Just diagnosed - 8.5 yo female beagle mix (Marley has passed)

[Marleys_Mom]

Just received confirmation of Cushing's for my sweet baby Marley. She is 1/2 beagle, 1/4 boxer and 1/4 lab. She started having symptoms over Thanksgiving of excess thirst and hunger as well as peeing while sleeping. Her LDDS test came back inconclusive of pituitary or adrenal and I was hoping someone could give me advise if I should have the high dose test done or an ultrasound?

Here are here cortisol sample readings:
Sample 1: 5.7 ug/dl
Sample 2: 7.8 ug/dl
Sample 3: 8.8 ug/dl

I started her on PetAlive Cushex Drops-S the same day that the testing was done (I didn't want to skew the levels) and I have seen an improvement on water and food consumption. I am currently limiting her water to 2.5 cups 2x per day. She hasn't had any accidents in the house and when I get home from work part of her breakfast is still in her bowl.

I will take any input you have. I love this baby girl like a child.

[Renee]

Hi there, I don't have time to type out a more thorough welcome, but

Please, Please, Please do not limit water!! Cushings dog need that water. They don't pee because they are drinking too much. The pee because the kidneys are always 'on', and that makes them drink more.

How long have you been limiting her? I am very fearful of dehydration at this point!

[Marleys_Mom]

This is good to know, I have been limiting water for a few weeks now. I had told my vet and she didn't say anything about it to me. I will stop immediately! Oh my gosh, I feel horrible :(

[molly muffin]

Yes it is rather backwards with dogs who have high cortisol, it makes their kidneys work over time, which makes them need to drink more water to stay hydrated.

Do you have the range for that LDDS test?

If the LDDS is inconclusive then ACTH and ultrasound are the next steps most take, if it is feasible of course.

Did she have any other abnormalities in her lab work? high or low? if so could you post them with her ranges?

Glucose for instance? (same symptoms as cushings)
Was her thyroid checked? (same symptoms as cushings)
has a UTI been ruled out and is her urine dilute? If dilute then a culture is often needed to determine if there is an infection or not.

Welcome to the forum!

[labblab]

Hello and welcome from me, too! In a situation such as this, I'd probably first put my money towards an ultrasound. Not only can it help you distinguish between pituitary and adrenal Cushing's, but it can also reveal other internal abnormalities that may be contributing to Marley's symptoms. Additionally, if an adrenal tumor is visualized, the ultrasound findings may help you decide whether surgical removal might even be an option.

We like to say that with an ultrasound, you get a lot of "bang for your buck." One cautionary note, however. If you opt for an ultrasound, you'll want to make sure it is performed on high resolution equipment with specialized interpretation. This is because the adrenals can be difficult to visualize, and therefore the imaging can often require referral to a specialty vet practice.

Marianne

[judymaggie]

Welcome to you and Marley! He is very handsome--how could he not be with his beagle/ boxer/lab mix. Don't beat yourself up about the water--this is a learning process for all of us and, as we have discovered, the same is true for many of our vets. Take some time to read the many articles in the resources section (I'm on a tablet so can't put in the link here).

[Marleys_Mom]

Here are the LDDS results, which diagnosed with Cushings, but did not differentiate between pituitary and adrenal.

Sample 1: 5.7
Sample 2: 7.8
Sample 3: 8.8

I've looked at results of others and didn't see any where the reading continued to increase over time. Anyone have any thoughts on that?

Did she have any other abnormalities in her lab work? high or low? if so could you post them with her ranges?

I've reviewed her lab work over the past few years that they sent me and these are the numbers that I see out of range:

12/9/15 Hematology
Platelets 416 10^3/uL H (170 - 400)

12/9/15 Chemistry
ALKP 143 U/L H (5-131)
TRIG 515 mg/dl H (29-291)

12/9/15 UA/Microscopy
PH 7.0 (5.5-7.0)

7/14/14 Hematolgy
MCV 73 fL (58-79)
Platelets 433 10^3/uL (170-400)
ABS NEUTS 10650/uL H (2060-10600)

7/14/14 Chemistry
GLU 127 mg/dL (70-138)
TP 7.1 g/dL (5.0-7.4)

6/10/13 Hematology
WBC 18.8 K/uL H (5.7-16.3)
Absolute Neutrophil Seg 13874/uL (3000-11500)

6/4/12 Hematology
HGB 17.8 g/dL (12-18)
MCH 25.4 pg (19.5-26.0)
MCHC 36.0 g/dL (32-36)
WBC 18.1 K/uL H (5.7-16.3)
Absolute Neutrophil Seg 13394/uL (3000-11500)

Glucose for instance? (same symptoms as cushings)
I don't know what glucose would be abbreviated as.

Was her thyroid checked? (same symptoms as cushings)
Not that I know.

Has a UTI been ruled out and is her urine dilute? If dilute then a culture is often needed to determine if there is an infection or not.
We ruled out an UTI, I had a urine culture done 1/13/16 with these results:

PH = 8
PRO = trace
GLU = normal
KET = neg
UBG - norm
BIL = neg
BLD = neg
USG = 1.007
COLOR = pale
APPEARANCE = clear
COLLECTION = cysto

I want to add that Marley has had severe allergies since the age of 2. She has had several cortisone shots, been on predisone way too long, we tried immunitherapy (it failed miserably), used Atopica but then became concerned about continual steroid use and then finally switched to Apoquel (which works wonderfully - when available). Currently Marley is experiencing NO ALLERGY SYMPTOMS but that is due to Cushings is what the vet said.

[Joan2517]

She is so cute! I'm so glad you mentioned the water. This morning I was toying with the thought of not leaving water down, but I have 3 other dogs and realized that it would be a mistake. I didn't realize that the kidneys were responsible for the excessive thirst. I am learning so much on this site and am so thankful to have found it...you will be to as you realize that you are not alone.

[molly muffin]

Okay so GLU (glucose) looks fine, UTI has been ruled out by a culture so that is all good, over all those aren't pretty good results.

True, cortisol can help with allergies, but I have to say, if you are using Apoquel, everyone I've talked to who is using it swears there is nothing better for allergies. Yes it's hard to come by, but it gets rid of the allergy issues completely, so that is a very likely reason for her allergy relief.

Is she off steroids now? I ask because there is itrogenic cushings, which is caused by steroid use, like prednisone. Especially over long term, the symptoms are the same as a cushings caused by pituitary or adrenal tumors.

If she is off steroids, how long has she been off them and was she tapered off?

Another thought to go with possibile ultrasound is that if the adrenal glands are smaller than normal, then you pretty much know that the steroid has taken over the cortisol production, is causing the cushing symptoms and that it has to be addressed as such. Tapering off with a vets guidance and testing to make sure that the adrenal glands kick back in on their own. So, just throwing that out there so you'll have some reference to go with when discussing treatments, testing etc.

I had a golden retriever with severe allergies who could never get off prednisone and it took a real toll on the body and back then, no one mentioned itrogenic cushings or the ramifications of prolonged steroid use for her.

[Marleys_Mom]

Marley has not been on steroids for over a year, and no we did not taper off, that was never discussed with me. When I first suspected Cushings, I was leaning towards itrogenic but it had been so long since she had been on any steroid I could find anything that would lead me to believe that it could still be that.

Do you think it is possible that it is itrogenic? I am using Cushex drops right now, and really have seen an improvement in her eating (she isn't starving to death anymore), her water consumption is also a little better. We actually went hiking this weekend, and she did it all and didn't get tired and actually was able to jump up on the sofa at the hotel where we were staying!

I had been considered about the long term steroid use, but never thought in a million years that it could cause so many issues, I'm heartbroken.

Right now, I am seriously considering the high definition ultrasound, I need to speak with my vet about the cost as they have to bring someone in from outside the clinic to perform the ultrasound.

Thank you all for your words, it is so helpful. I need to read through other threads and see what other useful information I can find.

[molly muffin]

Hmm, if Marley has been off steroids for over a year then it doesn't seem like it would itrogenic cushings. I mentioned the tapering as that is usually how you want to go off steroid, slowly so the adrenals start to kick in, but seems Marley's must have or she'd be in serious distress in not time after stopping. That is good that she didn't.

With the trig being high I would go for a lower fat diet. (just realized I'd forgotten to mention that).

[Marleys_Mom]

I read somewhere on here about someone using a kidney support. Can anyone suggest one for us to try? Thank you in advance :o

[Marleys_Mom]

I meant kidney support - sorry.

[Harley PoMMom]

Hi! As you can see, I've merged your new post into your original thread about Marley. This way, Marley's entire health and treatment history are all in one place.

I'm not sure if you looking for a liver or kidney supplement. If for the liver: In our Resource Forum we have a thread that has links to articles regarding liver supplements, here's a handy link to that thread: Milk Thistle/Sam-e and more (for liver "support") (http://www.k9cushings.com/forum/showthread.php?t=192)

For the kidneys: wild salmon oil and CoQ10 are two I have used.

Hugs, Lori

[molly muffin]

Omega 3's are good for kidney support too.

[Marleys_Mom]

I'm waiting for a call back from my vet regarding if they offer the high definition ultrasound. I have some degrees of improvement from the Cushex-S drops. She isn't eating as much food or drinking as much water. She did get into the trash while I was at work yesterday though. I need to be more mindful about putting 'stinky' things in there - cause the stinker the better for her :p

I order her food from Chewy, she has always been on Taste of the Wild, but they suggested Fromm Gold Holistic Reduced Activity & Senior dry as a low fat / low protein option. If anyone has any other suggestions I am open to them. I haven't received the new shipment so I can always update it and change to another brand/variety.

Thank you for all of your support. I just want to make sure my baby girl is well taken care of (and in no pain).

[molly muffin]

I've used the FROMM Reduced Activity & Senior and I like it as a food. Fromms is considered a high quality brand.

[Marleys_Mom]

I've used the FROMM Reduced Activity & Senior and I like it as a food. Fromms is considered a high quality brand.

Thank you! I will go with that food then.

[Marleys_Mom]

Two contributors on the Facebook page stated that they believe with Marley's LDDS results that it is highly likely that her Cushing's is adrenal related. I am relieved to hear this! I am still waiting for the call back from the vet, guess I better leave her another message so I can move forward with the ultrasound for confirmation.

[lulusmom]

Hi Julie and a belated welcome to you and Marley. I am very happy to see you here as well as the facebook page. I much prefer to have all of Marley's information in one place here which is not possible on facebook. I am the person on facebook who told you that the results of the LDDS show no suppression at all, which is what you would normally see in a dog with an adrenal tumor, but that you would need additional testing to differentiate between pituitary and adrenal disease. I am pleased to hear that you are pursuing an abdominal ultrasound. I think that's an excellent next step. FYI, general practitioner vets normally do not have state of the art equipment so most will refer their patients out to specialty facilities. That is even better in Marley case as you are open to surgery if she does have an adrenal tumor and those facilities are likely to have internal medicine specialists as well as board certified surgeons on staff. We have some very knowledgeable members here who are very experienced with adrenal tumors and I'm sure they will be following your thread for updates on the ultrasound.

Glynda

[molly muffin]

Oh yes, do let us know when you get the ultrasound.

It's true as a general principle that non suppression is at both 4 and 8 hours is indicative of adrenal tumor and suppression at 4 hours with a slip to non - suppression at 8 hours is more indicative of pituitary tumor.

However, any dog can throw up a different result than what is expected, so the only way to know anything for sure about an adrenal tumor would be to have the ultrasound, so I'm very glad you are pursuing that option.

[Marleys_Mom]

High density ultrasound scheduled for Thursday. Feeling nervous ...

[molly muffin]

Take Deep breaths and remember, it's easier to deal with something, once you have a better idea of what that something is. :)

[Marleys_Mom]

I am praying that they find something that they believe to be operable. I would be so happy :D

[Marleys_Mom]

Ultrasound is tomorrow. Is there anything that I should specifically ask for?

[molly muffin]

You want to see things like, adrenal glands, kidney, pancreas, spleen, heart, etc and if they see a tumor you want to know if there has been any invasion of the vena cava, how big it is, what side it is on.

[Marleys_Mom]

Thank you, I'll post tomorrow after I have results. Paws crossed!

[Marleys_Mom]

Vet just called, ultrasound revealed that all organs are normal. The adrenals were bilateral, and symmetrically enlarged - meaning that she has pituitary based Cushings.

They want to start her on Trilostane, but I think I may keep using the Cushex drops for a while longer. Her symptoms have really lessened over the past few weeks. When I get home from work she normally hasn't eaten all of her breakfast and often her water bowl is not empty. She hasn't had any peeing accidents in over a week.

Thank you all for your support, it means a lot to us. If I do decide to try Trilostane does anyone have any suggestions regarding that?

[judymaggie]

Hi, Julie! Great news about the ultrasound results! I wanted to pass on info about Cushex drops posted by our moderator, Leslie (Squirt's Mom):


I know it can be scary to think about the meds required to control the cortisol...but that is just what they are - required. Adrenal Gold, Cushex, and other such products may help with some of the signs (and they may well make some worse ) but they can do nothing for the enemy of Cushing's - cortisol. As long as the cortisol is allowed to run rampant in high levels, internal damage is occurring. Trust me - if these products worked, we would ALL be using them and this forum would not exist, there would be no need if Cushing's were so easily managed.

These companies have one goal - to make money on our fear. They do not care that their false words give false hope that can easily lead to the early death of our babies. All they care about is the money they make from the sale of these products. I am a firm believer in "natural" medicine - I harvest and make my own herbal meds. But I cannot support Adrenal Gold, Cushex, etc. They change the formulas often so you never really know what you are giving your dog. They use herbs like Dandelion that will increase urination, something our babies do not need help with. Their understanding of this disease is very minimal. They claim, or used to anyway (that may have changed, too), that their products will work for both Cushing's and Addison's - polar opposite diseases.

I am not sure what your hesitancy about using trilostane is but here is a link to information about it from our "Helpful Resources" forum:

http://www.k9cushings.com/forum/showthread.php?t=185

If you scroll down to the information provided by Dechra, the manufacturer of Vetoryl/trilostane, you will see the Client Brochure and Technical Brochure. Page 11 of the Technical Brochure has a flow chart showing exactly when to test levels and increase/decrease doses. Folks here will help you interpret test results and give guidance on dose. The best approach to using trilostane is to become knowledgeable about the medication yourself and work alongside a vet who is familiar with the proper protocols.

[molly muffin]

That is wonderful news from the ultrasound!!

As far as trilostane goes al. I would say is start at no more than 1mg/1lb. That is the safest dosage for beginning. Not more and can always do less.

[Marleys_Mom]

I have made the decision to continue using the Cushex Drops-S and am starting Denamarin tablets. I am going to do this for 3 months and then reevaluate to see if we should go on trilostane. Currently Cushex has been helping her symptoms. She has not had one accident, isn't gulping down water or food, no panting and has been sleeping well. She also actually jumped up on the couch all on her own!

I am hesitant for trilostane for 2 reasons. The first being the cost of the medication along with the required testing along with me reading that most people don't see to see a reduction in symptoms and that the medication does not 'cure' the disease or extend her life.

My wish is that the remaining time I have with Marley is spent with her not being in pain, not being embarrassed about wetting or slipping and not going to the vet on a continual basis.

[Marleys_Mom]

My baby girl has passed away.
Rest in peace my sweet girl
06/25/07 - 04/05/16

[Joan2517]

Oh, I'm so sorry about Marley. May she rest in peace...

[Brooke]

So very sorry to hear about Marley :( ..... big hugs to you.

[Tammysmom]

Julie, I am so very sorry for the loss of your sweet Marley. You tried so hard. She knew how much you loved her. Thoughts and prayers. Brianna

[molly muffin]

I am very sorry or the loss of Marley. :( my sincerest condolences.

[mytil]

I too am very, very sorry to read of her passing. My deepest condolences. She will always be with you and we will always remember her here.

((((hugs))))
Terry

[budindian]

So very sorry for the loss of your precious baby.

[DoxieMama]

I am sorry to hear this. May she RIP, and may you take comfort in your memories of her.

[judymaggie]

I am so sorry for the loss of your Marley. Please take care of yourself during this difficult time.