Intro: Lambi a 15½ year old toy poodle

[ozswede]

Hi everyone,

I am Marie - an Aussie living in Sweden. I found your site while looking at sites about Cushings disease in dogs.

We have a 15½ year old white toy poodle called Lambi:

http://lg-i-osund.smugmug.com/photos/540672630_ms5Rq-M.jpg

Yeah, I know - she's a bit of a princess :)

She was very ill last year and diagnosed with pyometra (an infection of the uterus) plus vaginal tumours and underwent a huge and expensive operation to remove her uterus, ovaries etc (spaying animals is a bit frowned on here in Sweden and not routinely done). She seemed to recover slowly but in the end did well, becoming a new dog. However, over the last couple of months we have noticed that she is less well than she was.

At first we thought it was simply old age, but her symptoms can't all be explained away by that. From my investigations online, I am positive that she has Cushings (not unusual in an old poodle) and we have an appointment on Monday to get the vet to test her.

Symptoms we have noted:


increased water consumption (we call her "the camel")
increased urination
increased appetite
starting to guard her food, plus begging (all new behaviour)
sagging, bloated appearance
weight gain (she's gone from 3.5kg to 4kg)
thinning hair and a couple of bald patches on her torso
dullness and dryness in her coat
hard lumps in her skin
loss of muscle in her legs
lethargy
hind-leg weakness
pronounced limping and constant licking of one of her front paws
reluctance to jump up on furniture
excessive panting
always seeking a breeze or cool surfaces to rest on
very sensitive to being touched - sometimes yelping in pain at the slightest touch. Which is hard as poodles require grooming daily.


I've been reading a lot about diagnosis and treatment options so we are prepared to push for what is best for her. I'm hoping to read about others' experiences and ensure we have the best possible outcome for our little companion.



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¤*.¸¸.•´¨`»*Marie*«´¨`•.¸¸.*¤

[frijole]

What an intro! I love the photo of Lambi and yes - princess for sure. :p

I can see why you would suspect cushings after reading those symptoms... that covers alot of them. Have you had a blood panel done yet? That is where we typically start, at least in the US. That way you get a complete idea of what is going on and rule out things like diabetes that can have similar symptoms.

My dog has successfully been treated for 3 yrs now on lysodren. If you have been doing alot of reading you know it is treatable and the key is to find a vet that is experienced and do sufficient testing to confirm or not the diagnosis. We see alot of cases of misdiagnosed dogs.

Do keep us posted on how your appointment goes. If you haven't yet discovered it yet we have a wonderful resource center with lots of information collected over the years.

Feel free to ask questions. We are just here to help. Best of luck to our newest princess!

Kim

[BestBuddy]

Hi Marie,

Welcome to you and Lambi, she is beautiful. It looks like you might need to do some testing to find out if it is cushings. What are the vets like over there? You need a vet/specialist who has some experience with cushings to help you get to the bottom of this.

Jenny

[Roxee's Dad]

Hi Marie,

Just wanted to add my welcome to you and Lambi.

Great picture and a princess she should be. She is a doll:D

[gpgscott]

Hi Marie, welcome to you both.

Different Drs. take different approaches to diagnositcs. One of least expensive and non inviasive is called UC:CR it is performed more routinely in the UK and EU than in the states. It is a urine collection first thing in the morning and a result in the negative range is considered a rule out for Cushing's while a postitive result is not considered conclusive but points to a probability of Cushing's and the need for further diagnostics.

This is the test I would want first.

Best wishes. Scott

[ozswede]

Thankyou everybody for that wonderful welcome. I am so happy that I found this site and have been avidly reading the resource material and looking at people’s experiences with Cushings. I admit that when I first read about this illness, I cried as I thought it was pretty much a death sentence for Lambi, but now I am a little calmer and am getting ready with my questions for the vet in the morning. Let’s hope we can get a clear idea of where we stand soon.

To answer specific questions people have asked:

Kim – No we haven’t had any bloodwork done yet. Tomorrow will be her first visit to the vet for this. She had extensive bloodwork done last year when she was so ill with “closed pyometra” (her symptoms were vomiting, loss of appetite and increased drinking and urinating). There were so many things that this could have been that they tested for a lot of things and apart from a slightly increased white blood cell count she came up as super healthy. They even commented that she was in excellent condition for her age. An ultrasound eventually showed what the senior vet had suspected all along and she was operated on immediately.

We have also been getting her rabies shots over the last 7 months so she can get her an EU Pet Passport to travel with us to Finland in the summer. But those blood tests (done in the UK) only look for the rabies anti-bodies. So while we have been at the vet recently, it was only for the routine rabies shot and blood test. She is normally a very healthy little dog.

The drugs that seem to be used here in Sweden for Cushings are Vetoryl and Lysodren.

Jenny - I agree that the choice of vet is vital. The vet we take her to has treated her since she was a puppy. We have since moved and the surgery is actually 160 kms away from where we now live, but that 2 hour trip is worth it as the care is outstanding. They have a website (http://www.vasbyvet.nu/) (Swedish only, I’m afraid). They are very well equipped, professional and thorough. We are confident that they will take the best care of our little princess.

We took her to a local vet last year when she was sick. What a dreadful experience! After carefully outlining her symptoms in detail and coming prepared with a fresh urine sample to get the ball rolling, the vet merely did a cursory physical examination and shrugged, told us that she was an old dog and asked if we wanted her euthanased!

We were shocked. We said we wanted her investigated, but he thought it was a waste of time and prescribed a strong painkiller. The second we left his office, we rang her old vet and his advice was to bring her in immediately, where they took blood, urine and ultrasounds and diagnosed her problem. Needless to say, we are ALWAYS going to take her there.

John - Thank you so much for your warm welcome. Lambi fully believes she is royalty. She'll be glad you saw that :)

Scott – thank you for that advice. I looked at the test you suggested and have taken note of it. I will ask that they do it first. I had already thought to bring her morning urine sample. Lambi is less than thrilled by vet visits and that may be a less stressful start for her. Getting blood will be hard as she has so much pain in her legs that she won’t let anyone touch them.

Let’s hope we can get some kind of treatment to increase her life quality. She can conceivably live for at least another 5 years, so if we are lucky and that happens I’d like them to be pain free years. I really feel for her now and want to do all I can to make her well.

Thank you again. I’ll let you know how it all goes when I get back from Stockholm tomorrow.



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¤*.¸¸.·´¨`»*Marie*«´¨`·.¸¸.*¤

[Squirt's Mom]

Hi Marie,

Welcome to you and your princess, Lambi! :) My Squirt is pleased to have another member in her court...she is convinced she is the Queen of Dogdom! :p

I know what you mean when you say you thought this was a death sentence...when my vet told me Squirt had Cushing's and explained what that meant, I literally broke down in the office. I didn't stop crying for months after, either! I was really a mess when I got here, but with loving care these folks have led me along until I could start to understand a little bit.

You are already off to a great start with all the research you have done and are doing. Your knowledge is the most important thing you can give to this endeavor on Lambi's behalf. Having a cush savvy vet is important, but more important is having one that will work with you as a team, who will listen to you, who is willing to learn if needed. It sounds like you have one of those vets already. If so, another plus on Lambi's side! :)

Keep reading, keep asking questions...we will be here to help you in any way we can. You and Lambi don't have to take this journey alone.

I am glad you found us and hope to learn more soon.
Hugs,
Leslie and the girls

[frijole]

Marie,

I had another thought because you mentioned pain in the back legs. This is quite common and with treatment the trembling and inability to jump on furniture goes away over time. Since our princess is 15 1/2 (same age as my cush baby) note that overproduction of cortisol has been "treating" normal aches and pains from aging dogs. So as you reduce the cortisol you might have to treat arthritis for example.

I just recently started my girl on Adequan. They are injections for arthritis and yesterday she ran thru the house like a young pup. I mean full speed ahead. Course it was to the kitchen for food. :p

Best wishes on your vet visit.
Kim

[ozswede]

Hi again,

We are back from Stockholm and am happy to report that the vet was very thorough, listened to us carefully, explained everything that he proposed to do and made a start on testing. We were a bit afraid that he might think we were crazy pet owners trawling the internet for a diagnosis, but he was happy that we showed an interest and knew what may be needed for a diagnosis.

After listening to us, examining the dog and observing her behaviour in the clinic, he decided to test for both Cushings and Addisons. He split the urine sample into two parts and sent one to the main lab in town for the Urine Cortisol/Creatinine Ratio Test. We should get the results on Thursday. The other he looked at for signs of liver or kidney problems. They also took a blood sample and looked at her levels of phosphorus, calcium, sodium, potassium, chloride as well as cholesterol and blood glucose. They also took an ultrasound of her liver and kidney area.

Nothing very significant showed up on the tests. She seems to be in good health, with some increase in white blood cells but nothing that stood out. However, they told us that she has excellent kidney health. He said he needed to eliminate CIN (chronic kidney disease) from consideration and her symptoms may have been that as well. That was a relief as we would have been looking at palliative care if it was that. It was a tense time waiting for the results.

We have also made a time next week to return for a dexamethasone suppression test, which will take 8 hours. This is assuming that we get a positive result for the UC:CR test. Otherwise he will administer an ACTH stimulation test for Addisons.

I was very surprised that he thought it could possibly be Addisons. Naturally I have looked as that as well when I researched on the net, but that disease, while it has some similar symptoms to Cushings, usually presents with a dog lacking appetite and losing weight. Lambi is actually eating like a horse and gaining weight!

It seems to be a disease on the increase here in Sweden according to the vet and poodles are the main breed that succumb. My reading indicated that it is the large, standard poodles that mostly get Addisons. But we will see. I agree with him that we ought to keep an open mind, but he is almost sure that it is either Cushings or Addisons. He said that Cushings was better known in Sweden than Addisons and that there is a large body of research on it and well defined treatment procedures. He explained about treatments for both diseases and reassured us that we ought not be over worried as it is treatable and she can have a happy life, which was the main thing.

So now we wait... though we are leaning more to Cushings.

It has been such a relief to have read the research material here and known in advance what to ask about. This is such a fantastic resource!

Leslie - it is lovely to meet you and the girls. Lambi is always happy to meet her royal cousins :)

Kim - yes, we did read that the elevated cortisone levels might be masking underlying arthritis. The vet also told us that there may need to be treatment for other things as time goes on.


she ran thru the house like a young pup. I mean full speed ahead. Course it was to the kitchen for food.

Oh boy, don't I recognise that sort of food obsessed behaviour! Lambi may be a "toy" dog, but she is totally in love with food. All day, every day. And she dances with joy at the thought of a special treat. They are funny little creatures.

[gpgscott]

Marie,

I am so pleased it went well, please check the link I have put at the end of this post concerning the need for a pooled sample of 3 days urine for a good UC:CR.

I really don't get the progression of proposed diagnostics you are posting however, Let me explain the issues as I see them;

If you have a positive UC:CR, I don't understand the need for LDDS, I would ask the Dr. to explain the need for this, to me it is unnecessary stress and cost. Likewise an ACTH is not a conclusive test for Addison's.

Addison's is rare, I have been on this board for a number of years and I cannot think of one spontaneous case of Addison's.

I will add the links, so this post may change over the next hour or so.

My desired progression of diagnostics would be UC:CR, abdominal U/S, ACTH full adrenal panel, treatment... (assuming positive results at each point)

Best to you both. Scott

http://www.k9cushings.com/forum/showthread.php?t=543
http://www.k9cushings.com/forum/showthread.php?t=198

[ozswede]

Scott,

Those links are invaluable. I feel so much in the dark about all of this and of course I want the very best possible outcome for Lambi. I wish I had known about the 3 day pooling BEFORE I went to the vet. He didn’t mention anything about it, only asking if it was the first morning’s pee.

His reasoning behind the proposed testing was that if her cortisol/creatinine ratio is okay, then it is probably not Cushings and he would then go on and test for Addisons. But in view of what you said about the pooled sample, if it is a negative result, I may ask him on Thursday if we can re-do that test with a better sample. We can drop that in to the lab ourselves if we have to.

He said that on the other hand, if she shows a high cortisol in her urine sample, that there are conditions other than Cushings which can cause this, so he’d move on to the LDDS to narrow it down. He thought it was the best next step. But I can read up a bit more on that before we decide.

She had an ultrasound on Monday, but we won’t know about that result until Thursday as well. He wants to discuss it with two of his colleagues in conjunction with her UC:CR results. They also want to talk about the results of her EKG and heart ultrasound (I forgot to mention that she has a significant heart murmur, diagnosed when she was 9 – she does cough sometimes but has been mostly fine). I think they are leaning towards treating the heart murmur as well now as he described it as indicating a progressive heart condition. It has gotten worse since her last heart ultrasound two years ago.

We’ve made a tentative time for it all on Friday next week, starting at 8am with 3 other times during the day. They wanted us to leave her there, but I know she would fret, so I vetoed that and instead booked into a dog-friendly hotel overnight so we can all get there on time and be with her all day. That will help it be less stressful for her.

The cost of vet care in Sweden is horrific – we already expect that. Monday’s trip set us back around $US800 and that does not include the lab test or ultrasounds. We’ve been told that Friday’s LDDS will be about $US300. We’ve barely recovered from last year’s $US4,000 treatment :eek:

But she has not cost us much in vet bills over the years. Mostly teeth cleaning and the regular annual shots so we’ve been lucky. I will read up more and see if we can perhaps go on to the ACTH full adrenal panel if she scores a positive on the UC:CR.

I was very surprised by his thoughts that it could be Addisons and nothing I’ve read up to now has changed my mind. She doesn’t fit the profile at all, especially the loss of appetite (says Marie watching Lambi eagerly wolf down her dinner…. :D )


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¤*.¸¸.·´¨`»*Marie*«´¨`·.¸¸.*¤

[Harley PoMMom]

Hi Marie,

Just checking in on Lambi and you, was wondering what her results of her EKG were, what her heart ultrasound showed and if she did have the LDDS test done.

Please let us know, bc we worry. :eek::)

Hugs to you and Lambi.
Lori