)

[Dixie'sMom]

The fat deposits are lipomas and are common in older dogs. Nothing to worry about unless it restricts movement or causes pain. I'm not sure about the other lump. Buttons has a cyst on her neck right where the collar rubs and it will grow quite large and ooze and get infected if I don't take her collar off right after we go out on the leash. The vet wanted a ridiculous amount of money to remove it so I just "doctor" it myself. :) If at some point in time she has to be put under anesthesia for something else, I will have it removed at the same time.

Dogs with Cushing's need a low fat diet because they are prone to pancreatitis. You don't want to start any meds and change foods at the same time because if there is a tummy upset you would have a hard time determining what caused it. Only one change at a time. Dixie is on a low fat weight loss food because she is so overweight. I have no personal experience with the foods you are using so maybe the others have some thoughts.


I
've made up my mind, I'm going to post to this forum EVERY step of the way. The feedback on here is second to none and I feel very confident that Chloe and I will not go it alone. :p

That's what we are here for. And it does feel good to have others rally around you and your sweet baby. Plus many minds looking at the same issue gives great insighter and allows fewer problems to slip by unnoticed. You are doing great. Hang in there! (Sorry about the bloodwork... that stinks!)

[addy]

Hi,

My girl had many eye issues and at one point was on 12 different eye drops. Her ophthalmologist thought keeping her cortisol down under 5ug/dl would help. It did. Make sure the Gen Teal is the severe gel.
We had to use both Tacrolimus and Cyclosporine to ensure her tear production was high. Since she also had problems with allergies we used Flurbiprofen during allergy season.

Hugs.

[Renee]

I think diet is such a hot button issue, and is certainly a personal choice. I would say that most well informed pet owners at least know the very bad choices to avoid (alpo, beneful, etc), but beyond that, we all make our own choices based on our knowledge and how our dogs respond. The recurrent UTI's may be due to the cushings, so once you have everything well controlled, I would encourage you to transition off the science diet (which is not a good food) and on to something better. Nothing burns my biscuits more than vets that blindly push the science diet formulas for every illness. :(

An incomplete homecooked diet can be far worse than even a bad commercial diet, so if you go down that road, make sure you do enough research and have proper guidance that you are not making things worse. I have homecooked off and on for years, but my dogs are all currently on The Honest Kitchen. I personally will not allow them to eat kibble. But, I don't knock people who do choose kibble. It's certainly convenient and a lot of dogs really enjoy it.

Supplements that I give daily (and which I would recommend for all dogs, especially cushings pups) is probiotics and fish oil. Some people interchange fish oil and coconut oil, but I'm still a little old school and think a good quality fish oil is more beneficial.

[judymaggie]

Kristin--as Suzie has said, lipomas (fatty deposits) are very commom in older dogs. Abbie has many of them. I do point out to the vet new ones or those that have started growing larger. He has a very good feel for what are truly lipomas vs. those that are questionable and I leave it up to him whether an aspiration is necessary. Abbie had a bilateral mastectomy shortly after I adopted her so the vet and I are probably more cautious than if her history was different.

[judymaggie]

Kristin--did Chloe have her repeat ACTH yesterday?

[Lola]

Hi Kristin,
I recently stumbled upon this website while doing some research about dog food and thought I'd share it with you. I am too thinking of weaning Lola off of the Wellness Core into something healthier and more complete.
let me know your thoughts.

http://www.treshanley.com/NewCC/Food/page22/page22.html


Nadia

[apollo6]

Below is a site that rates dog food
http://www.dogfoodadvisor.com
the best food would be home cooked,but most of us don't have the time. And with cushing the needs change. Hope this helps you.
Hugs Sonja and Angel Apollo
We all have different needs for our furballs and live in different regions,so What works for one may not work for another. I myself like more holistic ,and local made food ,natural foods and look at the site I gave you to look at content and rating.

[KristinT]

Hi Everyone - I just got home from the vet; I finally got the results of Chloe's ACTH Stim test. Here's the numbers:

Cortisol Sample 1: 8.9 (ref range 1.0-5.0) ug/dL
Cortisol Sample 2: 16.1 (ref range 8-17) ug/dL

She weighs 17.2 pounds.

He prescribed her Vetoryl 30mg daily. I didn't have time to talk to him about the dosage as he was in with patients and I didn't have an appt. He left me a voice message earlier today and said I could stop by anytime before 5:30pm so I rushed over because I wanted a copy of the test results. I asked him for a referral to Blue Pearl and he said no problem. I'm going to get her an appt. for an ultrasound as soon as they have an opening early next week.

I'm reluctant to start her on the 30mg today because I don't want her to get sick. Should I give her half (15mg) or ask the vet for a 10mg prescription to start off?

What do you think?

Thanks so much!!! Kristin

[KristinT]

Below is a site that rates dog food
http://www.dogfoodadvisor.com
the best food would be home cooked,but most of us don't have the time. And with cushing the needs change. Hope this helps you.
Hugs Sonja and Angel Apollo
We all have different needs for our furballs and live in different regions,so What works for one may not work for another. I myself like more holistic ,and local made food ,natural foods and look at the site I gave you to look at content and rating.

Sonja - Thanks for the link, I'm going to do some research. :)

[KristinT]

Hi Kristin,
I recently stumbled upon this website while doing some research about dog food and thought I'd share it with you. I am too thinking of weaning Lola off of the Wellness Core into something healthier and more complete.
let me know your thoughts.

http://www.treshanley.com/NewCC/Food/page22/page22.html


Nadia

Nadia - Thanks for the link, looks like some good information! ;)

[KristinT]

I think diet is such a hot button issue, and is certainly a personal choice. I would say that most well informed pet owners at least know the very bad choices to avoid (alpo, beneful, etc), but beyond that, we all make our own choices based on our knowledge and how our dogs respond. The recurrent UTI's may be due to the cushings, so once you have everything well controlled, I would encourage you to transition off the science diet (which is not a good food) and on to something better. Nothing burns my biscuits more than vets that blindly push the science diet formulas for every illness. :(

An incomplete homecooked diet can be far worse than even a bad commercial diet, so if you go down that road, make sure you do enough research and have proper guidance that you are not making things worse. I have homecooked off and on for years, but my dogs are all currently on The Honest Kitchen. I personally will not allow them to eat kibble. But, I don't knock people who do choose kibble. It's certainly convenient and a lot of dogs really enjoy it.

Supplements that I give daily (and which I would recommend for all dogs, especially cushings pups) is probiotics and fish oil. Some people interchange fish oil and coconut oil, but I'm still a little old school and think a good quality fish oil is more beneficial.

Renee - I completely agree, I most definitely did not want to give her Science Diet and only agreed to it for the short-term.

I"m going to do some research and find a healthy alternative with higher quality ingredients. Thanks for the feedback. :)
Kristin

[labblab]

Cortisol Sample 1: 8.9 (ref range 1.0-5.0) ug/dL
Cortisol Sample 2: 16.1 (ref range 8-17) ug/dL

Kristin, you need to hold up altogether, because this test result is "negative" for Cushing's!!!! The second sample would have to be higher than 17, probably by even a couple points, to be considered a "positive" result. So I do not understand why your vet is telling you to go forward with Vetoryl at any dose right now.

This does not necessarily mean that Chloe does not have Cushing's, because the ACTH does miss diagnosing a significant number of dogs. But I think you will still need some more testing, including that ultrasound, before you start treatment. I would not pay for any Vetoryl yet, and you need to talk directly with the vet about these results because they do not confirm the diagnosis!

Marianne

[KristinT]

Kristin, you need to hold up altogether, because this test result is "negative" for Cushing's!!!! The second sample would have to be higher than 17, probably by even a couple points, to be considered a "positive" result. So I do not understand why your vet is telling you to go forward with Vetoryl at any dose right now.

This does not necessarily mean that Chloe does not have Cushing's, because the ACTH does miss diagnosing a significant number of dogs. But I think you will still need some more testing, including that ultrasound, before you start treatment. I would not pay for any Vetoryl yet, and you need to talk directly with the vet about these results because they do not confirm the diagnosis!

Marianne

Thanks Marianne; I will not give her any medication yet. I'm going to get her in to see a specialist at Blue Pearl for the ultrasound and will ask him what further tests we should do to confirm if it is Cushings or something else.

Why do you think her Cortisol was so high for the first blood draw? Is that the baseline number? Is that the amount of Cortisol she has in her blood all the time and the second number is how much Cortisol she produced after the stim shot? I'm not completely clear on how it works.

[Harley PoMMom]

I agree with Marianne, another test/s need to be performed before a diagnosis of Cushing's is made. I would either have an ultrasound done and/or LDDS test and if the results indicate Cushing's, along with Chloe having many of the common Cushing's symptoms, I would then go forward with the Vetoryl but with a starting dose of no more than 20mg.

With an ACTH stimulation test the first blood draw is called the pre/baseline, it's what her cortisol is at resting, next they inject a stimulating agent (usually Cortrosyn) and after an hour they draw blood again, this number, the post, reflects how much cortisol is in her body which was produced from those stimulated adrenal glands. Stress can make the resting cortisol high, and we all know how are dogs just love their vet visits! :eek::D

Hugs, Lori

[KristinT]

Quick update. Chloe has an appointment with a Specialist this Thursday at 11am. She's going to have an Ultrasound and any additional tests he recommends. I'll check back in on Thursday afternoon with an update.

Have a great week everyone! ;)

[judymaggie]

Kristin -- looking forward to hearing what Thursday brings. I hope your experience at Blue Pearl is as good as mine have been.

[KristinT]

Kristin -- looking forward to hearing what Thursday brings. I hope your experience at Blue Pearl is as good as mine have been.

Thanks Judy! I actually got an appointment with Dr. Mears, so I feel very fortunate! Thank you so much for all your help! :)

[Dixie'sMom]

I'll be waiting here with the others to see how things go Thursday. I'm hoping you will get some answers. Hugs to you an Chloe!

[judymaggie]

Kristin -- I am so happy that you and Chloe are going to meet with Dr. Mears! :D He is so easy to talk with and is great at explaining everything. I also was very impressed at how gentle he was with my pups. When I took my Maggie to see him, she was so scared that she was hiding under a chair when he came into the room. He got down on the floor and coaxed her out. A little while later she was snuggling on his lap!

Please give him my regards -- he will remember Abbie (and Maggie)--our vet's name is Dr. Thomassy.

[molly muffin]

Yay, glad you were able to get in with a good specialist and have a plan of action.

Have a good week too!

hugs

[judymaggie]

Kristin --- how did your visit with Dr. Mears go?

[molly muffin]

I'm checking in to see how the visit with Dr. Mears went too and what his thoughts are.

Hoping all is well.

[judymaggie]

Kristin -- getting worried that we haven't heard from you. Hopefully, all is okay!

[Squirt's Mom]

Count me in on that worry, too. ;)

[judymaggie]

Kristin -- I wish you would come back and let us know how you and Chloe are doing.