My greyhound just diagnosed...

[lala22]

Hi, i'm new and looking for help. My 11 year old greyhound was just diagnosed.

We've been through a ton of recent emergency vet visits lately for huge variety of items. He's had deep cuts/puncture wounds, he's had a swollen elbow from hitting it on the floor, we just got him elbow pads and he had a side effect from that, and the emergency vet recommended the cushing,s test because of the loss of hair/thin skin etc.

He had the sono/ultra sound that showed swollen glands and the official blood test 2 days ago. Today we got the confirmation.

Ziggy, my gorgeous boy, has a lot of symptoms and this all seems to make sense now...thinning hair (but greyhounds typically have that), thin skin (they have that also), but also the thirst, frequent peeing, hunger and hyperventilating. i think greyhounds are always seem hungry anway...

Vet says to start trilosane on 10/3 as they are going to be on vacation and want to be around if the side effects are serious or extreme...that freaks me out!

I'm to start him out at 60mg. Does that seem right? He's about 81 pounds. He's my big boy. He said to order the meds from 1800petmeds and he gets it once a day with food.

Help...i'm freaking out.

[dsbailey]

Greetings,

I noticed that nobody has come by to greet you yet, let me be the first. There will be many people coming by asking you lots of questions and giving the best advice possible. There are a few that have prepared questions and information so I'm not going to get into that. What you can do is speak with the vet and start gathering information before they go on vacation. Without this information you're going to be without answers from us until the 3rd. Here's some paperwork that you should gather before they leave (Actual Copies of these):

- All Recent Bloodwork, Urinalysis, Etc.
- Ultrasound Report
- The Test or Tests Results Confirming Cushings (ACTH Stimulation, Low dose dexamethasone suppression (LDDS), urine cortisol creatinine ratio)

If you gather this information for us you'll be very well informed by the time treatment starts.

I agree with the starting dosage. We like to be conservative here and they call it "low and slow", My girl weighs about 55 lbs, started on 60 mg and has settled on 30 mg per day.

I also agree with starting on 10/3 when your vet returns. Cushings is a slowly progressing disease and no harm will be done waiting a week. I would want my primary vet to be available the first two weeks of treatment.

Don't withhold water thinking your helping your boy, you wouldn't be. He is not peeing more because he is drinking more. He is drinking more because he is peeing more. Make sense? Also, don't overfeed because you are getting the sad / rabid eyes during dinner. Get yourself a few bags of frozen green beans or peas and use those.

See if you can get that paperwork before they leave, you'll be a week ahead if you do.

Darrell and Lolita

[DoxieMama]

Welcome to you and Ziggy from me, too!

As Darrell has posted, if you can get copies of those test results, we can help you understand those numbers.

Cushing's is a slower-progressing disease, so waiting until your regular vet is available will be fine. There's a ton of information in resources forum (http://www.k9cushings.com/forum/forumdisplay.php?f=10) about Cushing's diagnosis and treatment - spend some time there familiarizing yourself. Please let us know of any questions you have!

In the meantime, we will do what we can to support you. :)

Shana

[lala22]

Thanks ladies, for the welcome. I had to call the vet about the prescription and had them fax over the ultrasound and the test he had 2 days ago.

The ultrasound had a lot of stuff, but the gland info says:

The left adrenal gland is mildly enlarged at 9mm in thickness the caudal pole and 8.8mm in thickness of the cranial pole. Th right adrenal gland is also mildly enlarged at 8.65 in thickness at the caudal pole. ....

Conclusions/recommendations: Bilateral mild adrenomegaly. Consideration could be given to pituitary dependent Cushing's disease or hyperplasia from increased physiologic stress due to other underlying disease. The mild increased echogenicity of the hepatic parenchyma may represent a vacuolar hepatopathy. Mild inflammation could also be considered. Neoplasia is not suspected.

The mixed echogenic nodule within the spleen may represent a resolving hematomoa, infant, nodular hyperplasia or benign or malignant neoplasia.

The blood test:

Time 1--pre
time 2--1Pm
time 3--5Pm
Cortisol sample 1--5.6
cortisol sample 2--2.6
cortisol sample 3--3.8

Thanks everyone in advance.

[dsbailey]

The Ultrasound and LDDS Test run definitely points to PDH Cushings. This form of Cushings is easier to treat through medication than the ADH type.

Someone else will be around to discuss the spleen mention.

Is it possible to get the latest blood / urinalysis results. Those are important and will give some information on how angry the liver is plus how the gall bladder and kidneys are functioning.

[lala22]

Thanks again. He had a blood test this past August.

i'm not sure what numbers you'll need but things that tested high/low are:

ALT 147 (HIGH) (12-118)
ALK Phophalase 550 (HIGH) (5-131)
GGTP 19 (HIGH) (1-12)
Cholesterol 343 (HIGH) (92-324)
PrecisionPSL 212 (HIGH) (24-140)
Hemoglobin 20.8 (HIGH) (12.1-20.3)

Total T4 <.5 (low) (0.8-3.5)

he didn't have a recent urinalysis, i have one from last July...i think we were worried about a urinary track infection--and i'm sure we were noticing the his thirst and wanting to pee a lot.

it said it was dark yellow, cloudy, the PH was 7, protein was 2+ (high)

[dsbailey]

These are pretty textbook as far as a Cushdog goes. They're not in range but nothing extraordinary sticks out. I see you listed the out of range values so next time to make everyone happy we usually post with ranges ie:

ALK Phophalase 550 (High) (5 - 131) U/L My girl was 1532 6 months ago, she is 422 now.

Are there any other values out of range? BUN/Creatinine Ratio, Urea Nitrogen, Creatinine? If so then post those also.

I'm the "B" team, the "A" team will be by later..... :D

Darrell and Lo

[lala22]

Thanks again.

Wow, that looks like a huge improvement for your girl! Nice!

This is all greek to me. Nothing else was labeled as high or low, but here are those tests anyway...

The BUN/creatinine ratio 13 (4-27)
Urea Nitrogen 16 (6-31)
Creatinine 1.2 (0.5-1.6)

[DoxieMama]

Me again. If you can go back and edit your previous post with the ALT/ALP/GGT numbers to add their normal ranges, that would be fantastic. Not all labs use the same ranges so what is normal for your lab is helpful to know.

You mentioned a lot of stuff on the ultrasound - were other abnormalities found or was it just the adrenals and the "mixed echogenic nodule" on the spleen? (Not that I am confident what that means, but there are some folks here who are. ;))

[lala22]

Thanks so much, again. I edited my post above.

The vet called me after the ultrasound and mentioned a node, but said that was not to worry about 'right' now--he was more concerned with getting the cushings test done. I typed in the entire Conclusion/Recommendation in that report, but they do mention other things. I wish I could scan it!

Here is rest of the report


The prostate is small and smoothly marginated. The urinary bladder contains a moderate volume of anechoic fluid. The urinary bladder wall is normal in thickness and is smoothly marginated. Both renal cortices are normal in echogenicity with good cortcomedullary definition....

The spleen is normal. Within the splenic parenchyma, there are a few irregularly marginated hyperechoic nodules that are considered consistent with benign myeloplipomas or granulomatous change. There is a single 1/6 cm x 1/36 cm diameter slightly mixed echogenic nodule that is hyperechonic centrally with a hypoechoic rim. The hepatic parenchyma is very mildly hyperechoic. No discrete modules or masses are noted within the liver. The gallbladder contains anechoic fluid and is thin-walled. Wall layering and measured wall thickness within the gastrointestinal tract is normal. Visible portions of the pancreas are normal although some portions were difficult to visualize due to the deep chested conformation of the patient. No abnormal lymph nodes or free peritoneal fluid are noted.

thanks again.

[dsbailey]

Way above my Software Engineer payscale but Googling of the big words doesn't seem anything abnormal.

"he was more concerned with getting the cushings test done" - does this mean the test that was done or is he planning more tests? I can't imagine any tests until 10 - 14 days after treatment starts.

Somebody else will know what this all means.

One thing of note being a greyhound I would imagine he may have some arthritic issues. A Cushdog is self medicated with Cortisol (Similar to Prednisone) so the joint swelling, aches, and pains have always been masked to an extent. Treatment that brings down the Cortisol will unmask things you may not have know existed. If all goes well with the medication the hard part will be finding the sweet spot. My girl has problems with arthritis because of age and knee surgery when she was a year old. I just had to lower her dosage to bring her Cortisol up which isn't the best for her internally but otherwise she has trouble walking without pain. Get it?

I'm sorry if I've overwhelmed you today but you said you were "Freaking Out". Knowledge is Power and helps us not freak out.

Hopefully this has helped - Darrell and Lolita

[lala22]

Thanks, DSBailey,
Yes, the test he said he wanted to get done right away was the test we already had, so if there is something else concerning about the ultrasound, he said the Cushings diagnosis was priority.

Thanks for the information about the arthritis...i'll have to keep an eye out for it.

i look forward to any other info about the tests this great group can provide me.

[Harley PoMMom]

ALT 147 (HIGH) (12-118)
ALK Phophalase 550 (HIGH) (5-131)
GGTP 19 (HIGH) (1-12)
Cholesterol 343 (HIGH) (92-324)
PrecisionPSL 212 (HIGH) (24-140)
Hemoglobin 20.8 (HIGH) (12.1-20.3)



That PrecisionPSL is a test used to diagnose pancreatitis, so I am a bit concerned with the results of that LDDS test because any non adrenal illness can create a false positive result with the LDDS test.

I wish the whole pancreas was seen on his ultrasound but unfortunately it was not so if this were me I would want to be sure that the pancreas is functioning properly.

Lori

[molly muffin]

Hello and welcome. It definitely is a case where you have to decide which takes priority. Unfortunately cushings testing can be affected by anything else being wrong in the body since the bodies natural reaction is to produce cortisol in reaction to other issues. So the question comes to why cortisol is raised and is it because of a spleen nodule, pancrease problem etc. And the answer is that it could be.
Are you now feeding a low fat diet? As that is helpful for the pancrease and liver to try and get it healthy.
You also mentioned some elbow and other issues lately which can pain and thus cortisol to rise.
So these are just a few things to keep in mind as you go down the path of trying to figure out what is going on.
Waiting for your vet to come back is definitely a good idea before starting any kind of cushing treatment but it would be excellent to have the pancrease numbers back in a normal range before starting too.

[dsbailey]

I told you that you would be getting some good advice from the others in the group. Just for reference when my girl was diagnosed in March her PrecisionPSL was 238 (High) (24-140) U/L. Her PrecisionPSL is now 143 (High) (24-140) U/L.

Darrell and Lo