My Sweet Laci

[AMaemone]

I have been told by my Vet that my 9 year old Brussel/Yorkie mix, Laci, has Cushings by her blood test results and liver sonogram. It all started with her having occasional seizures (about 6 per year). My vet says they are seasonal seizures, come with change of weather. I can remember her having what I now believe was a seizure when she was only 3 months old. I didn't know why she became stiff and couldn't stand and it never happened again so I dismissed it. When she had the first big seizure she was about 5 years old and I brought her to our then vet. She said it could be from her terrible teeth and I should have them cleaned. She was super super expensive so I tried our new vet (who is just expensive, LOL) who told me to not clean her teeth until we found out what was causing the seizures. He put her on a low dose of pheno. He said at that time he thought she may have Cushings, although no other indication other than the seizure. I had a liver sonogram which showed a slightly enlarged liver at that time and blood work. She had blood work the other day and now I am told that it seems the Cushings is progressing because now her thyroid is not working well and I should put her on thyroid meds. I am reluctant with just one blood test. I brought her urine in for testing today and am nervously waiting for the results. What are your thoughts and comments????

[DoxieMama]

Welcome to you and Laci, though I am sorry for the reasons that brought you here. Do you have copies of any of the blood tests? If so, posting the values which are high/low along with the reference ranges can be helpful to provide you with the best support.

I'm sorry all I have are questions. Hopefully one of the admins or other more experienced folks will be able to provide you with their insight.

Hugs,
Shana

[mytil]

Hi and welcome from me too. I am sorry you and your girl are having these problems. I too am sorry for all the questions as Shana mentioned, but the more we know the better we can help. Please post the test results of any Cushing's test here. Also post any elevated numbers in the blood work done.

Firstly I never have heard of seizures being brought on by the seasonal changes. What tests were performed to have the vet prescribe Pheno? How much is given and has she had any more seizures?

Cushing's is one of those syndromes that is hard to diagnose. The symptoms mimic so many others. So if you vet mentioned this without doing specific tests, it could be shot in the dark. You will need to do a series of tests (ACTH, LDDS for example). You mentioned enlarged liver - did your vet mention anything about looking also at the adrenal glands? Here is a good link to other links that will help you in understanding Cushing's, the tests and treatments. (http://www.k9cushings.com/forum/showthread.php?t=180). I would not rush to start Cushing's treatment until you get a firm diagnosis; especially with taking Pheno. You may want to find an internal medicine specialist that will sort through all this better than a GP vet who may not have a lot of experience with Cushing's.

Cushing's does not generally cause thyroid issues but some of the symptoms are the same.

Please keep us posted
Terry

[AMaemone]

Thank you for your responses. I don't have any of the numbers. My vet calls me and he is very hard to understand (he is from the Philapeans-sure I spelled that wrong) He did several blood works for the past 3 years, always saying he believed she had Cushings. He also did a sonogram of her liver and just yesterday did a urine test, saying her Creatine levels were elevated. I will call and ask them to send me her chart so I can post.
Talk soon and thanks again.

[molly muffin]

Creatinine levels are reflective of kidney function. Did he mention if the BUN was elevated?

I too haven't heard of seizures due to weather changes. Not to say it isn't true, but I haven't heard it.

Can you get copies of the test that have been done and the values? this will help us to give you better feedback.

[AMaemone]

The two elevated numbers in blood test were as follows:
ALP 2340
ALT 130
T4 0.9
Chol 446
Everything else was in range. Vet advised thyroid meds after this blood test.

Her urine test was as follows;
Urine cortisol 27.1
Urine Creatine 144.4
Urine Cortisol/Creat Ratio 59

Her sonogram showed as follows:
Liver enlarged with normal arch..... (can't read word) The adreanl glands were moderately enlarged bilateral L2.6x0.8 R2.2 x0.7cm and stomach wall mildly thickened Everything else was normal.

Comments and thoughts welcomed.

[judymaggie]

Hi! Thank you for posting the test results. Unfortunately, one more request ... would you post the reference ranges after each of the numbers you posted (for both blood and urine)? This will help us know how far above or below the range each number is.

I am also curious about Laci's seizures. How many seizures did she have before your vet prescribed phenobarbitol? Has she had any since she started the pheno? Here is a great site to read and learn about seizures:

http://www.canine-epilepsy-guardian-angels.com/site_map.htm

My first beagle had seizures and the "epi guardian angels" were extremely helpful.

Has Laci demonstrated any of the more common Cushing's symptoms? If you scroll down on this link, you will see a list of these symptoms:

http://www.kateconnick.com/library/cushingsdisease.html

Sorry to keep asking questions but, the more info we have, the better we can help guide you.

[AMaemone]

ALP 2340 Range 20-150
ALT 130 Range 10-118
T4 0.9 Range 1.1-4.0
CHOL 446 Range 125-270


BUN 12 Range 7-25

There is no range on the Urine results

Laci's seizures have been as follows:

1/12/13, 2/10/13, 4/11/13 & 10/9/13

2/5/14, 2/11/14, 7/19/14, 8/24/14, 9/22/14, 11/1/14 & 11/9/14

2/6/15, 6/20/15, 11/15/15, 11/18/15

2/2/16, 3/26/16 & 3/30/16

She had three seizures before vet prescribed Pheno. FIrst vet said they thought seizures were from bad teeth and wanted 850.00 to clean her teeth so I brought her to her current vet who said she couldn't go under anesthia until we found out why she was getting seizures. Still hasn't gotten teeth cleaned and they are really bad.


Her seizures last about one to two minutes and she doesn't fall over, just gets very stiff and makes a grunting sound. Then after it is over is she fine.

Her Cushing symptoms are as follows: I have two dogs and don't fill the bowls more than one time a day. She seems to want to go pee in the middle of night lately but doesn't wet anywhere in the house and is home all day in my basement with my other dog and no pee!!! Other than panting lately that is the only symptom I can tell.

As I mentioned I believe her first seizure was when she was about 2 months and not again until she was 6.

[molly muffin]

Okay so she has had seizures since starting pheno it sounds like.

Thyroid can also cause seizures have they talked about putting her on thyroid meds?

Looks like he meant the urine creatinine ratio was high but it didn't show creatinine or BUN high on her cbc right?

Just that ALKP is pretty high. So are they talking about doing an LDDS test to check specifically for cushings?

[AMaemone]

He never mentioned an LDDS test. They just gave me thyroid meds. Didn't request any other testing. Have you ever heard of Cush away If so is it recommended

[labblab]

Hello and welcome from me, too. In honesty, I am highly doubtful that Cushing's has anything to do with Laci's seizures, even if she truly has Cushing's. Since she has exhibited seizure disorder her entire life, I am guessing she has epilepsy or some specific physiological trigger other than Cushing's. I really don't know why your vet even thought about Cushing's based upon seizures alone. Seizures are not a typical Cushing's symptom.

I currently have a non-Cushpup Labrador retriever who first exhibited grand mal seizures of unknown origin several years ago at age 6, and she has been treated successfully with phenobarbital since that time. However, here are some important things for you to know about phenobarbital. First, it skews the results of basic thyroid tests and can make a dog appear to have low thyroid function even if that is really not the case. So before starting thyroid supplements, it would be important for the vet to request more involved thyroid testing than just the simple T4 level that appears on a basic blood chemistry panel.

Also, phenobarbital has to be monitored very carefully with regularly spaced blood tests. There is a therapeutic range within which the dosing must be maintained. If you give too little of the drug, it won't control the seizures. If you give too much of the drug, the liver can be damaged. If Laci has been taking the phenobarbital for a couple of years now, I would hope that the drug level in her bloodstream has been carefully monitored during this time. It is true that elevated liver enzymes can be caused by Cushing's, but they can also be caused by phenobarbital. Either way, for the safety of her liver, she may need to be switched from the phenobarbital to a different seizure medication that is not so hard on the liver. I would be very worried about a dog who has those liver readings and is continuing to take phenobarbital. There is a specific blood test that helps judge the actual liver function and it is called a bile acids test. It might be very important to see how well Laci's liver is actually working right now.

So in the absence of any overt Cushing's symptoms, I would be worrying much more about clarifying Laci's liver function and also requesting more thorough thyroid testing. I would want to ask the vet whether her phenobarbital level has been within tested therapeutic range during these past couple of years. And given her abnormal liver values, I would want to talk about switching her to a seizure medication that does not carry such a strong risk for damaging the liver further.

Marianne