Newbie to Cushings

[DakotasMom612]

Hi Everyone, please bare with me. This is the first time I've joined a forum, and I have no idea how to navigate around it in. My little Dakota is almost 11 years old, and we were devastated this week when the vet told us after her sonogram that she has Cushings. I have been all over the internet researching Cushings since finding out. When I found this site I decided to join hoping that I would be able to get advice and support from those of you that are going through this with your pups. Right now we have not started Dakota on any medications. The vet said that there are many who decide not to give medication because of the very serious side affects. He explained that the meds just treat the symptoms and don't slow down the progression of the disease. Right now aside from her drinking a little more, peeing a little more and be a little more hungry, she is her happy go lucky, energetic self. You would even know that she had this. He also told us dogs that are not treated could still of a decent quality of life for quite a while. Since she seems fine we don't want to put her on meds that will just make her sick and have problems that she doesn't have now. Is there anyone who has had any luck in easing the symptoms with holistic methods to escape giving meds that cause those horrible side effects? We did have to switch her food to a very low fat, low calorie food. The vet said she had pancreatitis also. We are also started giving her Denamarin to keep her liver healthy because the sonogram showed a slight change. I am at such a loss right now trying to process all of this. Any advice would be such a help and comfort right now.

[Joan2517]

Hello and welcome...she is a doll. It sounds like you have a very good vet. Others more knowledgeable than I am will be along soon. I just wanted to say hello.

[DakotasMom612]

Thank you so much! I'm so grateful for the support!

[Harley PoMMom]

Hi and welcome to you and Dakota!

I am a bit concerned with the accuracy of her diagnosis for Cushing's. Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed. One of the things that makes Cushing's so challenging is that there is not one test that can 100% accurately identify it, so vets have to perform multiple diagnostic tests to validate a Cushing's diagnosis. Also the tests used to diagnose Cushing's test can yield false positive results in the face of non adrenal illnesses or even stress. Is Dakota going through a pancreatitis episode now? If so, I would withhold having any tests for Cushing's performed until the pancreatitis is under control.

If it does turn out that Dakota does have Cushing's I want you to know that it is a treatable disease. However for the treatment to work safely and successfully it requires an educated pet owner along with an experienced vet. Adverse side effects are mostly seen when the proper protocols are not followed. We do have many members that are experiencing success with their dog's treatment for Cushing's. And, yes, with treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span. The goal of treatment is not to cure the disease but rather to help control those bothersome symptoms and get that superabundant supply of cortisol down within the therapeutic ranges, when that elevated cortisol is left uncontrolled over a long period of time is when systemic damage occurs.

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

[DakotasMom612]

Before Dakota had her sonogram, she did have blood tests. Based on those tests and her symptoms of drinking more, peeing more and being hungry they suspected it was Cushings. When they did the sonogram they saw that both her adrenal glands were enlarged which is when they said they knew for sure it was her pituitary. They also said based on her blood test it showed she had pancreatitis. From what I've read, dogs with pancreatitis vomit and won't eat and Dakota has none of that, but we did switch her food to low fat, low calorie as the vet suggested. I am a little confused. Based on what I've told you so far, are you saying that it's possible she has been misdiagnosed and she doesn't have Cushings even though she is showing the symptoms? I do have another question. I'm so torn about putting her on the meds because of the side effects because right now she seems healthy and happy. If we decided to put her on the medication, which one would be the safest with the least chance of causing negative side effects?

Once again thank you for all the support! It's a godsend!

[labblab]

Hello again from me. :)

Thanks so much for this additional info. At the risk of being a pest, I am going to ask if you can get copies of the actual numbers for Dakota's diagnostic blood tests. In addition to exhibiting certain common abnormalities on standard blood panels, there are two different blood tests that are specific to Cushing's: the ACTH stimulation test, or the LDDS (Low Dose Dexamethasone Suppression Test). I am assuming your vet performed one or the other of these two tests, and seeing the actual results will be helpful to us.

Given this additional info, I do understand why Cushing's is thought to be likely for Dakota. When we hear that dogs have been tested in the midst of other serious issues, we worry about the accuracy of the tests because both the ACTH and LDDS can return "false positives" for Cushing's when there is actually something else going on instead. But since Dakota was not exhibiting any acute symptoms of pancreatitis, and since you've now told us that she does indeed have some of the classic overt symptoms of Cushing's, I have a better understanding as to why your vet thinks that Cushing's is the culprit.

So that leads us to a discussion of treatment. We have seen many, many dogs who have done well with treatment. So for dogs who are uncomfortable due to symptoms, or for whom the disease is causing serious systemic problems, I do indeed recommend treatment (bearing in mind that I am not a vet myself). It is often said that treatment doesn't extend a dog's life, but I don't think that's necessarily accurate. Cushing's can result in a range of abnormalities, some of which can be more serious than others. For instance, some dogs develop hypertension or a particular form of kidney dysfunction, and both of these secondary conditions can lead to life-shortening issues. Vulnerabilities to infection, serious skin conditions, and ligament damage can also result. However, for other dogs, the biggest issues may be confined to things like the excessive thirst/urination/hunger. If both the dog and owner can tolerate those problems, then it may not be worth launching into treatment because it is true that monitoring the medication involves time, expense, and vigilance. Especially for senior dogs who are already approaching the natural end of their lifespans, treatment may not be the best option if their overt symptoms are tolerable.

Since you describe Dakota as remaining happy and relatively symptom-free right now, I wouldn't think you'd need to rush into treatment. Cushing's is typically a slowly progressing disorder, so you do have time to wait, watch for any symptoms to worsen, and think things over. However, since I am guessing she should still have several more years ahead of her, there are two things I'd want to first check, however, if you do hold off on treatment. One would be her blood pressure, if your vet is able to do that. Not all vets are equipped to do that. And the other is to check a recent urinalysis to see whether or not she is losing an excessive amount of protein in her urine. Cushing's can create a condition in the kidneys whereby that can happen, and excessive protein loss can end up causing further kidney damage over time.

So once again, if you can get those diagnostic test results for us, that will be a great place for us to continue our discussion.

Marianne

[Harley PoMMom]

From what I've read, dogs with pancreatitis vomit and won't eat and Dakota has none of that, but we did switch her food to low fat, low calorie as the vet suggested.

My boy, Harley, had pancreatitis which was initiately found on an ultrasound. He never showed any symptoms but the pancreatitis was confirmed with a special pancreatic test known as the spec cPL. The two enzymes, lipase and amylase, if elevated can be markers for pancreatitis but this isn't always the case as both of those enzymes were normal on Harley's blood panel.

Hugs, Lori

[DakotasMom612]

I am trying to post the Dakota's Sonogram report, but I don't know how. Can you give me directions on how to post it.

Thanks so much!
Chris

[Squirt's Mom]

We usually just type out the comments made on each organ.

[DakotasMom612]

Since I didn't know how to upload the report, I have typed out some of the information as Squirt's Mom suggested. Certain things on the report were in bold so I put the in bold as well.

LAB: 11/19/16
CBC: Increased HCT (65%) CHEM: AST: (106), ALT: (171) ALP: (177) CHOL: (459) PSL: (768) T4 (1.0) UA: (SG: 1.039, ph: 7.5, 1+protein, 21-50 struvite/HPf). UPC Ration (0.1)

LAB: 2/13/17
CBC: Increased HCT: 962%), Platelets: (457). CHEM: AST (90)
ALT: (290), ALP: (786), CHOL: (532), TG's: (856), PSL: (166). T4(2.2). UA:SG: 1.008, 2+Protein,pH:6.5, Inactive. UPC Ratio (2.4)

Assesment:
Liver: R/O Normal Hepatic Volume, increased density, granular appearance c/w vacuolar changes.

Kidneys: R/O Normal size, shape hyperechoic = inflammation, hazy architecture, mild decreased corticomedullary ratio c/w compensated interstitial & glomerular nephritis.

Adrenals: (Normal size for 18.7 lbs. Normal range:0.45 cm+/- 0.05 cm) R/O bilateral enlargement c/w PD-HAC

Recommendations:

Low Fat Intestinal Diet or Liver Supportive Diet for High Cholesterol, TG's & increased LFT's Enalapril & Fatty Acids for GN/CIN & Trilostane or lysodren for PD-HAC.

Our vet started her on Denamarin to support her liver. Also we have just switched her food, as per the vet, We are slowly introducing a much lower fat and calorie food (Natural Balance Fat Dogs)

[labblab]

Thanks so much for taking the time to type out this additional information! The results we are seeing here are indeed consistent with Cushing's, and perhaps as you yourself have noticed, some of these lab abnormalities have worsened between November and February. One that gives me particular concern is the significant increase in Dakota's urinary-protein-to-cortisol ratio ("UPC") from 0.1 to 2.4. This is exactly the kind of kidney protein loss issue that I was talking about earlier, and may end up being reason enough to start Cushing's treatment in order to try to keep the problem from worsening. I see that the sonogram interpretation recommends starting the medication Enalapril as well as oral fatty acids in conjunction with the kidney abnormalities. Has your vet discussed that with you yet? If not, I would definitely question him about that recommendation. With a UPC greater than 2.0, I believe you'll want to recheck Dakota's urine at regular intervals now, and you'd want to consider starting up with those treatments if her UPC remains elevated. You may also want to make sure that Dakota's new food does not have a high protein content, because high levels of dietary protein can result in higher levels of protein leaking into the urine. Moderate protein is probably fine, but I don't think you'd want to feed a really high protein food right now. Here's a link that explains more about UPC levels:

https://vcahospitals.com/know-your-pet/urine-proteincreatinine-ratios

And of course, that leaves us with the question about starting Cushing's treatment. As I wrote earlier, you don't have to rush into making a decision. But now that we know that Dakota may perhaps suffer from some kidney issues that may be worsened by leaving the Cushing's untreated, you may have added reason to go ahead and treat rather than not. A couple of our own staffers have dealt with this very same issue in their dogs, so I'm hoping they'll be able to stop by this week and talk to you more about it all.

Marianne

[DakotasMom612]

Thank you Marianne....you've been a wealth of information! The vet did say that her kidney function was ok, but we had to watch it. He didn't say we needed to medicate her for it yet, but I'm going to give him a call and question him. I was wondering if you could give me your thoughts on the new food we have starting giving her to lower her fat and calorie content in order to ease the pancreatitis and lessen the load on her liver. We have started intoducing Natural Balance Fat Dogs. Here is the breakdown: Crude Protein 26% minimum, Crude Fat 7.5% minimum, Crude Fiber 10.5 maximum, Moisture 10% maximum, omega 6 fatty acid 1.5% minimum, omega3 fatty acid 0.25% minimum. I hope the protein content is ok as I would hate to have to switch again just as I'm getting her used to this one...especially since she seems to really like the new food.

I look forward to hearing your thoughts, as well as others who might stop by with any other helpful advice.

Thanks,
Chris

[labblab]

In re-reading your lab results, I wanted to come back to add this very important comment. I am not seeing listed any results for either one of the two specific blood tests for Cushing's that I talked about earlier: either the ACTH stimulation test, or the LDDS (Low Dose Dexamethasone Suppression test). Regardless of whether or not other lab abnormalities are consistent with Cushing's, you need to have one of these special tests performed for additional confirmation that Dakota really has Cushing's. The ACTH takes 2-3 hour to run (and will have 2 numbers if you're in the U.S., 3 if you're in Canada); the LDDS takes 8 hours to run (and will have 3 listed numbers). So before we go any farther, we need to know for certain whether one of those two tests has been done.

[labblab]

We were typing at the same time. ;)

That protein level is probably OK for now -- I'll let our other folks who have more experience with protein loss comment further about that, but I'm guessing that would be considered moderate protein and therefore OK as long as her blood markers for kidney function are normal (BUN and creatinine).

[DakotasMom612]

Hi Marianne...a quick response to your inquiry about those other 2 blood tests. Based on the 2 blood tests she had, the sonogram and her symptoms, our vet did mentioned the other 2 tests you are referring to. He said he could do it, but he didn't think it was necessary to put her through it because he was sure based on everything prior that she had Cushing's. One thing I should mention about Dakota is that she is terrified whenever she goes to the the vet. She has been since she was a puppy. So much so they have to muzzle her whenever they check her. In fact, the day of the sonogram I asked if they usually sedate the dogs during the procedure. The vet said no they rarely need to do it for a sonogram. There is usually 2 or 3 of them that just hold the dog down. Well p.s....about 20 minutes later he came out and told us that she was just too traumatized, and they needed to sedate her to do the sonogram. I think my vet just felt he didn't need to do another test to confirm his diagnosis.

[judymaggie]

Hi, Chris -- a belated welcome to you and Dakota! Marianne referenced two staffers whose pups were diagnosed with proteinuria (UPC above normal range). I am one of those -- my almost 14 year old beagle, Abbie, has been diagnosed with glomerulonephritis and her last UPC was a whopping 6. 1! Her BUN has been elevated but has had normal creatinine levels. Abbie has been on Cushing's treatment with trilostane for a couple of years. She was also treated for high blood pressure -- not currently due to complications with medications.

I note that your vet is mentioning glomerular nephritis in his report -- I am not sure what "c/w" means but I think it is just mentioned as a possibility.

With Dakota's UPC numbers, I believe most vets would want to see two more UPC results -- most literature talks about the results of three tests done approximately two weeks apart before treatment is considered.

Another area that needs to be evaluated is Dakota's blood pressure. High blood pressure is often seen as a complication in dogs that have proteinuria. With Dakota's dread of vet visits, I am not sure how this could be done. My vet evaluates Abbie's blood pressure by putting her in a dark room with a vet tech who keeps her calm -- five or six BP readings are done and then an averaging is done.

Untreated proteinuria (confirmed by the three tests) can lead to kidney damage. Studies have shown that often, even if Cushing's treatment is started with Lysodren or trilostane, the proteinuria persists. Even if the BUN and creatinine levels are normal, treatment of proteinuria is recommended.

I hope all this info doesn't scare you!

[Squirt's Mom]

Based on the 2 blood tests she had, the sonogram and her symptoms, our vet did mentioned the other 2 tests you are referring to. He said he could do it, but he didn't think it was necessary to put her through it because he was sure based on everything prior that she had Cushing's.

Let me share a bit of my Squirt's story with you - She was diagnosed with Cushing's based on the LDDS, HDDS, ACTH, 2 abdominal ultrasounds, and the UTK panel ( a full adrenal panel). However a tumor on her spleen was noted on the second ultrasound. Once that was removed her cortisol level returned to normal - ie she did NOT have Cushing's at that time in spite of all that testing that said she did. This is just to show you how hard it is to correctly diagnose Cushing's in dogs.

It is IMPOSSIBLE for your vet or any vet to say a dog has Cushing's WITHOUT testing much less in cases like my Squirt's where a non-adrenal condition causes false positives. This is one of, if not THE, most difficult canine condition to correctly diagnose and I find it highly irresponsible for a vet to make a diagnosis based on no testing whatsoever not to mention want to start treatment with these powerful drugs. If I were you, I would be finding a new vet now.

Do not, under the current circumstances, start treatment on your sweet baby. ;)

[DakotasMom612]

H Judy.. Hi Squirt's Mom,

Thank you both for taking the time to help and advise me. My head is reeling trying to process all of this.

Judy, in response to your post, the vet did say we needed to keep an eye on her kidneys, but so far her function was good. He was more concerned right now with the changes to her liver. He started her on Denamarin which is a supplement for the liver. As far as her blood pressure goes, he did take it a few times while doing the sonogram. At first it was very high. As I said previously, Dakota is terrified of the vet. When they took her to do the sonogram, I could hear her all the way out in the waiting room. The way she was wailing you would have thought they were murdering her. Once they sedated her and she was calmer they got better readings, but it is something we are keeping an eye on. It's just going to be hard to get a true reading because she gets so terrified.

Squirt's Mom, I'm very confused now because listening to your story gives me hope that maybe there's a possibility that Dakota might not have Cushing's. From the numbers in her labs and from the symptoms Dakota was having, our vet suspected Cushing's but he wasn't sure. Which is why he did the sonogram, which showed both her adrenal glands were enlarged, which he then said pointed to pituitary Cushing's That's when he said he could do the LDDS, but he didn't think it would change the diagnosis. So here is my question. If your pup had all the necessary blood tests and a sonogram and they all gave a false positive....then what do I need to do to know beyond a shadow of a doubt that it is Cushing's? By the way, our vet told us we did not have to rush into treating her for the Cushing's and he could put us in touch with and endocrinologist first, if we wanted a specialist's opinion. This is all so overwhelming to process especially since up until now Dakota has never had any illnesses and she's almost 11. Our vet also gave us some literature to educated us and told us to think about all our options before making any decisions. I have been all over the internet trying to learn as much as I can which is how I found this forum. Once again, how can I find out for sure if it really is Cushing's? Please advise.

Thanks again to both you and Judy for all your help!
Chris

[labblab]

Hi again, Chris. In honesty, given Dakota's lab and sonogram results thus far, I do agree with your vet that Cushing's is the most likely culprit. Unfortunately, there is no single test that can unequivocally diagnose Cushing's. However, the LDDS or the ACTH are the only two tests that are specifically designed to test for the disease. That's why, if you do decide to consider treatment, I do believe it's necessary that one of those tests first be performed.

I appreciate the fact that your vet is providing educational info, and has also suggested the possibility of an endocrinological consultation. Under the circumstances, that may indeed be a really helpful option. Since Cushing's would be within his/her special area of expertise, that vet could oversee or recommend any additional testing. Given Dakota's lack of overt symptoms, the decision may still be to hold off on treatment for now even if further testing is indeed consistent with Cushing's. The specialist may also be better armed to tell you, though, whether treatment would be a good idea, especially if the protein persists in Dakota's urine.

I know you have a lot on your mind to think over right now. So please do continue to feel free to ask as many questions here as you wish!

Marianne

[DakotasMom612]

Thank you Marianne! Since her Cushing's symptoms are not that bad right now. We are holding off treating her for the Cushing's for now. However, we will be watching her kidney function and the protein in the urine. I will call the vet to ask when he needs to do another urine analysis.

Thanks,
Chris

[Squirt's Mom]

As Marianne said there is no one, or even 2, tests that can 100% diagnose Cushing's in dogs. But it is always better to do the testing than not. As with Squirt, even those tests can be wrong if something else is going on, like a tumor. One of my babies now, Trinket, has been diagnosed with Cushing's but I doubt that diagnosis even tho her ACTH was literally off the charts. Why? Because she has so many other things going on and those things could cause the cortisol to be very high resulting in false positives as in Squirt's case. There is a cyst on one of Trink's adrenal glands that is shrinking with Lysodren; she has a pocket in her colon by the rectum that collects feces; she is blind; she has anal gland disease; she has Colitis; she has COPD; she now gets upset at the vets when they take her away from me to the back. So even tho her vets are sure she has Cushing's, I am not. I am willing to continue the Lysodren which is being given at a very, very low dose because it is helping shrink that growth on the adrenal gland. Both her glands are enlarged so they think hers is also pituitary...but I believe those glands can become enlarged any time there is excess cortisol being produced for any reason, Cushing's or otherwise. As I said - this is one of, if not THE, most difficult diseases in dogs to diagnose. And there is no way in you know where I would start a dog on either Vetoryl (Trilostane) or Lysodren (Mitotane) without testing. No way. But that is me - others may be willing to take that risk....I am not. ;)

You are doing a great job educating yourself and asking questions. There is no rush so keep digging til your gut tells you what is right for your baby.

Hugs,
Leslie and the gang

[molly muffin]

Hello and welcome to the forum. :) I'm sharlene and the other staffer who had a dog with high UPC along with cushings. (high cortisol levels)

As Judy mentioned to know the true amount of kidney issue with the protein loss they like to have 3 consistent UPC tests showing elevation, about 2 weeks apart. That is how we diagnosed my molly with the protein loss and it was at that point that we started her on cushings treatment. As my IMS said at the time, it was and can be hard to know what came first, the elevated cortisol or the kidney issue, but it became important that we try to get the cortisol down to help the kidneys along with treating the protein loss, which is what the enalypril mentioned is for. If you can get both under control, then it can work out fine but it can be a tough road to do so and follow up testing would be needed. But I think i would talk to your vet about starting something for the protein loss and also doing an ACTH to check the cortisol level.

The issue is that left alone, eventually the BUN and Creatinine will start to increase and that is what we don't want to see for a long time. If it is possible to intervene and prevent that from occurring till much later in life, that is what I would and did do.

You can also have what is called an SDMA which is an kidney test that detects kidney disease much earlier than previous test did. You can check to see if this is listed on your test results. I would expect it to at this point be well within normal range, but is a test that you can use to keep an eye on the kidneys.