Howie's Mom
10-28-2015, 03:37 AM
Hello,
My 7 yo miniature dachshund, Howie, was just diagnosed with pituitary-dependent Cushing's disease. I'm devastated by this diagnosis and am crushed that this is happening at such a young age for him as most dogs seem to be diagnosed a bit later in life.
Late last year I noticed a slight increase in Howie's water intake which I attributed to the heat wave we were experiencing at the time. However, his water intake didn't ever seem to return to baseline and a couple of months ago I noticed that it had become much worse. He is approximately 14 lbs and was drinking ~ 45 mLs of water/day. I also saw he wasn't as playful as he used to be.
I took him to the vet who noted that his heart rate was slow and steady and, based on his symptoms, felt it could be hypothyroidism. We ran blood work (CBC w/ differential, CMP, T4, ) and a urinalysis. The abnormal results are as follows:
AST: 14 IU/L (ref range 15-66) LOW
GGT: 17 IU/L (ref range 1-12) HIGH
Cholesterol: 338 mg/dL (ref range 92-324) HIGH
Amylase: 184 IU/L (ref range 290-1125) LOW
Precision PSL: 212 U/L (ref range 24-140) HIGH
Neutrophils: 12870 /uL (ref range 2060-10600) HIGH
Specific Gravity: 1.005 (ref range 1.015-1.050) LOW
Occult Blood: 1+ (ref range NEGATIVE) HIGH
I think it may be relevant to note that his T4 was 1.0 ug/dL. The vet didn't mention anything about this and the lab listed the reference range as 0.8-3.5; however, in my research I've found that 1.0-2.0 ug/dL is considered low normal and may be hypothyroid.
The vet then did a urine culture to rule out a UTI/bladder infection. The results were negative for growth (normal).
After going to the vet I began to pick apart all of the changes I was seeing in Howie. I noticed his hind legs seemed like they had lost some muscle mass. He was going up the stairs more slowly than he had before and was wanting help getting up on the couch. I was having difficulty getting him to shed the little bit of weight he had put on. Previously he would shrink right back down when I would put him on a diet and increase his exercise, but with his decreased energy level it was difficult to get him to do much exercise and dieting didn't seem to make much of a difference. He doesn't have the typical pot belly that I have seen other cushpups have in photos, but he does have a smaller one.
His appetite has also increased quite a bit. Recently he has gone so far as to steal food out of people's hands if he has the opportunity, which he never dared to do before. He has also been yelping late at night and/or early in the morning to wake me up so I will feed him. I try not to because I don't want to reward the behavior, but it is so hard when I know he's starving! I normally feed him once in the morning and once at night but lately this has not been enough for him.
Following the urine culture, his previous vet was leaning towards the diagnosis of diabetes insipidus but wasn't sure how to test for it and referred me to an internal medicine specialist. At that time I was also referred by a friend to another vet who I took him to see. This new vet did an ultrasound with the following notable findings:
Liver: isoechoic (to fat), homogenous
Gallbladder: a little debris
Pancreas: slightly hyperechoic, slightly plump
Left kidney: a little brightness but ok
Left adrenal: 0.65 cm, 0.7 cm (slightly increase normal; ie >0.6 cm)
Right adrenal: 0.7 cm, 0.4 cm
Bladder: full
GI tract: slightly hyperechoic, slightly plump
The assessment stated the following: "A few ultrasonographic signs (ie pancreas, adrenals) making early Cushing's a possibility, even though more typical signs of increased ALP are absent. Would recommend LDDST."
The vet told me that pancreatitis has recently been linked to Cushing's and that the abnormalities seen with his pancreas are consistent with what I had told her in regards to his mild case of pancreatitis that he had last October. She also said that his skin did appear to be thin when they were shaving his belly for the ultrasound.
We performed an LDDST last Friday which yielded the following results:
Cortisol pre-dose: 18.3 ug/dL (ref range 1.0-5.0 ug/dL)
Cortisol 4Hr post: 15.7 ug/dL (ref range 0.0-1.4 ug/dL)
Cortisol 8Hr post: 7.5 ug/dL (ref range 0.0-1.4 ug/dL)
Based on these results they have now diagnosed him with Cushing's disease.
I find it a little odd that his ALP is still within the normal range because I've read that it has a direct correlation with the level of cortisol. The vet told me his case is atypical and we don't see all of the same symptoms in each dog.
For treatment she suggested starting him on 5 mg of Trilostane, the lowest dose available, because dogs have responded to doses much lower than the recommended dose and his clinical symptoms are so minimal. She also proposed trying an herbal supplement. She is a Certified Veterinary Acupuncturist and said she could do a Chinese physical assessment to determine which supplements to use and that it could take up to 8 weeks to see a difference. She has only read a few case studies using herbal supplements to treat Cushing's and it's not widely known or practiced. I'm hesitant to try something that hasn't been proven to work, but seeing as how he will be on medication for the rest of his life, I think it won't hurt to try...
I'm still considering if I should take him to the internal medicine specialist the original vet referred me to. Our current vet said she has dogs on Trilostane, but after reading threads on this site that clearly emphasize the importance of finding a vet that has experience with this disease, I am feeling very anxious because I'm unsure of the extent of her experience.
Does Cushing's sound like the correct diagnosis for my pup? I was hoping to get some feedback and see if there is anything we might be missing.
Has anyone else tried natural supplements with any success?
I apologize that this message is so long-winded and thank you profusely for taking the time to read it. I appreciate your help and support immensely.
My 7 yo miniature dachshund, Howie, was just diagnosed with pituitary-dependent Cushing's disease. I'm devastated by this diagnosis and am crushed that this is happening at such a young age for him as most dogs seem to be diagnosed a bit later in life.
Late last year I noticed a slight increase in Howie's water intake which I attributed to the heat wave we were experiencing at the time. However, his water intake didn't ever seem to return to baseline and a couple of months ago I noticed that it had become much worse. He is approximately 14 lbs and was drinking ~ 45 mLs of water/day. I also saw he wasn't as playful as he used to be.
I took him to the vet who noted that his heart rate was slow and steady and, based on his symptoms, felt it could be hypothyroidism. We ran blood work (CBC w/ differential, CMP, T4, ) and a urinalysis. The abnormal results are as follows:
AST: 14 IU/L (ref range 15-66) LOW
GGT: 17 IU/L (ref range 1-12) HIGH
Cholesterol: 338 mg/dL (ref range 92-324) HIGH
Amylase: 184 IU/L (ref range 290-1125) LOW
Precision PSL: 212 U/L (ref range 24-140) HIGH
Neutrophils: 12870 /uL (ref range 2060-10600) HIGH
Specific Gravity: 1.005 (ref range 1.015-1.050) LOW
Occult Blood: 1+ (ref range NEGATIVE) HIGH
I think it may be relevant to note that his T4 was 1.0 ug/dL. The vet didn't mention anything about this and the lab listed the reference range as 0.8-3.5; however, in my research I've found that 1.0-2.0 ug/dL is considered low normal and may be hypothyroid.
The vet then did a urine culture to rule out a UTI/bladder infection. The results were negative for growth (normal).
After going to the vet I began to pick apart all of the changes I was seeing in Howie. I noticed his hind legs seemed like they had lost some muscle mass. He was going up the stairs more slowly than he had before and was wanting help getting up on the couch. I was having difficulty getting him to shed the little bit of weight he had put on. Previously he would shrink right back down when I would put him on a diet and increase his exercise, but with his decreased energy level it was difficult to get him to do much exercise and dieting didn't seem to make much of a difference. He doesn't have the typical pot belly that I have seen other cushpups have in photos, but he does have a smaller one.
His appetite has also increased quite a bit. Recently he has gone so far as to steal food out of people's hands if he has the opportunity, which he never dared to do before. He has also been yelping late at night and/or early in the morning to wake me up so I will feed him. I try not to because I don't want to reward the behavior, but it is so hard when I know he's starving! I normally feed him once in the morning and once at night but lately this has not been enough for him.
Following the urine culture, his previous vet was leaning towards the diagnosis of diabetes insipidus but wasn't sure how to test for it and referred me to an internal medicine specialist. At that time I was also referred by a friend to another vet who I took him to see. This new vet did an ultrasound with the following notable findings:
Liver: isoechoic (to fat), homogenous
Gallbladder: a little debris
Pancreas: slightly hyperechoic, slightly plump
Left kidney: a little brightness but ok
Left adrenal: 0.65 cm, 0.7 cm (slightly increase normal; ie >0.6 cm)
Right adrenal: 0.7 cm, 0.4 cm
Bladder: full
GI tract: slightly hyperechoic, slightly plump
The assessment stated the following: "A few ultrasonographic signs (ie pancreas, adrenals) making early Cushing's a possibility, even though more typical signs of increased ALP are absent. Would recommend LDDST."
The vet told me that pancreatitis has recently been linked to Cushing's and that the abnormalities seen with his pancreas are consistent with what I had told her in regards to his mild case of pancreatitis that he had last October. She also said that his skin did appear to be thin when they were shaving his belly for the ultrasound.
We performed an LDDST last Friday which yielded the following results:
Cortisol pre-dose: 18.3 ug/dL (ref range 1.0-5.0 ug/dL)
Cortisol 4Hr post: 15.7 ug/dL (ref range 0.0-1.4 ug/dL)
Cortisol 8Hr post: 7.5 ug/dL (ref range 0.0-1.4 ug/dL)
Based on these results they have now diagnosed him with Cushing's disease.
I find it a little odd that his ALP is still within the normal range because I've read that it has a direct correlation with the level of cortisol. The vet told me his case is atypical and we don't see all of the same symptoms in each dog.
For treatment she suggested starting him on 5 mg of Trilostane, the lowest dose available, because dogs have responded to doses much lower than the recommended dose and his clinical symptoms are so minimal. She also proposed trying an herbal supplement. She is a Certified Veterinary Acupuncturist and said she could do a Chinese physical assessment to determine which supplements to use and that it could take up to 8 weeks to see a difference. She has only read a few case studies using herbal supplements to treat Cushing's and it's not widely known or practiced. I'm hesitant to try something that hasn't been proven to work, but seeing as how he will be on medication for the rest of his life, I think it won't hurt to try...
I'm still considering if I should take him to the internal medicine specialist the original vet referred me to. Our current vet said she has dogs on Trilostane, but after reading threads on this site that clearly emphasize the importance of finding a vet that has experience with this disease, I am feeling very anxious because I'm unsure of the extent of her experience.
Does Cushing's sound like the correct diagnosis for my pup? I was hoping to get some feedback and see if there is anything we might be missing.
Has anyone else tried natural supplements with any success?
I apologize that this message is so long-winded and thank you profusely for taking the time to read it. I appreciate your help and support immensely.