Might have a Cushings Dog- curious as to comments

[bvlessing]

I have an 8 year old 35 pound Cocker- Buddy. Its been an interesting journey.
Luckily- unlike many Cockers- he has been a pretty healthy dog- basically I have only had to see the Vet 2X a year- once for checkup and once for some ear or gastro issue.
About 6 months ago(feb)- he started having some gastro issues- diarrhea etc. the vet treated him for that.
It came back again 4 months ago(April)- and I decided was not in love with the vet I went to* there were 2 in the office- so my groomer recommended another one she went to. The new one had me do all sorts of tests and stuff and $600 later- was told he had crystals in the urine needed to be on Hill c/D for life etc... and treated with the usual drugs.
But then- we started to see alot of panting and crazy amounts of drinking water- and some peeing/pooping in the house( btw the previous two incidents of Gastro issues- also alot of peeing/pooping. The panting concerned us- and he did not want to walk like he usually did- and just was lethargic. I went back to the Name Partner on the door of the vet I usually went to see( basically I ended up seeing his Partner always)-- and he looked at the test results of the vet who did $600 worth of tests.- said actually the labs had shown there were no crystals but had high numbers for other items but panting/constant drinking and the results pointed to Cushings- btw- no hair loss, no pot belly- and he always like to scarf food..he did the first blood work- and got a result of 9-- resting cortisol test he called it- and range is 2-6. Paid $ 119 for that. This past Thursday-- he had him for the day and he did the three blood work tests- cost $300-- and results coming today/tomorrow.. What should I be asking when he gives me results. My groomer said- she has had dogs that have been sick- diagnosed with all sorts of things like Cushing- she said she worked with a guy who makes all natural pet food- grinding meats together etc.. and that with that diet- the numbers went back to normal etc.. Curious on your thought on this. I know with a dog panting when he first wakes up and when he goes to sleep- something is not right. But again-what numbers should I be asking for and thoughts on how to handle all this.... THanks!!

[Squirt's Mom]

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[DoxieMama]

Welcome to you and Buddy! I would ask for copies of all the test results, that way you have it all in front of you and available in case you need to take him to another vet. Do you have the results of the previous tests? If so, please post all that are abnormal, along with the reference ranges. When you get the results of the LDDS test post all three numbers. We'll help you make sense of it. :)

In the meantime, there's lots of helpful information in our Helpful Resources (http://www.k9cushings.com/forum/forumdisplay.php?f=10) forum.

Shana

[lulusmom]

Hello and welcome to you and Buddy.

Resting cortisol is often included in the blood chemistry test so I am assuming that the $119 you spent was not just for the cortisol but rather the full blood chemistry. Is that correct? If not, you should ask for a refund because that result cannot be used for anything. Regardless, your vet should have done a full senior screening which includes a blood chemistry, cbc and a urinalysis. Since buddy is suspected to have cushing's, your vet should have also done a urine culture. You mentioned that the vet didn't see any crystals in the urine so that's pretty clear that at least a standard urinalysis was done. I would be more interested in seeing the urine specific gravity (USG). Cushdogs with clinical polyuria and polydipsia caused by cushing's have low specific gravity so if Buddy's increased drinking and pee accidents in the house are being caused by excess cortisol, the USG should be low and his urine diluted. Shana has already suggested that you round up all of the testing and share the results here so I'll just echo her and will be looking forward to seeing the results.

FYI, the LDDS often times will tell you if a dog has pituitary dependent disease but if not, it is highly recommended that differentiation testing be done to make that determination. The abdominal ultrasound is what we recommend as it does much more than that. It give the vet an opportunity to check the adrenal glands and the liver for the usual abnormalities seen in cushdogs as well as a good look at surrounding organs to rule out any non-adrenal problems that might be contributing to or even causing 100% of the symptoms that are usually associated with cushing's. With Buddy's history of gastrointestinal problem, I would recommend that if finances allow, you consider an abdominal ultrasound regardless of the LDDS test interpretation.

Glynda

[bvlessing]

Thanks much- seeing Dr at Noon today and now I know what to look for.

I would add that he told me that Cushings often leads to lower immune system- so his thinking was that the recurring issues with gastro issues and the "bug"- could very well be due to that his immune system is low due to Cushings so can not fight off that bug causing the issue.

In any case- he wanted to read me the results and discuss over the phone per his office- but I insisted I wanted to come in and look at all the test results etc.. TKS and will let you know what happens

[judymaggie]

Hi and welcome to you and Buddy! I wanted to follow up on Glynda's suggestion to have an ultrasound as the next step. Many of us have gone this route, both as a diagnostic tool and as follow-up with regard to specific findings. It is very important to have the ultrasound done by an experienced technician on a high resolution machine. If not, the findings are not reliable and can be an expensive waste of money. I, and others, have chosen to pursue consultation and ultrasound with an internal medicine specialist (IMS). This usually requires a referral from one's vet and the ideal situation is where both vets work together.

Many vets (and I personally believe most) do not have a lot of experience treating Cush pups. This is another reason to consult with an IMS--they see and treat many more Cush pups. That said, what is critical in successful treatment is for the owner to self-educate. Do spend time in our Helpful Resources forum at the link that Shana provided. If you are educated and your vet is willing and open to communicate with you, Buddy will benefit!

[bvlessing]

so the original resting Cortisol was 9-- and baseline or normal is up to 6... So they had me do the Deamthasone supression test over 8 hours- drew 3 blood results..

Pre Dex baseline was 5, pst 4 was 6.5 and post 8 hours was 8.1 per the lab results.

based on these results-- if my post 8 number test as above 1.5 and the 8 hour test was 50% greater then the baseline of 5 or 7.5-- then the lab results stated it was consistent with pituitary dependent hyperadenocoriticim( PDH)

Dr wants me to have budd take 15 MG of ANipryl for 30 days and then see what happens with the sypthoms and call him and we can decide to leave as is or move up or down.

I trust this vet- I can buy medicine from him or on line- he did not care etc.. another words was not trying to make money and I have a copy of the lab results myself and what they stated... Lab was IDEX.


any thoughts/comments?

[Harley PoMMom]

In interpreting the LDDS results you do not check to see whether the baseline is less than 50% of the 8 hour result. You do the reverse, and check to see whether either the 4 or 8 hour results are less than 50% of the baseline. From Buddy's LDDS results his baseline is 5 (units are ug/dl correct?), his 4 hour = 6.5 and his 8 hour level = 8.1, so neither his 4 hr or 8 hr results were not at least 50% less than the baseline, so this does not differentiate between pituitary or the adrenal form of Cushing's.

I'm providing a excerpt from Dr. Bruyette in the article "ClinQuiz: Interpreting low-dose dexamethasone suppression test results results 2016 update" which he states:
When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism...

If the eight-hour post-dexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Just a note regarding Dr. Bruyette, he is a nationally known veterinary endocrinologist who is considered an expert in canine Cushing's and a frequent contributor to Dechra's veterinary CE courses.

Since the LDDS test could not identify the type of Cushing's Buddy has another test, such as an ultrasound, is needed to do so.

Hugs, Lori

[Squirt's Mom]

Hi and welcome to you and Budd! :)

My Squirt was put on Anipryl (Selegiline) when she was first diagnosed years ago. We were among the lucky ones in that it did help her and for quite some time - about 9 months. Anipryl works ONLY on the pituitary form and ONLY if the pituitary tumor is located in the pars intermedia portion of the pituitary gland. 85% of dogs with Cushing's have the pituitary form and about 20-25% of that 85% have the tumor located in the pars intermedia. So Anipryl will work only on a small population and usually for only a short time. My Sweet Bebe was an aberration....in more than one way. :p

I think it's worth a try especially if the signs are not strong. It does not require the testing that the other two drugs do but it does have some side effects, mostly digestive. Squirt had to take Pepcid AC (MUST be the AC form for dogs ;) ) and then switched to Tagment when the Pepcid AC stopped helping. Her tummy got upset very easily on the Anipryl but that was her only real issue with it.

Be aware that you will more than likely have to move on to either Lysodren (Mitotane) or Vetoryl (Trilostane) in a few months if you do decide to go this route now.

BTW - all forms of canine Cushing's involve a tumor except for the Iatrogenic form which is caused by the use of steroids but the pituitary tumors are microscopic and typically remain so tho there are cases in which the tumor starts to grow. So don't let my use of the word "tumor" upset you. ;)

I am glad you found us and look forward to learning more and sharing this journey with you and Budd as time passes. Know one thing for a fact - you are now part of our family and we will be with you all the way. You and Budd are never alone on this journey.

Hugs,
Leslie and the gang

[bvlessing]

Friends- this is an important one- I am looking at the IDEXX Labs and they say if your 8 hours is > 1,5 and >50% of baseline this is consistent with pituitary. PDH.. so my base line was 5 and the 8 hour was 8--- 8 is greater than 7.5 ( which 50% more than the baseline of 5) and is higher than 1.5 so this would confirm PDH.

Now according to the Vet expert Lori quoted- it says you compare the 8 hour and if it is 50% less than the baseline- which in his could would be 2.5? that does not make sense--- I think we are not interpreting the statistics properly- I think in a PDH dog we are concerned about over secretion of Cortisone- so you would want to see high numbers..

so at a base of 5, a four hour of 6.5 and an 8 hour of 8.1-- this follows that the diagnosis is correct-- I would not think that at 8 hours given the DEX suppression you would see the UG/DL levels go down..


tell me what I am missing?

[Harley PoMMom]

Friends- this is an important one- I am looking at the IDEXX Labs and they say if your 8 hours is > 1,5 and >50% of baseline this is consistent with pituitary. PDH.. so my base line was 5 and the 8 hour was 8--- 8 is greater than 7.5 ( which 50% more than the baseline of 5) and is higher than 1.5 so this would confirm PDH.

Now according to the Vet expert Lori quoted- it says you compare the 8 hour and if it is 50% less than the baseline- which in his could would be 2.5? that does not make sense--- I think we are not interpreting the statistics properly- I think in a PDH dog we are concerned about over secretion of Cortisone- so you would want to see high numbers..

so at a base of 5, a four hour of 6.5 and an 8 hour of 8.1-- this follows that the diagnosis is correct-- I would not think that at 8 hours given the DEX suppression you would see the UG/DL levels go down..


tell me what I am missing?

Buddy's baseline is 5 ug/dl, so his 8 or the 4 hour level would have to be less than or equal to 2.5 ug/dl (which is half of the 5 ug/dl baseline), for a diagnosis of PDH. I know this is so confusing and I hope that I am making sense. :o

Dogs without Cushing's will suppress less than 1.5 at that 8 hour time frame. On Buddy's LDDS test he did not suppress at all, which can be indicative for adrenal dependent Cushing's.

[DoxieMama]

Maybe this will help. See page 3. https://www.idexx.com/resource-library/smallanimal/snap-cortisol-testing-guide-en.pdf

Buddy's results are consistent with Cushing's, but you cannot differentiate whether it is pituitary or adrenal dependent, as both his 4 and 8 hour results are >1.5 AND >50% of baseline.

[molly muffin]

What you are doing with the LDDS test is seeing where their cortisol is at currently on the first draw. Then you are injecting dex which in a dog without cushings will cause them to suppress cortisol production by the adrenal glands The body thinks it has enough so doesn't need to make any more. Then you do this again at the 8 hour and see if they are still able to suppress. In a dog with No cushings, they will suppress to below 1.0 usually or very close to that.
In a dog with cushings, they don't get the message from the 4 and 8 hour injections that they need to suppress and they just keep making cortisol. They might suppress some, but it won't be enough and hence you know you have cushings.
Hopefully that helps you with the test results.