I'm terrified. My service dog diagnosed with Atypical today

[Pongo]

I'm so glad I found this forum. I can't stop crying, I'm so scared for my baby.

She's a 13 yr old Husky/Dalmatian mix. Started leaking, drinking urine excessively and licking herself about two months ago. Initially vet treated for urinary infection on clavamox, no improvement, another round of clavamox. After doing blood work, thyroid, urine test, all normal so she was treated for pain. Symptoms seemed to have subsided a little on Rimadyl.

Then she lost hair on eyebrows, swollen brows, appeared to have an allergy in her eyebrow bumps. Was treated with prednisone and eyebrows healed. She still was drinking excessively, and my vet yesterday decided to do a test where they injected her with something, I brought her back two hours later for retest, was a 22. Vet said normal range is up to 18, she's borderline.

Vet will start on herbal treatment today (will find more details like lab work numbers and name of herbal med and will post).

For now, I am terrified. Other than the excessive drinking, licking herself, very hungry...no pot belly, no hair loss, no other symptoms. Had the eyebrow problem which has healed.

What does Atypical with a 22 mean? Can this number be brought into the normal range with treatment? I'm so grateful for this forum. Please help me understand Atypical with a 22 and I will post more info after I go to vet today.

Thanks so much, I have to stop worrying, my girl can sense it.

Does changing diet help? We have fifteen stairs to go up several times a day. Will she be able to do this? Is she at risk for SARDS?

[labblab]

Hello and welcome to you and to Pongo! I am so glad you've found us, but so sorry about your problems right now. The bond you two share is so powerful and so special, it's no wonder that you are feeling terrified :o. But you are in the right place now ;), and we will do our very best to help you sort things out. :)

First off, it sounds as though the diagnostic blood test that she had was the ACTH stimulation test. The results for that test are usually arrayed in such a way that a normal range is given for dogs who don't have Cushing's (for your lab test it was up to 18); then there is a borderline or "equivocal" area when results are between 18-22; and then a result higher than 22 is considered diagnostic for conventional Cushing's. So if your girl tested at 22, she falls right at that borderline cut-off point. However, the confusing thing that I am going to tell you right now is that this one single test does not necessarily rule conventional Cushing's in or out. Unfortunately, there is no single test that confirms Cushing's beyond any doubt. It is a hard disease to diagnose, and so a lot of different information has to be gathered.

The lab analysis for a ACTH stimulation test typically only measures elevated reserves of cortisol, which is the hallmark of conventional Cushing's. However, one veterinary lab in the U.S. (at Univ. of Tennessee) can analyse ACTH blood samples in order to see whether adrenal hormones other than cortisol may be elevated. These other hormonal elevations may cause some of the very same symptoms, but that is where the official diagnosis of "Atypical Cushing's" comes in. That diagnosis is reserved for dogs who have normal cortisol levels but elevations in other adrenal hormones. So unless your vet sent the blood samples to Tennessee for analysis, your dog cannot be officially diagnosed with "Atypical" at this point. With a post-ACTH cortisol level of 22, it seems to me as though the jury is still out as to whether or not elevated cortisol may yet be an issue. There is other testing that can be done to help sort that out.

But I am putting the cart ahead of the horse. Can you tell us more about the prednisone treatment for the eyebrow issues? How much prednisone did she take, and for how long? Had it been discontinued prior to the ACTH blood test? If not, the prednisone itself would have raised the hormone level that was reported in the testing and therefore skewed the test results. Plus, prednisone can cause the exact same symptoms that are attributed to Cushing's.

Also, was an actual urine culture performed in order to be certain that no urinary tract infection remains? When dogs are drinking and peeing extensively, their urine can become so diluted that a normal urinalysis may not reveal the presence of infection even though it may still linger. From your description of her issues, a continuing or recurrent UTI still sounds like a possibility to me.

I have a ton more to say, but I will break off for now. First and foremost, please know that you are not alone and we will be here to help you sort out everything that is going on.

Marianne

[Pongo]

Hi Marianne,

Thank you SO much for the quick reply. I am so, so grateful to have come across this site. Your information already has given me insight.

She was on Pred 20mg started 1/11, half tablet orally twice a day for 3 days, then half tablet orally once a day for 3 days, then half tablet every other day until gone. Finished the Pred on 1/26. Also, she weighs 50 lbs.

Urinary infection showed as clear last we checked which was in late December, haven't checked since.

Thank you for explaining the test. I will have my vet request further testing from U of Tenn to get a more specific answer. She did say that it is possible to lower the number from 22 although once she has Cushings, she will always have it. How long can a dog live with Cushings? Am I at risk for losing her sooner? Can she live for many more years (other than Cushings she is an extremely healthy dog, active, happy, does nose work, has her Expert Trick Dog title, is always learning new tricks, etc.)

She wants to try the herbal meds (I'll post as soon as vet opens in 3 hours when I get more info on her results/other blood test numbers, as well as the herbal meds recommended). After treating with herbal, she wants to retest in one month and then figure out where to go from there.

I keep reading things about adrenal vs pituitary tumors, and if it's adrenal it could be surgically removed possibly. Then I keep reading that it could be her sex hormones. I'm wondering if early spay from the rescue (I rescued her at 8 weeks) could have caused this. What does cause Cushings? Is it something I did? I have always been extremely cognizant of her diet, she was on a holistic kibble (Solid Gold) until she turned about 7 then we went raw for a few years until she stopped wanting to eat that food (years ago). Now she is on Sojos Fruit & Veggies with 1/4 can of Evangers twice daily (either beef, chicken thighs or whitefish - strictly that protein, no other additives in the cans), emu oil (has been on emu oil for about 6 months), started Dasequin a few days prior to the diagnosis, but she's had the symptoms since November.

I am so grateful that I upped her insurance to cover her up to $20k/year back in November when she began peeing more (which we treated as a UTI after results showed that she had one).

She whines, is uncomfortable, acts as if she is trying to tell me something is wrong, stares at her food bag and back at me repeatedly, drinks water excessively. I just want to help her feel better. And I'm very worried about her potential inability to handle fifteen stairs to pee whenever she has to go and the possibility of SARDS. Are these things I need to worry about? How quickly can Cushings escalate? Other than the drinking, peeing, whining, hunger, eyebrow issue (which was all healed by the time the Pred was done), a little weaker than normal - no hair loss, pot belly or other physical signs.

Again, I cannot thank you enough for the quick reply. I know she can tell that I am worried and I am trying my best to act normal, but she can read me better than that as my service dog. :(

(Also I figured out what the quick reply meant. It was in reference to me replying, not for me to receive replies quickly. :) )

[labblab]

Me back again! :)

I do want to ease your fears that somehow you've contributed to the Cushing's. At this point, nobody knows what causes the syndrome, and there is no evidence of which I am aware that points to either early spay or diet.

It is true that Cushing's can be caused by either a pituitary tumor or an adrenal tumor. Both forms result in elevated adrenal hormonal activity. The persistent hormonal elevation is what causes systemic damage in the body. So if the elevated hormones are effectively controlled, the ill effects of the disease can be slowed and even halted. You are right that adrenal tumors can be surgically removed, and this actually cures the condition. The surgery is a major undertaking, however, and not every dog is a candidate. But in your case, it might be a consideration, especially if your insurance would help cover the high cost. In the case of pituitary Cushing's, even though the disease is not cured, there are two medications available that very effectively control the level of cortisol and permit dogs to maintain very functional lives.

Before getting to that discussion, however, you still have more diagnostics available to help guide you. Right now, rather than pursuing the question of elevated intermediate hormones with Tennessee, I would ask my vet about retesting with an alternative blood test for conventional Cushing's: the LDDS (low dose dexamethasone suppression test). One problem with the ACTH is that is has a high rate of "false negatives," meaning that many dogs who truly have Cushing's do not show diagnostically high values on that test. The LDDS is a more sensitive test for Cushing's, meaning that if a dog does have the disease, a "false negative" is much less likely. If Pongo was my dog, I would be very interested in having the results of both those tests to compare, especially since Pongo was so close to the diagnostic threshold on the ACTH. It may turn out that Pongo is indeed suffering from elevated cortisol, but the ACTH was not able to confirm that finding. If both the ACTH and the LDDS fail to confirm high cortisol, then that is the point at which I'd think about exploring the possibility of testing for other elevated intermediate ("sex") hormones through Tennessee.

Another really valuable diagnostic tool is an abdominal ultrasound. Dogs suffering from pituitary Cushing's most frequently exhibit enlargement of both their adrenal glands. Dogs suffering from adrenal Cushing's will exhibit an actual tumor or mass that can be seen on the imaging. And in addition to viewing the adrenals, an ultrasound can also provide valuable info about the health or abnormality of other organs. You can find out whether there are other organ changes that are consistent with Cushing's, or in the alternative, if there is something else entirely unrelated going on that could be the explanation for the external symptoms and also even an elevated cortisol level.

So if you are sure a persistent UTI has been totally ruled out, I believe those are the two diagnostics that I would request next: a LDDS blood test, and an abdominal ultrasound. One caution -- the ultrasound needs to be performed and interpreted using specialized equipment that GP vets may not have in their office. This is because the adrenal glands are very difficult to visualize accurately, and you want to make sure the person who is reviewing the images has had a lot of experience in determining the nature of any abnormalities. We can help coach you re: requesting a referral if your regular vet is not equipped to handle this level of diagnostic him/herself.

Marianne

[SasAndYunah]

Hi to you and Pongo from me (Saskia) and Quincy (my service dog) :) Years ago I found this forum when my dog at that time, had Cushings. Now, many years later, I still am around (not much though) since it is virtually impossible to leave these people, their dogs and their kindness, knowledge, support...they have the tendacy to become family :) So, you have come to the very best place possible to educate yourself and to help Pongo as best as you can. My Cushing's time lies far behind me so my knowledge is no longer up to date, I can't help you there I'm afraid. But there are many..truly many that have so much expertise and a huge willigness to help...so you are in good hands :)

As I mentioned, I too have a service dog, named Quincy. She is a 2 year old former Polish straydog and came into my life about 7 months ago. I, by the way, live in The Netherlands. If there is anything I can do to help or to just listen, just let me know. I know how devestating it is when your service dog is ill...

All our best,

Saskia and Quincy :)

[Pongo]

Thanks so much. I have a feeling this forum is going to keep me sane!

The blood work was done on 11/19/14, and the abnormal numbers were:

ALK 182
Calcium 11.9
Cholesterol 380
Platelet Count 413
(Lymphocytes 30 - at border)
Urine was cloudy, trace protein, trace occult blood
Pathology review: "fecal contamination or urine is evident with particulate debris, mixed flora bacterial rods, few cocci, and rare yeast forms seen on urine sediment cytospin"

She was put on CLavamox 375mg

After that was a clear urine culture, no more blood work was done. Figured it was a urinary thing, and the clavamox would have cleared it.

Then the drinking and licking herself continued, brought her back, did a fecal because she was licking down there, was very uncomfortable, would whine and lie down one place, get up and move to another, etc. and I wasn't sure if it was her front or back that she was licking. Dr. did full exam down there, everything was normal. He assumed it was pain, put her on Rimadyl for a week or so. Problem did see, to subside. After treatment ended I gradually noticed the increase in drinking again.

Then she lost hair and had swelling in her eyebrows. Dr. put her on vetroplycin gel and when it didn't work, on prednisone (as mentioned earlier: She was on Pred 20mg started 1/11, half tablet orally twice a day for 3 days, then half tablet orally once a day for 3 days, then half tablet every other day until gone. Finished the Pred on 1/26. Also, she weighs 50 lbs.). Her drinking and hunger increased again on the Pred, and Dr attributed it to the Pred.

After treatment stopped, I noticed that her drinking was still excessive, and now she was whining at me often (as if to tell me something, probably that she was hungry), looking at her sides a lot, licking herself, peeing more than usual.

Yesterday brought her in for the ACTH Stim you mentioned, her baseline cortisol was 3, ACTH cortisol was 21.8. Thyroid TT4 was 1.1.

Today I picked up her medicine, Dr prescribed a Chinese herb that she said she finds very effective called Kan Essentials Four Marvels - Si Miao San 120 x 500 mg Tablets, 2 tablets, twice daily.

She said symptoms should subside and/or we retest in one month. If it's not effective, we will try something else.

So that's where we are to date. I imagine that if I did a blood panel now it would be more advanced than it was in Nov. but I guess all that matters now is that she's at 21.8 and is now on this herb which will hopefully work...

[Spencersmom]

Yes...this forum and the family you have now joined will indeed keep you sane! You are in the best, most supportive and loving hands there ever was!

[Dixie'sMom]

Hello and welcome to you and Pongo. Pongo sounds like a very special fellow and his photo is precious. I'm sorry you and Pongo are going thru this trying time.

The experts here are very knowledgeable and have tons of experience with Cushpups so you are in good hands here. Unfortunately, I am not one of those experts so I cannot really advise you, only welcome you.

HOWEVER, (LOL) The big thing that jumped out at me is that Pongo has only been off of the steroids for a few weeks. I'm not sure that is enough time for his cortisol to go back to a normal level. Especially since he tested borderline, I would wait about 30 days and then have the vet do a LDDS. It's entirely possible that Pongo will test normal at that time. I don't want to get your hopes up, but I really don't think enough time has passed between stopping the Prednisone and his ACTH test for his adrenals to go back to secreting normally. Also the Prednisone suppresses the immune system which helps inflammation (Pongo's eyebrows) but it is entirely possibly his UTI is not gone because it could have actually created a nice breeding ground for any leftover bacteria from his UTI.

Just my thoughts. The others will be around shortly to chime in with their thoughts. Hang in there. You're not alone!

[Spencersmom]

Yes...this forum and the family you have now joined will indeed keep you sane! You are in the best, most supportive and loving hands there ever was!

[Pongo]

Hello and welcome to you and Pongo. Pongo sounds like a very special fellow and his photo is precious. I'm sorry you and Pongo are going thru this trying time.

The experts here are very knowledgeable and have tons of experience with Cushpups so you are in good hands here. Unfortunately, I am not one of those experts so I cannot really advise you, only welcome you.

HOWEVER, (LOL) The big thing that jumped out at me is that Pongo has only been off of the steroids for a few weeks. I'm not sure that is enough time for his cortisol to go back to a normal level. Especially since he tested borderline, I would wait about 30 days and then have the vet do a LDDS. It's entirely possible that Pongo will test normal at that time. I don't want to get your hopes up, but I really don't think enough time has passed between stopping the Prednisone and his ACTH test for his adrenals to go back to secreting normally. Also the Prednisone suppresses the immune system which helps inflammation (Pongo's eyebrows) but it is entirely possibly his UTI is not gone because it could have actually created a nice breeding ground for any leftover bacteria from his UTI.

Just my thoughts. The others will be around shortly to chime in with their thoughts. Hang in there. You're not alone!

Thanks for this info. I will run it by my vet for sure. I did a urine culture today, results should be back by Monday so I will know if there is a UTI. From what I've been reading though, the elevated cholesterol, ALK, and calcium issue, along with the excessive drinking, hunger and eyebrow/skin issue are all indicative of Cushings as well. SO the diagnosis does seem to fit....I do hope you are right.


Thank you all for welcoming me! My name, by the way, is Shannon. I have two 13 year old Husky/Dalmatian mix sisters, Pongo and Tonka.

One thing I am curios about - is there a genetic component? If Pongo has Cushings, is her sister more likely to get it too?

[Dixie'sMom]

Hey Shannon. The reason I suggested that Pongos "Cushings" may be idiopathic is because in your first post you said all the blood work was normal at the time of the initial UTI. It seems that the values you mentioned went to abnormal after starting the Prednisone. I may have misunderstood. Yes, run it by your vet and see what he thinks. I'll keep my fingers crossed for a no Cushing's diagnosis for Pongo.

[Pongo]

Hey Shannon. The reason I suggested that Pongos "Cushings" may be idiopathic is because in your first post you said all the blood work was normal at the time of the initial UTI. It seems that the values you mentioned went to abnormal after starting the Prednisone. I may have misunderstood. Yes, run it by your vet and see what he thinks. I'll keep my fingers crossed for a no Cushing's diagnosis for Pongo.

Hi Suzie,

I noticed the signs prior to the prednisone, that's why I was bringing her in for the urine test. The first test did say she had a UTI, but it was cleared and the symptoms were still present (all through December). She started the prednisone in January for the strange eyebrow thing that popped up early in the month.

I ran it by my vet and she said that she took into account the recent use of Pred. She believes the numbers are accurate, her symptoms were present at least a month before the Pred started.

We are treating the symptoms with the herb. I would like to put her on flaxseed lignans/melatonin but my vet wants to try the herb for a month, see if she is seeing relief from the symptoms and go from there. Next step would be flax/lignans/melatonin. My vet is holistic and wants to stay away from Trilo for as long as possible, and hopefully never, and said she absolutely abhors Lysodren.

I do trust my vet implicitly. She has literally turned Pongo's sister's life around several times. She works together with my traditional vet and between them, they offer the best course of action.

Here's a question I have: If she is seeing the relief of symptoms, do the numbers really matter?

Still curious about if there's a genetic component and/or if Cushings can be caused by early desexing of a dog. Not that it matters, but it's something I'm wondering about...

[labblab]

Here's a question I have: If she is seeing the relief of symptoms, do the numbers really matter?

Hi again, Shannon. I think it's great that you have an excellent relationship with your holistic vet because that makes it ever so much easier to discuss your questions and concerns. But here is a basic and major concern that I would have if Pongo was my own dog. At this point, I don't think you have identified the source of Pongo's problem, so you don't really have any idea yet as to what it is you are trying to treat. It seems as though your vet has decided that Pongo has "Atypical" Cushing's, but you don't have any testing that confirms that diagnosis (evidence of elevated intermediate adrenal hormones other than cortisol). Pongo has demonstrated borderline high cortisol on one diagnostic blood test, which may mean something or it may mean nothing of significance in terms of a final diagnosis. The "something" could be conventional Cushing's, or it could be some other unrelated underlying condition that is stressing her body.

If we choose to assume that she does suffer from conventional Cushing's, for a dog of Pongo's age, I think there is justification for limiting your major concern to alleviating outward symptoms and keeping her comfortable. For a younger dog, I think the numbers are equally important because of the silent systemic damage that chronic uncontrolled cortisol can cause: damage to the kidneys and vision as a result of high blood pressure, ligament vulnerability, muscle wasting, vulnerability to infections and pancreatitis, etc. As we discussed earlier, Pongo's borderline ACTH result does not necessarily rule out conventional Cushing's. And if she does truly suffer from that, I am unaware of any treatments other than prescription medication that will effectively lower cortisol levels sufficiently to control outward symptoms and internal damage.

If Pongo instead suffers from elevated adrenal hormones other than cortisol, the lignans/melatonin combo may offer relief. Some dogs are successfully treated with that combo, but it usually takes several months for the positive effects to be seen.

If Pongo suffers from neither conventional nor Atypical Cushing's, then we do not yet have any idea as to what treatment she really needs. I am not familiar with the herbs that your vet is recommending, so I cannot comment on their mode of action nor what abnormality they are intended to rectify.

To boil all my lengthy comments here down to one sentence: prior to treating, I think you first need more diagnostics so that you know what illness it is that you are addressing.

Marianne

[Pongo]

Hi again, Shannon. I think it's great that you have an excellent relationship with your holistic vet because that makes it ever so much easier to discuss your questions and concerns. But here is a basic and major concern that I would have if Pongo was my own dog. At this point, I don't think you have identified the source of Pongo's problem, so you don't really have any idea yet as to what it is you are trying to treat. It seems as though your vet has decided that Pongo has "Atypical" Cushing's, but you don't have any testing that confirms that diagnosis (evidence of elevated intermediate adrenal hormones other than cortisol). Pongo has demonstrated borderline high cortisol on one diagnostic blood test, which may mean something or it may mean nothing of significance in terms of a final diagnosis. The "something" could be conventional Cushing's, or it could be some other unrelated underlying condition that is stressing her body.

If we choose to assume that she does suffer from conventional Cushing's, for a dog of Pongo's age, I think there is justification for limiting your major concern to alleviating outward symptoms and keeping her comfortable. For a younger dog, I think the numbers are equally important because of the silent systemic damage that chronic uncontrolled cortisol can cause: damage to the kidneys and vision as a result of high blood pressure, ligament vulnerability, muscle wasting, vulnerability to infections and pancreatitis, etc. As we discussed earlier, Pongo's borderline ACTH result does not necessarily rule out conventional Cushing's. And if she does truly suffer from that, I am unaware of any treatments other than prescription medication that will effectively lower cortisol levels sufficiently to control outward symptoms and internal damage.

If Pongo instead suffers from elevated adrenal hormones other than cortisol, the lignans/melatonin combo may offer relief. Some dogs are successfully treated with that combo, but it usually takes several months for the positive effects to be seen.

If Pongo suffers from neither conventional nor Atypical Cushing's, then we do not yet have any idea as to what treatment she really needs. I am not familiar with the herbs that your vet is recommending, so I cannot comment on their mode of action nor what abnormality they are intended to rectify.

To boil all my lengthy comments here down to one sentence: prior to treating, I think you first need more diagnostics so that you know what illness it is that you are addressing.

Marianne

Hi Marianne,

I read your post to my vet and she said that it's absolutely something we can test for, though she didn't feel the need. She treats the symptoms, and as long as the symptoms go away, the treatment is working; she and I both want Pongo to be comfortable.

She said if I'd like to do the test, there's no reason why we can't, although she says we'd treat it the same way by addressing her symptoms. I will be taking her in on Monday for the LDDS. She says there's an additional test, something about the sex hormones, that we can also do after that as well. I am very grateful to have insurance!

Pongo is 13, but she is a very active dog. We do nose work, she has her ETD (Expert Trick Dog) title working towards her TDCH (Trick Dog Champion) title. If we can get this under control, barring any other serious illnesses or injuries, I'd like to think she'll live for another 5 or so years. So yes, she is a senior, but most people are shocked when I tell them her age.

I do want to do anything that can give us any more information about Pongo's status. My vet is certainly open to doing whatever I think would be the best thing for my little girl; she knows I am my dog's best advocate and respects that. She's really a fantastic vet. Thank you for urging me to get more answers!

Is there anything else I should know about or expect with the LDDS? I They said it's an eight hour test where they check her blood three times, 9am, 1pm and 5pm. I am not sure what the other test was regarding the sex hormones. When I find out more about that I will post here...

[SasAndYunah]

Hi Shannon,

"I read your post to my vet and she said that it's absolutely something we can test for, though she didn't feel the need. She treats the symptoms, and as long as the symptoms go away, the treatment is working"

I sure do understand about wanting to treat the symptoms :) But in my opinion, one can treat the symptoms once you know what causes those symptoms. In some cases, depending on the cause, you have no other option then to treat the symptoms but in other cases you can treat the underlying cause, which, in my opinion would be the best treatment.

If, and I understand that is still a big "if" at this moment, Pongo does have conventional Cushing's, treating (only) the symptoms would allow the underlying cause (the high cortisol) to continue to do it's harm inside the body without you noticing it. This could lead to all kinds of serious health issues as Marianne mentioned in her latest post. So in my opinion, unless and untill one knows the cause for symptoms that are being displayed, one cannot make an informed decission about what and how to treat. And I am not saying that whatever decission one makes would be "right" or "wrong" , but one would have come to that decission after knowing all the ins and outs, all the risks and/or benefits of one treatment over the other, the consequences of treating with medication A or medication B, etc.

Is Pongo still a working service dog? And what are her tasks, if I may ask? :)

All our best,

Saskia and Quincy :)

[Renee]

She treats the symptoms, and as long as the symptoms go away, the treatment is working

This is scarily wrong and a bit disturbing to hear this from a holistic vet. The only saving grace to this answer is that your vet is not recommending traditional cushings treatment at this time. If she was pushing vetoryl or lysodren, I would be very scared on your behalf.

It's difficult to know the appropriate treatment without knowing the cause of the symptom.

I am glad you are moving forward with the LDDS. I believe this will provide another piece to your puzzle and help you move forward.

[Pongo]

Hi Shannon,

"I read your post to my vet and she said that it's absolutely something we can test for, though she didn't feel the need. She treats the symptoms, and as long as the symptoms go away, the treatment is working"

I sure do understand about wanting to treat the symptoms :) But in my opinion, one can treat the symptoms once you know what causes those symptoms. In some cases, depending on the cause, you have no other option then to treat the symptoms but in other cases you can treat the underlying cause, which, in my opinion would be the best treatment.

If, and I understand that is still a big "if" at this moment, Pongo does have conventional Cushing's, treating (only) the symptoms would allow the underlying cause (the high cortisol) to continue to do it's harm inside the body without you noticing it. This could lead to all kinds of serious health issues as Marianne mentioned in her latest post. So in my opinion, unless and untill one knows the cause for symptoms that are being displayed, one cannot make an informed decission about what and how to treat. And I am not saying that whatever decission one makes would be "right" or "wrong" , but one would have come to that decission after knowing all the ins and outs, all the risks and/or benefits of one treatment over the other, the consequences of treating with medication A or medication B, etc.

Is Pongo still a working service dog? And what are her tasks, if I may ask? :)

All our best,

Saskia and Quincy :)

Hi Saskia & Quincy,

Pongo is a seizure alert service dog. So is her sister. They can alert prior to the onset of my seizures. Thankfully, I've been on a medication since 2010 and have not had any seizures since so I no longer take either of them everywhere with me. If I forget to take my meds though, they will alert to me, but that hasn't happened in a long time.

I am glad I am moving forward with the other test. I'm sure it will give us greater insight. I do have great faith in my vet though, she's done some miraculous things for my other dog several times over. She's not opposed to the other test, she just didn't feel it was necessary. Also, the herb she is on does treat high cortisol and a number of other symptoms related to Cushings - all of the symptoms presented by Pongo. I know nobody is perfect, but she's never been wrong about anything with my dogs so I have great faith in both her and our other traditional vet.

[Pongo]

She treats the symptoms, and as long as the symptoms go away, the treatment is working

This is scarily wrong and a bit disturbing to hear this from a holistic vet. The only saving grace to this answer is that your vet is not recommending traditional cushings treatment at this time. If she was pushing vetoryl or lysodren, I would be very scared on your behalf.

It's difficult to know the appropriate treatment without knowing the cause of the symptom.

I am glad you are moving forward with the LDDS. I believe this will provide another piece to your puzzle and help you move forward.

My vet is excellent. She says that she would never recommend Lysodren. Her course of action is the herb, with which she has treated many other dogs presenting the same symptoms & diagnosed as Cushings or Atypical Cushings. Restest in a month and see where we are at before any other action is taken.

I'm glad we're doing that LDDS too. I didn't know about it. Thankful for this board. Hoping the turnaround time is fast so I have more insight...

[labblab]

Shannon, I'm really glad you're going to have the LDDS test done, too. Whichever way it turns out, it will be one more puzzle piece to fill in.

I will confess that I am sorry to hear that your vet is so strongly opposed to the prescription medications that have helped so many dogs here with successfully treating conventional Cushing's. Of course, not all stories have happy endings. But we would not be recommending these medications if we did not feel they provided a much greater potential to help rather than harm. I am always puzzled by the position of some practitioners that herbal preparations are somehow safer or gentler than prescription meds. If the chemicals in the herbs are strong enough to effectively alter physiological functioning, then they have the very same potential to help/harm as do prescription meds. The big difference is just that they have not been subjected to controlled studies and regulatory oversight.

Over the years, we have had countless members for whom Lysodren virtually saved the functional lives of their dogs. So hearing that your vet abhors the drug will undoubtedly be pretty chilling to the members here who are using the drug successfully. The same is true of trilostane. I absolutely am not telling you this as a criticism of what you have written, but instead to warn you as to why you may get some blowback from folks who are not happy with your vet's position.

This conversation may end up being totally moot if Pongo's cortisol is not abnormally elevated after all. But if it is elevated, based on a decade of shared experiences on this forum, I am guessing that Pongo will need more than your vet's herbs to effectively control the symptoms and the damage. There is nothing wrong with first giving the herbs a try. But my worry is that your holistic vet seems to hold such a prematurely negative view towards the prescription meds. Has she personally had bad results with them in the past, or is it that she just does not like the idea of them? Is she familiar with the recommended treatment protocols associated with them? They are powerful drugs -- I won't dispute that -- so you want to make sure that the vet who is overseeing their use is confidently armed to use them properly.

Where does your regular vet stand in all of this? Has he/she had a chance to weigh in on the diagnostics and possible treatments?

Marianne

[Squirt's Mom]

Nothing quite like a vet with a closed mind on things. Kinda limits options, huh?

Let me ask you this question - if a woman with cancer has only been given morphine for the pain, does it matter that nothing else is being done for the cancer? Since the morphine makes the pain go away, is the cancer being treated?

I am all for Holistic medicine but NOT when it becomes as blind as Allopathic practitioners can. ;) Both methods have merit, both have value, and both can support each other. Whether we like it or not, there are simply things that a 'natural' approach cannot touch, cannot have any measureable or anecdotal effect on. If we turn our backs on what western medicine has to offer, we cut off a vital flow. Just something to think about.

[Pongo]

Nothing quite like a vet with a closed mind on things. Kinda limits options, huh?

Let me ask you this question - if a woman with cancer has only been given morphine for the pain, does it matter that nothing else is being done for the cancer? Since the morphine makes the pain go away, is the cancer being treated?

I am all for Holistic medicine but NOT when it becomes as blind as Allopathic practitioners can. ;) Both methods have merit, both have value, and both can support each other. Whether we like it or not, there are simply things that a 'natural' approach cannot touch, cannot have any measureable or anecdotal effect on. If we turn our backs on what western medicine has to offer, we cut off a vital flow. Just something to think about.

She is far from closed minded, has and does use Western medicine as well as holistic. I understand everyone's intent on helping me here, but I can say I am absolutely put off by the insults to my vet. She has treated countless animals, and like I said, works closely with my traditional vet. We have not involved him yet as it is MY decision to go about this holistically. She is not averse to Trilostane, but we're not jumping ahead. Like my vet, I believe in trying the least invasive methods to treat any disorder before going the conventional route.

It may be YOUR belief that "there are simply things that a 'natural' approach cannot touch, cannot have any measurable or anecdotal effect on." Just because a majority of dogs don't try the holistic route, you can't possibly say that with any certainty, regardless of your own experience. Especially if you/they never tried the holistic route first.

Like I said earlier, if there's a need for Trilostane in the future, it's not out of the cards. My vet is not an idiot, and I dislike people forming opinions of the way she and I prefer to treat my dog.

I appreciate the insight, am happy that I'm going through with the LDDS, but I don't want to read one more thing about my vet being incompetent. I'm a professional dog trainer, have sent countless clients to my vet, and many have been treated for serious illnesses holistically and do wonderfully. This includes the way my dog has responded to these treatments in the past. I've been careful to raise them holistically, eating extremely healthy, avoiding vaccinations (with the exception of puppy vaccines in '01 and another set in '08) as I prefer to use titers. You may find that unacceptable as well, but I don't.

My vet does not like Lysodren. I don't know what my traditional vet's input will be IF it comes to us needing to go that route. I will do what I believe is best for my dog, and my vet defers to me just as much as I defer to her. We are a team, and I will follow her lead, and IF we need to treat this traditionally, we will. But certainly not yet, and it's premature for me to even think that far ahead. This is NOT cancer, and while I understand the point you are trying to make, there are many more treatments for Cushings than there are for cancer, and I opt for those first.

Now, if we can continue this discussion without people insulting someone who is responsible for keeping many dogs stable and maintained on herbs, then I can stick around. If this is going to become a forum where people will jump down my throat for choosing to treat this holistically BEFORE - not opposed to - traditionally, I'm sure I can find answers elsewhere on the internet. I came here for help, not judgment. Feel free to read over 800 reviews of my vets, who have been in practice for over 30 years: http://www.demandforce.com/b/newport-mesa-animal-hospital

[labblab]

Shannon, I was very worried that you would feel as though we are attacking you and your vet. I do not believe that was the intent of any one of us, but I do understand why you feel as though we are ganging up on you. I do very much hope you will choose to remain with us, because I think we all have a lot to contribute to one another. But since you are asking for our suggestions and our feedback, we have no choice but to voice our honest and genuine concerns. Hopefully we can find ways to frame them going forward that do not feel hurtful to you or disrespectful to your vet. But for me personally, in good conscience, I have felt as though I must tell you why I am worried about the direction your vet is/was originally going with Pongo.

For the most part, I've said what I felt as though I needed to say in that regard. But here is one more piece that I am compelled to add.


This is NOT cancer, and while I understand the point you are trying to make, there are many more treatments for Cushings than there are for cancer, and I opt for those first.

At this point, neither you nor your vet can know that you are not dealing with cancer. As an example, if Pongo suffers from conventional Cushing's, it may be caused by an adrenal tumor, which may or may not be cancerous. Either way, allowing the tumor to continue to grow can be life threatening. As it turns out, the ACTH stimulation test does an especially poor job of correctly identifying Cushing's caused by adrenal tumors. But if they are identified early enough by other means, adrenal tumors can be surgically removed for a complete cure. Surgery of this sort is a major and expensive undertaking, and not every dog is a candidate and not every owner makes the choice to proceed. In the alternative, the Cushing's symptoms caused by the tumor can be managed by medication for a period of time. Perhaps it is the case that you would not give any consideration to surgery even if an adrenal tumor was identified for Pongo, and you would instead opt for medical management of the symptoms. But it concerns me that, without our prodding, your vet was not offering out any additional diagnostics for your consideration to either pursue or not pursue. And with an example such as an adrenal tumor, time can truly be of the essence if you want to cure the problem rather than just alleviate outward symptoms at the same time that the underlying problem is allowed to worsen.

If you are interested, we can tell you a lot more about the LDDS test, about the value of an abdominal ultrasound, about the Tennessee adrenal testing, and even about alternative diagnoses that other dogs have ended up receiving after their owners first came here in the mistaken belief that Cushing's was the culprit. But since these are things that your vet does not seem to be discussing with you, I am fearful that you will feel as though we are attacking her by bringing them up ourselves. I do not have an answer or a solution to that, other than saying that I hope we can try to be as respectful as we possibly can with the words we choose while engaging in our conversations here.

I really do hope you will stay with us.
Marianne

[Renee]

I think being defensive can only be a detriment to Pongo.

We don't know your vet personally, nor are we out to discredit or attack her personally. The very best of intentions can still work out the wrong way, and we are trying to share with you our concerns and advice based on a wide range of experiences in order to reduce the chance of something negative happening. Even good vets make mistakes or miss something.

I think our opinions or comments may come across rather bluntly, and I personally apologize if that was the case, however it is not intended to offend or attack.

[Dixie'sMom]

I came here for help, not judgment. And that is what you are getting from the members here. But to me it seems that you didn't really want help and that you and your holistic vet had it all figured out, even to the point of excluding your traditional medicine vet. I have no doubt that you are an intelligent dog trainer and take very good care of your animals. I have no doubt that you love them dearly and want the best for them. And that is why you should listen very carefully to what the experts on this forum have to say to you. They are giving you their time and expertise because they truly care about you and your furbabies.

I have explored the contents of the herbal remedy your vet is recommending. There is no statement in any of the ingredients that says that it lowers cortisol. The herbs appear very beneficial overall, but if you or your vet think they are a cure for cushing's disease or it's symptoms you both are wrong and if that ticks you off, then so be it. If it controls Pongo's disease then he most likely didn't have Cushing's to begin with.

You stated that your vet has treated many Cushing's patients with these herbs with good results.... How many? Would she be willing to let you speak with some of those pet owners? Has she ever owned a Cushing's dog herself?

This board has hundreds of pet owners who have seen their dogs improve and live out their normal lifespan by following certain protocols. On the flip side of the coin we have also seen many ignore the proper protocols and lose their beloved pups needlessly. We grieve right along with those pet owners too because every life matters to us.

Please try to remember that we are trying to help you and not allieniate you. In every other case in Pongo's and Tonka's whole life I am sure your vets have been excellent. Cushing's Disease is a whole new ballgame and a damn demon of a disease. In many cases it takes an Internal Medicine Specialist to get to the correct diagnosis and treatment plan. Do you have one of those in your area? If so, THAT would be the highest level of care for Pongo. If his LDDS comes back with a Cushing's diagnosis, then seek the best for him as you would do for your human baby. Your holistic vet and regular vet could continue to take care of their other medical needs.

What it all boils down to is that blind faith in any doctor - pet or human is a mistake. Always educate yourself and soak up ALL of the knowledge. Not just one or 2 opinions... consider them all. Education and support is what you will get here.

I wish you and Pongo the best of luck... and I truly mean that. I'm still praying your little guy doesn't have Cushing's at all and that whatever is going on with him is easily corrected and you both can go on to live a joyful life. If he does have Cushings, guess what? We'll be right here for you.

[Pongo]

And that is what you are getting from the members here. But to me it seems that you didn't really want help and that you and your holistic vet had it all figured out, even to the point of excluding your traditional medicine vet. I have no doubt that you are an intelligent dog trainer and take very good care of your animals. I have no doubt that you love them dearly and want the best for them. And that is why you should listen very carefully to what the experts on this forum have to say to you. They are giving you their time and expertise because they truly care about you and your furbabies.

I have explored the contents of the herbal remedy your vet is recommending. There is no statement in any of the ingredients that says that it lowers cortisol. The herbs appear very beneficial overall, but if you or your vet think they are a cure for cushing's disease or it's symptoms you both are wrong and if that ticks you off, then so be it. If it controls Pongo's disease then he most likely didn't have Cushing's to begin with.

You stated that your vet has treated many Cushing's patients with these herbs with good results.... How many? Would she be willing to let you speak with some of those pet owners? Has she ever owned a Cushing's dog herself?

This board has hundreds of pet owners who have seen their dogs improve and live out their normal lifespan by following certain protocols. On the flip side of the coin we have also seen many ignore the proper protocols and lose their beloved pups needlessly. We grieve right along with those pet owners too because every life matters to us.

Please try to remember that we are trying to help you and not allieniate you. In every other case in Pongo's and Tonka's whole life I am sure your vets have been excellent. Cushing's Disease is a whole new ballgame and a damn demon of a disease. In many cases it takes an Internal Medicine Specialist to get to the correct diagnosis and treatment plan. Do you have one of those in your area? If so, THAT would be the highest level of care for Pongo. If his LDDS comes back with a Cushing's diagnosis, then seek the best for him as you would do for your human baby. Your holistic vet and regular vet could continue to take care of their other medical needs.

What it all boils down to is that blind faith in any doctor - pet or human is a mistake. Always educate yourself and soak up ALL of the knowledge. Not just one or 2 opinions... consider them all. Education and support is what you will get here.

I wish you and Pongo the best of luck... and I truly mean that. I'm still praying your little guy doesn't have Cushing's at all and that whatever is going on with him is easily corrected and you both can go on to live a joyful life. If he does have Cushings, guess what? We'll be right here for you.

I apologize for being defensive. She is a wonderful vet, but of course I want what is best for Pongo. I will shut my mouth here and open my ears (or eyes rather, as we are online).

I just got off the phone with a renowned canine and human endocrinologist in Los Angeles, Dr. Al Plechner, who has studied endocrinology in pets and humans for 50 years. He discussed a lot of things in scientific terms that were difficult for me to understand. He stated several things that stood out, and I'd like your feedback.

1. He said that if the prednisone did work to cure her eyebrow issue last month, then she does not have Cushings.

2. He said I should do an Endocrine Immune Blood Panel sent to the U of TX to determine if the cortisol is active or inactive.

3. He discussed something called Atypical Cortisol Estrogen Imbalance Syndrome, which is when the cortisol presents as high but is not working.

4. He said that the LDDS test was unnecessary.

Is there a way for me to upload attachments here? If so, I would like to post what he sent me for your feedback.

Thoughts?

[Pongo]

If you are interested, we can tell you a lot more about the LDDS test, about the value of an abdominal ultrasound, about the Tennessee adrenal testing, and even about alternative diagnoses that other dogs have ended up receiving after their owners first came here in the mistaken belief that Cushing's was the culprit. But since these are things that your vet does not seem to be discussing with you, I am fearful that you will feel as though we are attacking her by bringing them up ourselves. I do not have an answer or a solution to that, other than saying that I hope we can try to be as respectful as we possibly can with the words we choose while engaging in our conversations here.

I really do hope you will stay with us.
Marianne

I'm staying. I need all the help I can get. Pongo is a daughter to me (I call her my dogter).

Once I get the results of the LDDS (I will be doing it on Monday, not sure what the turnaround time is on getting results) and the urine culture (results will be back on Monday), what are my next steps? How do I go about finding an Internal Medicine Specialist in my area? Are there any organizations or links? I'm in Orange County, CA, about 45 minutes from LA. There has to be someone around here knowledgeable in this. I did speak to that Dr. Plechner which I mentioned in my previous comment and he said that if the prednisone cleared her eyebrow allergy, then it is not Cushings.

I am so confused!

[labblab]

I am heading out of the house so only have a moment to post, but I promise to come back. Unfortunately -- and you are not going to like hearing this, I'm afraid :o -- but Dr. Plechner maintains beliefs and offers recommendations that are far outside mainstream veterinary research. If you plug his name into our "Search" function, you will find some other discussions about him on the forum. Living in Orange County, we can definitely help you find a conventional specialist with whom to consult, if that would be of interest to you. So stay tuned...

Marianne

[Pongo]

I am heading out of the house so only have a moment to post, but I promise to come back. Unfortunately -- and you are not going to like hearing this, I'm afraid :o -- but Dr. Plechner maintains beliefs and offers recommendations that are far outside mainstream veterinary research. If you plug his name into our "Search" function, you will find some other discussions about him on the forum. Living in Orange County, we can definitely help you find a conventional specialist with whom to consult, if that would be of interest to you. So stay tuned...

Marianne

Thank you for the insight, Marianne. I would LOVE help finding a specialist in my area. Looking forward to hearing more from you about to whom I should turn for help around here. Thank you!

[Pongo]

Got her urine culture back, it's negative. Urinalysis says her PH is higher than normal, my vet wants me to add more meat to her diet.

[Dixie'sMom]

I'm very glad that you have decided to stay with us. In the resource forum, there is a link to finding a specialist in your area. I will post the link but if the link doesn't work for some reason, look under the Resource Forum. I am also sure there are folks here on the forum in your area, but I don't know who off the top of my head, so when Marianne gets back she can give you that info.

http://www.k9cushings.com/forum/showthread.php?t=182 (http://http://www.k9cushings.com/forum/showthread.php?t=182)

Marianne and the others are also great an interpreting lab results too so they may be able to tell you more about the urine Ph. A quick google search revealed this:

Urine Ph 7.0 and higher indicates alkalinity
Alkaline urine may be caused by diets containing high carbohydrates or high percentages of grains. It may also be caused by the addition of excessive amounts of alkalizing medications to the diet. Consistent alkaline urine may also be caused by a urinary tract infection. Some of the types of bacteria that cause urinary tract and kidney infections produce an enzyme that breaks down to ammonia and turns the urine alkaline.

Consistent alkaline urine in dogs may also cause the formation of a type of kidney stone (crystals); these may also be caused by the indiscriminate use of sulphonamide antibiotics.

Another reason for persistent alkaline urine may be the inability of the kidneys to re-absorb bicarbonate.

Any consistently alkaline urine should be investigated, including a urinary sediment examination.

Do you know if this is the first time Pongo's Ph has been off? Has either of your vets ever said anything about his urine being dilute? (Dilute urine is another trait that Cushpups exhibit. If she hasn't mentioned that, then that would be another sign pointing to no Cushings.)

As far as your conversation with the endocrine specialist, I really have no opinion on what he said. I'm not sure I follow his train of thought with regard to "if the Prednisone cleared up the eyebrows, your dog does not have Cushings." Maybe one of the others knows what he means by that statement.

As far as posting an attachment, about the only way you can do that is to save it as a picture file, jpeg, jpg, gif, etc. and upload it to your photo album. If you can copy and paste the contents, that may be easier for you.

Hang in there Shannon! It's gonna be ok. :)

P.S. I am so sorry for calling Pongo a "him". I have been doing that all week long with everyone's pups. Duh me....

[judymaggie]

Hi -- here is the updated link to locate a Internal Medicine Specialist:

http://www.acvim.org/AnimalOwners/FindaSpecialist.aspx

I have heard folks here talk about Dr. David Bruyette who is with the VCA West Los Angeles Animal Hospital -- hopefully, someone who is familiar with his work will post to give more info about him (or perhaps someone else at that hospital if he is not available).

(P.S. Obviously, Addy and I were posting at the same time ...)

[addy]

How far are you from West Los Angeles?

Dr. David Bruyette has helped many of our members even via email and is pretty respected.

http://www.vcahospitals.com/west-los-angeles/our-team/veterinarians/david-bruyette/28374

[addy]

ah, we were posting at the same time also UC Davis Veterinary School.

[Harley PoMMom]

This post that I am providing is from one of Administrators, Glynda, and trust me, Gynda recommendations are highly valued around here! ;):)


Hi and welcome from me too.

You are lucky to live in Orange County because you have two excellent facilities there to chose from. My cushdogs treat with VCA All Care in Fountain Valley which is 50 miles away for me. Commuting is a small price to pay to sleep easy knowing that my dogs are in the best of hands. There is also a great facility in Tustin called ACCIM. I don't think you can go wrong with either. You do not need a referral from your vet to go to VCA but you will need a referral for ACCIM. Both hospitals are open 24/7 so it makes it really easy to have the acth stim tests done. I just had stims done for both of my dogs on Sunday.

http://www.vcaspecialtyvets.com/all-care
http://www.accim.net/

[pansywags]

I've been PMing with Shannon about Dr Bruyette as well.

Shannon, hang in there and remember to breathe. Let us know the test results when they're in. We are all pulling for the best outcome for you and Pongo.

[Pongo]

I'm very glad that you have decided to stay with us. In the resource forum, there is a link to finding a specialist in your area. I will post the link but if the link doesn't work for some reason, look under the Resource Forum. I am also sure there are folks here on the forum in your area, but I don't know who off the top of my head, so when Marianne gets back she can give you that info.

http://www.k9cushings.com/forum/showthread.php?t=182 (http://http://www.k9cushings.com/forum/showthread.php?t=182)

Marianne and the others are also great an interpreting lab results too so they may be able to tell you more about the urine Ph. A quick google search revealed this:

Urine Ph 7.0 and higher indicates alkalinity
Alkaline urine may be caused by diets containing high carbohydrates or high percentages of grains. It may also be caused by the addition of excessive amounts of alkalizing medications to the diet. Consistent alkaline urine may also be caused by a urinary tract infection. Some of the types of bacteria that cause urinary tract and kidney infections produce an enzyme that breaks down to ammonia and turns the urine alkaline.

Consistent alkaline urine in dogs may also cause the formation of a type of kidney stone (crystals); these may also be caused by the indiscriminate use of sulphonamide antibiotics.

Another reason for persistent alkaline urine may be the inability of the kidneys to re-absorb bicarbonate.

Any consistently alkaline urine should be investigated, including a urinary sediment examination.

Do you know if this is the first time Pongo's Ph has been off? Has either of your vets ever said anything about his urine being dilute? (Dilute urine is another trait that Cushpups exhibit. If she hasn't mentioned that, then that would be another sign pointing to no Cushings.)

As far as your conversation with the endocrine specialist, I really have no opinion on what he said. I'm not sure I follow his train of thought with regard to "if the Prednisone cleared up the eyebrows, your dog does not have Cushings." Maybe one of the others knows what he means by that statement.

As far as posting an attachment, about the only way you can do that is to save it as a picture file, jpeg, jpg, gif, etc. and upload it to your photo album. If you can copy and paste the contents, that may be easier for you.

Hang in there Shannon! It's gonna be ok. :)

P.S. I am so sorry for calling Pongo a "him". I have been doing that all week long with everyone's pups. Duh me....



Lol, no worries about gender. Pongo humps everything anyway, she'd be glad to be called a boy. :)

Her PH is a 10. I asked my vet to go back over her prior results: she was a 6 in Nov., a 7 in Dec. Yes, urine is dilute.

I have been doing research all day, I seriously feel like I am studying for a vet school exam. I found a specialist who is highly revered in Los Angeles, Dr. David Bruyette. (Here's one of his papers: http://www.vcaspecialtyvets.com/cms/pdf/conferences/165/9122003/140410111432/Canine-Hyperadrenocorticism-Bruyette-040313.pdf)
Once I get the LDDS results, he told me to have my vet send them to him. I will then go to LA for whatever other diagnostics he says we should do. Once we have a treatment protocol in place, I will continue to work with my vet to manage it. My vet commended me for my diligence and she says she absolutely respects that I want to work with a specialist as well as her.

After learning more about the urine, I am losing hope that this isn't Cushings. I asked my vet what I should do about the high PH and she said add more meat. Pongo is already on a grain-free, low carb diet and has been for years. Being a dog trainer, however, I use a lot of treats with her, albeit meat-based healthy ones.

Just for smiles, here is a video of Pongo learning to play the piano 2 years ago:
https://www.youtube.com/watch?v=Ak5xLledKXM

I am afraid whatever I do won't be the right thing for her. I am sick to my stomach reading about how complicated Cushings is. My heart goes out to all of you who have been through the ringer with this. I just hope there's no genetic component and that I won't have to go through this ever with her sister...

[Pongo]

Oh wow, I just saw all the posts above that I missed. Looks like Dr. Bruyette gets the thumbs up (thanks immensely Elaine)!

I'll have to scroll back up and read all that I missed...

[Pongo]

This post that I am providing is from one of Administrators, Glynda, and trust me, Gynda recommendations are highly valued around here! ;):)

Thank you for her quote. I've had bad experiences with VCA All Care. They tried to charge me for a $5,000 ACL surgery. Turns out my dog (Pongo's sister) had an uncomfortable, tiny lipoma on her knee. My vet lasered it off for $40. A close friend of mine is a vet tech there. I do know that they refused to release pets of people who could not pay their bills. I can't speak for how they treat Cushings, or which dr. would be good over there. I don't know the other place that requires referrals, but I will do as much research as it takes to get my girl the best care.

(edit: Just got off the phone with my friend who works at VCA. She said if I went to VCA All Care, I'd want to see Dr. Page but she will be taking maternity leave soon. I feel good about Dr. Bruyette. I was surprised that he got right on the phone when I called. That's pretty cool. I like how available he was, and that he seems to have really good feedback here.)

I'm willing to go to LA for Dr. Bruyette, I just fear that my neighbors will begin to complain when I take Pongo away for that long; her sister will stay home and howl and it's too hot to leave the windows closed. I will probably have to take her with us every time we need to go to LA.

[Pongo]

I've been PMing with Shannon about Dr Bruyette as well.

Shannon, hang in there and remember to breathe. Let us know the test results when they're in. We are all pulling for the best outcome for you and Pongo.

Thanks so much Elaine; I really appreciate your directing me to Dr. Bruyette. I am so much closer to Tustin and VCA All Care. As I stated above, I had a bad experience with VCA. I don't know anything about how they treat Cushings. Will call my friend who works there to see her opinion...

[Dixie'sMom]

Ok, so it sounds like things are coming together and you have a plan in place with Dr. Bruyette. So from here we go one step at a time... one day at a time. And as Elaine said, don't forget to breathe. :D

The video of Pongo is so precious it brought tears to my eyes. (I'm pretty sappy that way) I just loved it. As I've said many times on this forum, my favorite part is seeing all of the pups sweet little faces. And tell Pongo I said "you go old girl!" I admire that still she still has sex hormones at her age! LOL!

[ShibaMom]

Hi Shannon,

Welcome to the forum! I'm sorry for what has brought you here though :( Your sweet Pongo and Tonka are wonderful!

I'm pretty new here as well. I've read a bunch of threads now, and I can tell you that there are so many vets who are great vets, but have little clue about Cushing's. Some do, but their information is outdated. Of those, some are receptive to new material, and others aren't. It's such a crapshoot!

It sounds like you have a great team there, and I'm glad to hear you've reached out to someone with lots of Cushing's experience to augment that. Pongo's lucky to have you as her mom and advocate.

Hopefully they'll get down to the bottom of what's going on with her, Cushing's or not. My girl Zanya had a UTI (after several others), was on Clavamox, urine no longer showed bacteria or RBCs, and while improved, she still had symptoms of one. We sent a culture, it was negative. A little while later (a month? something?) symptoms were back really badly, and tested with another bad UTI. Although the culture was negative, I think the bacteria were hiding there somewhere. We're in the 2nd half of a 30 day treatment this time. She's much improved, but again, not 100%. My vet says she prefers to have Cushingoid dogs on the antibiotic for 30 days (which I've seen others concur with) since they can be tough to clear up. Cushing's makes them more susceptible to infection.

Anyhow, I also wanted to say how much I love your training videos! I watched a bunch. We've used very similar techniques training my daughter's puppy (1yr old Kappa, some sort of shepherd mix), so it's great to see more. I told my daughter we're going to teach Kappa to play piano ;-)

Hoping for good news next week!

...and yes, please remember to breathe!

Regards,
Samantha

[Harley PoMMom]

OMGosh, I just watched Pongo playing the piano, how adorable she is!!!

You and Pongo will be in very capable hands with Dr. Bruyette, as he is one of our countries leading experts on Cushing's and other endocrine disorders.

Hugs, Lori

[labblab]

Wow, I see a lot has transpired since I left the house last night!

Shannon, I'm so glad to see you have a new diagnostic plan in place. You may end up at exactly the same point -- giving Pongo medication to control Cushing's symptoms -- but it will be with so much greater confidence about the true nature of the diagnosis. Definitely ask your vet to send all of Pongo's other test results to Dr. Bruyette, along with the LDDS.

He is a remarkably responsive man. For a brief time he actively posted on our forum here and he still welcomes direct email inquiries from our members. I swear, he must keep an email device nearby at all times. I have personally sent emails to him from my home here on the east coast that arrived in L.A. at odd hours due to the time difference -- and I still get a response within 30 minutes. His dedication is amazing to me!

Anyway, definitely keep us updated and I am really, really glad you are hanging in here with us! :) :)

Marianne

[Pongo]

Thank you all so much for your support and guidance. Your words give me comfort. Pongo, and her sister Tonka, are my life.

I am grateful to Elaine for steering me towards Dr. Bruyette, and I'm starting to feel like this is not a death sentence but a life lesson. Really grateful right now.

Happy Valentines Day to all of you from me and PonTon! (That's how I refer to Pongo & Tonka)

https://www.facebook.com/K949Training/photos/a.126858410716200.21048.108790432522998/761331813935520/?type=1&theater

[Pongo]

http://www.flickr.com/photos/131300022@N05/16529409242/

[Pongo]

http://www.flickr.com/photos/131300022@N05/16529409242/

Hopefully this works....not sure why I'm having trouble uploading an image. Advice?

https://www.flickr.com/photos/131300022@N05/16529409242/

[ShibaMom]

Adorable, Shannon!!

You can't have embedded pics in a post. The links are working just fine!
Happy Valentines Day to you as well!!

[Pongo]

So we went in for our LDDS test today. We go back at 1pm then 5pm. I also want to check her for diabetes, am going to see what the vet says about that. Fingers and paws crossed that the LDDS test comes back with no scary results. Can anyone please tell me a little about this test? What will it show? What are normal values? Above or below what numbers would indicate issues?

[labblab]

Hi Shannon! Here's a great article that will explain a lot about the LDDS test. And the extra bonus is that it's written by Dr. Bruyette, so you'll get a preview of him! ;) :)

eterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Take a look at the article, and then let us know about additional questions that you are still left wondering about.

Marianne

[Pongo]

Hi Shannon! Here's a great article that will explain a lot about the LDDS test. And the extra bonus is that it's written by Dr. Bruyette, so you'll get a preview of him! ;) :)

eterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Take a look at the article, and then let us know about additional questions that you are still left wondering about.

Marianne

Hi Marianne,
Link didn't work. Can you please repost? Thank you!!

[pansywags]

The letter 'v' was clipped from the beginning of the link, it should start with veterinary:

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

[labblab]

Let's give this a try...sorry! :o

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

[Pongo]

Thanks! They told me I didn't need to fast her, so I hope that doesn't have any effect on the results as she had breakfast. She was so unhappy going there twice already. One more visit at 5pm...

[labblab]

I do hope they actually checked re: the fasting with the lab that will be performing the analysis. Just to be on the safe side, you may want to confirm that with them before you return for the final blood draw in the event the test needs to be repeated in order to be accurate. :o

[Pongo]

I do hope they actually checked re: the fasting with the lab that will be performing the analysis. Just to be on the safe side, you may want to confirm that with them before you return for the final blood draw in the event the test needs to be repeated in order to be accurate. :o

I asked three times, once early this morning, once after I read the link, and once on our last visit, and they assured me that it was fine. I still wish I had fasted her just in case.

[labblab]

OK, well you certainly covered your bases the very best you could! Apparently some labs do not require fasted samples so we will assume that is the case for you guys!

[Dixie'sMom]

I'm here waiting with you to get the results. We are getting a snow storm so if I disappear then I probably don't have internet service.

Still sending prayers and crossing Dixie's and Button's paws for great results. Hang in there. You are doing good. :D

[ShibaMom]

Do you know when you'll get the results back? Crossing fingers!!

[Pongo]

I'm here waiting with you to get the results. We are getting a snow storm so if I disappear then I probably don't have internet service.

Still sending prayers and crossing Dixie's and Button's paws for great results. Hang in there. You are doing good. :D

Thanks so much. All testing done. They do the analysis in-house, so results will be back in an hour and a half and my vet will call me. I asked them to check for diabetes as well. They checked for blood glucose so I'm guessing that was the first test necessary for diabetes. I'm concerned that Pongo's sister has also been drinking more water lately. I'm hoping it's all in my mind since now I'm constantly on edge when either one goes to the water bowl. Tomorrow I have to get a sample of Tonka's urine for her microalbuminuria test; she has trouble filtering out the protein and has been on meds for that. I was holding off on rechecking last week because I couldn't take more bad news but I can't put it off.

My landlord said Tonka was howling when I left with Pongo tonight worse than the other two visits this morning/afternoon. I always leave her puzzles and chew bones, and was hoping she'd improve throughout the day with each visit but instead got worse. Catch 22 is that I can't give her too much stuff because whatever is high enough in value to occupy her when we leave is high in protein.

I wish I had separated them more as puppies so they weren't so bonded. I know when one passes the other won't know how to deal. One of my clients referred to them as "womb mates" which I thought was cute, but it's not going to be cute when either one can't comprehend life without her sister.

I sure hope the storm doesn't hit you hard. I would feel like I fell off the earth without internet...

[Pongo]

Do you know when you'll get the results back? Crossing fingers!!

Within the hour. I'm watching the Westminster Dog Show, trying to keep my mind occupied and hoping the Dalmatian takes this group...

[Dixie'sMom]

After Dixie got her Cushing's diagnosis I found myself scrutinizing every dog I saw for potbelly, hair loss, etc. (Dixie hasn't had hair loss except on her enormous pot belly.) I think that may be somewhat normal since getting a diagnosis or even a suspicion of Cushing's is upsetting. Hopefully Tonka will be fine and never have to deal with it. Poor baby... sounds like she has separation anxiety. I wish you had a good sitter for her so you could drop her off and not have to worry about her. I know you can't take her everywhere. :(

So far so good with the storm. Snow and some sleet but I still have power and internet and phone and TV. Earlier this week we had some high winds and a tree fell across my road taking down lines on both sides of the street. Luckily the power and tv came back up very quickly but I had no internet and phone for a little over 24 hrs. I hated it. LOL. I can't drive or even see to use a cell phone so I'm cut off from the world without phone and internet. My 22 y/o lives with me and he has a cell phone but he was at work when it happened. I've decided I'm going to have to go shopping for a cell phone big enough that I can see in case that happens again. Hopefully we won't lose anything and I can just enjoy the pretty snow. Button's and Dixie love it! Dixie wants to come back inside quicker than Buttons though. I think it's because her little potbelly gets cold dragging the ground in the snow, LOL.

Ok. Let us know when you hear anything. We'll be right here waiting.

[Pongo]

PONGO DOES NOT HAVE CUSHINGS!!!
I REPEAT...PONGO DOES NOT HAVE CUSHINGS!!!

SOOOOO glad we did that LDDS test!! Thank you thank you thank you to everyone who said I should request it be done.

She's still drinking a lot of water, but her blood glucose is normal so she doesn't have diabetes either! My vet said to read about diabetes insidious, which could be the explanation.... in the meantime:

PONGO DOES NOT HAVE CUSHINGS!!!

[labblab]

Shannon, can you please tell us the actual test result numbers, along with the reference range? I know you are feeling really relieved, but we'd just like to double-check those numbers. Was this your holistic vet who ran the test? If so, I am really surprised that they had the capacity to run such a specialized test like this in-house. That is really, really unusual.

[Pongo]

Shannon, can you please tell us the actual test result numbers, along with the reference range? I know you are feeling really relieved, but we'd just like to double-check those numbers. Was this your holistic vet who ran the test? If so, I am really surprised that they had the capacity to run such a specialized test like this in-house. That is really, really unusual.

It was my traditional vet. He didn't give me the actual numbers (I'll get a copy tomorrow when I take Tonka's urine in), but he explained that there was more than a 50% drop each time increment (I think he said more than; he explained it but my mind was just shocked at the fact that the test came back normal that I didn't hear the specifics), and that her resting level was 1 point something. I'll post actual results tomorrow, but he was certain.

[Pongo]

I can't wrap my head around her urine PH being a 10 and dilute. She has no UTI. It was a 6 in Nov, a 7 in Dec and 10 now. She does not eat a high carb or sugary diet. She eats a healthy amount of protein, fruits and veggies. No grains except for some treats. I'll have to ask about that in the morning.

[Dixie'sMom]

:D:D:D:D:D

WHOOOHOOO!

Unfortunatley you do not get to escape from us quite so soon. Get those numbers so we can do a little quality assurance check. :)

I hope you will also stick around until we get to the bottom of what is going on with Pongo. Since Tonka is beginning to consume large amounts of water also, do you think the treats could be the culprit? Maybe they contain a little more sodium or a certain ingredient that is triggering this?

[Pongo]

:D:D:D:D:D

WHOOOHOOO!

Unfortunatley you do not get to escape from us quite so soon. Get those numbers so we can do a little quality assurance check. :)

I hope you will also stick around until we get to the bottom of what is going on with Pongo. Since Tonka is beginning to consume large amounts of water also, do you think the treats could be the culprit? Maybe they contain a little more sodium or a certain ingredient that is triggering this?




I will definitely post the numbers as soon as I get them in the morning. I'm thinking Tonka drinking a lot was in my head. I literally jumped every time either dog went near the water bowl, practically counting how many laps they took. I'm going to ask if something in the diet can be causing it. The urine PH is a bit baffling, as is the hunger and whining. I wish I could get inside her pretty little head and ask how she is feeling.

[Dixie'sMom]

I think the urine pH could be a big clue. Maybe some sediment or a kidney stone? That doesn't explain the hunger but sure would explain the whining (pain).

But you know what? Enjoy tonite. Pongo doesn't have Cushings. :D

[Pongo]

I think the urine pH could be a big clue. Maybe some sediment or a kidney stone? That doesn't explain the hunger but sure would explain the whining (pain).

But you know what? Enjoy tonite. Pongo doesn't have Cushings. :D

Thank you!!! I am relieved to hear his certainty.

I was thinking the same thing re: stone. That would make sense with the whining and her looking at her flank a lot. Also would fit in nicely with why she seemed to be more comfortable when she was on Rimadyl. I'm going to give her more meat and less veggies in the morning, then talk to my vet about adding a probiotic and/or Cran-Actin, and about the possibility of this being caused by a stone.

Either way, when I get the numbers I will post here in the morning. You are all wonderfully helpful and supportive!

[Dixie'sMom]

Her urine is dilute because she is drinking alot of water. If the vets cannot get to a diagnosis with lab work, an ultrasound could give them a look inside to see if anything odd exists. Hopefully the others will come by soon with their thoughts. Hugs and have a restful nite. :)

[pansywags]

Shannon, I hope you sleep well tonight - I know it's been a really trying week. We look forward to seeing the test results when you get them tomorrow.

[Pongo]

Shannon, I hope you sleep well tonight - I know it's been a really trying week. We look forward to seeing the test results when you get them tomorrow.

I'm going to sleep like a baby, thanks Elaine.

This is the email I just sent my vet:

"Hey Dr. A,

Dr. Tom called with Pongo's LDDS results. Totally normal and cleared for Cushings, much to my relief. So I'm listing her symptoms:

1. A pH of 10
2. Dilute urine (which makes sense with her drinking so much)
3. High water intake
4. Longer time spent peeing (makes sense with high drinking volume)
5. Licking her self (was worse in Dec before she was put on Rimadyl which seemed to help)
6. Occasionally turning her head to look at her flank
7. Whining to get my attention; once I look at her, she stares at food bag & treat drawer repeatedly looking back at me and back at food.
8. Had that weird eyebrow allergy, which cleared up on the Prednisone

Should I keep her on the Four Marvels pills since the ACTH stim is a 21.8? Should I put her back on the Rx Biotic probiotic? Add Cran-actin or D-mannose?

Could it be kidney stones, and if so, wouldn't she act more uncomfortably? The drinking, licking, pacing and painting did seem to get better when she was on Rimadyl.

If her ACTH stim was borderline at 21.8, is she at risk for Cushings and/or diabetes? If so, how do I prevent it from crosses over into the 22+ range?

Dr. Tom mentioned something called Diabetes Insipidus, but that doesn't explain the rest of her symptoms.

Lots of questions I can't answer. I don't want to put her through an ultrasound. She really hates going there, but if it's a kidney stone, I can't understand why she is not uncomfortable all of the time.

Here is what she eats in a day (meals are once at 7:45am and once at 4:45pm). She also eats lots of treats, but they are usually all protein, and none have wheat, corn, soy, BA, ethoxyquin or anything else bad for dogs. Nothing made from China.
I know you mentioned adding more meat; should I lessen her vegetable intake?

She gets Sojos Fruit & Veggies, about 1 cup along with 1/3 Evanger's can of either chunks of beef, whole chicken thighs, or whitefish as her protein. I stopped using the Emu oil (six squirts per meal) a couple of days ago since ACTH stim test. Also stopped giving her coconut to keep fat content low but I'd like to add that back. Could the vegetables be high in carbs? The Sojos being mostly all veggies have a decent amount of carbs, but again, she's been on the Sojos for years; no change in amount enough for her to have a pH of 6 in November, 7 in December and a 10 now.

Sojos Ingredients: sweet potato, carrots, broccoli, celery, apples, whole egg, cranberries, tricalcium phosphate, flax meal, parsley leaf, carob powder, dried kelp, dried alfalfa, ginger root, garlic, sunflower oil, vitamin D3

Guaranteed Analysis
crude protein 14.3% min., crude fat 5.1% min., crude fiber 8.2% max., moisture 10.0% max. calorie content (ME calculated, as fed): 2925 kcal/kg, 332 kcal/cup

Protein sources: Evangers cans - Only pure protein: beef, whole chicken thighs or whitefish, about 1/3 can at each meal mixed in with the Sojos.

[Dasequan: 1/2 of a 60 lb to 120 lb size per meal. (she weighs 50 lbs.) - just started these about a few days ago. - adding this now; forgot to add that in the actual email]

Can we please discuss these tomorrow if you have time?

Thanks for everything, as usual!

~ Shannon ~"

Anything else I should ask?

Meanwhile, that Dr. Plechner who people think is a quack was on the money about insisting that if the eyebrow allergy cleared up on the prednisone, then it can't be Cushings. I gotta give him credit for that. He may stray from the herd in terms of viewpoint, but perhaps there's more to his Plechner's Syndrome than I thought...it's worth investigating further if we can't explain away her symptoms.

[pansywags]

Are you still planning on sending the test results along to Dr. Bruyette when you get them? It might be a good idea while you are at the vet today to get, say, all records for the past year or so so that you have them at hand for reference.

[Pongo]

Are you still planning on sending the test results along to Dr. Bruyette when you get them? It might be a good idea while you are at the vet today to get, say, all records for the past year or so so that you have them at hand for reference.

I have saved every single record of her medical history since 2008. Didn't plan on sending to Dr. Bruyette now that I have the results. My traditional vet has been doing this for almost 40 years. I do trust his evaluation of the results, and we have a state of the art clinic.

Going to the vet now, will post back when I have numbers.

[pansywags]

Best wishes for Tonka today!

[labblab]

Since you will have all Pongo's relevant test results in your hands and you've already made the initial contact with Dr. Bruyette, I'm thinking it might still be worth your while to proceed with at least one consultation with him since his expertise ranges beyond just Cushing's. The thing is, you still have a number of symptoms without an explanation. And even though the negative LDDS makes conventional Cushing's far, far less likely, it doesn't absolutely rule out adrenal involvement of some sort. That's the darn frustrating thing about Cushing's -- there is no single test that can diagnose it or rule it out with 100% confidence. This was part of that LDDS article yesterday:


If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

So Pongo was negative on the LDDS, but right at the diagnostic borderline on the ACTH test. Is there still a chance that she is in the very early stages of conventional Cushing's? I don't know, but Dr. Bruyette would be better able to tell you. Also, remember, we talked about symptoms possibly arising from elevated adrenal hormones other than cortisol ("Atypical" Cushihng's)? Dr. B may not be an endorser of that theory and may not recommend testing to check that possibility, but that is another thing you could ask him. Or based on these test results, he may say, "Yup, take Cushing's entirely off the table, but here's another direction to explore."

Since you are still searching for an explanation as to Pongo's entire constellation of symptoms, it seems like a golden opportunity to pick the brains of an endocrinological expert. Just sayin'...:o

Marianne

[Pongo]

Since you will have all Pongo's relevant test results in your hands and you've already made the initial contact with Dr. Bruyette, I'm thinking it might still be worth your while to proceed with at least one consultation with him since his expertise ranges beyond just Cushing's. The thing is, you still have a number of symptoms without an explanation. And even though the negative LDDS makes conventional Cushing's far, far less likely, it doesn't absolutely rule out adrenal involvement of some sort. That's the darn frustrating thing about Cushing's -- there is no single test that can diagnose it or rule it out with 100% confidence. This was part of that LDDS article yesterday:



So Pongo was negative on the LDDS, but right at the diagnostic borderline on the ACTH test. Is there still a chance that she is in the very early stages of conventional Cushing's? I don't know, but Dr. Bruyette would be better able to tell you. Also, remember, we talked about symptoms possibly arising from elevated adrenal hormones other than cortisol ("Atypical" Cushihng's)? Dr. B may not be an endorser of that theory and may not recommend testing to check that possibility, but that is another thing you could ask him. Or based on these test results, he may say, "Yup, take Cushing's entirely off the table, but here's another direction to explore."

Since you are still searching for an explanation as to Pongo's entire constellation of symptoms, it seems like a golden opportunity to pick the brains of an endocrinological expert. Just sayin'...:o

Marianne

I asked about the 5-10% and he said I shouldn't be concerned. I just dropped off Tonka's urine and all of my questions for the vets.

So I got Pongo's numbers, and they say some weird things which seem to concern me, but I don't know how to read this. Is there a way for me to scan and link/upload instead of posting them all? Maybe Dropbox?

[Pongo]

LDDS - https://www.dropbox.com/s/rpro9iod5bjtynt/LDDS%20-%20Pongo%202.16.15.jpeg?dl=0

Urinalysis Page 1 - https://www.dropbox.com/s/c99qbf5urbprfyu/Urinalysis%20-%20PONGO%202.11.15%20page%201.jpeg?dl=0

Urinalysis Page 2 - https://www.dropbox.com/s/sonmzvq4pyjv68s/Urinalysis%20-%20Pongo%202.11.15%20page%202.jpeg?dl=0

[Pongo]

LDDS - https://www.dropbox.com/s/rpro9iod5bjtynt/LDDS%20-%20Pongo%202.16.15.jpeg?dl=0

Urinalysis Page 1 - https://www.dropbox.com/s/c99qbf5urbprfyu/Urinalysis%20-%20PONGO%202.11.15%20page%201.jpeg?dl=0

Urinalysis Page 2 - https://www.dropbox.com/s/sonmzvq4pyjv68s/Urinalysis%20-%20Pongo%202.11.15%20page%202.jpeg?dl=0

OK, I think the first half that confused me was just for reference. Her actual numbers do appear to be in the normal range to me.

[Pongo]

(Edited my above comment with the correct link to the LDDS test)

[Renee]

Hope I am reading it right.

Baseline 2.2 ug/dl
4 hr 0.7
8 hr <0.5

Based on the ranges, this is normal, not cushings.

[Pongo]

Hope I am reading it right.

Baseline 2.2 ug/dl
4 hr 0.7
8 hr <0.5

Based on the ranges, this is normal, not cushings.

That's what my vet said. I read that there's still a 5-10% chance it could be PDH upon doing some research online. Still think I should send these results to Dr. Bruyette?

[Renee]

I think Dr B is a good resource, and you have nothing to lose by forwarding this to him. But, I also think I would put more energy towards exploring other scenarios and table traditional cushings for now.

If you've ruled out everything else (diabetes, thyroid, UTI), then the next step could be a high resolution ultrasound, done by a specialist. This may give you more information on what's happening internally.

[pansywags]

Those values look normal. I think it would be a good idea to send the test info (including earlier urine and ACTH results) to Dr Bruyette since you have already made the contact. Another data point is always a good thing since there are strong symptoms and you are still in the diagnostic stage.

[Pongo]

Those values look normal. I think it would be a good idea to send the test info (including earlier urine and ACTH results) to Dr Bruyette since you have already made the contact. Another data point is always a good thing since there are strong symptoms and you are still in the diagnostic stage.

Sent an email to my vet requesting that the results be sent to Bruyette. Also asked if they think an ultrasound would be necessary at this point. I will keep her on the herbal supplement and see what they tell me.

[labblab]

Yep, those LDDS results are definitely "negative" for Cushing's.

I just want to clarify that the reason I think you might still benefit from letting Dr. Bruyette review Pongo's test results (everything: ACTH, LDDS, recent blood and urine panels) is not because a conventional Cushing's diagnosis remains likely, but instead because his experience is much broader than just Cushing's. He's the medical director for the VCA Hospital and among other things, previously headed up the Internal Medicine Dept. at the Kansas State Veterinary School. He does have a special interest in all hormonal disorders (including diabetes and thyroid issues, too), and for whatever reason, Pongo's cortisol level was elevated above the normal range on the ACTH. So I just thought his perspective might be useful since you've seemingly come to a dead end on the frontline obvious testing that there is to be done.

But I have absolutely no hidden agenda here, and it is entirely your decision as to whether you think consulting him might be worth your while.

Marianne

Edited to add: I see we were typing at the same time. I really think you have nothing to lose by letting Dr. B look over all the testing info/lab results, and maybe something to gain.

[Pongo]

Yep, those LDDS results are definitely "negative" for Cushing's.

I just want to clarify that the reason I think you might still benefit from letting Dr. Bruyette review Pongo's test results (everything: ACTH, LDDS, recent blood and urine panels) is not because a conventional Cushing's diagnosis remains likely, but instead because his experience is much broader than just Cushing's. He's the medical director for the VCA Hospital and among other things, previously headed up the Internal Medicine Dept. at the Kansas State Veterinary School. He does have a special interest in all hormonal disorders (including diabetes and thyroid issues, too), and for whatever reason, Pongo's cortisol level was elevated above the normal range on the ACTH. So I just thought his perspective might be useful since you've seemingly come to a dead end on the frontline obvious testing that there is to be done.

But I have absolutely no hidden agenda here, and it is entirely your decision as to whether you think consulting him might be worth your while.

Marianne

I requested that my vet send the results to Bruyette. I will do whatever my vets and/or Bruyette recommend in order to lower that ACTH level. I'm thinking the herb my vet already put Pongo on should be sufficient at this point and will retest ACTH stim in a month, but I agree that it never hurts to get a specialist opinion. I just don't want to keep questioning my vets. They are truly stellar, and refer a lot of clients to me for training so I don't want to offend them. I've been questioning them throughout this entire process, and so far they've been right. At the same time, I do want to do what's best for my dog and I know they respect that...

[labblab]

Now that the LDDS results are in, what is your traditional vet suggesting in terms of the next diagnostic step? I see he has mentioned D.I. Is he recommending any other additional testing to get to the bottom of things?

[Pongo]

Now that the LDDS results are in, what is your traditional vet suggesting in terms of the next diagnostic step? I see he has mentioned D.I. Is he recommending any other additional testing to get to the bottom of things?

No, but he did bring up the D.I. as a suggestion. I will know more when they answer my barrage of questions. And I will keep an eye on Pongo for any more strange symptoms, but at this point I am not really worried. I do want to understand the elevated ACTH stim level and her symptoms, but I personally am confident that we can lower that number with the herb now that we've ruled out conventional Cushings. If they suggest I do nothing but keep her on the herb for a month and retest, that's what I'll do. For now, my mind is on Tonka and the results of her microalbuminuria test...

[pansywags]

I hope things go well for Tonka and that you keep us posted on further testing for Pongo. The more we know about how your situation turns out, the better we can help someone else in the same boat in the future.

[Squirt's Mom]

What herb are you using to lower the cortisol?

[Pongo]

Sorry it's been a few days! Presently we are keeping her on just the Four Marvels. We have sent her ACTH stim and LDDS results to Dr. Bruyette along with all her medical records, blood work, urine, etc. from when the symptoms began back in November. There were X-rays done in Dec. and my vet was able to check to see if she had any visible kidney stones to see if that could explain her symptoms but there was nothing visible. Because she has all the signs of Cushings but the only questionable result was the ACTH stim, we will await hearing from Dr. Bruyette on whether an ultrasound or testing for sex hormones is next on the agenda. Will post again when I have more answers...

[molly muffin]

We will be very interested in seeing what Dr. B recommends for the next step.

I consulted him about when to start my molly on medication (trilostane). (also got an opinion from Dr. Peterson in NYC.)

[Pongo]

So she's been on this herb for a bit and there is definitely a huge improvement. She is drinking a lot less water, peeing less, not whining, not seeking food (except for trying to get me to give her pig ears and bones from her treat drawer, which she doesn't even eat but carries around for a day or two before digging in).

Dr. Bruyette is out of the country on a mountain excursion until March 3rd, so I won't have answers until then, and I imagine he'll be swamped with emails and patients, so I hope he can respond quickly as to whether we do an ultrasound or sex hormone test.

At least Pongo is definitely more comfortable now, and that is a relief.

[Squirt's Mom]

Four Marvels, or Si Miao San, is a TCM formula recommended by Dr. Steve Marsden for


Biliary tract inflammation

High ALP and no elevated post-prandial bile acids. Pathogenesis: cholestasis caused by steroid hepatopathy and biliary tract inflammation causes several secondary changes, including fibrosis and apoptosis of hepatocytes and cholangiocytes

It contains the herbs Cang Zhu (Atractylodes rhizome), Huai Niu Xi (Achryanthes root), Yi Yi Ren (Coix seed), Huang Bo (Phellodendron bark).

http://www.ivcjournal.com/articles/chinese-herbs-for-liver-disease/

According to the Manual of Natural Veterinary Medicine- Science and Tradition by Susan G. Wynn, DVM and Steve Marsden, DVM, Si Miao San is used for "any condition in which Damp Heat arises from Spleen deficiency; a stronger formula than San Ren Tang; hind limb proprioceptive disorders; recurrent cystitis or colitis". In the index of the Manual, it is listed for use in several conditions, but nothing pertaining to Cushing's specifically.

In the same manual, the TCM formula Long Dan Xie Gan Tang is recommended for Cushing's by Dr. Marsden and Dr. Wynn recommends Ginko, Lysodren, and TCM herbal formulas for support as needed.

[labblab]

Thanks so much for updating us, and I'm so glad to hear that Pongo is doing better :)! Please do continue to keep us in the loop.

Marianne

[Pongo]

Four Marvels, or Si Miao San, is a TCM formula recommended by Dr. Steve Marsden for



It contains the herbs Cang Zhu (Atractylodes rhizome), Huai Niu Xi (Achryanthes root), Yi Yi Ren (Coix seed), Huang Bo (Phellodendron bark).

http://www.ivcjournal.com/articles/chinese-herbs-for-liver-disease/

According to the Manual of Natural Veterinary Medicine- Science and Tradition by Susan G. Wynn, DVM and Steve Marsden, DVM, Si Miao San is used for "any condition in which Damp Heat arises from Spleen deficiency; a stronger formula than San Ren Tang; hind limb proprioceptive disorders; recurrent cystitis or colitis". In the index of the Manual, it is listed for use in several conditions, but nothing pertaining to Cushing's specifically.


In the same manual, the TCM formula Long Dan Xie Gan Tang is recommended for Cushing's by Dr. Marsden and Dr. Wynn recommends Ginko, Lysodren, and TCM herbal formulas for support as needed.

While I appreciate your looking this up, you are referencing a manual. With all due respect, my vet attended the esteemed Chi Institute, and has extensive experience using these herbs. Just because a manual doesn't say it is used specifically for Cushings does not mean that it does not work to help.

My vet has used this herb for multiple Cushings dogs with great success. Presently, it's working to control my dog's symptoms. What I CAN say is that my dog isn't excessively thirsty, isn't peeing more than normal, isn't starving, isn't whining, isn't uncomfortable. That's all I need to see to know the herb is having an effect.

As I stated, I will await Dr. Bruyette's review when he returns from his vacation. Until that point, I respectfully ask that you don't second guess my vet when it comes to her knowledge of Chinese medicine vs. what you are reading in a book. Again, I appreciate that you've looked that up, but my dog is a lot better than she was when I started this thread, and that's enough to make me worry less. I do not need to worry more when there's nothing I can do until Dr. B informs me of the next step.

See bottom for recommended herbs. She is on the weakest one, and it is helping. With an ACTH of 21.8 and a clean LDDS, this seems to be effective for her symptoms. http://www.medhelp.org/posts/Holistic-Care-For-Pets/Holistic-treatment-for-Cushings-diet-supplements-homeopathy-herbs/show/1363085

See page 16: "Although the mechanism of Si Miao San in controlling Cushings has not been determined, it has been proposed that the beta-sitosterol content of phellodendron can help normalize adrenal cortical output (Marsden, 2009). Sitosterols are one of the most common sterols found in plants and act as hormonal growth regulators in plants (Wynn 2006)." http://www.civtedu.org/uploads/41572/ufiles/Journal/JCIVT_Volume_1_Issue_1_June_2011.pdf

More use of Four Marvels with success: https://pathwithpaws.com/blog/2011/06/25/managing-cushings-disease-in-dogs-holistically/

[Squirt's Mom]

Honey, I was simply sharing information with you. But it is abundantly clear that is not what you are interested in, so I will refrain from offering further info to you.

I wish you, and certainly Pongo, the very best.

[Pongo]

Honey, I was simply sharing information with you. But it is abundantly clear that is not what you are interested in, so I will refrain from offering further info to you.

I wish you, and certainly Pongo, the very best.

I am appreciative of your efforts to help. I'm sorry if that came off wrong. Reading it back, I realize I was feeling defensive when I wrote it, and for that I apologize. I was also just doing my taxes so it has been an emotionally draining week!

I went to see my vet today and asked specifically about the herb you mentioned vs. the Four Marvels. She produced one of Marsden's manuals, and the following photos are taken from the book. Marsden recommends Four Marvels for Cushings.

https://www.flickr.com/photos/131300022@N05/16462106640/

https://www.flickr.com/photos/131300022@N05/16461924438/

As it is, I am worried about my little girl, but she is definitely doing better than she was. Whatever this herb is, it is certainly helping her, and for that I am very grateful! Until Dr. B directs me on what to do next, there's nothing I can really do but trust my vet and my observations of Pongo's behavior. If I question too much stuff right now during the waiting game, I get anxious, which does neither Pongo nor I any good.

Anyway, sorry I snapped. I do appreciate your trying to help. Chinese medicine is a very specialized field, and all dogs are different. Right now, my angel is feeling better and that's pretty much all that matters to me.

[Pongo]

Just a quick update that we have not heard back from Dr. Bruyette. He had been away until March 3rd, and has not yet responded to my email, my vet's email or my phone call.

Instead of waiting, my vet opted to do the sex hormone test (expensive!!) and it is being sent off to U of Tenn. Supposedly it takes a couple of weeks to get results back. So far, she is responding nicely to the herb but of course I want to treat the cause, once we find it. We decided to do the sex hormone test before the ultrasound (we were waiting for Dr. B to let us know which to perform next).

If her LDDS came back as no Cushings and her ACTH stim was 21.8, what would an ultrasound show vs. the sex hormone test?

[labblab]

The full adrenal panel performed at UTK will give you a repeat analysis of the cortisol level before and after stimulation (which will be interesting to compare to the original ACTH). It will give you the same analysis for the other adrenal hormones. Although research is not conclusive, there is some thought that elevated adrenal hormones other than cortisol can also produce similar symptoms. This condition has been labelled by UTK as "Atypical Cushing's:" normal cortisol but some/all elevated adrenal hormones other than cortisol. UTK has some specific treatment recommendations that may help with this condition. But it will also be very interesting to see whether Pongo's cortisol level has changed, as well.

An ultrasound will show you whether or not there are internal abnormalities that are consistent with Cushing's, but it also can reveal abnormalities in the other internal organs (kidneys, liver, spleen, gallbladder) that might independently contribute to Pongo's symptoms. As an example, Leslie's Squirt was highly symptomatic and tested positive on every Cushing's test under the sun, but an ultrasound revealed a tumor in her spleen. When that was removed, she normalized significantly and conventional Cushing's was no longer the diagnosis.

Marianne

[Pongo]

The full adrenal panel performed at UTK will give you a repeat analysis of the cortisol level before and after stimulation (which will be interesting to compare to the original ACTH). It will give you the same analysis for the other adrenal hormones. Although research is not conclusive, there is some thought that elevated adrenal hormones other than cortisol can also produce similar symptoms. This condition has been labelled by UTK as "Atypical Cushing's:" normal cortisol but some/all elevated adrenal hormones other than cortisol. UTK has some specific treatment recommendations that may help with this condition. But it will also be very interesting to see whether Pongo's cortisol level has changed, as well.

An ultrasound will show you whether or not there are internal abnormalities that are consistent with Cushing's, but it also can reveal abnormalities in the other internal organs (kidneys, liver, spleen, gallbladder) that might independently contribute to Pongo's symptoms. As an example, Leslie's Squirt was highly symptomatic and tested positive on every Cushing's test under the sun, but an ultrasound revealed a tumor in her spleen. When that was removed, she normalized significantly and conventional Cushing's was no longer the diagnosis.

Marianne

Thanks so much for the explanation, Marianne.

I have her sex hormone results. They are all elevated except her cortisol, so my vet is sticking with the Atypical diagnosis.

Results:
Cortisol Baseline: 1.9
Cortisol Post ACTH: 16.2

Androstenedione Baseline: 0.43
Androstenedione Post ACTH: 8.43 (normal is 0.27-3.97)

Estradiol Baseline: 119.4 (normal is 30.8-69.9)
Estradiol Post ACTH: 114.8 (normal is 27.9-69.2)

Progesterone Baseline: <0.20
Progesterone Post ACTH: 2.62 (normal is <0.20-1.50)

17 OH Progesterone ng/ml Baseline: 0.13
17 OH Progesterone ng/ml Post ACTH: 6.64 (normal is 0.40-1.62)

Testosterone ng/dL Baseline: <15
Testosterone ng/dL Post ACTH: <15

It says:

"These result indicate presence of mild-moderate increased adrenal activity. Baseline estradiol is elevated along with elevated post-ACTH androstenedione, estradiol, and progestin concentrations. Deviation from the reference intervals is moderate to significant. Estradiol is not a specific indicator of adrenal activity since it may also be synthesized by other tissues such as adipose tissue or skin however it may still contribute to clinical signs. Various treatment options are attached for your consideration if clinical signs of hyperadrenocorticism are present."

Then there is a whole page of treatment options.

My vet has her on the Four Marvels which has been great, very few signs, in fact she's only drinking slightly more than normal, peeing regularly, not excessively hungry; she seems perfectly fine.

We are adding Lignans for Life. At this point that's what we will do. My vet does not believe it's necessary to do an ultrasound. We'll see how she responds, add melatonin if necessary, and recheck in the future. If things get worse, we will do an ultrasound to see if there's a tumor worth removing. Right now I am satisfied with the diagnosis and proposed treatment.

[labblab]

Thanks so much for the update, and I'm so glad to hear that Pongo is still behaving much more normally :). She is an interesting case study for us all, no question about it!

FWIW, UTK tells us that it is the combo of melatonin and lignans that is most helpful in lowering estradiol and some other hormones instead of either supplement in isolation. So until/if you decide to also start the melatonin, it may not be the case that giving the lignans alone will contribute to much improvement. Since it can take a fairly long time for the combo to have an impact on hormone levels, you may not want to wait for long before beginning the melatonin, as well, if that is a treatment recommendation you wish to follow. Just a thought to discuss further with your vet.

Also, even though Pongo's cortisol level was not entirely out-of-range, it is right there knocking on the door (I think UTK's upper limit for normal range is 17). So in combo with the earlier elevated cortisol result, I would think that maintenance Lysodren dosing could be safely considered as another treatment option if Pongo's symptoms start rebounding once again.

In the meantime, thanks so much for getting back to us! Out of curiosity, did Dr. Bruyette ever reply to you with any additional thoughts or suggestions? It will be so strange if he didn't; he's usually so good about responding to folks.

Marianne

[Squirt's Mom]

Adding only the lignans will not do much for those hormones according to UTK, the leaders in research on this form of Cushing's btw. ;) It is the COMBINATION of the lignans and melatonin that do the trick. Start them both together and be patient - this treatment can take up to 4 months or longer to show improvements...but it does work. :)