just diagnosed but questioning

[Tealster]

Hello:

I am so grateful to my Vet for sending me this link. So, my dog Roo, who is probably a chi/pug mix, was just diagnosed with Cushings. We did the all day fast test with coming back at 1 and 5 for bloodwork. We don't know where the tumor is but my Vet said we need to go on the meds now and he will be on them the rest of his life. I started doing some research and I see that 1. Maybe surgery can be done if not in the Pituitary and then he won't need meds. The vet said this but the chances of that being there I think are low. If we do that and we get the tumor, can it grow back? Would we be back at square 1?

2. Should I go the Holistic Vet way? I do animal acupuncture so I could do the treatments for that. I would imagine the meds are hard on the pooch. I believe my previous dog died from the meds not being accurate in Addison's disease.

Any advice from anyone is appreciated.

Teal

[labblab]

Hello to you and little Roo! Unfortunately, I have only a moment to type right now so I can't talk over as much as I'd like to. But I definitely want you to know how glad we are you've found us, and I know more "welcomes" and info will be coming! ;) :)

Marianne

[Joan2517]

Hello from me too...do you have copies of the test results? If not, can you get them from your vet? Others more knowledgeable than I am will be along and will want to see those results.

[Harley PoMMom]

Hi Teal,

Welcome to you and your sweet boy, Roo! With our new members we ask a lot of questions, this is not because we are nosy, instead, it allows us to provide you with our best possible feedback. So here are some questions that I have:

Could you get copies of all tests that were done on your boy and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. What test/s were done that diagnosed the Cushing's and could you post those results? What symptoms did your boy display that led to the testing for Cushing's? How much does Roo weigh? Does Roo have any underlying illness that he is taking medication for? And if so, what is it and what is the medication? Is he taking any supplements, medications or herbs?

If it is the adrenal form of Cushing's and the dog is a good candiate for this type of surgery than an adrenalectomy is a cure however this is a very serious and very expensive surgery which only a well seasoned surgeon should perform.

As far as holistic medications, unfortunately I don't know of any truly effective alternatives to Rx medication when one wants to lower cortisol levels significantly. Having said that, if clinical symptoms are not that bothersome to the dog or owner, 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).

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

Hugs, Lori

[Tealster]

thank you all. I am trying to get the results from the vet so I can post these to make a decision. One quick question that you might be able to answer now is if we do the surgery, does the tumor grow back?

thank you,

Teal

[Tealster]

OK, I just received the report from the vet. Roo weighs about 15 pounds. He has always been a big drinker and a nervous dog. He has always emptied his bladder quite a bit but the last year or two its more in the house and he knows better.

Having said that I am not sure what tests you need to know:

1. His cortisol pre dex was 10.9
4 hour post was 0.7
8 hour post was 3.1

2. Glucose was 148 reference value is 63-114
3. BUN was 7. Reference value 9-31
4. Albumin was 4.1 Reference value was 2.7-3.9
5. ALP was 2,443. Normal value is 5-160 (wow)
6. Cholesterol was 394. Normal is 131-345

Those were all the numbers in red. I believe the last doc missed the high number in the blood test for the ALP last year.

Thoughts on going natural route vs. meds?

[Tealster]

Can I please get some feedback on these results? I am not sure if I should try going the Holistic route, as in a vet that practices that or put him on meds or pay another $450 for the test to tell me where the tumor is to see if surgery is the best option.

thank you,

Teal

[DoxieMama]

Hi Teal, I'm sorry no one has responded to you on the test results yet. I'll reach out to a couple folks and ask them to stop by when they can.

Hang in there!

[labblab]

Hi again, Teal! Thanks so much for posting this additional info. First off, the results of the diagnostic LDDS test (the one with the three cortisol values) already tells us that Roo's results are consistent with the pituitary form of Cushing's instead of an adrenal tumor. This is because both the 4 and 8-hour values are less than 50% of his baseline value. Here's a link that explains LDDS test interpretation in greater detail:

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

So if you are here in the U.S., surgical intervention for a pituitary tumor is not commonly considered to be an option unless the tumor has enlarged to the extent that it is pressing on other areas of the dog's brain and creating neurological problems. For most dogs, the tumor remains microscopic in size, and the Cushing's symptoms are controlled with medication.

So, speaking of symptoms, can you tell us about any observable problems that Roo is experiencing? What led you to test for Cushing's in the first place? I see that his ALKP is quite high, which is not uncommon for Cushpups. One other issue is a bit of elevation in his glucose level. That in itself might be reason enough to start treatment with prescription meds, because abnormally elevated circulating cortisol can trigger diabetes in some dogs, and of course that disorder can be associated with so many additional issues.

So before talking more, it'll help us a lot if you'll tell us more about any other symptoms that Roo is exhibiting. Thanks so much in advance!

Marianne

[Squirt's Mom]

Hi Teal and welcome to you and Roo! :)

Marianne has already asked for more health details so I won't repeat but I will repeat that the GLUC result is a bit alarming.

What treatment did your vet mention, Vetoryl (Trilostane) or Lysodren (Mitotane)? I can tell you that holistic treatments have mixed results - some claim they have worked but refuse to do the ACTHs to check the cortisol level so there is no way to be sure if their approach was working or simply masking signs. Herbs, diet, and supplements can help with signs but there is is no scientific proof they can control the cortisol - the enemy in Cushing's and what causes internal damage and other issues, like the diabetes Marianne mentioned. I am a novice herbalist and have several veterinary texts from holistic vets - every one chooses to use one of the traditional treatments, some along with herbs but always with either Vetoryl or Lysodren. That says something to me. ;)

Your training in acupuncture can come in very handy tho and can help Roo with other issues often associated with Cushing's - like arthritis. He is blessed you have that to offer him.

I'm glad your vet sent you to us and look forward to learning more about your sweet boy soon.

Hugs,
Leslie and the gang

[Tealster]

thank you both. What lead my doc to do the test was the results from his "senior blood work". The levels, don't know which, were very high. I imagine it was the protein. Apparently, it was high last year as well but the other vet didn't bring it up. She is no longer there.

I have witnessed him drinking lots of water all of his life. He has always been a "nervous" dog as well. Neither of these are new. He also used to pee in the house when he was mad at me or when I went away and came back. Now its a lot more and not due to anger or emotion.

He has about 13 fatty tumors that I made the vet aspirate all but one, it was hard and not in a good area. It would have been painful. All fluid was non cancerous.

He was born with crooked legs and I am sure they are hurting him too.

His mother had breast cancer twice. She just passed at 14. She survived all her cancer.

I am not sure where to treat him. Thank you for your kind words about this. I assume spleen, liver, gallbladder and kidney at the least.

I am thinking as I read your info that I will probably do meds. I might go to the holistic vet just to see what she says. That depends on price. I was also thinking of getting a second opinion from a vet that a friend of mine loves and helped her quite a bit when her cat had cushings. Is there a standard protocol for meds so I don't have to decide which one and most vets are aware of?

Teal

[Squirt's Mom]

Vetoryl, or Trilostane when compounded, is the one most often used these days. But I am the oddball and prefer Lysodren (Mitotane). There is a very specific protocol to follow with Vetoryl that your vet must be aware of and adhere to in order to minimize risk. Both drugs are fat soluble and must be given with a meal. Both drugs have the same risk factors but both are life-saving when correctly used by the vet and when the parent is observant and responds when anything is "off". The main difference to me between the two is the life in the body - Vetoryl has a very short life and is leaving the system in 2-12 hours. This means if there is a problem, the drug is quickly out of the system often with no other steps required...it also means it must be given at least once a day every day, sometimes twice a day; we have had at least one dog who needed it 3x a day. Lysodren remains in the body for much longer - up to 48 hours so if there is a problem intervention with Prednisone is almost always required. But that also means once the optimal level of cortisol is achieved by twice daily dosing (called a loading phase), the drug is only given 2-14 times a week thereafter (called a maintenance phase). Vetoryl is cheaper per pill but since it is given more often the cost rises. Based on my observations, more ACTHs are needed with dogs on Vetoryl because the dose is changed more often than the dose of Lysodren and with each dose change the testing schedule starts all over at the 2 week mark. You can learn much more by reading in our Helpful Resource section. Here is a link to it - http://www.k9cushings.com/forum/forumdisplay.php?f=10

If you read many threads on the forum, you will notice most pups are on Vetoryl (Trilostane) so you can get an idea of what that is like to use. There are a few of us that use Lysodren as well, but not near as many. ;)

One key factor is which drug your vet is most comfortable with and has had the most success using....as well as the one you feel you would be most comfortable managing at home.

[Tealster]

Is the Western treatment more or less the same at all vets so I don't need to go to a specialist or is there more to it than that?

[Harley PoMMom]

Yes, the medical treatment for canine Cushing's is pretty much the same from vet to vet, however many general practitioner vets do not keep up with the latest or new treatment protocols for Cushing's so this why it is so important for a pet parents to educate themselves when it comes to treating their pet for Cushing's.

Veterinary specialists (IMS) vs. general practitioners, the difference is that there is a higher chance that an IMS sees many more cases of Cushing's that a GP vet does. Also there are IMS' that specialize in endocrinology, and they usually have more experience treating a dog that has multiple health issues.

Many of our members have an IMS on board just for their GP to confer with when treatment gets complicated.

Hugs, Lori

[molly muffin]

Hello and welcome from me too.

I'm just going to say along with leslie the glucose being elevated like is a worrying sign and LDDS test can be false positive if something else is going on. As the symptoms of cushings is also consistent with the symptoms of diabetes, did your vet discuss this with you? Diabetes? Even if cushings is a background culprit, dogs can literally going into diabetes with cushings very quickly (as in one day not, a couple days later full out)

If you are treating for cushings and using vetroyl and diabetes is involved, be aware that you need to do twice a day dosing (according to Dr. Peterson the expert) so that cortisol levels remain steady for the entire day without bouncing as this helps to control the insulin levels better.