15 year old chihuahua just diagnosed with Cushings

[Christi846]

So today I received the news Gidget has Cushings disease. She was diagnosed by an internal medicine dr. I was told that I would hear from her dr and that she would be put on meds for the rest of her life. Gidget is already on ursodol and denamarin for liver. She had blood work done several months ago and her tests were really high so she was put on this and it brought them in normal range. She will be on it forever tho. The only real symptom she has right now for the Cushings is the excessive drinking and urinating. She panted a lot on Sunday but I was on vacation for a week and I got back that day and I think her stress was high from the excitement from being home again. My mom keeps her when we go on vacation. She doesn't have a potbelly or anything. She weighs 9lbs and she doesn't look her age or act it. Even the internal med dr and all the girls in the office couldn't believe she was 15 1/2. Is the Cushings med a good idea? I'm so scared after reading all the side effects and some of the stories. Any input would be appreciated

[labblab]

Hello, and welcome to you and little Gidget! We're sorry for the worries that have brought you here, but we're surely glad you've found us and we'll do our best to answer your questions.

Given her age, Gidget has now entered her senior years. That being the case, there may be pros-and-cons to Cushing's treatment that you'd want to think over. In my own mind, the decision whether or not to treat any dog depends on a number of factors: age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen. For a younger dog, I would want to provide as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.

However, since the damage 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. Instead, my biggest 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 might choose not to treat, especially if my senior dog suffers from inflammatory conditions like arthritis that may actually be soothed by the elevated cortisol level of Cushing's. Treatment also involves frequent vet visits and blood draws, especially at the beginning. So again, if vet visits are really stressful for a senior dog, I'd also factor that into my treatment decision.

The Cushing's drugs are indeed powerful, so they must be used carefully. However, we have witnessed many success stories here and we will be happy to offer our support and suggestions should you decide to proceed to treatment. Most importantly, though, you do not need to rush to make a decision. You can, and should, feel as though you can take as much time as you need to feel comfortable that your questions have been answered and you feel secure in whatever decision you end up making.

Marianne

[Joan2517]

Hi, I've already been in touch with you on my thread. I didn't know this forum existed when Lena was diagnosed at age 14 and I rushed into treatment before I knew anything. You have time to learn and become a knowledgeable advocate for Gidget, and then you can decide what to do.

[Christi846]

I was told a month ago she was slowing signs of early stage on kidney disease. Do you think this is the case or do you think it is the Cushings disease?

Gidget is eating and drinking. She's def not eating excessively tho. She is drinking and is possibly drinking a bit more then usual but not a whole lot. For the most part she is in good health. Back in march she wouldn't move much and when you touched her back she cried out. Come
To find out she had a CT and it showed an area in the cervical spine that looked chronic. She was put on an anti inflammatory and I have completely
Blocked her from jumping and I got her a ramp to get on and off the couch. She still plays and seems
Mostly Like herself. I just want to do what's best for her and I don't want this Cushings to take her away from me sooner. I'm trying to keep her heathy as possible cuz I cAnt imagine life without her

[molly muffin]

Hello and welcome from me too.

Do you have the results of the test that was done to diagnose cushings? It would be either an ACTH or an LDDS test. Ldds is an 8 hour test and acth usually a two hour test.

You said her liver values are now back in normal range? Is all her other blood work in normal range now too?

I do wonder, if having a spine issue that causes pain, might not also cause her cortisol to elevate (naturally) It is the body's response to stress, pain, etc.

One thing to worry about with lowering the cortisol is whether the spine might not feel more painful to her.

I think I would evaluate how elevated the cortisol is, and discuss with specialist/vet whether or not it would be more painful for her with her back if the cortisol is lowered. Also the kidney disease(?) is that a diagnosis or a possibility? How are her Bun and creatinine results? Has she had an SDMA test to verify kidney function? this is a newer test that shows kidney disease earlier than the older one did.

I know that's a lot of questions. My apologies. It does help us to give better feedback though

[Christi846]

I am still waiting for the dr to call me back. The internal medicine dr forward results to her doctor and he was off Friday. Here are the blood work results tho.

The 2 hr ACTH test was done on her tho.

Hematology
8/7/17 (Order Received) 6/5/17 5/10/17 8/7/17 10:57 PM (Last Updated)

TEST RESULT REFERENCE VALUE
RBC 6.6 5.39 - 8.7 M/µL 6.08 6.05
Hematocrit 44.6 38.3 - 56.5 % 41.3 40.0
Generated by VetConnect® PLUS August 8, 2017 09:26 PM Page 1 of 5
GIDGET HUMPHREY PET OWNER: HUMPHREY DATE OF RESULT: 8/7/17 LAB ID: 8101465046
Hematology (continued)
TEST RESULT REFERENCE VALUE
Hemoglobin 15.7 13.4 - 20.7 g/dL 14.4 14.4
MCV 68 59 - 76 fL 68 66
MCH 23.8 21.9 - 26.1 pg 23.7 23.8
MCHC 35.2 32.6 - 39.2 g/dL 34.9 36.0
% Reticulocyte 0.4 % 0.4 0.4
Reticulocyte 26 10 - 110 K/µL 24 24
WBC 9 4.9 - 17.6 K/µL 9.7 9.3
% Neutrophil 85.2 % 87.8 85.2
% Lymphocyte 8.2 % 6.8 9.1
% Monocyte 3.2 % 3.5 3.3
% Eosinophil 3.4 % 1.9 2.4
% Basophil 0.0 % 0.0 0.0
Neutrophil 7.668 2.94 - 12.67 K/µL 8.517 7.924
Lymphocyte 0.738 1.06 - 4.95 K/µL L 0.66 0.846
Monocyte 0.288 0.13 - 1.15 K/µL 0.34 0.307
Eosinophil 0.306 0.07 - 1.49 K/µL 0.184 0.223
Basophil 0 0 - 0.1 K/µL 0 0
Platelet 510 143 - 448 K/µL H 434 553
Remarks SLIDE REV... SLIDE REV... SLIDE REVIEWED MICROSCOPICALLY. NO PARASITES SEEN

Chemistry
8/7/17 (Order Received) 6/5/17 5/10/17 8/7/17 10:57 PM (Last Updated)
TEST RESULT REFERENCE VALUE
Glucose 99 63 - 114 mg/dL 105 102
IDEXX SDMA (a) 20 0 - 14 µg/dL H 22 20
Creatinine 1.2 0.5 - 1.5 mg/dL 1.1 1.2
BUN 49 9 - 31 mg/dL H 45 33
BUN:Creatinine Ratio 40.8 40.9 27.5
Phosphorus 4.7 2.5 - 6.1 mg/dL 3.9 4.4
Calcium 11.3 8.4 - 11.8 mg/dL 10.4 10.9
Sodium 149 142 - 152 mmol/L 144 146

Generated by VetConnect® PLUS August 8, 2017 09:26 PM Page 2 of 5
GIDGET HUMPHREY PET OWNER: HUMPHREY DATE OF RESULT: 8/7/17 LAB ID: 8101465046
Chemistry (continued)
TEST RESULT REFERENCE VALUE
Potassium 4.8 4.0 - 5.4 mmol/L 4.7 5.4
Na:K Ratio 31 28 - 37 31 27
Chloride 107 108 - 119 mmol/L L 106 109
TCO2 (Bicarbonate) 22 13 - 27 mmol/L 21 21
Anion Gap 25 11 - 26 mmol/L 22 21
Total Protein 6.6 5.5 - 7.5 g/dL 6.9 6.9
Albumin 3.5 2.7 - 3.9 g/dL 3.3 3.4
Globulin 3.1 2.4 - 4.0 g/dL 3.6 3.5
Alb:Glob Ratio 1.1 0.7 - 1.5 0.9 1.0
ALT 185 18 - 121 U/L H 241 104
AST 39 16 - 55 U/L 36 29
ALP 198 5 - 160 U/L H 175 171
GGT 13 0 - 13 U/L 11 9
Bilirubin - Total 0.1 0.0 - 0.3 mg/dL 0.2 0.1
Bilirubin Unconjugated 0.0 0.0 - 0.2 mg/dL 0.1 0.0<0.1
Bilirubin Conjugated 0.0 - 0.1 mg/dL <0.1 0.1
Cholesterol 286 131 - 345 mg/dL 311 362
Amylase 697 337 - 1,469 U/L 551 755
Lipase 273 138 - 755 U/L 211 250
Creatine Kinase 188 10 - 200 U/L 219 90
NHemolysis Index b N 1+
NLipemia Index c N 1+

(a) SDMA IS INCREASED AND CREATININE IS WITHIN THE REFERENCE INTERVAL. IDEXX SDMA Test is a more reliable indicator of kidney function than creatinine because SDMA detects declining kidney function earlier and is not impacted by muscle mass. Creatinine can miss early function loss and be falsely decreased in patients with poor muscle mass. SDMA increases in acute and active injury as well as chronic kidney disease. A complete urinalysis should be performed to evaluate for inappropriate specific gravity, proteinuria and other evidence of kidney disease. If SDMA is 15-19 ug/dL and there is other evidence of kidney disease, action should be taken. If SDMA is 15-19 ug/dL with no other evidence of disease, recheck in 2-4 weeks. If SDMA 20 ug/dL or is persistently 15-19 ug/dL, regardless of whether there is other evidence of kidney disease, action should be taken. For information on recommended actions visit: www.idexx.com/SDMAalgorithm Note: In puppies, SDMA reference interval is 0-16 ug/dL. SDMA reference interval studies are underway for kittens and Greyhounds, and results should be interpreted in light of other findings.
Generated by VetConnect® PLUS August 8, 2017 09:26 PM

[Christi846]

CORTISOL SAMPLE 1-
5.4 1 - 5 ug/dL

CORTISOL SAMPLE 2-
31.2 8 - 17 ug/dL



Test Results Ref. range Unit Cortisol Serial 2 ACTH Pre Post CORTISOL SAMPLE 1 5.4 1 - 5 ug/dL CORTISOL SAMPLE 2 31.2 8 - 17 ug/dL HYPERADRENOCORTICISM (HAC): Post ACTH results greater than 20 ug/dL (dog) and greater than 15 ug/dL (cat) are consistent with HAC. NOTE: ACTH results should always be interpreted in light of clinical signs. False positive results may occur with stress or non-adrenal illness. In addition, exogenous steroids may be measured by the assay and result in falsely elevated cortisol levels. Because of wide variability, resting (basal) cortisol should not be used to rule-out or diagnose HAC. IATROGENIC HYPERADRENOCORTICISM: Resting cortisol is usually between 1-5 ug/dL with little to no increase in the post-ACTH cortisol level. HYPOADRENOCORTICISM (HOC): Resting cortisol is usually subnormal (less than 1 ug/dL) or low normal with no increase after ACTH. POST-LYSODREN: Pre & post cortisol levels after Lysodren loading or while on maintenance Lysodren should be between 1-5 ug/dL. POST-TRILOSTANE: Pre & post cortisol levels between 1.5-9.1 ug/dL indicate optimal control.

Recommendation from Internal Medicine Dr.

Results of the ACTH Stimulation test - compatible with Cushing's disease. Diagnosis: ?Adrenal-dependent Cushing's disease with the enlarged Left Adrenal gland. This dog is too old to have an adrenalectomy so Vetroyl appears to be the treatment of choice. Thanks again for the referral,

[labblab]

Thanks so much for all this additional info. One more question for you, though -- the vet's notes indicate that Gidget's left adrenal gland is enlarged, presumably due to a tumor, and this would be what is causing the Cushing's. I'm assuming Gidget must have had an ultrasound done. Did the vet give you any specifics about the appearance of her adrenal gland and the possible tumor? This might have a bearing on the symptoms that may arise going forward.

Honestly, though, I'm not sure whether or not I would choose to treat the Cushing's right now if Gidget were mine, for all the reasons we've already discussed. She does still have some liver elevations, but they are actually much closer to normal range than is often the case for Cushpups. If Gidget's only outward symptoms are excessive thirst and urination -- and they are not a big problem to you -- than I don't know how much you'd really gain from treatment right now. Her elevated SDMA does correspond to declining kidney function, but as to whether or not that is more related to general aging as opposed to a direct result of Cushing's, I do not know.

I realize I am not being very helpful :o. But unless your vet believes that Cushing's treatment will be beneficial for her kidneys, you may want to discuss holding off until Gidget's outward symptoms become more pronounced or uncomfortable to her. Just the thought I have in my head right now...

Marianne

[molly muffin]

I think it is really tough when you have an older dog and are trying to balance two different issues, in Gidgets case, the kidneys and the cushings.

I would ask the vet about whether or not cushing meds would be beneficial in light of the kidney problems. Would they make it worse or not. It's worth haveing that discussion.