New Diagnosis -confused on starting treatment

[linda126]

I have a 12 year old Doxie that I took in for a UTI. Was given an antibiotic for UTI and some bloodwork was done where her ALKP was 1216 U/L (normal 23-212). ALT slightly high 133 U/L. Did a survey ultrasound and a few X-rays to see if there was possibly a tumor or growth. None found. Said with her pot belly and UTI she should be tested for Cushings. Went back Thur and did a Corisol test (ACTH sim) where they injected and drew blood a few hours later. The results showed 29.1 ug/dl (not a u looks like a backwards y). Which says in the indication of clinical signs, results are consistent with Cushings. She was going to prescribe Vetoryl but I talked to her about clinical signs. Other than the pot belly which she has had for years, there is no excessive thirst, she begs for food a lot but always did, no abnormal urinating, has slowed down but she is 12 years old. We both agreed to wait since if we start it will be hard to see if clinical signs are improving which is part of the dosage evaluation. Now I do not know what to do. Should I start her on Meds anyway just so it does not get worse. I do not want her to quickly go downhill. What danger is there in Meds. Is there non drug alternatives. Should I wait for more symptoms. The reason I do not want to jump in is that I lost a Doxie to SARDS who was mistakingly treated for Cushings.

[Harley PoMMom]

Hi and welcome to you and your girl!

I think the "wait and see approach" is a good plan especially since your girl is not showing the most obvious symptoms of Cushing's. Could you share with me what symptoms she was displaying that an UTI was suspected? And is she taking any other herbs/supplements/medications? Were her adrenal glands visualized on the ultrasound? One question I have regarding the protocol used for her ACTH stimulation test, with this type of test two blood draws are taken; one is the "pre" value and the second one is the "post," which is usually done one hour after the stimulating agent is injected, was her "post" blood draw performed one hour after the stim agent was injected? Also, was this test performed while she had the UTI? Has an urine culture and sensitivity test been done to make sure that the UTI is completely gone as sometimes they can be a bugger to get rid of.

We do have another thread on the forum where different medications are discussed, here's a link to that thread: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments (http://www.k9cushings.com/forum/showthread.php?8551) One particular link in that thread is to an article published by noted endocrinologist, Dr. David Bruyette: Part 3: Current & Investigative Options for Therapy (https://media.wix.co/ugd/38e433_2a59a2806e7c493d81988c1d9fd721cd.pdf)

However, those medications have not been widely researched compared to the conventional drugs of Trilostane (Vetroyl) and Mitotane (Lysodren). And yes, both of these medications are strong drugs and have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed.

Cushing's is really a slow progressing disease so if your girl is in the early stages, you could be waiting a very long time before you see any symptoms. If I were in your position, unless your girl started to show overt symptoms associated with Cushing's, I'd not worry so much about treating for Cushing's but I would consider liver supplements and check liver values in 3 to 4 months.

I want to express my condolences on the passing of your other Doxie, it is so hard losing them. Please know we are here for you and your sweet girl and will help in any way we can.

Lori

[labblab]

Hello Linda, and welcome back to us although I’m so sorry to learn about the loss of your little Copper. It has been a number of years since you talked with us about Copper, and I want to go ahead and add a link to his thread so that we can refer back to your experience with him should the need arise. Also, if you wish to tell us when he passed, it would be our privilege to add Copper’s name to our special memorial thread of honor that will be maintained here always.

http://www.k9cushings.com/forum/showthread.php?3512-13-Year-Old-Miniature-Dachshund

Turning to your little girl, Lori has gotten you off to a great start and she has asked some very helpful questions. I’ll be anxious to read more about your girl as we continue to discuss the best path forward.

Marianne

[linda126]

Thank you for your help. The prevalue which was 3.5 was taken 9:40 (after fasting from 9 pm the night before). Post taken at 10:40 am which was 29.1. Her symptoms for a UTI was blood in urine and frequency wanting to go outside. The UTI was the reason I took her to the vet in the first place. On the initial urine test WBC >50. RBC 6-20 Bacteria Rods present. Ph=5, LEU and PRO 100, BLD 250. She was given Baytril 68 mg tablets (1/2 tablet twice a day for 14 days). Urine test after showed WBC and RBC 1-5 and no bacteria rods present. Other values not on report so not measured? Right now infection seems to be gone. Only clinical signs I am seeing is not wanting to go for any long walks (but it is icy and cold here and she usually does that in winter) and her pot belly. She is always begging for food but seems like she has done that most of her life. There is dry dog food left out in the evening and overnight and she very seldom eats any. . Just begs for treats mostly. Her bark is also not as strong as it used to be. Hard to know what to chalk up to old age or Cushings. Coat seems good. She does have back/ neck issues and sometimes has to take Methocarbonal, Tramadol, and has gotten Laser Treatments about a year ago. She usually has an issue when she attempts to jump off porch or sofa. She has steps and ramps she uses most of the time. But that is maybe once every year. ACTH test was on Jan 25. Last antibiotic day for UTI was Jan. 22. Should have have another test done or wait til I see other symptoms like excessive thirst, etc. we do have a limited budget so not sure it is necessary to go through a lot of tests at this point. But if it will prolong her life I am willing.

[linda126]

Copper died Dec. 11, 2011. He had rough time the last few months. One thing after another. Took him to a specialist where the Cushings diagnosis was corrected to SARDS. He also had a tumor near his heart. Said wasn’t much they could do and plan was to make him comfortable. Surgery for the tumor was too dangerous. We had been giving him IV fluids and near the end was not eating much. We had made the decision to let her go after I got back from a conference. The day I came home my husband found him deceased on his bed. No sign of struggle. He seemed to die in his sleep.
He was 13 years 7 months.

[Harley PoMMom]

Is there a value for her urine specific gravity (USG) on the urinalysis? And was the urine sample collected from the first morning pee?

[linda126]

I wondered too. Pre treatment for UTI specific gravity was 1.014 with OH of 5. After UTI treatment specific gravity was 1.028 with ph of 6

[linda126]

Urine was collected about 4 am before going to vet at 8. I meant ph not oh

[Harley PoMMom]

Since it was 4 hours until the vet visit, was the urine placed in the refrigerator? In an ideal situation the urine sample should be evaluated within 30 minutes after it was collected, however, sometimes our furbabies just don't want to cooperate to that protocol (like my boy :)) so putting it in the frig and then getting it out right before leaving for the vet appointment will do.

[linda126]

Yes it was refrigerated. The vet is an hour away. We live in a rural area. Put it in a small cooler when traveling.

[Harley PoMMom]

Kudos to you in knowing how to handle the urine sample correctly!!! Dog's with Cushing's generally have a low specific gravity (<1.010) my Harley had an USG of 1.006, so that 1.028 USG is really good. Regarding her ultrasound, were her adrenal glands visualized?

[linda126]

I don’t know. It was called a Survey Ultrasound and think they were looking for general tumors. It was before the Cushings test when I took her in for the UTI. Said something about some sludge in tummy but not a tumor. We can’t afford tons of tests so I figured in a few months should she get more clinical symptoms or when she has her yearly checkup in May I will thoroughly discuss options, tests, based on what I learn here. Can you recommend commercial canned dog food or diet. I know she needs less grain or no grain. I see lots about raw diet but in a rural area where I live, good quality meat is super expensive. And the supplements I would have to all order online. What kind of supplements are recommended. Right now get glucosamine chondroidin with vitimins and minerals.

[Harley PoMMom]

If she's doing good on the food she is eating now I don't think I'd change it. When I adopted Marvin 2 years ago he came with many issues as he was used for breeding purposes and kept outside his whole life. The rescue had to shave all his hair off because it was severely matted and then to discover from all that matting his skin had many sores...poor little guy :( I forget the dog food brand they were feeding him, his stools were a bit too soft for me and he was scratching a lot so I switched him to Fromm as I always had good luck with that. However, Marvin didn't like it so I then tried Primal Raw Frozen Canine Chicken Nuggets, nope didn't care for that either and he was still scratching, preceded to go grain free which helped some...but come to figure out he has a chicken allergy so now he's fed American Journey Limited Ingredient Grain-Free Salmon & Sweet Potato, and finally, this seems to be working for him.

Milk thistle is a supplement that is recommended for the liver, if my memory serves me right Jarrow Formulas Milk Thistle is one brand that had a good review from ConsumerLab. com, from a quick Google search it sells for $8 - $11 for 100 capsules. And looking at the mg amount she would need 1 capsule.

And as I said before, if I were in your position, unless your girl started to show overt symptoms associated with Cushing's, I wouldn't treat her right now.