6 1/2 yr old Boxer

[Bella's mom]

Hello all,

I'm new to this site, actually just found it today as I scoured the internet for answers about Cushing's Disease. My Bella is a 6 1/2 yr old Boxer. I took her to the vet because of excessive water drinking, excessive peeing, hair loss, lethargy, and weight loss (she was a little over-weight and I adjusted her food measurement but she lost 10 lbs in 3 mos). Her preliminary results have a slightly elevated liver enzyme but still much lower than what is usually seen with Cushing's. She is having the 8 hr Cushing's test on Monday to verify. I have read other's posts about their dogs being there for them and this is so true of my Bella. She has been with me through some rough times and I want to do whatever is needed for her in return. I'm not sure what I expect by posting this, but feeling a little overwhelmed at the moment.

[Harley PoMMom]

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Hi and welcome to you and Bella!

I am sorry for the reasons that brought you here but so glad you found us. We certainly understand the overwhelming feeling, Cushing's is a frustrating and scarey disease that becomes less frustrating and scarey as you become more and more knowledgeable. You've come to the right place for an education as well as lots of support from some pretty experienced members. ;)

Now, we ask a lot of questions from our new members, in that way we learn as much about a member's dog which than can enable us to provide meaningful feedback....so here are some of those questions :eek::)

Could you get copies of all tests that were done on Bella and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. If Bella is having a diagnostic test for Cushing's that last for 8 hours it is the low-dose dexamethasone suppression test (LDDS) and we will be especially interested in those results, so please do post them here. Does Bella have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? Were other non-adrenal illnesses ruled out such as diabetes, UTI, or a thyroid problem? How much dose Bella weigh?

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. There isn't one test that can accurately identify it so multiple tests are needed to validate a diagnosis for Cushing's. The key to facilitating safe and effective treatment is an experienced vet and an educated pet owner. It is when one or both is missing that dogs get into trouble.

The best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and also includes articles written by some of the most renown veterinarians that specialize in endocrinology http://www.k9cushings.com/forum/forumdisplay.php?f=10

I look forward to your responses and any other info you can share. :)

Hugs, Lori

PS, just saw your avatar and Bella sure is a cutie!!

[Bella's mom]

Hi Lori,

I went over all the results with my vet on the phone and honestly I'm a little foggy on all of it but will ask for them when I drop her off Monday for the 8 hr test. The only thing I wrote down was her liver enzyme that was 143. The vet said this was low for Cushing's but it can happen. She feels strongly that it is Cushing's because she has symptoms that are common with Cushing's such as a skin lesion, hair loss, and lethargy... outside of the excessive drinking and peeing, which didn't sound like diabetes or thyroid issues. She considered insipidus diabetes but felt the symptoms more closely matched Cushing's. The only thing that didn't fit was her weight loss...she does not have a big appetite and it isn't uncommon for her to leave her food sitting. She was a little overweight so I started measuring her food instead of putting her on diet food, she dropped 10 lbs in 3 mos which concerned me. Bella does not have any underlying medical issues and is not on medication. They did discover a mild double ear infection and she has ear drops for 7 days. Bella currently weighs 59 lbs. My vet had said that the 8 hr. test was 97-98% accurate so I am hoping that is true.
Thank you for the link....I will be looking through that. This is all so overwhelming and there is so much to learn. I have spent the entire day on the computer since getting off the phone with the vet so your site is so appreciated :)
I will post her results when I get them on Tuesday.

Thank you,

Holly (Bella's mom)

[Harley PoMMom]

Hi Holly!

Cush dogs can get a skin condition known as calcinosis cutis, it gets pretty nasty, a skin biopsy is required to diagnose it correctly. Did the vet mention that she may do a skin biopsy?

More than likely Bella's vet was referring to the liver enzyme, alkaline phosphatase (ALP), 80% or 90% of dogs have a steroid induced isoenzyme of ALP so if one of those dogs has Cushing's, you are gonna see anywhere from a mild to severe increase in ALP. Now, there is that 10 -20% of dogs with Cushing's and their ALP does not elevate that drastically, I have seen this situation a couple times on the forum.

The LDDS test is accurate at diagnosing Cushing's, however any illness and even stress can create a false positive test result. If this were me, I would not have the LDDS test performed until Bella's ear infection is 100% healed.

If you have any questions at all, please do not hesitate to ask them. ;)

Hugs, Lori

[molly muffin]

I would maybe do the skin biopsy because as lori mentioned if this is calicinosis cutis, it is very probable that it is due to high cortisol.

The loss of weight is not the norm though with cushings, ravenous hunger is, so I think that I would probably want to have an ultrasound done of the internal organs (if that is feasible) and see if there is anything else going on inside. It gives you a Lot of bang for the buck.

Just a thought you can discuss with your vet.

[Bella's mom]

I called for Bella's results this morning (she had the LDDS test yesterday)....the vet needs to call me back because it will be a long conversation, but it came back positive for Cushing's. I will post her results when I get them in writing.

Her preliminary lab results (highs and lows only) are as follows:

EOS 0% low (0-1)
NEUT 78% high (60-77)
ALKP 143 high (5-131)
GGT 16 high (1-12)
T4 0.5 low (0.8-3.5)
SP GRAVITY 1.002 (1.015-1.050)

[molly muffin]

Based on the GGT being increased, you might want to consider the sam-e/milk thistle supplement liver support option.

Let us know what the LDDS results are and what the vet says.

[Bella's mom]

I spoke with Bella's vet this afternoon. Her test results are as follows:

Cortisol baseline 7.7 ( <1.5 )
4 hour 6.3 ( <1.4 )
8 hour 5.0 ( <1.4 )

So she will be starting on Trilostane 60 mg.

[Harley PoMMom]

Those LDDS test results are indicative of a dog with Cushing's, however, they do not differentiate between the adrenal or pituitary type of Cushing's. The main reason in identifying the form of the disease is if you would want to consider surgery in the event that Bella has an adrenal tumor. This type of surgery is very expensive and very serious, but it is a cure for a dog that has the adrenal form of Cushing's.

Dechra, the makers of Vetoryl, recommend a starting dose of 1 mg per pound of a dog's weight so Bella's dose of 60 mg is reasonable for a dog weighing 59 lbs. This is going to be given once a day, right? It is very important that the Vetoryl be given with food so that it can be properly absorbed. And those ACTH stimulating monitoring tests have to be performed 4-6 hours after the Vetoryl is administered.

How are Bella's ears and has she gotten over her ear infections?

Here's a link from our Helpful Resource sub-forum with information regarding Vetoryl/Trilostane: http://www.k9cushings.com/forum/showthread.php?t=185

Please let us know if you have any questions about anything. ;)

Hugs, Lori

[Bella's mom]

Hi Lori,

First let me say thank you for all your info...it calmed me down just reading through all the posts. I had never heard of Cushing's Disease in a dog let alone knew of anyone that had a dog with it. At this point I am going to go with the meds because as everyone has said, this is quite expensive and honestly I can't afford the surgery for her and I know it is risky so really hoping she does well on the meds. Yes, the dosage of 60 mg is once per day. Her ear infection cleared up right away. I'm anxious to see her back to her old self :)
I will keep you posted and thank you for the medication info link.

Thanks again!

Holly

[Bella's mom]

Calcinosis Cutis.....Can anyone give me any suggestions on the best way to take care of the sore? She has 2 about the size of quarters on the front of her chest. They don't seem to bother her much, but they look so painful....thank you.

[Harley PoMMom]

If this were me, I would have a skin biopsy done on one of the places that is sore on Bella, you really want to be sure that it is calcinous cutis (CC).

Now, if it does turn out that Bella does have CC let me warn you, Calcinosis Cutis gets far worse before it gets better. And to get CC under control you'll need to bring Bella's post cortisol level down to 5 ug/dl, or lower - and keep it there long-term, that's one reason that you need to know if it is, indeed, CC that you are fighting. CC can be quite painful so pain medication is generally prescribed. And this is one skin affliction that requires some patience because CC takes approximately 6 months to resolve.

Renee is our resident CC expert for which I am providing a link to her thread, she also has an album with pictures of her Tobey with varying degrees of CC. I'm sure Renee will stop by soon and share her insight in dealing with that CC, in the meantime here's the link to her thread: http://www.k9cushings.com/forum/showthread.php?t=5908

And to her album: http://www.k9cushings.com/forum/album.php?albumid=805

I know this all seems daunting, but let me assure you that we have all felt that feeling, and when you gain knowledge about Cushing's you will be less scared and overwhelmed....also remember that we are here for you and Bella. ;)

Hugs, Lori

[molly muffin]

Hi, I'd keep the sores dry and use an anitibiotic spray on the sores, cut away any hairs around the sores themselves. You want them to be clean and to keep any bacteria from spreading.

[Renee]

Hi there, dropping in to give some advice regards the CC.

Lori is absolutely correct - best to have a biopsy done to confirm if you are in fact dealing with CC. Lesions on the front of the chest, and no where else, is not a common occurrence with CC. Most of the time CC starts along the back and spinal area, spreads down towards the tail and up towards the head. That's not say it's not possible, just not the common pattern to only have it on the front of the chest.

If you are dealing with CC, then there are some things you can do to help it along the way, but the number one most important piece is controlling the cortisol levels. There are a number of other things you can do to assist in healing the CC, but no 'cure' except lowering cortisol into the proper range and keeping it there long-term.

[molly muffin]

One of our members had sores we thought might be cc, but turned out it was an aggressive staph infection, so it's always good to know what you are dealing with.