My sweet boy was diagnosed yesterday, need input

[Norts Mom]

Hello, I was very glad to find this group. My 5 year old was diagnosed yesterday. I feel very uniformed on Cushings in general. I haven't read anything that refers to dogs this young being diagnosed. I was the one to request that he be tested. He was diagnosed for thyroid, and takes solexine for that. He also has severe allergies that he gets allercept immunotherapy shots for. My reason for requesting the test was the excess weight, bloated stomach, frequent drinking, urinating and panting. I have his test results, but I'm not sure which number to post. He was prescribed 7.5 Anipryl to take in mornings. Any pointers or direction would be greatly appreciated! We just want our boy to be healthy! Thank you!

[Harley PoMMom]

Hi and welcome to you and your boy!

We're happy to have you aboard but sorry for the reasons that brought you here.

Cushing's is probably the most difficult canine disease to diagnose. Physical symptoms associated with Cushing's are shared by many other diseases, blood and urine abnormalities are shared with other other diseases and the diagnostic tests to measure circulating cortisol are flawed and can yield false positive results in the face of non adrenal illness or even stress. All of these things make it very challenging to correctly diagnose Cushing's which makes it one of the most misdiagnosed canine diseases.

We initiate our new members by asking them a ton of questions which helps us to provide more meaningful feedback, so get ready for your initiation. :D

How much does your boy weigh? Is he taking any other herbs/supplements/medications. Was your boy on any kind of steroids for the allergies? Besides his allergies, does he have any other health issues? Could you get your hands on copies of all tests that were done on your boy and post any abnormalities that are listed...e.g....ALT 150U/L (5-50). Was an urinalysis done, and if so, could you post those findings too? Also, could you tell us what diagnostic tests were performed to diagnose his Cushing's and post those results here? Does he have the pituitary or the adrenal form of Cushing's?

We have a wealth of information regarding Cushing's in our Resource thread, which does include articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman, so please utilize it to educate yourself. We all eventually figured out that safe and effective treatment is much easier facilitated if the vet is experienced and the pet owner is educated. Here's a link to our Resource thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Please know we will help in any way we can, and do not hesitate to ask all the questions you want.

Hugs, Lori

[Norts Mom]

Thank you Lori. Like I said, I feel very uniformed on this, and our vet really didn't give much information (when I went to pick him up, they handed me a packet with pills in it). We have spoken to them since, and at this point they are thinking that it is pituitary, and they will try this medication for 45 days and then retest? My guess is they did ACTH Stimulation? He went in the morning, then they tested at 4 hours and then again at 4 hours. It is itemized at Cortisol resting, post dex and 8 hour post dex.

He currently weighs 15.8 pounds vs 12 pounds about a year and a half ago. He takes the soloxine for low thyroid, and chlorpheniramine and the immunotherapy injections for his allergies, neither of which have steroids. He had frequent ear infections before the allergy and thyroid diagnosis, which was treated one time with a steroid for about a week.

I have chemistry results dated 6/18/14, which ALT is 32U/L ranging from 10-100. I do have "Immunoassay results from IDEXX VetLab In Clinic", I just can't make heads or tails of it, and I don't know which portion to post.

I'm sorry this is so long, thank you for reading all of this.

[Norts Mom]

I tried to upload a picture of his test results, but I can't figure out how to do it. Also, the only think on his June chemistry that shows high was LIPA, at 2055 U/L H 200-1800.

[StarDeb55]

Welcome to you & your boy! I notice you say that he suffers with severe allergies. In trying to deal with the allergies, has your boy been placed on any type of medication that contains cortisone or any other steroid, this includes his shots? I ask this because long term use of steroid medication will induce what is termed iatrogenic Cushings. The only cure for iatrogenic is to wean the pup off the steroids.

I don't want to discourage you at this point, but anipryl has fallen out of favor for treatment of Cushing's. It is only effective in about 15% of pups who have a lesion in the pituitary in a specific location.

Debbie

[Norts Mom]

Thank you Debbie. No, his allergy shots are non-steroidal. We were worried about steroids, so we chose to use the immunotherapy. Thank you for the advise on the anipryl, I wasn't reading much in support of it.

It seems after reading on these boards that I should request an ultra sound be done? Would that be the best plan? Does the ultrasound result help in determining the correct and safest medication? And would the ultrasound rule out any possibility of a misdiagnosis? I have read that a lot of other things can mimic cushings.

Thank you!

[Squirt's Mom]

Hi and welcome to you and your baby boy! :)

My Squirt was initially started on Anipryl and did very well on it. Anipryl is not effective for most cush pups but it was for her. For this drug to work, the pup MUST have the pituitary form and the tumor MUST be in the pars intermedia portion of the pituitary gland. And even then, it is only effect about 25% of the time and that is for a limited length of time - usually a few months. Squirt did well on it for 9 months, proving this drug does not fail in all pups. ;)

Squirt's story is not typical - she was diagnosed with PDH (based on 5 different tests) but after a tumor was found and removed from her spleen, her cortisol returned to normal, invalidating that diagnosis. She did continue to test positive for Aytpical (NORMAL cortisol, elevated intermediate hormones) and was treated for that with melatonin and lignans for several years. Her cortisol did start to rise, as is expected with Atypical pups, and at that point we put her on Lysodren as a maintenance only along with the melatonin and lignans. But for her fist 9 months, Anipryl did very well for my baby. ;)

Hugs,
Leslie and the gang

[Harley PoMMom]

Concerning those test results, just post those values that abnormal. Regarding an ultrasound, they can be a very useful diagnostic tool, as other abnormalities may be found on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc. Also if the adrenal glands are visualized, a diagnosis for adrenal or the pituitary type of Cushing's can be made. Our motto here is you get a lot of bang for your buck with an ultrasound. However not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. Usually a Board Certified Veterinary Specialist is the best choice to perform an ultrasound.

Hugs, Lori

[molly muffin]

Hello and welcome, the 8 hour test is called an LDDS, or low dex test. It will have a base reading, then a 4 hour and an 8 hour. If you could post that it would be helpful (with the range)

Only the results that are not within range are needed to be posted. That will make it easier.

If you want to ever upload a jpeg picture, you go to the top of your thread page, where it says User CP. Click on that and the next page you will see, pictures and albums on the left hand side. Click that and then Add an Album, click that and name your album. (mark the settings to be seen by public or no one can see them, even on here) and then you choose 3 pictures at a time to upload to your album.

Hope that helps. Let us know if you have any problems.

I should say, we have seen some younger dogs diagnosed with cushings, it just is more common is dogs a bit older.

Welcome again

[Norts Mom]

Thank you to everyone that has helped to give us some direction. I have been reading, and researching, and trying to figure out what is best for our baby. Thank you Sharlene, I was able to add an album and post the results that the vet faxed to me. If anyone would mind taking a look, I would greatly appreciate it. Thank you!

[Harley PoMMom]

I took a look at your boy's test results, and frankly I disagree with the diagnosis for Cushing's.

CORT03 = 1.7 ug/dl (which I am pretty sure that is the "baseline number") the next numbers for the 4 and 8 hours blood draws are <1.0 ug/dl. I am pretty certain that those results are from a low-dose dexamethasone suppression (LDDS) test and this shows a negative response to Cushing's. Could you tell us when this test was performed?

Those other numbers look like they came from an ACTH stimulation test, however this statment has me confused: (Await 8 hour post result for interpretive comments) With an ACTH stim test there are 2 blood draws, the first is the pre number, then a stimulating agent is injected and after 1 hour ( 2 hour if the gel is used) another blood draw is taken and this is the post value. If the pre number they have listed = 1.9 ug/dl and the post number = 9.1 ug/dl than along with the negative LDDS, these test results reflect as a negative diagnosis of Cushing's.

The increased drinking and urinating are also the symptoms of an UTI or diabetes, have these two illnesses been ruled out? Was an urinalysis done and if so could you post those findings?

Lori

[labblab]

Hey Lori, these Low Dex results are printed out differently from the way we typically see them, but I think they actually do support pituitary Cushing's. I think the results are printed out "upside down" though, and the 8-hour result ("Cortisol #3") is the top one that is listed (along with the 8-hour interpretation guidelines which is where you are picking up the <1.0 info). If so, this is how the test proceeded (this is the reverse of how they are listed out):

Sample #1: Baseline cortisol: 9.1

Sample #2: 4-Hour cortisol: 1.9

Sample #3: 8-Hour cortisol: 1.7

And if this is correct, the 1.7 is "positive" for Cushing's overall. And since both the 4-hour and 8-hour results are less than 50% of the baseline, the results are consistent with pituitary disease.

Marianne

[Norts Mom]

Lori, they did not do a urinalysis.

[Norts Mom]

Thank you to everyone that has helped us. I have to say that the initial diagnosis put us into a spin, and quite frankly, broke my heart for our Norton. Reading here has helped us understand that with the right treatment he can have a great life.

After you all asking us questions, that in hindsight, we should have results and answers for, we have realized that those others tests weren't done, such as urine and blood work.

Going forward at this point, can we get suggestions on how any of you would proceed? Any tests we should request? I'm thinking that it sounds like an ultrasound is very important. Also, it doesn't sound like the Anipryl is a very reliable, widespread treatment option. What medication would any of you recommend? Or should we get more tests done first? I don't want there to be chance that he is misdiagnosed, is that still a possibility, based on the results I posted?

Sorry to ask so many questions, and I truly appreciate all of your help!

Thank you,
Michelle & Nort

[Bonnie0420]

Michelle, just wanted to say hello and wish you the best of luck with your fur baby. The ladies on here are a wealth of information and have great suggestions and will help guide you every step of the way. I'm not knowledgeable in a lot of this as for the testing results etc but will give support however I can

Hugs

Bonnie

[Harley PoMMom]

Hey Lori, these Low Dex results are printed out differently from the way we typically see them, but I think they actually do support pituitary Cushing's.

Sample #1: Baseline cortisol: 9.1

Sample #2: 4-Hour cortisol: 1.9

Sample #3: 8-Hour cortisol: 1.7

And if this is correct, the 1.7 is "positive" for Cushing's overall. And since both the 4-hour and 8-hour results are less than 50% of the baseline, the results are consistent with pituitary disease.

Marianne

Marianne, thank God you caught my goof :o

Hi Michelle,

In order to keep myself on track, :eek::) I've typed my comments in blue text within the body of your post below.


Thank you to everyone that has helped us. I have to say that the initial diagnosis put us into a spin, and quite frankly, broke my heart for our Norton. Reading here has helped us understand that with the right treatment he can have a great life.

When I first joined here I was such a mess, so I can relate being on system overload. This forum was a Godsend for me, the support I received was amazing.

We totally understand that Cushing's is indeed a complicated disease to grasp. I was so confused and scared when I came here, however, knowledge is power so I began to educate myself about Cushing's and with this gained knowledge my fear lessened.

After you all asking us questions, that in hindsight, we should have results and answers for, we have realized that those others tests weren't done, such as urine and blood work.

Now, don't be so hard on yourself. ;) Until I joined this forum I didn't know that I needed to be so involved in my furbabies medical treatment. I was putting blind faith in my vet, but now I know better. ;) Unfortunately a lot of vets are clueless when it comes to canine Cushing's and the treatment protocols. Many of us have had to fire our vet and find another one and since we as pet parents are the voice and advocate for our furbaby we do what we have to do because we love them so much.


Going forward at this point, can we get suggestions on how any of you would proceed? Any tests we should request? I'm thinking that it sounds like an ultrasound is very important. Also, it doesn't sound like the Anipryl is a very reliable, widespread treatment option. What medication would any of you recommend? Or should we get more tests done first? I don't want there to be chance that he is misdiagnosed, is that still a possibility, based on the results I posted?

Unfortunately there isn't one test that can accurately diagnose Cushing's so multiple testing is required to validate a diagnosis of Cushing's.

Strong symptoms do play a huge role in the diagnosis for Cushing's. And those physical changes that Nort displays; excess weight, bloated stomach, increases in drinking/urinating and panting, are commonly seen in dogs with Cushing's.

There are also certain anomalies that are generally observed in a cush dog's CBC/chemistry blood-work such as: increased levels in cholesterol, triglycerides, a low BUN, a mild to severe increase in ALKP and usually there are only mild elevations in the ALT; on the CBC it might show an increase in the number of red blood cells (RBC’s) and/or an increase in platelets, there is also white blood cell abnormality which is called a "stress leukogram". So, since Nort's CBC/chemistry blood panel is from June of last year I would recommend having this done again to see if those abnormal levels are present.

Dogs with cushing's usually have dilute urine and low urine specific gravity. If this is seen on the urinalysis, a culture should be done as the urine is diluted out and a normal urinalysis will not pick up the real number of white cells nor identify the type of bacteria in order to determine an appropriate antibiotic.

As for deciding which medication to use, it depends on the vets knowledge, experience and familiarity with the drug s/he uses, how comfortable the pet owner is with the treatment plan, and the dog's general health. Vetoryl/Trilostane is no safer than Lysodren/Mitotane, and vice versa. Adverse effects usually only happen when the proper protocols are not followed.

Sorry to ask so many questions, and I truly appreciate all of your help!

Never be sorry in asking questions, education is key with this disease and an educated pet owner along with an experienced vet are effective in facilitating safe and efficacious treatment with few to no side effects.

Thank you,
Michelle & Nort

Well it seems that I have wrote a novel so I will stop now and let you catch your breath, just remember we are here to help in anyway we can.

Hugs, Lori

[Norts Mom]

Thank you everyone for your support and knowledge. Nort has an appointment on Sunday to go see an internal specialist at a VCA Veterinary Hospital. They have requested what test results he does have from his regular vet. We are hopeful that we will have solid answers, safe travels, and if needed, a good treatment plan.

If there are any specific questions that we should ask, we would be grateful for your input!

Again, we can't thank you all enough!

[molly muffin]

I would have a urinalysis done and a cbc to see what his general blood work looks like. I would also ask them about cushings, how many have they treated, what sort of success have they had, which drug do they prefer to use. Those are just things you want to know in general with any vet that is treating cushings.

I am sure the others will think of more questions for you.