Maia- 6yo Australian Shepherd

[positivelypuzzled]

Hello everyone. My name is Stephanie and I just received the official results yesterday for my sweet 6yo Aussie Maia. She is pituitary dependent. When we first started testing my heart was broken. I was scared for her and immediately thinking that hope was lost. I think I cried for two days. Then I turned to the Internet and started to try and beat the fear of the unknown at the very least. I'm still not sure about a lot of things, but finding this forum has been one of the best discoveries I've made. I am eager to learn from anyone here.

Maia had TPLO surgery when she was two for a torn ACL. She still has stiffness from this which we treat with Phycox daily. I thought we were done with the major medical issues. :')

The signs she started presenting were increased urination (and increased thirst, though I was only acutely aware of it). I thought she had spay incontinence and my vet was inclined to agree with me, so we did a UA to check to make sure there was no infection before starting estrogen therapy with her... And found out her specific gravity was super low. We started a course of 28 days amoxicillin to clear up an infection she did have, but her specific gravity remained abnormal.

On to the abdominal ultrasound. Results showed both adrenal glands enlarged, though still peanut shaped. The liver was exactly as it should be, no abnormal signs there. Everything else was normal as well.

Then we did the LDDT last Friday that showed this was pituitary dependent cushings. It's been a long month, but I am more at peace with the diagnosis now... Just ready to figure out where to go from here.

Maia also pants a lot. There have been no signs of muscle weakness, abdominal distention, or hair loss yet. She's also got allergies which I treat with an antigen shot every 2-3 weeks depending on the season.

My baby is a mess, haha.

The vet I see wants to start her on trilostane, 25mg(?) twice a day. She is about 60lbs. I've seen that this therapy makes sense. I was apprehensive and looking for alternatives until I saw the posts here. They've made me feel better about it.

I do wonder if I should see an internal medicine specialist. My vet is very competent and I trust him a lot, but he says Maia is not a typical cushings dog that he's seen. His dosing advice seems spot on though. What do you think? Do specialists work with GPs or independent of them? I mostly just want a second opinion. More heads are better than one, I think.

Also what lab work should I request in addition to LDDT and her ultrasound? I don't have any blood work yet.

I'm concerned about the cortisol production being suppressed and really exacerbating her arthritis from the TPLO surgery, but I want whatever is best for her. Anyone else had the concern of arthritis?

Last question- I am a teacher, so my schedule will be more free this summer. Should I wait until then to start trilostane so I can monitor her reactions to it closely? What is that initial medication phase like? My vet says we have time on our side right now.

I am already so thankful for anyone here who reads this and even just shares their own story with me. It's a relief to have a community to fall back on!!

I look forward to talking with all of you.

[Harley PoMMom]

Hi Stephanie,

Welcome to you and Maia! A diagnosis of Cushing's sure is scary, I remember when my Harley first got diagnosed, OMG I was a mess, and thankfully I found this forum with these wonderful and knowledgeable group of people. Trust me, once you become more educated about this disease the less scary it is.

So, the test results, if you could get copies of all tests that were done on Maia and post the results here, that would be great. With respect to a chemistry/CBC blood panel we just need to see any thing that is marked abnormal and please include the reference ranges too. The majority of dog's with Cushing's have an enlarged liver and their chemistry blood panel usually shows a very elevated ALP (liver enzyme) along a moderately high ALT (another liver enzyme) and cholesterol. So I am a bit surprised that Maia's liver is of normal size.

The vet is right, Cushing's is a slow progressing disease. Just curious, why is he saying that Maia is not the typical cushdog? Many of our members do use an IMS (Internal Medical Specialist) for consults with their GP. And unfortunately that excess cortisol can mask the symptoms of arthritis. From what I have read glucosamine/chondroitin are two supplements that are usually given for dogs with arthritis, another medication that some members have used is called Adequan, which is an injectable medication. Fish oil also has some anti-inflammatory properties.

Was the UTI diagnosed from a regular urinalysis or is the vet thinking that she may have one and is hoping that the amoxycillin will take care of it? I'm assuming that Miai has diluted urine, yes? If so I would recommend having an urine culture and sensitivity test done on Miai's urine, in this way the exact bacteria can be known so the appropriate antibiotic can be prescribed.

Dechra, the makers of brand-name Vetoryl (which Trilostane is the active ingredient) recommend a starting dose of 1mg per pound of a dog's weight. So, the starting Trilostane dose that Maia's vet is prescribing is an adequate dosage for her weight. There are certain protocols that need to be followed when using Trilostane as the treatment for Cushing's. One such rule is that Trilostane has to be given with a meal to be properly absorbed. Another important thing is that treatment is monitored with ACTH stimulation tests and those tests have to be done 4-6 hours post pill. I'm going to include a link about Trilostane from our Resource Forum, which has some really excellent information and many articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman.....those links: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) AND Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

We understand that you are fearful but we will help you and your dear furbaby in any way we can, we will walk this journey with you, ok? If you have any questions please do not hesitate to ask them ;)

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.

As you can see, we start out by asking a lot of questions and asking to see any blood work results, including the LDDS test you had done. This helps us to give you better feed back.

It could be that this is early cushings and the dilute urine is certainly a factor but you want to see how she will be once the UTI is cleared up. (I think you mentioned that they confirmed she did have one)

So get that cleared up, then see how she is doing, retest the urine, including gravity and if you haven't done a full blood panel and kidney panel on her, that would be my next step.
You do have time, as cushings is a slow progressing disease, but you want to be absolutely sure that is what you are dealing with first.

If and when you do start treatment, then starting at the dosage indicated should present no problems as it is within and even below the manufacturer recommendation for starting dose and should be a safe start point to see how she is doing. You will start her, then retest in a couple weeks to see how she is reacting and then retest again at 30 days and determine if an increase or decrease in dosage is needed. It's always great to be around when they start medication but it's not always feasible and many can't be. You could certainly start during the summer break if that feels better for you.

We're sure glad you found us to. :)

[mytil]

Lori and Sharlene started you off and answered your questions, so I wanted to welcome you and Maia - from another Aussie lover.
Keep us posted
Terry

[positivelypuzzled]

Hello Lori, Sharlene, and Terry! I appreciate your kind words of welcome. I contacted my vet yesterday to ask about getting a referral to one of the internal medicine specialists in our city, just to collaborate on her case.

I think I was unclear about the uti :). We tested her to rule out an infection back in January during her annual visit, and during that test we did see that her specific gravity was abnormal. She had some bacteria growth as well, so we put her on an 28-day course of amoxicillin after sending her urine sample off to a lab to analyze what bacteria it was. We were hoping this would also clear up the incontinence issues and the abnormal specific gravity. After the month of antibiotics, I went back to have her retested. The bacteria was gone, but the specific gravity was still low. She was still having accidents, but less frequently.

We moved on to the ultrasound from that point on 3-3-16.

Results were:
Liver: Normal size, normal curvilinear shape and echogenicity. No focal lesions are appreciated. The gall bladder is clean and of normal size and shape. The liver is not hyper echoic and no parenchymal nodules or masses are identified.

KidneysNormal size and shape with normal corticomedullary dimensions. The corticomedullary junctions are intact and there is normal medullary scalloping. No pyelectasia appreciated. No dystropic mineralization.

Spleen Normal.

Urinary Bladder The urinary bladder wall has normal thickness and layering. The bladder is full of anechoic urine without any debris. The proximal urethra is normal.

Adrenal Glands Both adrenal glands are enlarged: right= 9.7-11mm; left=8.8mm. The general shape of each adrenal gland remains "peanut-like". There is no vascular involvement of either adrenal gland.

Pancreas No significant findings.
Intestinal TractWNL- normal bowel layering, wall thickness, and motility. No mucosal stripling or disproportionate layering appreciated.
Lymph Nodes No abnormal visualized.
Serosal Surfaces WNL

Abdominal Ultrasound Interpretation:
1. Bilateral adrenal gland hyperplasia; the right is wider but not a mass.
2. The liver is normal; the changes normally seen in the liver as a result of Cushing's disease are not evident.
3. The urinary tract is normal.


After I got those results we scheduled the LDDS. Here are the results for that:

Predex: 1.8 (Reference range: 1.0-6.0 ug/dL)
Post 4hr Dex- 0.4
Post 8Hr Dex- 2.7

"Consistent with pituitary-dependent hyperadrenocorticism (PDH)" is listed a few times on here too.



These are the two tests I have results for at the moment. So my next step is to request the kidney panel and the full blood panel on her. What information will I be looking for in that? Just abnormalities?

I think he said he wasn't expecting cushings because she was only 6 and not a typical breed that he saw with Cushings, but what I imagine he meant was that we were really seeing this at the early stages and caught it at the beginning. He says when they usually make the diagnosis it's pretty clear what they are dealing with just how the dog is presenting: distended abdomen and hair loss along with the incontinence and increased thirst. Beyond the accidents at home and the panting (which I thought was just due to her surgery and arthritis), she wasn't showing anything else.

I really don't know. I think this is a pretty solid case of Cushings... but seeing a specialist won't hurt, I think. It'll make me feel better. :)

Thank you again for coming to talk to me and reassuring me that we'll make it through this. :o

[positivelypuzzled]

Alright, I have results back from her lab work that was done yesterday.

Everything was in normal range except her ALKP which was Low at 12 U/l (Normal: 23- 212 U/l).

I am told that a Cushings Dog has elevated levels of ALKP, and he found it very strange that Maia was below normal instead of higher. He is putting together the information so I can take her to a specialist.

Has anyone else dealt with low ALKP? What does that mean?

[Harley PoMMom]

80% to 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, so it could be that your girl falls in that 10% - 20% group.

Hugs, Lori