Gigi (my heart)..13.9yr Bichon new dx PDH

[Jnewmark]

Hi, I find myself on this site again for Gigi. I'm so glad it and you are here! I didn't post too much last time which was in 2008 when it was first suspected Gigi had Cushing's Disease as it was eventually ruled out after 2 LDDS tests with a specialist here in Atlanta. At that time her only symptom was panting and I think her one lab was high ( I can't even remember which one, it may have been her cholesterol). Since the LDDS testing was negative I saw the holistic vet for her opinion and she thought her issue was gastric related and wanted me to change her food protein to fish. As usual, my holistic vet was right on and the symptoms went away and blood work was normal over the next 6 years. That brings us to last year 2014...Gigi would have pee accidents whenever I was out of town (May, July) and my mom would take her to vet and she had UTI's. Blood work was fine in July and no stones were seen. I then notice the increase in water intake and pee accidents in Sept/Oct. and panting so I try switching brands of food 2-3 times. She had a dental in Oct. (I went ahead and did one because her teeth were not looking so good and her blood work in July was fine). By November there was another UTI and her blood work was off. ALKP was starting to get high and cholesterol was high my regular vet did discuss it could be Cushing's. I wanted her liver and kidneys checked so the regular vet had the ultrasound travel vet come do a ultrasound which showed her pancreas was "scarred up" indicating chronic inactive pancreatitis; her kidneys were small with "poor architecture"; her liver was enlarged; gall bladder had a small to mod debris in lumen but no gall stones yet; her bladder was normal wall and lumen; her adrenals were said to be normal at 0.4cm. The ultrasound vet tells me he doesn't think that it is Cushing's because he's "never seen a Cushing's dog with normal size adrenals". Sooooo......after discussing results with my regular vet he suggested we treat as liver disease to thin the bile and recommended Denamarin or Actigall (he may have mentioned still the possibility of Cushing's but i can't remember. Well needless to say I was in the phone with the specialty vet to get a appointment with holistic nutritional vet to get her opinion before I did anything and to see what I should be feeding her based on this info. ***Sorry this is so long I just want you to know what was going on and what was seen***.

On 12-8-14 saw Holistic vet and she really wanted us to see internal medicine to get a good dx. She was thinking Cushing's Disease but in the mean time put her on Denamarin, Dandelion root and a home cooked diet. Apparently her Calcium was high at regular vet in Nov. but came back fine this day 10.6. Her chemistry on this day was ALP 259, ALT 234, Chol 613, GGT 23, Trig 391.

Saw internal medicine on 12-30-14 for LDDS, urine culture and new ultrasound.
LDDS Test.... 0 hour 7.6
4 hour 2.0
8 hour 4.7

UA-SG 1.010 (very low) and negative for sediment

Abdominal ultrasound indicated no abnormalities within abdominal viscera.

Started Trilostane 5mg 2x/day on 12-31-14. She had a one week follow up for ACTH stim test and urinalysis. I don't have that number but was told medicine is a good dose and urine specific gravity was much better. She will have another follow up at the end of January to check levels and do full panel of bloodwork. She is not panting or having accidents. Her water intake is much less.

So I would like your opinion, does this sound like a typical path of PDH???? I just wonder why her liver was enlarged on the first ultrasound at regular vets office and not at specialty vet. She had been on Denamarin for 3 weeks but that wouldn't effect the liver size would it?

Anything else I need to ask about or have tested?

I'm doing a home cooked diet for the most part. Occasionally I will have a day of her regular food. The holistic vet will balance the diet after next round of blood work. She wants her on a moderate protein 22-24% and low fat 12-14%. I read a lot about Cushing dogs on a higher protein, low fiber, low fat diet so I'm a little confused why she wants less protein. Any input or thoughts? I've read dogaware and dogadvisor. I read that canned is better than kibble for moisture and then I read some people say raw. I have read about doing flaxseed lignans and melatonin. Are many of you using those???? I'm feeling confused on what to feed as I want to do what is best (and I know that varies greatly by dog).

Thank you so much for reading this and taking the time to give me any input you can!!!!!!!! I'm so glad this forum exists!!!!!
Julie

[Harley PoMMom]

Hi Julie,

I am sorry for your need of us and will help in any way we can.

Were Gig's adrenal glands visualized on the ultrasound? Was diabetes ruled out? How much does Gigi weigh? That ACTH stimulation test that was done a week after starting the Trilostane could you get those results and post them here? Besides the increases in drinking/urinating and panting does Gigi show other symptoms of Cushing's such as a ravenous appetite or a pot-bellied appearance?

That moderate protein and low fat diet is appropriate for a dog with Cushing's as long as the protein is of high quality, meaning that the meat is listed as the first ingredient. If a dog is doing well on the diet that they are on than I see no reason to switch it to something else.

If this were me, I wouldn't bother giving the melatonin and lignans, that treatment is for dogs that have a normal cortisol level but one or more of the adrenal intermediate hormones are elevated.

The one test that I would recommend is the spec cPL, this test measures the pancreas-specific lipase in the blood. My boy Harley had pancreatitis that a ultrasound found, he never had any signs of that disease. The pancreatitis was confirmed by the spec cPl test and his result was in the 500's, the reference range for that test is 200. :eek:

Please know we are here for you and Gigi and we will walk this journey with you.

Hugs, Lori

[Jnewmark]

Hi Lori,
Thanks so much for your reply! Gigi does have a ravenous appetite. I don't think she has ever missed a meal, but the pawing me to eat and begging for food has increased over the years. Gigi's current wt is 15 lb (this is a increase since being on the home cooked diet with rice in it, she was grain free and now I feel like her food is so "carby" and white). Speaking of her weight one thing I did not mention earlier when I was trying to find her a new food last fall, I put her on a freeze dried food (Grandma Lucy's Valor Fish) and I began to notice her losing wt and pooping 3-4 times a day as well as the increased urination (which at the time I thought was from the extra water to hydrate the food). She was obviously not absorbing this food and lost about 3 pounds. Once I switched her food she easily put the wt back on.

I will get the ACTH stim test result you mentioned and post.

I am fairly certain Diabetes was considered. All her glucose levels have been fine. But no other specific tests were done. Is there something I should as for?

I will ask about a spec CPl test. Since the ultrasound showed chronic pancreatitis do you think she really needs it???

To answer another question you asked, the adrenals were observed on each of the ultrasounds. I know the first one measured normal at .4cm and the second one I was just told everything was normal.

Thank you for your help with this!!!!!

[Harley PoMMom]

Gigi does have a ravenous appetite. I don't think she has ever missed a meal, but the pawing me to eat and begging for food has increased over the years.

Strong symptoms do play a huge role in the diagnosis for Cushing's. So with her ravenous appetite, the increased drinking/urinating, the abnormalities in her chemistry blood panel along with those LDDS test results that do point to PDH, it sure seems that the diagnosis for Cushing's is likely. The one thing that does bother me is that her adrenal glands are within normal limits, generally cush dogs with PDH have bilateral enlarged adrenal glands, but maybe the Cushing's was caught early.


I will get the ACTH stim test result you mentioned and post.

That would be great...thanks!


I am fairly certain Diabetes was considered. All her glucose levels have been fine. But no other specific tests were done. Is there something I should as for?

I see that Gigi did have recurrent UTI's, dogs that have diluted urine (low specific gravity) sometimes a regular urinalysis isn't sensitive enough to pick up the bacteria. In that case an urine culture and sensitivity test is needed, this test would be able to show exactly what the bacteria is so the appropriate antibiotic can be prescribed.


I will ask about a spec CPl test. Since the ultrasound showed chronic pancreatitis do you think she really needs it???

My Harley had chronic pancreatitis so I monitored him with the spec cPL test. Even with other changes and getting a diet formulated for pancreatitis his numbers never did fall below the 300's.


To answer another question you asked, the adrenals were observed on each of the ultrasounds. I know the first one measured normal at .4cm and the second one I was just told everything was normal.


As I mentioned above, with the pituitary type of Cushing's most times when the adrenal glands are observed with an ultrasound it will show that both adrenal glands are enlarged, however, if the Cushing's diagnosis is caught early this may not of happened yet.

Hugs, Lori