Doxy Just Diagnosed on Friday

[Burlene K]

I am brand new here, our almost 16 year old dachshund Maggie, or Weenie as we call her, was diagnosed on Friday after the LDDS test on Wednesday. Here's the history:
Maggie will be 16 in October. She has always had a huge appetite and for years has had a big belly. Her weight has been about 17 pounds since she was about 4. For the past 2 summers, we haven't walked her because she seemed heat intolerant. This summer, she started panting a bit when she gets overly excited, over exerted or hot. It is 106 where I live today. This is new. She seems to drink a little more than normal, but she and our Golden Retriever together only drink about 5 cups of water per day. She occasionally pees in the house, but she has never been well house broken. She may get up once during the night to pee, sometimes not at all. She has no hair loss, in fact the slight hair loss on the back of her legs that she had some years ago has grown back for at least 2 years. Her skin is good, although she has had a couple of infections that were treated easily with topical antifungals. All of her legs are weaker than they used to be, but I have attributed that to spinal problems from being a Doxy..her back has gone out a few times over the last 3-4 years, and the vet said that she has nerve damage to her limbs from her spine. She can still run, but can't jump up on the couch anymore. She is, after all, almost 80 years old.
Last year in June before her dental cleaning she had routine lab work. Everything was normal except a mildly elevated ALP of 360 and ALT of 260. Repeat liver enzymes in August showed an increase in the ALP to 408, with the ALT down to 171. In November, the ALP was 375 and ALT 175. We had started her on Denamarin prior to the November lab. In March, her ALP went up to 904 (we had stopped the Denamarin) and the ALT 244. In April, again off the Denamarin, her ALT was 947 and ALT 209. She had a brief ultrasound that month as well that showed an enlarged liver but no masses. On July 10, Maggie started limping on her right forearm, so after 2 days, we took her to the vet, who examined her, took xrays, said it was arthritis. He looked at her labs which included the elevated liver enzymes and a urine specimen that showed dilute urine, and said that he thought she may have Cushings. The following week on July 20, she had a non-fasting LDDS. The results were pre-test 13.8. Four hr post injection: 5.0. Eight hour post injection: 4.2. I spoke to the vet on Friday after researching the treatment options and thought it better not to treat Maggie at this time due to her age. He agreed, but is willing to treat her if we decide to go that route. I spoke to a very experienced vet at UC Davis as well who said that "Unless Maggie's quality of life was unacceptable, I wouldn't treat such an elderly dog."
I am here to ask for feedback from all of you. Is Maggie too old to treat? Are her symptoms really significant at this point? She isn't uncomfortable, but I realize that this disease may be doing damage that we cannot see. I want her to have a good quality of life, but if she can be successfully treated, should we start and see how it goes? As a RN, I am used to dealing with humans and some elderly people are strong enough to go through chemo and other difficult treatment, and some do very poorly. I am torn.
Any suggestions and experiences with older dogs like Maggie would be appreciated.
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[Harley PoMMom]

Hi and welcome to you and Maggie!

First let me just say that the fact that Maggie is almost 16 years young is quite a testament to what a great job you have done in making the right decisions for her so far. Cushing's is typically a slow progressing disease, and the decision whether to treat or not depends on a number of factors: age of the dog, apparent discomfort, and severity of symptoms (both external and internal).

The goal of treatment is to control the troublesome symptoms (things like excessive thirst, urination, hunger, panting) and since the damage of untreated Cushing's usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly and my primary concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I probably wouldn't.

It doesn't sound as though Maggie's outward symptoms are problematic to either of you and it seems that, mainly, only the abnormal lab values are what brought the Cushing's treatment into play. In the absence of strong, obvious symptoms it certainly makes it harder to judge if treatment is working. Another reason that makes it difficult in deciding to treat is that it's not pleasant for any dog to go through the trauma of multiple vet visits and the many monitoring tests that are required for treatment and for a senior dog it can be worse. Also, if a dog is already suffering from arthritis, Cushing's treatment may cause more discomfort as that elevated cortisol does have anti-inflammatory properties.

I'm very sorry for the reasons that brought you here but I'm glad you found us. You and Maggie are family now and we're all here to support you in your decision to treat or not.

Hugs, Lori

[Burlene K]

Thank you. Our goal is for Maggie to be happy and comfortable for as long as possible. Going to the vet is so stressful for her and considering the high rate of adverse affects of the meds, we are going to stay the course for now.
Are there any supplements that have helped relieve any of the the symptoms of Cushings? Any diets that would be beneficial? We are working on reducing Maggie's weight to 14 pounds just to make it easier for her to get around. She's carrying alot of weight on those short legs!
Also, Maggie is due for her yearly dental cleaning. Any problems with anesthesia in Cushings dogs? The vet says no, but I'd like to hear from this group.

[Harley PoMMom]

Some members have told us that Cushex and Adrenal Harmony Gold worked very well in controlling symptoms but only for a short time period. Now, Cushex and Adrenal Harmony Gold have no controlled clinical testing whatsoever to back up their claims (we know this because we have contacted the manufacturers and we have been told that no testing has been done).

Concerning the diet, there really isn't a "set" diet for a cushdog, it should be tailored to that individual dog's needs. However, because of the effects of excess steroid on protein and fat metabolism, a good quality protein, moderate fiber and a low fat diet is recommended.

My boy, Harley, had a dental cleaning along with having 3 teeth extracted when his Cushing's was not controlled and he did fine with the anesthesia. I, too, was very concerned about him and the anesthesia. His vet assured me that if he would show signs of distress that they could bring him out of the anesthesia really fast.

One other question I have :eek::) were the adrenal glands visualized on the ultrasound?

Lori

[Burlene K]

I do not have the report, it was a "brief" ultrasound done 3 months before her diagnosis to check out her liver since her enzymes were elevated. It was not a truly diagnostic abdominal ultrasound. Do you think that I should ask for one?

[DoxieMama]

Hi, Lori's got you covered already so I'm just stopping in to say welcome to you and Maggie! You're doing a great job with that little lady. Give her some ear scritches from me. :D

Hugs,
Shana

[Burlene K]

Thank you all!

[Harley PoMMom]

I do not have the report, it was a "brief" ultrasound done 3 months before her diagnosis to check out her liver since her enzymes were elevated. It was not a truly diagnostic abdominal ultrasound. Do you think that I should ask for one?

I am always in favor of having an abdominal ultrasound performed in dogs that are suspected of having Cushing's. I believe it gives the vet an opportunity to get a good look at surrounding organs to rule out any non-adrenal problems that might be contributing to or even causing the symptoms and lab abnormalities that are usually associated with Cushing's.

However, they are expensive to have done and not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting. The technician, most likely, will perform their own and therefore, it should be those most experienced with capturing good windows and images. That would be a board certified radiologist or board certified Internal Medicine Specialist. Likewise the one interpreting it should be the most experienced as well, and that's generally one of the 2 above.

Hugs, Lori

[Burlene K]

I have an appointment to speak to the vet on Friday and will ask about a more thorough ultrasound. I do have a couple of questions.....
I read in an earlier post that the LDDS test should be done fasting. Maggie had hers done right after a full breakfast. Also, except for the "elevated" cortisol noted in the LDDS, the only other labs out of range are her ALP and ALT. The ALT came down from last year and her ALP has decreased from about 950 to just a little over 700 in the past 3 months. She has no protein in her urine and as far as I know, her blood pressure is normal. I am wondering about this diagnosis, especially since Maggie has such mild symptoms and none of the true hallmarks.. no polydipsia (she drank about 1 cup of water today) or polyuria, no hair loss, no skin infections. She has some limb weakness due to disc disease and arthritis confirmed by xray. At the age of almost 16, I don't expect a dachshund to not have some back problems. She still runs in the yard. Since her "diagnosis", I have attributed things that are normal in a 16 year old dog to Cushings, and yet nothing seems to be preventing Maggie or us from enjoying her life, especially after reading some of the other stories here of much worse symptoms. I am so glad that we didn't jump to treat her, given that Cushings progesses slowly and may not cause her eventual passing.

[Joan2517]

Hi and welcome from me, too~ At her age, and with the few symptoms mentioned, I would let her live out whatever time she has left untreated...the vet visits, testing, monitoring are nerve-wracking and very stressful on us and our babies. You know her better than anyone else and if she seems content, I would let her be...

[Harley PoMMom]

Not all labs require fasting for the LDDS test but generally it is preferred because lipemia may interference with the results, vets will need to check with the lab they use to see whether fasting is necessary.

Taking in account her age, plus since she doesn't have bothersome symptoms, and all in all she is a happy girl, I would be more inclined to not treat.

Hugs, Lori

[Burlene K]

We are feeling more comfortable in our decision to not treat. Everyone here has been a great help with that decision. As a nurse, I know how awful it can be for an elderly patient to be subjected to treatments that have no guarantee of success and may make their quality of life worse or even hasten death. If I didn't know about this diagnosis, I would just assume that Maggie was a normal elderly Dachshund, and that's pretty much where we want to keep our thoughts.

[Squirt's Mom]

I would do the same in your shoes! ;)

So here's your treatment plan - snuggle often, feed your baby her favorite treats at least once a week, belly rubs several times a day, have many conversations with Maggie always telling her how much you love her, make every minute an important one, create memories to cherish, do the things she loves most, and simply enjoy your lives together. :)

Hugs,
Leslie and the gang

[Joan2517]

That's what I wish I had done for my Lena, not treated...but I did all the rest....

Snuggled constantly, fed my baby her favorite treats whenever she wanted them, hugs as many times a day as I could, had many conversations with her always telling her how much I loved her, made every minute an important one, and prayed for more time to create memories to cherish, and do the things she loved most, but we ran out of time for the last two.

[Whiskey's Mom]

Just spent the past day second guessing myself (again) about my decision to stop the Vetoryl. So thanks Joan and Squirts Mom. And Burlene. For the reassurance. Whiskey is doing good without it. He's more like the old Whiskey- Very expressive and waggy tailed. Hadn't realized how subdued he'd become. I'm going to take all of your wonderful advice and remember it. All the best to you all!

[Joan2517]

I'm glad Whiskey is doing good...give him a big kiss from me!

[Burlene K]

I have an appointment with the vet on Friday, just to consult re: any further testing, etc. Should I pursue the abdominal ultrasound, just in case there is something else going on? Any questions that I should ask him? I'm thinking about going to another vet since this one has only 2 years of experience and that bothers me alot. Our former vet was very experienced and a sweet guy, but too laid back for my taste. I did talk to a vet from UC Davis, but didn't bring up the ultrasound issue. What do you all think?

[molly muffin]

Hello from me too. I think that if there is anything that I was going to do it would probably be an ultrasound just to get a good over view of the internal organs and leave it at that for now. Do the yearly wellness tests and see then how her blood work looks and how she is.
At 16 I agree that it is all about quality of life. :) Seems to be that her quality is pretty good for an aging lady.

[Burlene K]

Thank you. I'm also sweating out her teeth cleaning because of the stress to her, but I don't want her to get an abcess and have pain.

[Burlene K]

We took Maggie to a new vet today, someone who specialized in internal medicine at UC Davis and studied under Dr. Nelson, the Cushing's "guru" there. She said that Maggie does not have any clinical signs...the supposed pot belly is just "fat dachshund". She doesn't like to treat a dog with only positive lab tests and no visible symptoms. I was relieved to hear that. So we are going to stay the course of non-treatment for now, and if she shows any signs, we will re-evaluate. She told us that except for dental disease that almost all small dogs have, and being a bit fat, she is in great shape with no heart murmur that she said is almost unheard of in a 16 year old dachshund. We are really happy with this news. Now just sweating out her teeth cleaning on Monday. Hope all goes well.

[Joan2517]

That is good news! Very happy to hear it...

[judymaggie]

Excellent report from Dr. Nelson! I bet Maggie will feel even better after her teeth cleaning.

[DoxieMama]

That's great!

[Burlene K]

Thanks everyone. I like this veterinarian's philosophy....Just because we can treat doesn't mean we should. We'll just take it as it comes for now. It is what it is.

[Burlene K]

We took Maggie this morning to have her teeth cleaned. She had labs done prior which showed a lipase of 5323 (normal range 200-1800). Her lipase was normal in April. She has no symptoms of pancreatitis....no diarrhea, had one episode of bile emesis this morning because she was starving, but none prior to this for months. Her belly doesn't seem tender. Her ALP and ALT were stable from last lab draw on July 12. Our vet did an ultrasound that showed a tender pancreas but no pancreatic inflammation, enlarged liver (we knew that from the previous US), normal sized adrenal glands (supposed to be enlarged with Cushings?), normal kidneys, no gallbladder wall thickening, meaning no gallbladder disease, no masses anywhere. She's a little stumped. Anyway, no teeth cleaning until her lipase comes down. I started her on a white rice, boiled chicken breast and broth diet this evening. Maggie must be one heck of a trooper because she never complains about anything!

I read here that the latest research doesn't indicate that Cushings dogs have more pancreatitis than other dogs. Is that true?

[Harley PoMMom]

I read here that the latest research doesn't indicate that Cushings dogs have more pancreatitis than other dogs. Is that true?

Yes, one of Administrators posted the following article:
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.

http://www.k9cushings.com/forum/showpost.php?p=191683&postcount=21

My boy Harley had pancreatitis which was found via his first ultrasound. I was totally shocked because he never showed any symptoms of an inflamed pancreas so I had the spec cPL test performed and it confirmed the pancreatitis.

Keep us updated!

Hugs, Lori

[Burlene K]

Maggie is doing so much better on the low fat diet, feeding 3 times a day. We give her tramadol as needed for the pain, and that has improved as well. She has lost almost a pound in 2 weeks, but we are feeding her less calories and alot less fat. If she could eat what she wanted, she would have gained 5 pounds! Amazingly, she has bounced back and then some. She is back to running, greeting us at the door when we come home, wagging her tail all the time. The trip to the vet last Monday took so much out of her. I don't know if that is the Cushings or just old dog stress. She still has only mild panting as her only symptom so far, and my vet tech daughter in law says that alot of old dogs pant more because of decreased lung compliance.
I dread taking her back to get her lab rechecked and then later to do the dental cleaning because the stress is so debilitating for her.

[lulusmom]

Hi and welcome to you and Maggie.

I am the administrator who shared the information on the connection between pancreatitis and cushing's. I just wanted to add that overweight dogs are at risk for pancreatitis so I'm glad to hear that Maggie has dropped some of her excess weight. It is amazing how much more active our little fatties become when they are at a healthy weight. In the last year, I've seen three obese dogs misdiagnosed with cushing's. They panted constantly, had high sensitivity to heat, drank more than usual, had trouble rising from prone position, extreme exercise intolerance and voracious appetites. These are all signs that are seen in obese dogs as well as cushing's. These dogs also had elevated ALKP which was most likely caused by pancreas inflammation that was noted in the ultrasound interpretations or a cushing's diagnosis made on the heels of active pancreatitis. Symptoms completely resolved as the these dogs lost weight. I am not inferring that your dog was misdiagnosed. I just wanted folks to know that extra weight on our dogs is extremely unhealthy and predisposes them to some serious health issues, including diabetes.

Glynda

[molly muffin]

Glad to hear that you got a good report from U Davis. Good people there that seem to really know their stuff.

Drat on the pancrease issue, but glad she is doing better on the low fat diet and dropping a couple pounds probably helps that.

[Burlene K]

Can pancreatitis cause the LDDS test to be positive for PDH? Looking back, she was having a few symptoms of pancreatitis then.

[molly muffin]

It's possible. That is why you don't want to test for cushings when something else is going on. So, that's a maybe, of course you didn't Know about the pancreatitis at that point, but if she had the elevations she Could have a false positive on the LDDS. You wouldn't know for sure unless you retested her once her pancrease is well and I don't know if I would bother to retest or not, unless considering treatment. Course I can also be OCD about it and test just to know for myself LOL

[Burlene K]

I am a bit OCD, but I don't really want to put Maggie through that again. Are there other tests that can diagnose without the long testing period? Of course, only after she has fully recovered from the pancreatitis!

[Burlene K]

So Maggie has been through pancreatitis and then 2 weeks ago her toe became swollen. She has been on antibiotics and deramaxx and the pain has really decreased (she was limping and holding her paw up). Today, we took her in for a check up and labs for the pancreatitis. Xray was done, thankfully no bone destruction indicating cancer in that toe. She has 6 more days of antibiotics. Her ALT went up, so no more deramaxx. We have tramadol for the pain if she needs it. Our vet ordered a topical medication that has antibiotics, an antifungal and dexamethasone in it. I questioned that with the Cushings should she be using a steroid with Maggie and she said for the short period of time and small amount applied to her toe there shouldn't be a problem.
What do you all think? Would it be safe for her? I do trust this vet, she is very thorough.
I do have some antibacterial, antifungal spray that has no steroid in it that I was thinking about using.

[labblab]

I think your vet's opinion makes sense -- short-term use of the topical steroidal probably carries more pluses than minuses right now. The anti-inflammatory effect of the dexamethasone may be really helpful as far as completely clearing up Maggie's toe. So I believe I would use the ointment as prescribed.

Marianne

[Burlene K]

Thank you for your reply. The other vet that I consult with, retired from UC Davis, says that it isn't uncommon for Cushdogs to get infections around their nail beds. Is this a problem for anyone's pup here? If so, how do you stay on top of it?
By the way, Maggie's ALKP went from 749 to 487 (normal 23-212) in a month. Wonder if it was high from the pancreatitis...but looking at her labs, it was high when her other labs were normal. Does the ALKP fluctuate that much with Cushings?

[molly muffin]

Pancreatitis can be a devil on other internal organs.

Interesting about the toe bed infection area. I don't think I was aware of that. Infections in general yes, but not toe bed specifically.

I would use a topical steroid in such a case.

[Burlene K]

Maggie's nail bed infection has cleared up nicely, especially with epsom salt soaks that opened up the ulcer to drain. She is back to her old self. Still see no other symptoms of Cushing's yet. I have ordered the canine cushing's fur test that another member mentioned and waiting to receive that. I'm curious to see what that may show, it's supposed to be very accurate.

[molly muffin]

That is wonderful that the infection has cleared up. Infections anywhere can cause cortisol to raise, so that is something to keep in consideration too.

[Burlene K]

So Maggie turned 16 0n October 9. Yay!!! She has been doing very well until Thursday when she suddenly had an episode of vomiting with some blood in it. So off to the vet we went. Xrays showed nothing, labs again show pancreatitis. Her labs looked very good otherwise, including her ALKP which is the lowest it has been in 2 years at about 250....normal range 23-212. Our vet just flat out said these are not the labs of a cushingoid dog. She is quite knowledgeable about this and trained under Dr. Nelson, a Cushing's specialist at UC Davis. I have had Maggie on a fairly low fat diet since the initial diet of boiled chicken breast and white rice. I'm thinking that she may need to stay on this diet forever now.
Does anyone have any advise about what to do to prevent another episode of pancreatitis?

[Squirt's Mom]

She will need a low-fat diet but a steady diet of chicken and rice will not provide the nutrients her body needs so I would talk to the vet about a good commercial diet, a supplement to add to the chicken and rice to balance that food, or work with a canine nutritionist, like Monica Segal, to have diet designed for her. Short term to get her thru this episode the chicken and rice is fine but not for the long-haul. ;)

[Burlene K]

Thx...I was going to talk to our vet about the prescription canned stuff. I don't want this to keep happening and I'll do whatever it takes to keep her as well as possible for as long as possible. I will also contact the nutritionist.