Confused!? Scooter

[MyBabyScooter]

Hello, this is my first post. I am hoping someone could please give me their opinion? I have been studying my dog for weeks, checking for symptoms of Cushings. He is a Maltese X Fox Terrier and has just turned 10.

a) He has had a bloated tummy for a while, but it does change in size.
b) He is always STARVING!!
c) As for drinking, it is minimal - 2 or 3 times a day equalling about 1 cup.
d) He has never panted.
e) He 'may' have thinning hair in his armpits and tummy. His hair is very glossy and soft and I have read Cushings makes hair dry.
f) I think his skin is thin.
g) His spine has been prominent for a month.
h) This week, I am able to feel his ribs and bones all over really. He feels so much smaller than ever before.
i) He has lots of energy and can walk & run a long way.

I took him to the vets 6 weeks ago for a blood test and his liver ALP was 1247 rather than 150. I read that the ALP can go up and down all the time, so disregarded that and kept watching his symptoms. All his other readings were perfect, including cholestoral, thyroid etc. etc. The vet could not feel an enlarged liver.

He has lost a pound in the last 9 days, but I have reduced the amount of food I give him, after googling that he should be getting 160 grams (5.5oz) if he weighs 8 kg (17lbs). He now weighs 7.5 kg (16lbs). Yet even though I feed him a mixture of 160g of raw meat + steamed & raw vegetables, I also feed him a chicken neck, a sardine, 2 dental biscuits, a small vitamin treat, a small spoonful of natural yoghurt, and half a fried egg sometimes. Does that seem like a lot or not enough or okay?

Maltese Terriers should weigh between 2-4kgs and Fox Terriers up to 8.25kgs, so he is near the top of the range, so why can I feel nearly all his bones?

I want to have an ACTH test tomorrow, but it's so expensive and I am so unsure regarding his symptoms. Any advice please? :confused:

[Harley PoMMom]

Hi and welcome to you and your boy!

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. :)

Cushdogs generally have increased drinking/urinating, ravenous appetite, pot-bellied appearance (that really doesn't change in size), exercise intolerance, and difficulty or unable to go up steps or jump on furniture, their hair loss is normally concentrated to the torso and tail, and the skin looks thinner than normal. So, I can see why you are confused, some of your boy's symptoms can be associated with Cushing's but others are not.

Even your boy's blood abnormality, the elevated ALP, is commonly seen in cushdogs, however there are other chemistry/CBC levels that are generally seen in dog's with Cushing's, which are high cholesterol and triglyceride levels. They also have what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS). So your boy's case is quite puzzling to me :confused:

Does your boy have any underlying health issue that he is taking medication for? If so, what is it and what is the medication? Is he taking any supplements or herbs?

The LDDS, ACTH, UC:CR, and/or an ultrasound are the diagnostic tests used to help diagnose Cushing's. The low-dose dexamethasone suppression (LDDS) test is considered the gold standard test used for diagnosing canine Cushing's. Since there is a big question mark in whether your boy has Cushing's I believe I would have an abdominal ultrasound performed. An ultrasound can be a very useful diagnostic tool, as other abnormalities may be found on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc. Our motto here is you get a lot of bang for your buck with an ultrasound.

However not all ultrasounds are created equal. And yes, they can be quite costly and having them done correctly is important. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. Usually a Board Certified Veterinary Specialist is the best choice to perform an ultrasound.

I am sorry for the reasons that brought you here but glad you found us and we will help in any way we can.

Hugs, Lori

[MyBabyScooter]

Thankyou for replying, Lori :) His blood test was normal for everything except the ALP. He has no medication but when I suspected Cushings, I stopped giving him his daily fish oil capsule, and his 'Osteocare Joint Health Chew' which contains kangaroo, glucosamine sulfate, chondroitin sulfate, emulsifiers, binders, Vit C, dimethylsulfone and manganese gluconate. I heard Cushings makes them not need help with arthritis any more.

He did have and still does 'Multi+Trytophan Multivitamin Chews with Tryptophan' which contain kangaroo, flaxseed meal, emulsifiers and binders, polyunsaturated fatty acids (with DPA/EPA), L tryptophan, vitamins C, E, B3, B2, A, B1, K3, B6, B9, B12, B7, dimethylsulfone, zinc sulfate, iron sulfate, copper sulfate, manganese oxide, calcium iodate and selenium.

One of his dental biscuits only contain cereals, byproducts, fat and emulsifier, and the other one contains cereal, starch, humectant, vegetable gum, minerals, sodium tripolyphosphate, byproducts, cellulose fibre and zinc sulphate.

While I'm here I'd like to ask your opinion re the health treats, and if they're necessary when he has raw meat and vegetables every day? And do the dental biscuits even sound healthy? :eek:

I will ring the vet tomorrow re an ultrasound. Am I able to post pics of him and his tummy (just wondering).

Thanks for any help :)

[DoxieMama]

Welcome from me, too! I don't have answers for you regarding the testing, etc. I used to feed my dogs raw and the reference ranges I read were typically 2-3% per body weight per day as a starting point, though smaller dogs may need more and larger dogs may need less. Since he's losing weight at 2%, I'd add more. I read to adjust by no more than 10% at a time, so maybe bump it up to 6 ounces for now. Dogaware.com (http://dogaware.com/articles/wdjhomemade3.html) has some helpful information.

You can create an Album and load pictures to it. The info on how to do that is in the FAQ: http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

Hugs,
Shana

[MyBabyScooter]

Thankyou Shana :) I am tempted to give him more of the meat & veg, and if he goes over 8 kg, then cut it back again, so good idea!

I will now have a look at your link and the Albums pages :p

P.S. I have now looked at the link and that lady sure feeds healthy food to her dog... some excellent ideas there! As for the album, I will upload photos tomorrow... it's almost 11 pm here in South Australia and I am beyond tired as I just started a new job today zzzz Back in the morning :)

[MyBabyScooter]

Hi... just letting you know I have uploaded photos of Scooter and his tummy for anyone to comment re the changing size and possibility of Cushings. That has been the main symptom for a long time, so may not be Cushings? The other main one is extreme hunger. He has very little thirst, and has lots of energy for long walks etc as I wrote about in my first post above. He is quite bony now, his spine and just about all over. Could this just be aging - he's just turned 10.

I would really appreciate any comments - thankyou! :o

[Harley PoMMom]

Yep he does have that pot bellied appearance going on. Some dogs just do not follow the rules when it comes to Cushing's ;) and it is also true that dog's with Cushing's do not display the exact same symptoms. So, it could very well be that the Scooter's ravenous appetite, pot-bellied appearance, and the elevated ALP are the symptoms from Cushing's.

Since his symptoms mostly overlap with either diabetes or a thyroid issue and both of these have been ruled out, my layperson's advice would be to have an abdominal ultrasound and/or the LDDS test performed. My preference is leaning more to an ultrasound because it can give the vet a really good look at the surrounding organs to see if there is a non-adrenal problem that can be contributing to Scooter's symptoms and lab abnormalities.

This is just my opinion and hopefully the others will stop by and offer theirs as well.

Hugs, Lori

[MyBabyScooter]

Thanks Lori, so you think his flat tummy photos don't mean much? Not questioning your expertise, just wondering....

I really must go to bed, can't keep my eyes open... will check in the morning :)

[Harley PoMMom]

It does seem that his belly does fluctuate from being a bit round than flattens out some and I'm just not sure what to make of that. :( Scooter's symptoms are puzzling to me :o so please always feel free to question what I or anyone else has to say, that's just being an excellent advocate for your sweet boy because only you know your boy best. ;)

Hugs, Lori

[Harley PoMMom]

Just found this article during my routine Cushing's searches :o: The title is "Meal-induced hyperadrenocorticism in dogs: Not to be overlooked" When to suspect that food is at fault—and what to do about it.

Jan 22, 2016
By Carla Johnson, DVM
VETERINARY MEDICINE


http://veterinarymedicine.dvm360.com/meal-induced-hyperadrenocorticism-dogs-not-be-overlooked and it made me think of Scooter's situation.

An excerpt from that article:
If you suspect meal-induced hyperadrenocorticism in a dog, at this point “it’s a very simple thing to diagnose,” says Bruyette. Have the clients fast the dog for 12 hours and obtain a urine sample at home. Ideally use the first morning-voided sample. Instruct them to feed the dog and four hours later have them go for a walk and obtain another urine sample. Submit the carefully labeled pre- and post-meal urine samples for a UCCR on each. A 100-fold increase in urine cortisol in response to the meal will be diagnostic for food-induced hyperadrenocorticism. “In general, we do want to at least see the UCCR double, but there are not really enough cases yet reported to show a range,” says Bruyette. “In a normal dog, when he eats, there is no rise in cortisol.”

Treatment for this condition is to give adrenal enzyme blockers two to three hours before every meal. This blocks the effect of GIP on the receptors during GIP stimulation by food, so oral trilostane twice daily with every meal is a very effective treatment. Use the ACTH stimulation testing to monitor treatment as you would to monitor any classic Cushing’s disease case. Perform the test four hours after the morning meal, which is about six to seven hours after treatment with trilostane.

Do you think that testing Scooter for this is a good option?

[MyBabyScooter]

Thankyou for all your research on my behalf Lori!!! :) It does look interesting and I will have a good read of the link. Tomorrow morning I will ring the vet and mention the ultrasound, plus this new possibility. We'll get to the bottom of it yet! :D

[randomguy]

My dog has thin skin, large amounts of hair loss, a pot belly, and muscle weakness. He does not have any panting and doesn't drink a lot of water. I got him tested using the acth test and the doctor said he has it. He told me that not all dogs have the same symptoms. So I guess I have a weird case as well. Good luck!

[MyBabyScooter]

My dog has thin skin, large amounts of hair loss, a pot belly, and muscle weakness. He does not have any panting and doesn't drink a lot of water. I got him tested using the acth test and the doctor said he has it. He told me that not all dogs have the same symptoms. So I guess I have a weird case as well. Good luck!

Scooter sounds similar to Chuck then.... does his belly ever go flatter or always big? Scooter now drinks even less - about 1 drink a day instead of 2 (half a cup at most). I don't think Scooter has muscle weakness as he loves long walks and runs, but I'd say he has muscle wastage as I can feel a lot of his bones now - legs, back and head.

[randomguy]

Initially I couldn't tell, but now i notice its larger and its stayed that way. I have noticed muscle wasting as well and he will no longer try jumps he used to do before. And I definitely did start noticing a lot more bone. Also there are black heads and little calcium deposits on his skin as well. He really is a pretty happy and healthy dog--you wouldn't notice his tummy as all when he's standing, its really weird. I'm hoping the medicine will give him hair regrowth and allow his muscles to build upa bit. I'm sending prayers and positive thoughts your way and hoping your pup has a good life ahead of it! :)

[MyBabyScooter]

Initially I couldn't tell, but now i notice its larger and its stayed that way. I have noticed muscle wasting as well and he will no longer try jumps he used to do before. And I definitely did start noticing a lot more bone. Also there are black heads and little calcium deposits on his skin as well. He really is a pretty happy and healthy dog--you wouldn't notice his tummy as all when he's standing, its really weird. I'm hoping the medicine will give him hair regrowth and allow his muscles to build upa bit. I'm sending prayers and positive thoughts your way and hoping your pup has a good life ahead of it! :)

Thankyou for that info. Scooter has tiny blackheads around his "manhood" and has for many months... the vet noticed too but didn't say anything, but I do know they can be a symptom of Cushings. Not sounding promising for Scoot. I've held off getting the expensive tests done due to lack of drinking which is supposed to be the MAIN symptom, but as it's not the case with Chuck, I will have to get him tested now, early this week. Will definitely keep you all posted... I hope it's a good outcome....:cool: If you ever want to post pics of Chuck, they would be great to see, but of course, don't worry if not able :) Thankyou again!

[MyBabyScooter]

When my dog had a blood test recently, his ALP was greatly raised, but everything else was normal including glucose, cholesterol and white blood cells. If he had Cushings, would any of those 3 be abnormal? Thanks :)

[lulusmom]

I have merged your latest post with your original thread so as to keep all of Scooters history in one place. Sometimes it's difficult to find our threads when they aren't showing on the first few pages so I will be sending you a message with a link to your thread so that you can bookmark it or just keep it in your inbox for ready reference. Please keep an eye out for a message alert.

Now as for your question about ALP, Lori (Harley PoMMom) was the first to respond to your thread and she did include the answer to that question. Rather than duplicating, I've included a link to Lori's post below:

http://www.k9cushings.com/forum/showpost.php?p=191271&postcount=2

[MyBabyScooter]

Hi.... as I have read Cushings dogs should have little or no fibre, how will that help re pooping? I don't want to constipate him. Thanks

[Squirt's Mom]

I have merged your lasted post concerning fiber in a cush pup's diet into your original thread. We like to keep all posts about each pup in one thread. That way it is much easier to keep up with the history for us as well as for you. I am also changing the title of your thread to include your pup's name so hopefully that will help you find it easier. If it has been a while since you posted, you will need to scroll thru the threads til you find Scooter's. ;)

Thanks for the cooperation in the future!
Hugs,
Leslie and the gang

[Squirt's Mom]

As for reading that cush pups should have limited to no fiber - that information is simply incorrect. Fiber in the diet has no bearing for a cush pup in relation to Cushing's. Now if a cush pup also has a digestive disorder, such as IBD, etc., then the fiber MIGHT be a factor. But it is not for our babies in general.

The thing to watch out for in the diet of a cush pup are FATS. Our babies are prone to Pancreatitis and fats can trigger that condition. A dog with Cushing's should have moderate to low fat content.

Hope this helps!
Hugs,
Leslie and the gang

[lulusmom]

Thank you, Leslie, for sharing the info on fiber. I've been searching for credible information on proper diet for cushdogs for years and have always come up empty. It seems every site that pops up in my search says the same thing, low fat, low fiber, low purines and with the exception of low fat, none explain why these restrictions are recommended. While there was a long standing belief that cushdogs are at high risk for pancreatitis, that connection was made based on rabbits as test subjects. I've provided an excerpt below from the Fourth Edition Canine and Feline Endocrinology veterinary textbook. This is from Chapter 14 - Glucocorticoid Therapy attributed to Dr. Claudia Reusch. Chapter 10 - Canine Hyperadrenocorticism authored by Dr. Ellen Behrend contains a blurb referring readers to Chapter 14 which says; "Pancreatitis is uncommon in dogs with HAC. Although a link between gluccocorticoids and pancreatitis has previously been postulated, the concerns have largely been dismissed".


Pancreatitis and Cushing’s (Amylase and Lipase)

Pancreatitis is uncommon in dogs with HAC. Although a link between glucocorticoids and pancreatitis has previously been postulated, the concerns have largely been dismissed. More than 500 drugs have been reported to the World Health Organization (WHO) because they were suspected to induce pancreatitis in humans. In many of them, evidence of causality is weak, and for only 31 of those drugs a definitive causality has been established. Among them are steroids, but they do not belong to the group of high risk drugs. Previously, glucocorticoids were also assumed to cause pancreatitis in small animals. Much of the evidence regarding this association, however is related to increased viscosity of pancreatic secretion shown in rabbits. In dogs, increased viscosity of pancreatic secretions has been shown only when isolated pancreases were perfused with a huge dose of methylprednisolone (400 mg); a lower dose (200 mg) did not change the viscosity. Pancreatitis has also been seen in dogs treated with glucocorticoids. However, these were sporadic cases, and the dogs suffered from intervertebral disc disease, which may alone be a risk factor. The administration of dexamethasone to healthy dogs in various doses for up to 3 weeks did not cause pancreatitis. However, it increased lipase activity without any histological damage to the pancreas. In a more recent study, evaluating the canine pancreatic lipase immunoreactivity (cPLI), immunosuppressive doses of prednisone (2.2 mg/kg once daily) given for 6 weeks did not result in an increase in cPLI.

In dogs and cats, the early concerns that glucocorticoids could cause pancreatitis have now largely been dismissed. Steroids are no longer included in the list of drugs suspected of being associated with pancreatitis. It is possible, however, that glucocorticoids are a contributing factor in sick animals or that only a subset of patients is susceptible for steroid-induced pancreatitis.

While that information on higher fat diets may be a revelation as it relates to cushing's and pancreatitis, obese dogs, whether healthy or cushingoid, on higher fat diets are at increased risk of pancreatitis. While studies show cushing's does not cause weight gain, pet owners who feed their cushdogs to keep them from driving them nuts, are a lot more likely to make their dogs fat. My first cushdog gained weight because I free fed for years and she was simply eating too much. She wasn't morbidly obese but definitely chunky so I was lucky that she never had pancreatitis in the months and months she went undiagnosed.

High fat diets can also present a very real risk to those cushdogs who may have hypertriglyceridemia that is an incidental finding on blood chemistry at the time of a cushing's diagnosis. Miniature Schnauzers are a breed at the top of the list for genetic predisposition to this condition. Our experience would support that as we have seen a good number of Mini Schnauzers who have had severe elevations in triglycerides which automatically mandates a hard look at fats in the diet. Hypertriglyceridemia can cause some of the same lab abnormalities associated with cushing's so we've also seen some misdiagnoses in this breed.

I apologize for being long winded but I wanted to share all of the credible information I have that relates to increased risks associated with fat in canine diets. What I haven't been able to determine is a credible percentage threshold, on a dry matter basis, that would indicate a meal plan, whether commercially or home prepared, is too high in fat. I am hoping other members may know the answer and can share.

Glynda

[labblab]

Here's a link to an article by Mary Strauss about dietary fat that has been extremely helpful to me ;). It includes definitions, calculation formulas, recipes, and analyses of both home-cooked and commercially available dog food.

http://dogaware.com/articles/wdjlowfatdiets.html

Marianne

[MyBabyScooter]

As for reading that cush pups should have limited to no fiber - that information is simply incorrect. Fiber in the diet has no bearing for a cush pup in relation to Cushing's. Now if a cush pup also has a digestive disorder, such as IBD, etc., then the fiber MIGHT be a factor. But it is not for our babies in general.

The thing to watch out for in the diet of a cush pup are FATS. Our babies are prone to Pancreatitis and fats can trigger that condition. A dog with Cushing's should have moderate to low fat content.

Hope this helps!
Hugs,
Leslie and the gang

Thankyou Leslie :) I made a list of Cushings dogs food needs from googling and they were....

Low fibre
Low salt
Raw meat
Raw veg shredded
Potassium e.g. beans, broccoli, potato skin
Fruit as treats
No fish oil or osteoporosis treats that I had been giving him

So when I made up his raw meat and veg mixture last time, I chose only veg that had the smallest amount of fibre, and I didn't shred them, I chopped them and later pureed them... and I did have to steam some e.g. sweet potatoes. The meats I choose are always low fat e.g. kangaroo, chicken breast, fat-free steak (yes, he's spoilt!) and a bit of chicken liver.

I tried to cook potato skins but they turned out a soggy mess - I think I used too much olive oil and should have just sprayed them.

I have been giving him a slice of apple a day which he loves, and realise that is fibre, but I believe he needs SOME. He was constipated yesterday, which led me to write the post.

I guess I have read some wrong info so I'm really glad to know he can have fibre and will add different veg when I have to make up another dog mixture, which is this Sunday. Thankyou so much for that :D

[MyBabyScooter]

I will read the other answers now... thankyou ladies :)

[MyBabyScooter]

Today the vet emailed me these blood results from 2 months ago. Contrary to what I was told, the cholesterol is up. Can you tell from any of this (confusing to me) report, if Scooter likely has Cushings. I've noticed tonight his hair is definitely thinning in his armpit area. Has only had one drink today and that was after a walk. Thankyou for any help :)


BIOCHEMISTRY

SODIUM 147 mmol/L (139 - 153)
POTASSIUM 5.0 mmol/L (3.9 - 5.9)
CHLORIDE 101 mmol/L (101 - 118)
BICARBONATE 22 mmol/L (12 - 26)
NA:K RATIO 29.4 (26.0 - 35.0)
ANION GAP 29.0 mmol/L (14.0 - 32.0)
GLUCOSE, FL.OX 4.8 mmol/L (3.3 - 6.8)
GLUCOSE, SERUM 4.6 mmol/L (3.3 - 6.8)
UREA 5.0 mmol/L (2.5 - 10.0)
CREATININE 0.06 mmol/L (0.05 - 0.15)
SDMA 6 ug/dL (0 - 14)
CALCIUM 2.3 mmol/L (1.9 - 2.9)
PHOSPHATE 1.5 mmol/L (0.8 - 2.1)
CA:P RATIO 1.5 (1.2 - 3.0)
PROTEIN, TOTAL 71 g/L (52 - 80)
ALBUMIN 38 g/L (23 - 40)
GLOBULIN 33 g/L (25 - 45)
A:G RATIO 1.2 (0.6 - 1.4)
BILIRUBIN, TOTAL 1 umol/L (0 - 7)
ALP 1247 H IU/L (1 - 150)
ALP STEROID ISOENZYME 622 IU/L
AST 42 IU/L (18 - 80)
ALT 165 H IU/L (16 - 90)
CK 304 IU/L (73 - 510)
CHOLESTEROL 9.5 H mmol/L (3.5 - 9.0)
AMYLASE 298 L IU/L (333 - 1500)
LIPASE 495 IU/L (77 - 750)
GAMMA GT 10 H IU/L (0 - 9)
SAMPLE APPEARANCE Mild haemolysis
Nil lipaemia

HAEMATOLOGY

RBC 8.0 x10^12/L (4.9 - 8.2)
HAEMOGLOBIN 179 g/L (100 - 206)
HAEMATOCRIT 0.50 L/L (0.35 - 0.58)
RETICULOCYTE % 1.5 % (0.0 - 1.5)
RETICULOCYTE ABS 120 H x10^9/L (10 - 110)
MCV 63 L fL (64 - 76)
MCH 22 pg (21 - 26)
MCHC 358 g/L (310 - 360)
PLATELET COUNT 487 x10^9/L (200 - 500)
WBC 5.7 x10^9/L (4.5 - 17.0)
NEUTROPHILS% 80 %
NEUTROPHILS 4.6 x10^9/L (3.5 - 12.0)
LYMPHOCYTES% 15 %
LYMPHOCYTES 0.9 x10^9/L (0.9 - 3.5)
MONOCYTES% 5 %
MONOCYTES 0.3 x10^9/L (0.0 - 1.1)
EOSINOPHILS% 0 %
EOSINOPHILS 0.0 x10^9/L (0.0 - 1.4)
BASOPHILS% 0 %
BASOPHILS 0.0 x10^9/L (0.0 - 0.1)
BLOOD SMEAR EXAMINATION Automated CBC.

A glucose result obtained from a plain serum clot tube has the potential to provide a falsely lowered result due to ongoing consumption of glucose in such tubes. The result obtained from a Fluoride Oxalate tube will be a more accurate estimation of the true glucose value.

SDMA is a new test to help evaluate kidney function. It increases earlier than creatinine in some animals with chronic kidney disease. Unlike creatinine, SDMA is not impacted by lean body mass. SDMA and creatinine should be interpreted together, along with a urinalysis.

Both SDMA and creatinine are within the reference interval which indicates kidney function is likely good. However, if SDMA and/or creatinine is approaching the upper end of the reference interval, early kidney disease cannot be ruled out. Evaluate urine specific gravity and urinalysis for proteinuria to help confirm there is no other evidence of kidney disease.

For more details about IDEXX SDMA please visit http://www.idexxsdma.info

Haemolysis may falsely decrease Bilirubin, Glucose and T4, and may affect GGT in an unpredictable manner.

ENDOCRINOLOGY

T4 TOTAL 20 nmol/L (13 - 52)

Result consistent with normal thyroid function. Target values following replacement therapy for hypothyroidism:
* Peak T4 (sample collected 4-6 hours after thyroxine administration): 27 - 70 nmol/L;
* Trough T4 (sample collected within one hour of the next scheduled dose): 12 - 50 nmol/L.

[MyBabyScooter]

One vet at that clinic wanted to do an ACTH test after that. Another vet there said a blood test as the one above should be repeated first.

The ACTH test is $A300 and the blood test $A200 so if Cushings is MOST likely, I would rather go ahead with the ACTH. But if a repeated blood test would make more sense, I would go with that?


Sorry, I am not sure if I wrote the money in the American way, but I meant Australian dollars, so maybe that's $AUD300 ???

[Harley PoMMom]

Some of Scooter's abnormal blood levels can be associated with Cushing's such as the elevated ALP and cholesterol and the moderate increase in the ALT. However, on the haematology report this isn't what we normally see on a cushdog. Like I mentioned before they also have what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS). So your boy's case is quite puzzling to me. :confused: especially since he does not display the common symptoms of Cushing's.

So, if this were me, I would have an abdominal ultrasound done instead of an ACTH stimulation test because a small percentage of dogs who truly have Cushing's will present with a "false" negative on the test.

This is just my layperson's opinion and hopefully the others will share their opinion as well.

Hugs, Lori

[lulusmom]

Until you posted the June blood labs, you had maintained in few posts that ALP was the only abnormal value and that there was absolutely no other abnormalities. Was this a mistake on your part because the vet did not tell you about any other abnormalities on the test or is there additional blood labs that were done. I suspect these are on in the same as you mentioned in prior posts that ALP was 1247 which is the same as the result you just posted. So Scooter has abnormalities that are commonly seen in dogs with cushing's but they are not exclusive to cushing's which is probably why your vet wanted to recheck the blood chemistry before launching diagnostics for cushing's. Honestly, I don't think he would need to rerun a complete blood count (CBC) and may be able to do a limited blood chemistry panel that would be a lot less expensive. If it were me, I'd probably wait for three months from time of the last test and ask the vet to recheck the blood chemistry. Was Scooter fasted for the last test?
If the new tests shows a continued increase in ALP and cholesterol, I think that might be a very good indicator that cushing's is likely.

Aside from the increased appetite, Scooter really doesn't have the usual symptoms that are commonly associated with cushing's and the area of his hair loss is definitely not the usual in cushing's. Have you had Scooter shaved or scissored down for the summer. If so, did his coat grow back okay? I ask because dogs with uncontrolled cushing's experience very slow to no regrowth of coat. Does Scooter constantly beg and forage for food? My first cushdog was always food driven, with a very healthy pig-like appetite; however, with cushing's, she was way beyond that and drove me nuts dancing in circles, whining for food, stealing her siblings' food, foraging for any little morsel that even looked like food. She was a chunky 5 lbs back then and I couldn't imagine what it must be like for people with bigger dogs who can knock over trash cans and counter surf. That would be nightmare. :eek: Is Scooter's need for food driving you nuts yet?


Glynda

[MyBabyScooter]

Until you posted the June blood labs, you had maintained in few posts that ALP was the only abnormal value and that there was absolutely no other abnormalities. Was this a mistake on your part because the vet did not tell you about any other abnormalities on the test or is there additional blood labs that were done. I suspect these are on in the same as you mentioned in prior posts that ALP was 1247 which is the same as the result you just posted. So Scooter has abnormalities that are commonly seen in dogs with cushing's but they are not exclusive to cushing's which is probably why your vet wanted to recheck the blood chemistry before launching diagnostics for cushing's. Honestly, I don't think he would need to rerun a complete blood count (CBC) and may be able to do a limited blood chemistry panel that would be a lot less expensive. If it were me, I'd probably wait for three months from time of the last test and ask the vet to recheck the blood chemistry. Was Scooter fasted for the last test?
If the new tests shows a continued increase in ALP and cholesterol, I think that might be a very good indicator that cushing's is likely.

Aside from the increased appetite, Scooter really doesn't have the usual symptoms that are commonly associated with cushing's and the area of his hair loss is definitely not the usual in cushing's. Have you had Scooter shaved or scissored down for the summer. If so, did his coat grow back okay? I ask because dogs with uncontrolled cushing's experience very slow to no regrowth of coat. Does Scooter constantly beg and forage for food? My first cushdog was always food driven, with a very healthy pig-like appetite; however, with cushing's, she was way beyond that and drove me nuts dancing in circles, whining for food, stealing her siblings' food, foraging for any little morsel that even looked like food. She was a chunky 5 lbs back then and I couldn't imagine what it must be like for people with bigger dogs who can knock over trash cans and counter surf. That would be nightmare. :eek: Is Scooter's need for food driving you nuts yet?


Glynda

Thanks Glynda.... his only test was done around 20th May so almost 2 months ago. The vet told me "everything was perfect, except for the ALP"!!?

I never fast any of my pets for blood tests, but I guess that would be ideal! I guess I should go ahead with another blood test, and you say in about a month's time, and I will fast him first (he will LOVE no breakfast :rolleyes: )

Re his hair, as shown in my photos, the groomer practically SHAVED him in February (I wasn't happy as she also sliced off a wart from his back, yet continuously denied she did it, and left his foot bleeding too). His hair growth since February was Very slow except the last week or two, it is growing FAST, and is very silky and soft. But in general, I would say it's a little thinner as I can see his pink skin more easily all over, rather than a solid coat. His tail is the worst with minimal hair growth coming back.

I'd say Scooter is similar to your dog re foraging, even trying to lick nothing off the floor, and sometimes whimpers as he sits and stares at me expectantly, so yes, his appetite is huge. But I don't give in and stick to his usual food for the day as he has been very fat before and I don't want him that way again. His weight is steady and the weight I'd like him to be. But it's not like he stares at me all day.. more like at the typical meal times.

Thanks so much again for your help and advice!! :)

[MyBabyScooter]

Some of Scooter's abnormal blood levels can be associated with Cushing's such as the elevated ALP and cholesterol and the moderate increase in the ALT. However, on the haematology report this isn't what we normally see on a cushdog. Like I mentioned before they also have what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS). So your boy's case is quite puzzling to me. :confused: especially since he does not display the common symptoms of Cushing's.

So, if this were me, I would have an abdominal ultrasound done instead of an ACTH stimulation test because a small percentage of dogs who truly have Cushing's will present with a "false" negative on the test.

This is just my layperson's opinion and hopefully the others will share their opinion as well.

Hugs, Lori

Hi Lori.... thanks for more help again :) I'm glad you know how to read the blood result charts and can see only some things suggest Cushings.

I will ring the vet this morning and mention the ultrasound, or the blood test Glynda mentioned. I really hope after all this, he doesn't have Cushings - or anything too serious!

Thanks heaps again for people like you who are so helpful Lori :)

[MyBabyScooter]

Hello again.... I emailed the vet and said the haematology side of things did not seem like Cushings and should he have another blood test or ultrasound. He just answered and wrote this....

"Haematology is a very unreliable tool for cushings disease and we don't advise you try to use it to assist in a diagnosis. ACTH stimulation or LDDS testing is the reliable path and both tests are very trustworthy.
All dogs with cushings disease require an ultrasound examination. We do this after blood testing but you can do it before if you wish. All that matters is that we get to a confirmation of what is only now a suspicion, as of course there could be something else even more serious causing Scooter's signs. Please book in for either an ACTH stimulation test or an ultrasound examination as soon as you can."

He then gave me a link to their clinic's website on Cushings, and you don't have to read it all but can if you like :) Re the symptoms, I will highlight the ones Scooter has and not the rest.

"What Is Cushings Disease?
Simply, it’s caused by an excess in the body of the hormone cortisol, or artificial substitutes like prednisolone.

What Does Cushings Disease Look Like In Dogs?
Excess cortisol causes many symptoms. They include:

Drinking a lot of water
Increased appetite or hunger
Thin hair and hair loss on the back, sides and rump
Pot belly
Less interest in play or exercise
Increased weight
Panting even in cool conditions
Urinary infections
Hard skin patches or blackheads
Loss of fertility
Thin skin & slow wound healing

These days, with the increased use of annual screening blood tests we find a raised Alkaline Phosphatase enzyme and diagnose the disease before anyone is aware it’s there.

What Causes Cushings Disease?
There are three sources of the excess hormone:
Pituitary Dependent Hyperadrenocorticism (PDH)
Adrenal Tumour (AT)
Iatrogenic Hyperadrenocorticism (IH)

PDH is caused by a small, usually benign, tumour in the pituitary gland, which is located at the base of the brain. The tumour produces too much of the hormone ACTH which in turn tells the adrenal glands to make too much cortisol. AT is a simple tumour in the adrenal gland itself. This time it’s the tumour cells themselves that produce too much cortisol. Later you’ll see why this matters.

IH is a bit of an ‘oops’ moment. This form used to be very common when cortisone, prednisolone, triamcinolone or dexamethasone were used a lot to treat canine skin disorders. The overuse of these drugs mimics natural cushings disease symptoms. Nowadays there are many better ways to treat skin problems in dogs but sometimes IH can’t be avoided when we treat an autoimmune disease.

How Do We Diagnose Cushings Disease?
Vets can use a variety of very accurate tests. We mostly use the ACTH Stimulation Test. This is the same test we use to monitor your dog’s progress so it also gives a baseline level prior to starting therapy. The Low Dose Dexamethasone Suppression Test is another good test but can sometimes cause false positive results from other illnesses; sometimes both tests are needed to establish a clear diagnosis. Cushings tests require at least half a day in hospital and a series of injections.

How To Treat Cushings Disease In Dogs
Treating the IH form is easy: just withdraw the drug. Notice we didn’t say stop. If a dog is on cortisone drugs for a long time, it causes the body’s own cortisol production to stop and the adrenal gland to shrink via a feedback loop. If you stop the drug cold turkey, you will cause a severe and usually fatal adrenal crisis called Addison’s Disease. Talk to your vet about slowly tapering the drug in a controlled manner.

To treat PDH or AT you really need to know which form it is. To do this, all we need to do is schedule an abdominal ultrasound examination. Any trained ultrasonographer should be able to easily locate and carefully examine the adrenal glands.

If the adrenal glands are both evenly enlarged, it’s PDH. If one gland is irregularly enlarged, and the other one shrunken, it’s AT.

Treating AT can be easy or hard. If it’s nicely isolated then it’s a reasonably simple surgery to remove an adrenal tumour. The problem is that the adrenal gland nestles next to the aorta and vena cava, the two major blood vessels in the body. If the tumour has spread into these (usually already detected on ultrasound) we can’t operate.

Dogs with inoperable AT, or those awaiting surgery, often still respond well to trilostane…

Dogs with PDH have a good prognosis. The pituitary tumour is not yet able to be removed in Australia, but it shouldn’t cause any other problems.

We use drugs to either suppress the production of cortisol or block its action in the body.

Trilostane (Vetoryl™)
The only drug registered for the treatment of cushings disease in dogs in Australia is trilostane. It’s also the safest. For these reasons, we’ll always recommend using this drug first. It works by blocking the action of cortisol at the receptor sites in the body.

Advantages are the high safety index, the reversibility when stopped and good results (and the legislative protection for us vets!). It’s also a very good drug to use when planning AT surgery.
The main disadvantage is cost, when compared with the older treatment. There is also a reported occurrence of acute adrenal necrosis when using trilostane, which we have seen twice without serious consequences.

Mitotane (Lysodren™)
For decades this was the treatment of choice until the availability of trilostane. It is a form of specific chemotherapy which targets the adrenal gland. By giving just the right amount, we selectively destroy or deactivate a percentage of the adrenal gland until it produces the right amount of cortisol. You can see why this drug is more dangerous; too much can cause irreversible damage. It’s also not licensed in dogs, meaning vets have to obtain informed consent for its use. Owners need to take full responsibility for any unforeseen or harmful effects resulting from its use, and release the vets from any blame.

We still use mitotane in three situations, when:

Trilostane treatment produces unsatisfactory results
The cost of trilostane is unacceptable to a dog owner
Giving tablets is very hard or unsafe
Long term therapy with mitotane is possible with only one or two doses per week, instead of daily doses with trilostane.

With both treatments, frequent monitoring is essential. Cortisol is a vital hormone in the body, and overdosing with either drug can be fatal.

How Successful Is Cushings Treatment?
Very. We like diagnosing and treating Cushings Disease in dogs because we know how much most dogs will improve. The onset of symptoms is slow and often thought to just be the effects of ageing. Inside most dogs with cushings syndrome is a playful, active & healthy puppy just waiting for you."

You can disagree with any of this, ladies - I do not particularly like the vet who emailed me as he was extremely rough with my geriatric cat, and prefer Dr Clare Daly who works there. Do they sound honest in everything written above? It looks like its going to be VERY EXPENSIVE with the ACTH test, PLUS ultrasound, plus any other tests, then medicine. It's not fair to do this to pet owners who want the best for their pets :(

[MyBabyScooter]

http://www.k9cushings.com/forum/picture.php?albumid=1106&pictureid=8433

I hope I added a photo here in the right way?... It is showing Scooter's hair growth which was very slow then Boom! Long and glossy, but not thick like it used to be.

[molly muffin]

I have to say that their write up on cushings is in my opinion, spot on. They seem to be very aware of the testing and the treatment options and what they do and the dangers associated. So that is good.
The key is getting a firm diagnosis, and then making sure they start at the right dosage, 1mg/1lb or 2mg/1kg. If it is an adrenal tumor I think there was something written recently about perhaps starting at 1mg/1kg too.

I would have an ultrasound as a next step, just bang for the buck. In the end myself, I had all the tests done, LDDS, ACTH, ultrasound. Since cushings progresses slowly there is time to go slowly and make sure that it really is cushings before jumping into treatment and that was what I personally opted to do.

Yes got a nice coat going there. Molly's isn't thick any longer either. She has lost that undercoat that she always had and now has the longer straight hair, not curly like it use to be. She is still white though, as some dogs hair comes back in a totally different color. Those hair follicles can be tricky little buggers and it's amazing how much affects them.

[MyBabyScooter]

Thanks Sharlene, but I believe in Lori's comments that the haematology would be affected, yet my vet downplayed that. I do have a distrust of vets, I'm afraid. Partly because their fees are so HIGH. And many years ago, I admitted to a vet before they treated my sick cat that I couldn't pay in full on the day and they turned me and my cat away without treatment! I told them they care about money more than animals, and she said as a pet-owner, I shouldn't have them if I couldn't afford them (well, enough for the vet's payment on the day, that is!)

Plus my current vet said they do the ACTH test, yet other vets I have rang do the LDD and that is the one I would prefer. But my vet is the cheapest at $280 for that test and other vets are $350 - $450. Plus the ultrasound?? This is going to break me financially. I love Scooter more than anything but these vet prices are so unfair. I will ring the vet tomorrow re the price of the ultrasound. Could the ultrasound alone discover Cushings?

P.S. Also, I've read that the LDD can be misread if the dog is stressed, more so than the ACTH. My dog is VERY stressed, beginning from my young son constantly teasing him as a puppy, despite my reprimands. To be at the vets for many hours (and without me) would cause him a great deal of stress. If you think that is true, I guess I should opt for the ACTH.

[Harley PoMMom]

In this economy it is a day to day struggle just to keep a roof over our heads so finding extra funds to pay for ridiculously expensive testing and treatment is daunting. One of the ways that helped me with the expense was applying for Care Credit. If you are not familiar with this, it's like a credit card and depending on how much the bill is, you can get interest free terms anywhere from 90 days to a year. This information and other financial resources can be found here: http://www.k9cushings.com/forum/showthread.php?t=212

Unfortunately one of the things that makes Cushing's so challenging and expensive is that there is not one test that can 100% accurately identify it, so vets need to perform multiple diagnostic tests to validate a Cushing's diagnosis. An ultrasound would be my next step and if both of the adrenal glands are visualized this can aid in differentiating between the adrenal or pituitary type of Cushing's. If an adrenal tumor is involved, one adrenal gland will be larger and the other gland will be much smaller or even atrophied from lack of use. When bilaterally enlarged adrenal glands are seen this is indicative to the pituitary type of Cushing's.

Since Scooter does experience a high degree of stress at the vets I wouldn't recommend the LDDS test because extreme stress can skew those results so an ACTH stimulation test and/or ultrasound, I believe, would be a better option.

Hugs, Lori

[MyBabyScooter]

Thanks again Lori.. I don't think any of those funds are in Australia, but I will do some research in the morning and see if there's something like that here :)

P.S. Two days later. I wrote to the vet, asking for the cost of the ultrasound, and if he knows of any similar funds and received no reply. Does he want my custom, I wonder

[MyBabyScooter]

Hello again... I read today Cushings dogs should not have sardines and offal (something to do with purine). Only one website mentioned it and no other sites said anything about them. I was wondering if anyone knows as I've been giving my dogs a sardine each for a couple of years and 10% of the raw meat mixture I make has been chicken livers. Also I read they should have fish oil daily but I stopped that when I suspected Cushings as I thought it was now unneeded. Thanks for any help :)

[MyBabyScooter]

I will just continue as usual.

Scooter is having the LDDS at the only vet I trust a long way from here on Friday.

[Whiskey's Mom]

I don't know anything about sardines, etc. I just know my dog thinks he's a person since he only eats dog food when he feels like it! I'm about out of my mind trying to figure out food, supplements etc. it's all very confusing! Good luck with your test-Scooter is such a cutie!

[Harley PoMMom]

I do remember reading somewhere that foods high in purine levels should not be given to dog's with Cushing's but have never found a concrete reason why they shouldn't be given.

[Squirt's Mom]

Squirt ate sardines in her home cooked food every single day for over 6 years.

[MyBabyScooter]

Squirt ate sardines in her home cooked food every single day for over 6 years.
Good to hear... I will continue with his daily sardine... thankyou :p

[MyBabyScooter]

I do remember reading somewhere that foods high in purine levels should not be given to dog's with Cushing's but have never found a concrete reason why they shouldn't be given.

Thankyou for that :)

[MyBabyScooter]

I don't know anything about sardines, etc. I just know my dog thinks he's a person since he only eats dog food when he feels like it! I'm about out of my mind trying to figure out food, supplements etc. it's all very confusing! Good luck with your test-Scooter is such a cutie!
Thankyou, yes he's gorgeous :D

[MyBabyScooter]

Tomorrow is D-DAY!! Scooter is finally going to the vet for an LDDS test! I chose the ONLY vet I trust, half an hour away rather than my new one much closer, had a chat to him, and now Scooter is on a 12 hour fast, poor thing. I have to take him very early in the morning and my favourite vet will check him over to see what he thinks, then go ahead with the test if he thinks he needs it, at a greatly reduced price because he's just the Best :p

Scooter's only symptoms are hunger and boniness... I can feel his bones all over, including his skull. He's not underfed; I've been feeding him more this last week in case he was just becoming thin from hunger, but his boniness has only increased. He has no other symptoms!! (oh a pot belly, but that's not overly big)

I will let you all know the outcome late tomorrow! :confused:

[DoxieMama]

That's great! I'll be watching for your update. :)

[MyBabyScooter]

That's great! I'll be watching for your update. :)

THANKYOU :o

[Joan2517]

He is just sooo cute!

[MyBabyScooter]

He is just sooo cute!

Thankyou - and so is the gorgeous doggie in your icon! :p :p

[MyBabyScooter]

Scooter had his LDDS today, and he was so funny when I got him 9 hours later, running round the vet's surgery wildly and hardly even recognising me as he was running too fast to stop and look!! In the car on the way home, he jumped on my lap which he never does when I'm driving, and just acting extra silly. I don't know if he had been in a tiny cage for all that time and was finally free, or what?? :o

The vet said during the examination before the test that he didn't seem like a usual case of Cushings - so will find out the result tomorrow or Monday.

Tonight he has drank so much water, he does seem like a Cushings dog, unless maybe the medicine they inject gives them a small dose of Cushings??? I don't know :confused: Anyway, I'm trying to give him a lot of love after all he went through today, and am eagerly awaiting the vet's phone call!

[judymaggie]

Hi! Many of us have seen our pups return home, after an ACTH or LDDS test, with what I call the "crazies", hyperactive and with exaggerated thirst. The LDDS involves giving them a low dose of dexamethasone (af form of cortisone). This wears off after a period of time.

We will be awaiting test results along with you!

[MyBabyScooter]

Hi! Many of us have seen our pups return home, after an ACTH or LDDS test, with what I call the "crazies", hyperactive and with exaggerated thirst. The LDDS involves giving them a low dose of dexamethasone (af form of cortisone). This wears off after a period of time.

We will be awaiting test results along with you!

That's EXACTLY how he was judymaggie!!! :D Only two hours left before vet closes today so if I don't hear from him by then, I'll have to wait till Monday :(

[MyBabyScooter]

Despite only having hunger, boniness (if that applies - muscle-wasting?) and a pot belly sometimes, Scooter does have Cushings. No other symptoms.

He had the LDDS test last week, which said it's pituitary (wrong spelling no doubt). I heard if they're an anxious dog, the LDDS can be falsely positive, but the vet doesn't agree. And he said Scooter slept most of the 9 hours. But due to being teased as a puppy, he has always been a nervy dog.

The vet wants to give him 20 mg trilostane and he weighs 7.6 kgs now. I thought that seemed a slightly high dose but the vet said it's okay.

I can't wait to get the medicine started and get some meat back on his bony frame :o

[MyBabyScooter]

The results say -

Resting Serum Cortisol 94 nmol/L (20 - 165

Post Dexamethasone Serum Cortisol (3-4 hrs) 22 nmol/L (<40)

Post Dexamethasone Serum Cortisol (8 hrs) 235 nmol/L (<40)


The vet did not suggest an ultrasound, and unless necessary I would like to spare that cost. The medicine and ACTH tests in the near future are expensive enough.

[MyBabyScooter]

Just thought I'd let you all know, as some were curious if he had Cushings.

[molly muffin]

Yes it sure looks like he didn't suppress at all at the 8 hour mark.

I call it the 48 hour spazz as that is how long molly bounces around after her ACTH test. Ferociously hungry, bugging us constantly for something, like every minute, drinks tons, runs around the house, the whole works.

[Harley PoMMom]

I heard if they're an anxious dog, the LDDS can be falsely positive, but the vet doesn't agree.

I disagree with the vet, stress can yield a false positive result on the LDDS test.


Stress and other factors to avoid when performing the LDDST
It is important to remember that "stress"activates the hypothalamic-pituitary-adrenal axis, leading to increased secretion of both ACTH and cortisol. In some normal dogs, the stress response may override the suppressive effects of the LDDST to produce a false-positive test result.

This excerpt is from Dr. Mark Peterson's blog and can be found here: http://www.endocrinevet.info/2012/05/helpful-tips-to-improve-accuracy-of-low.html

Lori

[MyBabyScooter]

I disagree with the vet, stress can yield a false positive result on the LDDS test.



This excerpt is from Dr. Mark Peterson's blog and can be found here: http://www.endocrinevet.info/2012/05/helpful-tips-to-improve-accuracy-of-low.html

Lori

Thankyou Lori, I read the link. The vet said he slept most of those 9 hours so wasn't stressed. But I think he's a stressed dog in general, especially compared to my maltese shih tzu who is very laid-back. But maybe it's his breed (maltese x foxterrier) or maybe his temperament is normal, I don't know, I've just always thought he was a very nervy dog.

I am meant to be collecting his trilostane in a couple of hours but now I am hesitant. Do you think I should have the ACTH test done first? Do the results from the LDDS seem like normal numbers or way over the top or unusual?

I will add a photo of Scooter in a minute that I took last night as his tummy seems bigger and he MAY be losing hair which you will see, but as for drinking, infections, bruising, lethargy, etc, no way! He does have a lot of boniness - does that mean muscle-wasting?

[MyBabyScooter]

http://www.k9cushings.com/forum/picture.php?albumid=1106&pictureid=8446

His tummy seems somewhat bigger but when lying on his back, it's flat. Hair may be thinning near front leg.

If you compare the photo to some others I have uploaded, his hair was thinning in that place a couple of years ago...

I REALLY need to know your opinion, as in Yes it looks like Cushings, as I am supposed to be collecting the trilostane in a couple of hours.

Thankyou so much!

[Harley PoMMom]

His LDDS test results do point to the pituitary type of Cushing's and I don't see anything out of the ordinary with them....they just point to PDH.

In that pic it does seem like his girth grew somewhat.

With having an ACTH stimulation test done before treatment is started, it does give you a sorta "base-line" result to compare to.

I can't say that this is absolutely Cushing's, gosh, I am sorry, I do recommend that you go with your gut decision on this, because only you know Scooter best.

Hugs, Lori

[MyBabyScooter]

His LDDS test results do point to the pituitary type of Cushing's and I don't see anything out of the ordinary with them....they just point to PDH.

In that pic it does seem like his girth grew somewhat.

With having an ACTH stimulation test done before treatment is started, it does give you a sorta "base-line" result to compare to.

I can't say that this is absolutely Cushing's, gosh, I am sorry, I do recommend that you go with your gut decision on this, because only you know Scooter best.

Hugs, Lori


Thankyou Lori.... I guess I should have mentioned I have been feeding the 2 dogs more in the last two weeks as I think I was underfeeding them (2% of body weight instead of 3%), and Scooter has gone from 7.5 to 7.8 kg whereas Daisy my maltese shih tzu has stayed the same.

I rang the vet just then, and he said for peace of mind, I could get a urine test done which would prove it, but he is 100% sure Scooter has Cushings. Arghhh!! And you wonder why I called my thread Confused! Now it's whether to buy the trilostane, do a urine test, or an ACTH test.

He must have an ACTH test two weeks after the medicine starts, or would that be too late to tell if he has Cushings?

[molly muffin]

The ACTH test that is done after he starts out on the medication will tell you how much is cortisol has lowered. It won't tell you where you started at. However, since the LDDS does point to cushings and his belly (mine is flatter if I lay on my back too!!!) could point to cushings, along with some hair thinning. I personally don't think it is absolutely necessary to have the ACTH before you start. Don't skip the 12 - 14 day one though. If you see any adverse effects you stop the med.
It sure can be confusing and money is always a factor so those are my thoughts.

[MyBabyScooter]

The ACTH test that is done after he starts out on the medication will tell you how much is cortisol has lowered. It won't tell you where you started at. However, since the LDDS does point to cushings and his belly (mine is flatter if I lay on my back too!!!) could point to cushings, along with some hair thinning. I personally don't think it is absolutely necessary to have the ACTH before you start. Don't skip the 12 - 14 day one though. If you see any adverse effects you stop the med.
It sure can be confusing and money is always a factor so those are my thoughts.

Thankyou for writing :) I worked out last night that he has 5 of 15 symptoms.... pot belly, hunger, possible thinning hair, a few blackheads, and boniness (if that means muscle-wasting). No drinking, panting, lack of energy (it's boundless), infections etc. I could wait another few weeks and see if he loses more hair, then I'd be more convinced. Or have him tested further now, or start on the trilostane. Decisions, decisions... they're really affecting me over Scooter :(

[molly muffin]

My dog never had the hungry or drinking symptoms. Her hair didn't get bad for a long time just lost the undercoat at first. It has gotten thinner now even on med but then she also has kidney issues now. I'd say she didn't really look Cushing's until quite recently. She's been on meds for awhile.
The thing I am getting at is every dog is different.
None of this is easy we know our decisions affect and do we want to make the best decision possible. This leads to us second guessing ourselves every step of the way. You aren't alone. We all do it.
I personally opted for the ACTH before starting. That was just me though and she had do few symptoms that I felt I had to be sure of what was going on. She did have high cortisol. And we started treatment when she also developed high blood pressure that was causing some eye problems. That's our story. Don't know if it helps or not. But we do understand as we have all been where you are now.

[MyBabyScooter]

Thankyou Sharlene. I decided to not buy the trilostane today. But am still so confused. Re the urine test, the vet already gave me a collecting bowl and small jar last week. Do you know if this test is very accurate? And does it have to be his morning wee? If it's VERY accurate, it sounds the way to go....

[DoxieMama]

From what I understand, if this test is the urine cortisol:creatinine ratio test, it will absolutely tell you if he does NOT have Cushing's.... or that he MIGHT have it. It will not tell you for sure that he does. I hope that makes sense.

[MyBabyScooter]

Hmmmmmm..........

[Squirt's Mom]

Please help me out - am I understanding correctly that you or your vet is wanting to start treatment for Cushing's WITHOUT any testing for the disease?

[MyBabyScooter]

This is the third time I'm writing this but it hasn't been showing when I click submit :( Just 2 more questions... Is a bony spine, hips, shoulders etc a symptom of Cushings as googling this all the time is not telling me :( And a possibly silly question is can trilostrane harm a dog if they don't have Cushings? Thanks for any help, again.

[MyBabyScooter]

Please help me out - am I understanding correctly that you or your vet is wanting to start treatment for Cushing's WITHOUT any testing for the disease?

No, not at all

[labblab]

Hello from me, and I'm so sorry for all your worry and confusion. I don't believe I've had the chance to write to you before, but here are a few thoughts of my own in answer to some of your questions.

First, redistribution of fat to the abdominal area alongside weakening abdominal muscle mass/strength are what account for the development of the classic Cushing's pot belly. It would make sense to me that if fat is shifting from elsewhere in the body, it could result in the appearance of some "boniness" in the areas left behind. But as to whether or that would be enough to account for Scooter's overall bony appearance, I do not know. What would not be characteristic of uncontrolled Cushing's is for the pot belly to fluctuate dramatically over a short period of time. Once it has formed, it would likely remain until cortisol levels are normalized. So if Scooter's tummy is truly going up-and-down over the course of a few days or a couple of weeks, I'd have to suspect that something else is going on -- perhaps periodic fluid collection in his abdominal area? Although expensive, this might be another reason to consider an abdominal ultrasound, especially during a time period when his tummy is enlarged, in order to visually inspect what is really going on.

Secondly, DoxieMama is correct: if the urine test is a UC:CR (urinary cortisol to creatinine ratio), it cannot confirm Cushing's. It can tell you whether there is an abnormal level of cortisol present, but it cannot tell you whether or not Cushing's is the cause. The LDDS is a test that is specifically designed to test for Cushing's, and Scooter's 8-hour result was most definitely elevated (it converts to 8.5 ug/dL for our U.S. readers). That reading is highly above the normal cut-off. With a reading that high, I don't think I'd personally bother with a UC:CR urine test. The urine test is typically used as an initial screening tool to decide whether there is any value to proceed to the more specific LDDS or ACTH testing. Since you've already got the LDDS results in hand, I don't think the UC:CR will add a lot to the mix.

Since finances are certainly a consideration and if it is a choice between an ACTH or an ultrasound, I think I'd personally opt for the ultrasound. It is true that the ACTH is the most "specific" Cushing's blood test. But since we know from the LDDS that Scooter's adrenal hormone production is abnormal and consistent with Cushing's -- for me, the question would be, "Is there anything else going on internally, other than Cushing's, that might account for the elevated LDDS result." If not, then I'd figure that Cushing's is the best explanation and proceed.

If finances prohibit any more testing at this time and you do proceed with the trilostane, you have asked whether it will harm Scooter if he doesn't actually have Cushing's. Trilostane is a powerful drug, and obviously it should not be given without careful monitoring. However, in reality, it has also been used by some researchers to treat hair/coat disorders in dogs who do not suffer from Cushing's. So as long as you start with a low dose of the drug and proceed with appropriate monitoring blood testing, the probability is that Scooter would not suffer from ill effects that cannot be remedied if the drug is discontinued. Of course, however, any dog can react poorly to any drug. Effective medications always also carry risks.

Whatever you decide to do, please know that we'll remain here to walk alongside you, OK?

Marianne

[Squirt's Mom]

No, not at all

~~whew~~ My little mind was going bonkers with fear! Thank you for helping me understand.

[MyBabyScooter]

Hello from me, and I'm so sorry for all your worry and confusion. I don't believe I've had the chance to write to you before, but here are a few thoughts of my own in answer to some of your questions.

First, redistribution of fat to the abdominal area alongside weakening abdominal muscle mass/strength are what account for the development of the classic Cushing's pot belly. It would make sense to me that if fat is shifting from elsewhere in the body, it could result in the appearance of some "boniness" in the areas left behind. But as to whether or that would be enough to account for Scooter's overall bony appearance, I do not know. What would not be characteristic of uncontrolled Cushing's is for the pot belly to fluctuate dramatically over a short period of time. Once it has formed, it would likely remain until cortisol levels are normalized. So if Scooter's tummy is truly going up-and-down over the course of a few days or a couple of weeks, I'd have to suspect that something else is going on -- perhaps periodic fluid collection in his abdominal area? Although expensive, this might be another reason to consider an abdominal ultrasound, especially during a time period when his tummy is enlarged, in order to visually inspect what is really going on.

Secondly, DoxieMama is correct: if the urine test is a UC:CR (urinary cortisol to creatinine ratio), it cannot confirm Cushing's. It can tell you whether there is an abnormal level of cortisol present, but it cannot tell you whether or not Cushing's is the cause. The LDDS is a test that is specifically designed to test for Cushing's, and Scooter's 8-hour result was most definitely elevated (it converts to 8.5 ug/dL for our U.S. readers). That reading is highly above the normal cut-off. With a reading that high, I don't think I'd personally bother with a UC:CR urine test. The urine test is typically used as an initial screening tool to decide whether there is any value to proceed to the more specific LDDS or ACTH testing. Since you've already got the LDDS results in hand, I don't think the UC:CR will add a lot to the mix.

Since finances are certainly a consideration and if it is a choice between an ACTH or an ultrasound, I think I'd personally opt for the ultrasound. It is true that the ACTH is the most "specific" Cushing's blood test. But since we know from the LDDS that Scooter's adrenal hormone production is abnormal and consistent with Cushing's -- for me, the question would be, "Is there anything else going on internally, other than Cushing's, that might account for the elevated LDDS result." If not, then I'd figure that Cushing's is the best explanation and proceed.

If finances prohibit any more testing at this time and you do proceed with the trilostane, you have asked whether it will harm Scooter if he doesn't actually have Cushing's. Trilostane is a powerful drug, and obviously it should not be given without careful monitoring. However, in reality, it has also been used by some researchers to treat hair/coat disorders in dogs who do not suffer from Cushing's. So as long as you start with a low dose of the drug and proceed with appropriate monitoring blood testing, the probability is that Scooter would not suffer from ill effects that cannot be remedied if the drug is discontinued. Of course, however, any dog can react poorly to any drug. Effective medications always also carry risks.

Whatever you decide to do, please know that we'll remain here to walk alongside you, OK?

Marianne
Thankyou very much Marianne for such a well thought-out comment - you must have done a lot of reading about Scooter :) So the LDDS could be completely inaccurate if he was a stressed out dog? Or are the readings too high for that? Would most dogs be stressed at the vets? If so, he's not much different to them? But I know they only waited half an hour to start the test, yet I've read vets should wait an hour before starting.

I am not 100% sure if his tummy is constantly changing, but I feel it has, and going by the photos.

The only reason I would be keen to start trilostane now is his hunger and boniness. He has no other symptoms that are worrying.

I am getting on in years which is why I am confused and my mind is a jumble over this - and other things! :rolleyes: I will come to a decision today re ultrasound or trilostane. Thankyou again, Marianne!

[Squirt's Mom]

When my baby, Squirt, was going thru the diagnostic phase to see if she had Cushing's I wanted to be sure I had every base covered so she had every test available - LDDS, HDDS, ACTH, UTK panel, and two ultrasounds - and she was positive for Cushing's on all of them. After the second US (long story) I was told about a tumor on her spleen. I opted for surgery and after the tumor and half her spleen were removed her cortisol returned to normal. It was the tumor causing all those tests to be positive. So in my experience the abdominal ultrasound is the test I recommend most often for pups in the diagnostic phase. Not only will it let them see the adrenal glands and should let them see tumors there, it will give them a look at many other organs to see if there are any issues - like that tumor on my baby's spleen. It was several years before she had to start treatment for Cushing's but if I hadn't had that ultrasound I would have started treatment right away - and the odds are she would have died when the tumor ruptured. So if folk have the funds and access to a high resolution ultrasound machine, this is the test I strongly recommend all dogs have.

FYI - the HDDS is an OLD test that was used to determine if the pup had the pituitary or adrenal form of the this disease. The LDDS can now make that distinction so the HDDS is no longer used. ;) The UTK panel is a test that looks at not only the cortisol, like the LDDS and ACTH, but also looks at the intermediate hormones, or sex hormones. Most people don't have the UTK panel unless all the other tests are normal yet their baby is still showing signs of Cushing's - then we look at the intermediates. But I'm a bit of an obsessive mom and I usually want to know EVERYTHING ..... NOW! :D :o

Hugs,
Leslie and the gang

[MyBabyScooter]

Thanks Leslie... it sounds like an ultrasound is really important, especially with such few symptoms of Cushings yet positive LDDS test. I am running so short of money but should consider it.

I know Vet A, who I don't really like or trust, re the way he handled my geriatric cat, plus high prices, charges $450 for ultrasounds which is a huge amount to me now.

Vet B, who is the only one I trust, has just started using ultrasounds - they've just acquired their first machine. He would charge less, as he's always considerate of my financial situation, but hopefully he would be just as experienced despite being a newbie with ultrasounds.

Vet A said they always do ultrasounds after the ACTH (they don't do LDDS). Vet B has not offered an ultrasound. So A or B? lol I think I will ring B tomorrow morning, ask the price and see what his opinion is on Scooter having one. Thankyou again, Leslie :)

[judymaggie]

Hi! Leslie mentioned the need for an ultrasound with a "high resolution" ultrasound machine. This is really important in order for the vet to clearly see all the organs and what is going on with them. You would be wasting your money otherwise. So ... in trying to decide which vet to go with, be sure to ask them about their machine.

[MyBabyScooter]

Hi! Leslie mentioned the need for an ultrasound with a "high resolution" ultrasound machine. This is really important in order for the vet to clearly see all the organs and what is going on with them. You would be wasting your money otherwise. So ... in trying to decide which vet to go with, be sure to ask them about their machine.

Okay, but it's going to be a bit embarrassing to ask How good is your machine lol They will both probably say Excellent :o

[Squirt's Mom]

What you ask is - "Is this a high resolution machine?" and if they say no - then ask where you can take Scooter to have the test done on such a machine. ;)

[MyBabyScooter]

What you ask is - "Is this a high resolution machine?" and if they say no - then ask where you can take Scooter to have the test done on such a machine. ;)

Oh thankyou, that sounds better :)

But due to how much water Scooter has been drinking the last two (cold) days, I may not need much more proof... more than usual, that is for sure, so it may be another symptom :(

[Squirt's Mom]

The purpose of the ultrasound isn't so much more proof - it is to make sure there isn't something else going on, like a tumor somewhere. ;)

[MyBabyScooter]

The purpose of the ultrasound isn't so much more proof - it is to make sure there isn't something else going on, like a tumor somewhere. ;)

It does seem a bit strange that Vet A (who charges a lot) and who only does the ACTH test, not LDDS, said he ALWAYS does an ultrasound after the test (at $450).

Vet B, who has only just acquired an ultrasound machine and did the LDDS, did not even mention doing an ultrasound?

I will ring my favourite, Vet B, tomorrow and ask if there's any purpose to having an ultrasound and see what he says.... :)

[MyBabyScooter]

I was just reading another thread and read the dose of trilostane is 2mg per kg. Scooter has been prescribed 20mg and he is 7.8 kg roughly. Is that dose okay if he does start the medicine? Thanks...

[MyBabyScooter]

Hello again... I have been visiting here but haven't posted for a while. Just watching Scooter's symptoms still before picking up the trilostane that is waiting for me to collect...

His only symptoms are the pot belly which is not HUGE, the hunger which now my maltese shih tzu has too unless she is copying her big brother and wants to stare at me most of the day (she IS a copy-cat in many ways), and his boniness. No thirst (2 drinks a day at 10 seconds each), no hair loss, silky hair, no skin discoloration or infections, no panting, lots of energy, can jump and walk for miles.

I just rang Vet B who I trust re an ultrasound, and as their machine is new to them, they said they wouldn't have the expertise yet to use it on Scooter but they could send me to a specialist. I know Vet A who I don't really like or trust told me a while ago they always do ultrasounds after the ACTH test (they don't do LDDS) and it's $450.

Vet B suggested an ACTH test on top of the LDDS they recently did, to see if Cushings is confirmed. So do you think I should have an ACTH test now at $250 with Vet B, or an ultrasound at $450 with Vet A... considering his lack of symptoms?

If I have the ultrasound done with Vet A, it's going to be so embarrassing to tell them I had the LDDS with a different vet, considering all the communications I had with them weeks ago (and with Vet B) when deciding what to do lol

Thanks for any help :o

[Harley PoMMom]

Regarding your question about the dose in you prior post; 2 mg per kg is the recommended starting dose so for Scooter's weight of 7.8 kg (17.4 lb) the 20 is a bit high, if Vetoryl is the choice of treatment and if this were me, I would feel more comfortable with a starting dose of 10 mg especially taking in account his lack of symptoms.

My preference between an ACTH test or an ultrasound performed would be the ultrasound as it may find something else that is causing his symptoms.

Hugs, Lori

[MyBabyScooter]

Regarding your question about the dose in you prior post; 2 mg per kg is the recommended starting dose so for Scooter's weight of 7.8 kg (17.4 lb) the 20 is a bit high, if Vetoryl is the choice of treatment and if this were me, I would feel more comfortable with a starting dose of 10 mg especially taking in account his lack of symptoms.

My preference between an ACTH test or an ultrasound performed would be the ultrasound as it may find something else that is causing his symptoms.

Hugs, Lori

Thank you for replying Lori and I appreciate the idea of less trilostane...great advice there! :) I have just rang another vet Scooter has seen and they only charge 150 for an ultrasound. He said its not the greatest machine as it can't see all the details of the heart but can easily check the liver, intestines etc. So I'm giving that a go in an hour. He will also check him over in general and give me his opinion re his symptoms etc. Scooter ate 3 hours ago but he said fasting wasn't necessary. I would love to be in the room with him but apparently I can't... unless he's super stressed. So fingers crossed I will learn more today!!

[MyBabyScooter]

Back from Vet C. She examined Scooter all over and said everything internal feels normal, liver, spleen etc. She said his heart is slow which is apparently good. She said no need for ultrasound and I appreciate her honesty. She said going by the previous blood tests, he does have Cushings... maybe it was caught early which is why he has few symptoms. She recommends I start him on the trilostrane. So just one day of thinking and then I will probably go and collect it. Any final comments? ��

P.S. Do you think I should have the ACTH before starting the trilostane or do I have proof enough? I remember reading, I think, that we shouldn't believe only ONE test re Cushings?

[MyBabyScooter]

Regarding your question about the dose in you prior post; 2 mg per kg is the recommended starting dose so for Scooter's weight of 7.8 kg (17.4 lb) the 20 is a bit high, if Vetoryl is the choice of treatment and if this were me, I would feel more comfortable with a starting dose of 10 mg especially taking in account his lack of symptoms.

My preference between an ACTH test or an ultrasound performed would be the ultrasound as it may find something else that is causing his symptoms.

Hugs, Lori

Thanks Lori... I just remembered, the trilostane is all made up and waiting for me and is probably capsules! 20mg ones. Either I ask the vet to change the dose, or I accept these capsules... what would you do? Scooter now weighs a little less - 7.6 kg.

[Squirt's Mom]

Too bad you couldn't find a vet with a high resolution machine. :(

[MyBabyScooter]

I can see everyone's fed up with me now and I won't be posting or visiting any more.

[Squirt's Mom]

Oh dear....why?! No one is fed up with you at all! We want to know what's going on every day with your sweet baby! You can't leave! You're family! :(:(:(

[Joan2517]

I can see everyone's fed up with me now and I won't be posting or visiting any more.

Why would you say that? No one ever gets fed up with all the news...where else can you go on and talk about poop? :rolleyes:

[DoxieMama]

Thanks Lori... I just remembered, the trilostane is all made up and waiting for me and is probably capsules! 20mg ones. Either I ask the vet to change the dose, or I accept these capsules... what would you do? Scooter now weighs a little less - 7.6 kg.

I would ask for a lower dose. I *did* ask for a lower dose than the vet wanted to start for my pup.

I too hope you stay. It's difficult sometimes to post on a forum, especially about something so near and dear to us as our pups, wanting and waiting and hoping that someone will reply - and soon! My patience has been tested many times on forums, wondering if anyone is going to reply to my post. Personally, I do not always reply to the posts because I don't know what to say... no suggestions or questions or anything really helpful. At those times, I need to remind myself that if it were ME that had posted, even a response that says "I'm sorry, I don't have any answers but you are not alone" can provide me some measure of calm.

Maybe there is another reason for your comment, but this is how I feel sometimes. And if it is how you feel, too, then please know that we are here for you. You are not alone. It just might take us a few more hours to reply....

Hugs and ear scritches for your cute little Scooter.
Shana

[Harley PoMMom]

I can see everyone's fed up with me now and I won't be posting or visiting any more.

Oh sweetie, I am so very sorry if we made you feel like that :( in no way what so ever are we "fed up" :( please, please do not leave us. I know sometimes I can lose track of a member's post and rest assured, it's not because I'm avoiding them.

Since the Trilostane is already in the 20 mg capsules, I believe what I would do, if feasible, is purchase 5 mg capsules, in this way Scooter could be started at 10 mg and if a dosage increase is needed you can just add 5 mg at a time, and if the dosage increases to 20 mg than you already have them.

Hugs, Lori

[Squirt's Mom]

I second every word Shana and Lori said. It's often difficult to communicate in writing well, too. We can't see body language, see facial expressions, or hear tones and infections in voices so it's easy to take something one way when it was meant another altogether. If my comment is what upset you, I apologize - nothing more was meant by it other than what it says....I am sad better equipment wasn't available for you and your baby. I was lucky when Squirt was diagnosed to live in a large metropolis where anything and everything needed was there....that's not the case where I am now. I have a pup who was first diagnosed with severe heart disease because of an inferior xray machine and bad film that was used. I learned that sadly there are no cardiac vets in my state - none. But when an IMS in the large city nearby re-ran the tests, turns out her heart was fine but her lungs are diseased. She was misdiagnosed and the wrong treatment prescribed all because of the equipment available in my small town.

None of us are vets but we do all care and we all want to help where and when we can using our own experiences and knowledge gained thru the years here. We are here for you and Scooter, and I hope to hear from you again soon.

[Whiskey's Mom]

I hope you stay too! :)I'm a sensitive person and even more so when it comes to my loved ones (human and furry). I would love to comment on everyone's posts-especially new people-because I know how overwhelming & emotional I felt and still feel, but I don't want to seem like a pest. Please stay, because I wish I would have joined this forum immediately after Whiskeys diagnosis- the support and knowledge would have been most helpful. All the best to you and Scooter!

[molly muffin]

Oh dear. I'm afraid that some of your posts didn't get the response they should have. :( We do apologize for that as we have been short staffed the last few weeks.

I would try to get a 10 or 15 compounded trilostane to start due to lack of symptoms.

I do think if you did ever decide to do an ultrasound that a high res one would be preferred so they could adequately measure adrenal glands or anything else that shows up.

Did you go with the 20mg and start? How is Scooter reacting if so?