Kiltie - newly diagnosed Cushings Schnauzer

[KiltiesMom]

Hi everyone, my name is Rebecca and I am writing on behalf of my family, which includes our beloved Kiltie, a mini-schnauzer. Kiltie recently turned 10 and was just as recently diagnosed with Cushings. I found your website and everyone seems so supportive and extremely knowledgeable about this disease. Can you help me be less of a nervous wreck so we can actually help my dog:)

Kiltie was diagnosed in Toronto,after a blood test and further pathology. Both results came back as 'borderline'. Her water intake test was also 'borderline', meaning she wasn't above the max, but was meeting it. Vet has recommended Vetoryl, which I believe is Tristolane(?), and seemed to offer no concerns about her quality of life on this med. However, we have talked to another owner of a mini schnauzer who's dog was debilitated by this drug ( and has now died), and also read the long list of common side effects attributed to it. I am so worried about starting this medication; I can't stomach the thought of treating this disease, only to see Kiltie become sick and depressed each day. I also am wondering if anyone has had tests come back as 'borderline' and it turns out not to be Cushings after all?
I should also mention that she appears happy & healthy now, and we recently had arrived home from a cottage trip where she was up & down steps several times a day and on long walks, and she had lower water intake and no panting during this whole time.
The only other additional concern re: her health is a diagnosis of deep moist pyoderma first discovered in 2007, and is being treated successfuly by pulsing Cephalexin once every 4 weeks.
I really appreciate your patience in reading this long post and thank you for any help and advice you can offer!
Rebecca/Kiltie's Mom

[Roxee's Dad]

Hi Rebecca,
First I would like to welcome you and Kiltie to K9cushings. I am however sorry that Kiltie was diagnosed with cushings. The others as I affectionately call them will be around shortly to ask you 20 questions. We are here to help you and Kiltie however we can. Did the vet mention which type of cushings?

If you have copies of the test that were performed to diagnose cushings, please do post them as they will be of great help. If you don't have the test results, please ask your vet or receptionist to provide you copies, they should be happy to do so.

Hang in there, we are here to help. There are many here using Trilostane or Lysodren.

PS: Rebecca, Please do not feel a need to rush into treatment. Cushings is a slowly progressing disease. Trilo and or Lyso are drugs to be respected and if used according to published protocol and by a knowledgeable and experienced vet are safe to use. There are many, many success stories.

[frijole]

Hi Rebecca! I am going to make your day by saying that cushings is NOT a death sentence. My Haley is a schnauzer diagnosed THREE years ago at the age of 12 1/2. She is still kicking. :D Treated successfully with lysodren.

Before we go there --- your comment about "borderline" concern me simply because we see so many cases where dogs are misdiagnosed. Most of us went thru a series of tests to conclude cushings. It can be tricky.

Did your vet do a blood panel? If so if you could post the numbers that would be helpful (particularly anything that is elevated above normal ranges). Did your vet rule out hypothyroidism? It is common in schnauzers - as a matter of fact my other dog Annie just was diagnosed last week with it. (I was fearing cushings but I lucked out). This is a simple thyroid test. Treating it is simple and not expensive.

Diabetes - was that ruled out? Also common in schnauzers.

Has your dog been on any steroidal medications?

The more you share with us the better we can help you. So please detail Kiltie's story. The symptoms that led to testing. The names of the exact tests (all) that have been done and the results. (numbers)

That way we can determine WHAT is meant by borderline. I would NOT treat yet. There is no rush to treat cushings. It is much better to make sure of the diagnosis.

Glad you found us. Please don't worry at this point you cannot be sure it is even cushings. And if it is - then we will help you with that as well. BUt first things first. Hugs to Kiltie!

Kim

[jrepac]

Rebecca,

if Kiltie is truly borderline, you may not want to treat at this time...it really depends on severity of symptoms. I've been dealing w/a "borderline" situation for some time now (over a year) and have been treating only with generic anipryl (selegiline) and various supplements. And, have been getting various tests done/re-done over that time to monitor the situation. What results lead your vet to feel/believe Cushings is present?

Jeff

[haf549]

Hi Rebecca:

Just a quick welcome from another Torontonian. Actually, I live in Thornhill, 'the city above Toronto'. There have already been a lot of questions asked and the people here are extremely knowledgable. My siberian husky was diagnosed with Cushings last fall and we went the Trilostane route. It was a bit of a bumpy ride at first, but now Kira is doing extremely well.

If you become certain that Kiltie has Cushings and that you will go with Trilostane, I just want to put in a quick word. The vet might recommend the highest dose for a dog Kiltie's size (whatever that may be). You might ask the vet what the low-end dosage is would be and start with that. I started Kira at the high-end and ran into a few bumps in the road (nothing tooooo serious). Currently she is on the minimum dosage for a dog her size. It may take a little longer to stablize her but in the long run, I personally think it is a safer route. At this point you're saying Kiltie is 'borderline', so don't rush into anything. This disease is totally treatable.

Heidi

[gpgscott]

Welcome Rebecca,

You don't sound crazy at all even though I know you mind is running a million miles a minute trying to get all the facts straight.

I have to agree with the direction the others posts are taking that you do not yet have a firm diagnosis.

Diagnostics can be influenced by other medical conditions, how the diagnostic test is administered and even the state of agitation of the pup during the testing.

Please tell us more, the good thing about Cushing's is it is a disorder of slow progress. I think it is good to make a clear diagnosis before beginning to administer meds which can interfere with a proper diagnosis.

Best to you both. Scott

[Wylie's Mom]

I also am wondering if anyone has had tests come back as 'borderline' and it turns out not to be Cushings after all?

Hi Rebecca & Welcome,

I would say "yes" to your question. Cushing's is a very difficult disease to diagnose correctly. As the others have asked, please let us know what tests were used to determine that Kiltie has cushing's and post the actual test results here... this would help us to understand what's going on and we can better comment on your situation. Many of us here ask our vets for copies of all test results - this information can also really come in handy if you have to see a different vet, perhaps in an emergency situation.

Also, please let us know what cushing's symptoms she has. For the water consumption, how much does she drink (range) and how much does she weigh? From what you've said so far, she doesn't really drink excessively, and the only symptom I see (which may not even be from Cushings) is the pyoderma (since Cushpups are more proned to skin infections).

I would second what John said, about not being in a rush to treat... take the time to be very sure of the diagnosis first;).

-Susy

[Harley PoMMom]

Hi Rebecca,

Welcome from me too. I urge you also to get a better diagnosis of cushings for Kiltie than just "borderline."

When my Harley was dx'd with cushings by his former vet with a LDDS test his former vet wanted to treat him with Trilostane. At the urging of these amazing and knowledgeable people I had a full adrenal panel done on Harley, which is only done at the University of Tennessee, and found out Harley has Atypical Cushing. Therefore Trilostane is not an option for Harley as a treatment for his cushings.

You definitely have come to the right place for support and guidance, as these people know their "cushings." I don't know what I would have done if I hadn't found them.

Best of luck to you and Kiltie.
Lori

[KiltiesMom]

Hi Everyone - thanks so much for your kind and extremely helpful words. There is alot more info I need to go back and get from our vet to be able to answer some of your questions which I will do tomorrow.

In terms of her diagnosis she had 2 water intake tests that floated between 650-700 ml both days, and she had an all day blood test done where a steroid was injected, and her blood retaken at different intervals to see her tolerance. In the blood analysis one of her liver enzymes was approx. 24times normal.

There is yet another question I have if you can bear with me - since treating Kiltie for over a year w Cephalexin her ability to take a pill orally is becoming increasingly difficult and stressful. I know we can't grind up these Veteryl pills (if we choose to treat soon), and I wondered if anyone has a creative way to give them (we have done peanutbutter, cheese, yogurt, breads, pill pockets, as well as the most recent drastic course which is to pry her jaw open and shove them down, and we are now using a mortar/pestle).

Thanks again, and all the best to your furry family members.

[haf549]

Kira isn't a big problem to give pills to, but what I've done is bought the 'Laughing Cow Party Cubes' of cheese. The pill fits snuggly into the little cube and after eating, Kira looks forward to her cheezy treat.

Heidi

[frijole]

Glad you are going to get the files. Like I said earlier.. there is no rush to treat and frankly some hold off on "borderline" cases. The all day test is probably the low dose dex suppression test. That one will have 3 numbers that we'll need.

If you can please tell us what symptoms Kiltie has and a summary of what got you to this point - it truly helps get us up to speed. Otherwise we might assume something that it isn't correct.

As someone mentioned... trilostane is not always the best solution. If the LDDS test came back as inconclusive (not the same as borderline) I would definitely hold off on trilostane because as someone else explained, it could be atypical cushings which usually can be treated with flax and melatonin... no chemo drugs.

Glad you found us. Kim

[KiltiesMom]

I love that idea Heidi, thank you!!

[MiniSchnauzerMom]

Hi Rebecca,

A belated welcome to you and Kiltie from another MiniSchnauzer owner/lover! I must say that I agree with everyone else about not rushing into giving treatment with a borderline diagnosis.

You mentioned that Kiltie appears healthy and happy. Is she displaying symptoms? IMO I definitely wouldn't start giving meds based on lab numbers only and no symptoms. I learned the hard way as that's what happened to my Munchie (who was misdiagnosed).

Will be watching for Kiltie's updates. Give that little Schnauzer girl some extra pets from me.

Louise

[KiltiesMom]

Hi Everyone,

Well the update for Kiltie is that she has Cushings 100%. The confusion regarding a borderline result came from our vet's newest employee relating them. Vet reconfirmed w lab today and it's definetly Cushings & a pituitary kind ( I had been really hoping for atypical to be honest). He also reassured me that if Kiltie was his dog he would be putting her on Veteryl. We are going to start today or tomorrow, and she'll be rechecked in 10 days. It's the lowest dosage too so that is a bit better.
I'm going to pick up her actual paper results in 10 days too and will post them then.
Again thank you for such a warm welcome and as I learn more about Cushings I hope to be able to offer help to others some day soon:)

[Harley PoMMom]

Hi Rebecca,

It would really help us if you get copies of Kiltie's test results and post them before you start the Vetoryl. The Atypical Cushings can only be tested at the lab at the University of Tennessee, your vet would do the draws of blood and send them to the University of Tennessee.

What symptoms of cushings does Kiltie show signs of?

When my Harley was first dx'd with his former vet with a LDDS test, I also had an ultrasound and an endogenous test done on him that was done by an IMS at the University of Penn. Then I had the full adrenal panel done at the University of Tennessee. It takes more than just one test to confirm cushings, and which kind of cushings. This took 2-3 months to do. IMHO I would take the time to make a correct diagnosis of which cushings Kiltie has. These people on the forum can help you with that, belive me, they helped me with my Harley and he is doing much better.

Lori

[Wylie's Mom]

Hi Rebecca,

Please consider what Lori has said... even if Kiltie does indeed have regular Cushing's, it is still possible that she may be Atypical as well. Hopefully I can explain this to you well enough... The concern is:


Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in assays??), and frequently increases estradiol and androstenedione as well. LysodrenTM may be preferred for Atypical Cushing’s cases.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing's.pdf

Now, I/we are not saying you shouldn't use Trilostane, we just believe you should rule out Atypical first (particularly, elevations of those hormones listed). If those levels are fine, you may be out $350+, but you(and we:D) would have more peace of mind. If however, she does have atypical, she may possibly get worse after being on Trilo for some time. It is just more difficult to figure things out later and you may feel like you're back at square one. If you want to test her for Atypical after starting Trilo, you would have to stop the Trilo first (not sure if its for a couple weeks or a month).

My pup was first dx with PDH and I elected to use Lysodren... after a while, I wondered if he may have Atypical also. I had him tested and he indeed was also Atypical. I was so relieved that I happened to use Lysodren because the particular hormone that was elevated was estradiol and if I had been using Trilostane, those levels would probably have been elevated even further.

Glynda (lulusmom) is another good example, I'll look for a post of her's explaining her story.

-Susy
P.S. Plus, we here would feel even better if we can see those test results on the Cushing's before you treat - okay, so we like to hold people's hand through this whether they like it or not;).

[gpgscott]

Rebecca,

I just gotta say that without numbers none of us can evaluate the treatment which is being recommended to you as compared to ours.

I would not begin this treatment based on what you have posted. First I have a prejudice as concerns Trilostane (vetoryl) as it affects intermediate hormones. Some pups are put on it because it is erroneously assumed to be a safe med and their symtoms never cease, and sometimes even escalate.

I think you are moving way too fast. A trip to an IMS (internal medicine specialist) would be the way I would be moving at this time.

This is an issue many vets never see and even specialists are divided concerning treatment as their area of interest takes them in different directions concerning treatment.

Best to you both. Scott

[Wylie's Mom]

Hi Rebecca,

Scott's recommendation of seeing an IMS is an excellent suggestion. When my GP vet highly suspected Cushing's, she immediately referred us to an IMS.

I found one of Glynda's posts, taken from:
http://www.k9cushings.com/forum/showthread.php?t=560&page=3
UTK = Univ. of Tennessee, Knoxville, the only lab in the world that runs the Atypical test
intermediates = intermediate hormones


I am assuming that the UTK panel was done prior to starting treatment with Trilostane? If so, it was apparent back then that Palmer was atypical and Dr. Oliver's treatment recommendations did not include Trilostane for a reason. I seem to recall that you wrote to Dr. Oliver about using Trilostane and he did say that at some point you would probably see a return of symptoms as Trilostane always elevates one or more of the intermediates. At this point, I am not sure that the continuing symptoms you are seeing are from excess intermediates or the cortisol. The last post stim was quite high so this could easily explain why symptoms have not resolved.

As I explained to you before, my Lulu had elevated intermediates when I started treating her with Trilostane and over the course of two years, she lost the coat she had regained with Lysodren and her intermediates had skyrocketed. I must admit that the Trilostane did a superb job of controlling her cortisol and the voracious appetite, PU/PD and the heavy panting improved tremendously once we got her stabilized on the 30mg once daily. Without fail, her post cortisol was in the 2's and 3's for two years at that dose and aside from losing her coat and her skin getting a lot worse, she did very well.

It is quite possible that once you get Palmer's post cortisol within range, all of his symptoms will resolve and he'll do just fine. However, given that he is atypical, Dr. Oliver's comments will come to fruition and you will see some symptoms return at some point. I also think that you will find that some of the intermediates that were normal on the first UTK panel will be elevated on future UTK panels. I would highly recommend that you keep a very close eye on the intermediates by having a UTK panel done every six months. Had I done that, Lulu would have been off the Trilostane a lot sooner.


-Susy