Hoping for good news!

[Tracey0127]

Hi All, I am about to go an pick up my 13 year old Bichon, Boo from the vet after his LDDS testing. I am very worried about the results. I don't want to get ahead of myself , but I can't help it. Especially in light of researching the side effects of the medications. With my baby luck.

Tracey

[DoxieMama]

Welcome, Tracey!

I'm sure one of the admins or other resident experts will be by shortly, but I wanted to welcome you and share that regardless of those results, you and Boo have found a great resource to help you through whatever comes next. My boy Visuddha just started taking Trilostane on Monday, so I don't have personal experience with it, but there are many, many others who have successfully treated their dogs with Trilostane/Vetoryl and the older (still available) Lysodren.

Please post the results of the LDDS test and we'll support you in your journey.

Hugs!
Shana

[Harley PoMMom]

Hi Tracey,

Welcome to you and Boo from me as well! We certainly do understand your fear of this disease and the medications used for it but once you understand more about Cushing's your fear will subside and remember we are here for you and Boo ;)

It would help us a great deal if you could share more information about your boy, in this way we can provide you with our best possible feedback, and we get this information through a ton of questions so here goes some of mine.

Could you get copies of all tests that were done on Boo 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. Would you post the results of the LDDS test that was performed on Boo? Does your boy display any of these common Cushing's symptoms: increased drinking/urinating, a ravenous appetite, skin/hair issues, pot-bellied appearance, exercise intolerance, and difficulty or unable to go up steps or jump on furniture? Does Boo have any underlying illness that he is taking medication for? And if so, what is it and what is the medication? How much does Boo weigh? Is Boo's urine diluted and does he have a low urine specific gravity? Is Boo taking any supplements or herbs?

The two medications that are usually prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane, one is no safer than the other. These are strong drugs and both have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. We have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success.

We realize that you may have some apprehensions in starting treatment but you are not alone and we will walk this journey with you. If you have any questions please do not hesitate to ask them.

Hugs, Lori

[mytil]

Hi Tracey,

Welcome from me as well.

Here is a link (to other links) that describes Cushing's, the treatments etc - http://www.k9cushings.com/forum/showthread.php?t=180 - all very good reads in understanding more about Cushing's. We have found the more information an owner is armed with the better they can be advocates for their dogs and things become less scary.

Keep us posted
Terry

[judymaggie]

Hi, Tracey & Boo! Don't panic --- as Terry has said, knowledge is key and that means your educating yourself and your vet either knowledgeable about the disease and the proper protocols for treating it or is willing to learn.

Hang in there!

[Tracey0127]

Thank you all for your kind words. I have some of Boo's results and am having a hide time figuring out how to post them here.

Can someone help?

Thanks!

[judymaggie]

Tracey -- we can't post attachments so the easiest way is to just type the information in your post. In order to avoid the possibility of getting kicked out when you are posting, I would suggest that you type everything into a Word doc and then copy and paste into your post here.

Remember, as Lori advised, you need only post those blood or urine tests which have results that are marked high or low along with the normal range. Be sure to include the date of testing. For example,

4/01/16

Alk Phosphatase 560 (HIGH) (range 1-131)

Do the same for any urinalysis that has been done. For example,

Specific Gravity 0.598 (LOW) (range 1.015-1.050) or
Protein 3+ (HIGH) (neg)

For the LDDS test, you will have three numbers to post.

I hope that helps!

[molly muffin]

Hello and welcome to the forum.
Judy gave you good example for posting the abnormal resutls.

Also do you have the LDDS results yet? That will have a base, 4 hour and 8 hour result.

[Tracey0127]

Thank you all so much. Here are Boo's results. (FYI, he has a sonogram on Tuesday and I am awaiting those results.)

September 2015 results
TEST RESULTS RANGE
ALKP 257U/L 5-131
Ca 11.6mg/dl 8.9-11.4
CHOL 342mg/dl 92-324
Potassium 5.6 mEq/L 3.6-5.5
TP 7.5 g/dl 5.0-7.4

April 2016 results
TEST RESULTS RANGE
ALKP 593U/L 5-131
Ca 11.5mg/dl 8.9-11.4
CHOL 351mg/dl 92-324
B/C Ratio 28 4-27

LOW DOSE DEX - April 14 2016
Cortisol Serial 3 (DEX) RE: 1530 Time 1 Pre RE: 1532 Time 2 Post 1 RE: 1534 Time 3 Post 2 RE: 1900 Cortisol Sample 1 - 3.4 ug/dL RE: 1902 Cortisol Sample 2 Dex <1.0 ug/dL Result verified RE: 1903 Cortisol Sample 3 Dex 2.1 ug/dL

Thanks in advance for your input!

Tracey

[molly muffin]

I'm just going to put the LDDS test in a more easy to read format.

LDDS 14 April, 2016

Cortisol Sample 1 - 3.4 ug/dL
Cortisol Sample 2 Dex <1.0 ug/dL
Cortisol Sample 3 Dex 2.1 ug/dL

Do they have a reference range with the LDDS results.

Just looking at it and with the ALKP elevating upwards, this does seem to be consistent with Pituitary cushings I believe. You may get suppression at the 4 hour, which you see on your test but then it tends to slip at the 8 hour, which is also consistent with the test you posted.

With the cholesterol a bit high, you might want to reduce any fat in his diet downwards. We usually see dogs do good on a good quality moderate protein and lower fat diet. Cushings dogs can be prone to pancreatitis so this is doubly important.

You will know more once you have the sonogram results too.

What is your vet recommending?

[Tracey0127]

Thanks for your reply.

Boo's sonogram revealed no adrenal tumors. Both glands were the same size with no sign of any abnormality. His liver was free of any abnormality as well.

The vet has suggested trilostan but I am considering holding off on the medication until his yearly visit in September because a vet friend believes that he is "borderline" Cushings.

I am torn and absolutely need advice.

Any suggestions on lowering cholesterol?

We feed him:
Fromm Family Classics Mature Formula Dry Dog
Fromm Four-Star Nutritionals Shredded Chicken Entree Canned

We alternate between these treats: (he gets 1 of the following 3 each time he is walked)

Fromm Four-Star Nutritionals Grain-Free Salmon with Sweet Potato Recipe Dog Treats

Fromm Four-Star Nutritionals Grain-Free Chicken with Carrots & Peas Recipe Dog Treats

Hills Ideal Balance Soft-Baked Naturals

Tracey

[DoxieMama]

Tracey,

It looks like you've done your homework on food! The Fromm is a brand that I have only recently heard of, containing a very low fat profile which I understand is a good plan for dogs with Cushing's (who can be prone to pancreatitis). The fat % on a dry matter basis for the dry food is 12.6%, and for the canned is 10.2%. The treats are 5.7% and 12.7% for the Hills. Protein percentages are 24, 44.6, 13.6, 13.6 and 16.8 (in the order you listed the foods). I don't have suggestions for lowering cholesterol, but wanted to list this out in case anyone else would like the numbers for analysis.

From my understanding, diagnosis of Cushing's is dependent on both lab results and symptoms. What symptoms have you seen in Boo? There are a plethora of common and uncommon symptoms, not all of which are exhibited by every dog. But I'm curious what led you and your vet to begin testing for Cushing's in the first place. Can you provide a little back history on him?

Hang in there!
Shana

[Tracey0127]

Hi Shana-

Boo does seem to love the Fromms.

About a year ago Boo started panting which he only used to do after exerting himself. As time went on the panting increased as did his hunger. At first I thought he was hungrier because the food he was now eating (Fromms) didn't have all the fillers in it so he need more substance. My vet told me that wouldn't be the case and suggested a full panel of testing which put us onto the possibility that he might have cushings. He advised to retest in 6 months which we did. Boo's levels increased and he had also gained 3 pounds. During this time he was panting almost non-stop and you couldn't eat anything without him going insane to get at it.

While my vet is suggesting medication I am still hesitant because, while he does exhibit symptoms, they are minor and I truly am worried about putting him on the medication.

So, I am torn. I can live with the panting and the craziness over food, but I don't want him to be in any discomfort or develop any of the more serious symptoms.

Any advice is much appreciated.

Thanks,

Tracey

[Tracey0127]

About a year ago Boo started panting which he only used to do after exerting himself. As time went on the panting increased as did his hunger. At first I thought he was hungrier because the food he was now eating (Fromms) didn't have all the fillers in it so he need more substance. My vet told me that wouldn't be the case and suggested a full panel of testing which put us onto the possibility that he might have cushings. He advised to retest in 6 months which we did. Boo's levels increased and he had also gained 3 pounds. During this time he was panting almost non-stop and you couldn't eat anything without him going insane to get at it.

While my vet is suggesting medication I am still hesitant because, while he does exhibit symptoms, they are minor and I truly am worried about putting him on the medication.

September 2015 results
TEST RESULTS RANGE
ALKP 257U/L 5-131
Ca 11.6mg/dl 8.9-11.4
CHOL 342mg/dl 92-324
Potassium 5.6 mEq/L 3.6-5.5
TP 7.5 g/dl 5.0-7.4

April 2016 results
TEST RESULTS RANGE
ALKP 593U/L 5-131
Ca 11.5mg/dl 8.9-11.4
CHOL 351mg/dl 92-324
B/C Ratio 28 4-27

LOW DOSE DEX - April 14 2016
Cortisol Serial 3 (DEX) RE: 1530 Time 1 Pre RE: 1532 Time 2 Post 1 RE: 1534 Time 3 Post 2 RE: 1900 Cortisol Sample 1 - 3.4 ug/dL RE: 1902 Cortisol Sample 2 Dex <1.0 ug/dL Result verified RE: 1903 Cortisol Sample 3 Dex 2.1 ug/dL

So, I am torn. I can live with the panting and the craziness over food, but I don't want him to be in any discomfort or develop any of the more serious symptoms.

Any advice is much appreciated.

Thanks,

Tracey

[Harley PoMMom]

Hi Tracey!

As you can see I've merged your new post into your original thread about Boo. This way, we will be able to keep track of his entire health and treatment history all in one place.

The decision to treat or not is a very personal one and we are here to support you with the treatment plan you feel is best for Boo because only you know your dear boy the best.

I believe this quote from Marianne is a really good reply in which she addressed this same question from another member:



But in answer to your question, in my own mind, the decision whether or not to treat depends on a number of factors: age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen.

Since the damage usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly. My biggest concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I might not.

However, for a younger dog, I would be equally as concerned about the silent internal damage. I would want to give my dog as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.


...As you will see, I do think that the decision to treat an elderly dog may be based on certain considerations that are a bit different than those for a younger dog.

Absolutely, we have seen dogs of all ages do very well with treatment. However, regardless of age, there can be some trade-offs. For instance, you mention itchiness for Roxie and the fact that her itchiness has actually been better lately. It is true that lowering cortisol levels can "unmask" conditions that are actually improved by the anti-inflammatory effect of steroids. So, for instance, dogs with allergies or arthritis may see those conditions worsen again once the cortisol level comes down. So in my mind, this is an example of the trade-offs of treatment for an elderly dog -- which symptoms or problems will be more uncomfortable? Also, treatment requires regular trips to the vet for bloodwork and monitoring. For some dogs, this is not an issue. For others, this in itself is very stressful. But also bear in mind that you always have the option of giving treatment a try and halting it if you do not think the benefits are outweighing the negatives.

Overall, the point I wish to make is that I think that, if you wish, it is perfectly OK for you to take a little more time to make the decision for Roxie that feels best to you. I just read an article by Moira Anderson Allen that contained this great quote: "Your veterinarian is the best judge of your pet's physical condition; however, you are the best judge of the quality of your pet's daily life." In the case of my own dog, his Cushing's symptoms were making him so miserable that I would have treated him at any age and regardless of his fear of the vet's office. But your evaluation of Roxie's quality of life will depend on her own situation...

Marianne

Hugs, Lori