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-   -   Barney - 8yo Jack Russell Terrier (http://k9diabetes.com/forum/showthread.php?t=900)

Kelley 05-09-2009 02:20 PM

Barney - 8yo Jack Russell Terrier
 
Hello everyone,

I have an 8 year old Jack Russell Terrier who has been diagnosed this week with Cushings. Our journey to this diagnosis began in January, the vets were initially looking for a kidney problem and originally diagnosed him with Chronic Kidney Disease. When all the kidney tests came back negative, they decided to throw in a Cushing's test as well. They told me before the test it was likely to come back negative and we would still have no diagnosis. They were very surprised when the Cushing's came back positive.

Our primary vet has sent the results to the Small Animal Hospital at University of Florida for review. We had been working with the vets there as well trying to diagnosis his suspected kidney problem. We don't know yet what type of Cushing's he has and we are feeling really worried about all this right now. From what I've read, the treatment for Cushings is pretty tough to go through.

I'm pregnant right now with our first child, but he's been our baby for 8 years. I'm trying to keep positive and not let all the negative stuff get to me but it's hard. I'm so worried about him and would just appreciate some information.

I don't' have a copy of the labs yet, but I'll get a copy of them on Monday.

Thanks in advance,
Kelley

frijole 05-09-2009 02:59 PM

Re: Barney
 
Heh Kelley!

I am going to make your day. Treatment of cushings is only tough when vets aren't experienced and get in over their heads.... it really isn't that bad. I am delighted your vet has forwarded results to a specialist. There are different types of cushings and they are treated differently so what you are doing right now is the best thing you can do for your dog. You want to be sure of the diagnosis before treating and you want a vet that has experience.

My dog is over 15 (schnauzer) and she has been treated using lysodren for 3 yrs now. She's a happy little thing and her only problems right now come from old age - not cushings. :)

So don't fret. Continue to post and ask questions. The more you know about the disease the better but there is no rush to treat. Congrats on the pregnancy!

Kim

k9diabetes 05-09-2009 04:49 PM

Re: Barney
 
I believe that's UF in Gainesville and I have seen them do some very fine work with endocrinology. I was impressed with Dr. Schaer so hope that's who will be taking a look at Barney's case.

Natalie

LuvMyMunchie 05-09-2009 08:17 PM

Re: Barney - 8yo Jack Russell Terrier
 
Kelley,

Just wanted to stop by and say "hi and welcome" to you and Barney. Sounds like you've got Barney in good hands for testing and diagnosis. As Kim said, post and ask questions. We're here to help!!

Louise

P.S. Congratulations from me too on your pregnancy.

Kelley 05-10-2009 12:54 PM

Re: Barney - 8yo Jack Russell Terrier
 
Thanks so much for the quick responses!

Kim-Thanks so much for the reassurance. I'm SOOO happy to hear of a dog that is doing well! I've told a couple of people about Barn's diagnosis and they just say, "I'm so sorry" as if it's a death sentence. :(

Natlie-you're exactly right, it's the Small Animal Hospital is at UF in Gainesville. If we have to go back there for testing, maybe I can request Dr. Schaer. Currently we are working with someone else who specialty is kidney diseases, but I'm thinking they'll refer us to another doc.

Thanks so much for the welcome and congrats Louise!

I will continue to post his progress and let you know when they diagnose which type of Cushing's he has.

I'm so glad to have found this forum. I'll keep you updated and I really appreciate the responses.

Kelley

Kelley 05-12-2009 05:54 PM

Re: Barney - 8yo Jack Russell Terrier
 
Here's the latest update on Barney...
The vet just called me, she heard back from the vet at the University of Florida. Apparently, the resident presented Barney's case in grand rounds. There was some disagreement as to how to proceed with his treatment and now they aren't so sure that he has Cushings even though his test was positive. He's going for another test on Friday, the low-dose dex suppression test.
I've requested the results from his other test and they are going to fax it to me tomorrow. I'll post the results when I get the fax.
The vet did say that if the second test comes back positive, they recommend Trilostane for a traditional treatment.

Kelley 05-12-2009 06:12 PM

Re: Barney - 8yo Jack Russell Terrier
 
They faxed over the results this evening. I'd really love to hear feedback about these results. All were way above normal and the note on the test say "these results indicate presence of increased adrenal activity-severe"


Test Result (baseline) Result (post ACTH)

Cortisol 166.0 229.7

Androst- 4.0 9.9
enedione

Estradiol 114.4 110.4

Progesterone 1.61 3.74

17OH Progest. 1.03 3.5

Aldosterone 653.6 727.1

The top of the page for treatment options says "Steroid Profiles in the Diagnosis of Atypical Cushing's Disease" The vet has never mentioned atypical...can anyone help me understand what that means?

Thanks in advance for your advice and help.

Kelley

AlisonandMia 05-12-2009 06:37 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi,

I've just posted below the reference range for those tests - would you be able to just check that the reference ranges that show up on Barney's tests are the same as these one's.

Quote:

Cortisol:
Baseline: Normal 2.1-58.8
Post Acth: Normal 65-174.6

Androstendedione:
Baseline: Normal 0.05-0.57)
Post Acth: Normal 0.27-3.97

Estradiol:
Baseline:30.8-69.9
Post Acth: 27.9-69.2

Progesterone:
Baseline: 0.03-0.49
Post Acth: 0.10-1.50

17 OH Progesterone:
Baseline: 0.08-0.77
Post Acth: 0.40-1.62

Aldosterone***
Baseline: 11-139.9)
Post Acth: 72.9-398.5)

Alison

AlisonandMia 05-12-2009 06:45 PM

Re: Barney - 8yo Jack Russell Terrier
 
Just compared Barney's results to the reference ranges I just posted and, boy, do I see what they mean by severe!

Have you had an abdominal ultrasound done to rule out an adrenal tumor? (I'm not saying that these results suggest that necessarily at all but it is something you'd want to have checked out if you haven't already.)

I would think with the big elevations in all those hormones that actually Trilostane will not be the best treatment because although it lowers some of the hormones it elevates others as a side effect and this can cause a continuation or even worsening of symptoms especially over time. Dogs with these sorts of results on this testing are usually treated with Lysodren and melatonin and lignans to help address the estradiol which is sometimes not addressed completely by the Lysodren.

The UTK will have included a treatment recommendation along with the test results.

Debbie's (stardeb55) dog Harley had similar results on his testing and he is being treated with a combination of those three treatments and is doing well - I'm sure you will hear from her soon.

Alison

Kelley 05-12-2009 06:50 PM

Re: Barney - 8yo Jack Russell Terrier
 
Here are the normal ranges on the report:

Cortisol:
Baseline: Normal 2.0-56.5
Post Acth: Normal 70.6-151.2

Androstendedione:
Baseline: Normal 0.05-0.36
Post Acth: Normal 0.24-2.90

Estradiol:
Baseline:23.1-65.1
Post Acth: 23.3-69.4

Progesterone:
Baseline: 0.03-0.17
Post Acth: 0.22-1.45

17 OH Progesterone:
Baseline: 0.08-0.22
Post Acth: 0.25-2.63

Aldosterone***
Baseline: 11-139.9
Post Acth: 72.9-398.5

Kelley 05-12-2009 06:57 PM

Re: Barney - 8yo Jack Russell Terrier
 
Thanks so much for the reply Alison!

Barney had an ultrasound in March of this year when they were looking for kidney problems. Here's the results:
Ultrasound of the abdomen revealed that both kidneys appear normal. A single nodule was found in the spleen and determined to be reactive lymphoid hyperplasia.

The UTK report has 12 treatment options listed. I wonder why my vet said she would recommend Trilostane? It says on the list "Lysodren may be preferred for atypical Cushings". Maybe I got them mixed up??

stardeb55 05-12-2009 07:03 PM

Re: Barney - 8yo Jack Russell Terrier
 
Kelley, I'm the Debbie that Allison mentioned. Barney is, indeed, Pit Cushing's + Atypical which is what my Harley is. Some of Barney's values are higher than Harley's were, while Harley was higher on others. Harley is being treated with Lysodren + melatonin +purified lignans. Lysodren is used to control the cortisol but it will also control most all of the other associated hormones because of the common biochemical pathways that these hormones share. The problem is estradiol. Estradiol has non-adrenal sources of production such as fat cells besides other tissue. Lyso will control the adrenal production of estradiol, but does not affect the non-adrenal sources of estradiol. This is where the use of melatonin + lignans comes into play, so that the non-adrenal production is controlled. I totally agree with Allison that Trilostane usually isn't an appropriate choice of treatment for a pup with these kind of values on a full adrenal panel. It would be very helpful to get a copy of the treatment recommendations.

Has Barney had an abdominal ultrasound? If not, I would strongly recommend that as your next step. Not only will you be able to get a look at the adrenal glands, but also all of Barney's internal organs, so you can get a better idea of his overall health. Based on my experience during the diagnostic phase for Harley, I disagree with the need for an LDDS at this point for Barney. All Harley had done to diagnose was the full panel & an abdominal US. In fact, I even asked the IMS that I was using at that point if she needed to do the LDDS, she said nope, all she needed was the US & the full adrenal panel results.

Hope this helps.
Debbie

frijole 05-12-2009 07:45 PM

Re: Barney - 8yo Jack Russell Terrier
 
Kelley

I don't have much to add but want to reinforce what Alison and Debbie just said. If you had the UTK panel done there should be treatment recommendations from Dr Oliver who is THE guy in treating atypical cushings. I agree that it doesn't seem like doing the LDDS test has any value - am curious why they are recommending it. Again, get the treatment recommendations from that lab report and maybe it'll be explained. I also agree that the preferred treatment for atypical cushings is not trilostane. It is easy to get all of these drugs confused so don't worry if you did. We all make mistakes. :p

I'm just glad you found us!

Kim

gpgscott 05-12-2009 07:57 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

Sorry your Barney is having issues.

You need the treatment recommendation from UTK.

Better to wait until you have a good diagnosis than to commence a treatment too early.

It appears to me that Trilo is not indicated as you have elevations of intermediate hormones.

Scott

SasAndYunah 05-12-2009 11:36 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

Sorry about the problems Barney's having. I understand that at this time it's not exactly clear with wich medication Barney will be treated. But I wanted to let you know that if the treatment will be with either Trilostane or Lysodren, that neither of these meds should be given/handled by pregnant women. (or women planning to become pregnant sometime in the future for that matter) I'm pretty sure your vet will also tell you this when the time comes to start treatment but wanted to let you know anyway. Congrats on the pregnancy :) And the best of luck with barney...

Saskia and Yunah,
The Netherlands.

Kelley 05-13-2009 08:03 AM

Re: Barney - 8yo Jack Russell Terrier
 
Thanks for the info everyone. I hadn't heard about not handling the meds while pregnant, thanks so much for that. The treatment options on the report from Dr. Oliver are as follows (I wonder if these are in order of preference? anyone know?)
1. Ultrasound (we had one done in March)
2. Melatonin
3. Melatonin Implants
4. Flaxseed oil with lignans
5. Maintenance dose of Lysodren
6. Lysodren traditional treatment
7. Trilostane (it says in the notes that Lysodren may be preferred for Atypical Cushings)
8. Ketaconazole
9. Selegiline
10. Specific hypertrinism treatment
11. Ovarian remnant detection (he's a boy...)
12. Retained testicle detection

stardeb55 05-13-2009 08:17 AM

Re: Barney - 8yo Jack Russell Terrier
 
The recommendation sheet isn't in any specific order. There should have been a comment that was something to the effect that say treatments #2, 3, 4 are recommended.l

Debbie

Kelley 05-13-2009 09:49 AM

Re: Barney - 8yo Jack Russell Terrier
 
Unfortunately, there aren't any solid recommendations from Dr. Oliver. The comments say: Various treatment option considerations are attached. Some veterinarians consider items 2-6.

Squirt's Mom 05-13-2009 10:10 AM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

Did the ultrasound say anything about his adrenal glands? These are the glands looked for in an U/S on a cush pup so I am curious as to what they had to say about them.

As for the treatment options, it sounds as if Dr O would use either melatonin and lignans, or those plus the Lysodren as maintenance or with the usual loading approach. On Squirt's results, it states which numbers are "recommended" but I have noticed some of the latter results say "some veterinarians consider items..." like yours does. Still, whether recommended by Dr O directly or whether stated as it is on your sheet, I would stick with his ideas, which doesn't include Trilo. As high has some of her hormone levels are already, that would be playing with fire, IMHO. So I hope you simply got confused with what your vet said. Very easy to do with all these new terms, meds, etc! ;)

You're doing a great job, so keep it up!
Hugs,
Leslie and the girls

PS. Since you are pregnant, please use gloves if you use the Lyso and wash your hands and arms off good after dosing, ok? We want all in your house to be well! :)

Kelley 05-13-2009 10:21 AM

Re: Barney - 8yo Jack Russell Terrier
 
The ultrasound just said that his kidneys are normal and a nodule was found in the spleen. I wonder if another ultrasound should be done to focus on the adrenal glands?

For the meds, she said she didn't want to use the one that destroyed the adrenal cells, just the one that inhibits them...does that help clear it up? I'm thinking if she suggests the Trilo, I'll have to disagree. Barney is also on an ACE inhibitor for his blood pressure and I read that Trilo is contraindicated with that as well.

SasAndYunah 05-13-2009 10:30 AM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley and Leslie,

I really want to emphasize that a pregnant woman should not be handling Lysodren (or Trilostane) at all. Not even wearing gloves. I thought that maybe it was "just" a Dutch regulation but found the same on an American site...

"Cautions:
Side effects include lethargy, weakness, and vomiting. If they occur, stop using the medication and contact your veterinarian. It should not be used in pregnant or nursing animals. Always wear disposable gloves when giving Lysodren to your pet and wash your hands after handling this medication. Pregnant women, or women trying to get pregnant should not handle this medication."

I really like this to be very clear...

Saskia and Yunah :)

stardeb55 05-13-2009 11:26 AM

Re: Barney - 8yo Jack Russell Terrier
 
Kelley, I'm certainly glad you mentioned the ACE inhibitor as you are absolutely correct that Trilo is contraindicated with this type of BP med. I would certainly think another abdominal US is warranted. I would take the $$$ you would spend on an LDDS, & use that for the US.

Quote:

she didn't want to use the one that destroyed the adrenal cells
I must respectfully disagree with the vet who said this. Lysodren does necrose enough of the adrenal cortex where the cortisol is produced to stop the overproduction of cortisol, but the med does not destroy the adrenal gland by a long shot. My first Cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15. As I mentioned yesterday, Harley, is also being treated with lysodren, & is doing well. It has been a little over a year since he was diagnosed.

Debbie

afortunato 05-13-2009 12:00 PM

Re: Barney - 8yo Jack Russell Terrier
 
My dog recently had been tested for Cushings. He is presently a diabetic dog. So, as of yet he was considered borderline. He also has cancer. Since 2005 I found this wonderful Chinese Vet. in Speonk, LI that has been treating my dog for his cancer with herbs from China. In 2005 the traditional vets only gave him to the end of the year. When he had a problem with his Trachea, he gave him herbs, when he had a problem with the bleeding from his nose (cancer) he gave him pills to stop the bleeding. And if he was to have cushings, he has herbs for treatment for the cushings disease. And when he was diagnosed with Pancreatis, he gave him the pills. SO I believe there is another way to treat animals without traditional drugs. I know alot of vets from diff. states call him with problems and he mails out the herbs to them for treatment. I had a co-worker how's dog had lymphomia, in 2007, he went to him and he is still here and doing wonderfully with the herbs.

Squirt's Mom 05-13-2009 01:01 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hey Kelley,

Saskia is absolutely right.... you shouldn't handle the meds at all. Thanks Saskia! :)

You will need to get your hubby to dose Barney for you, clean up any time he throws up after a dose, which hopefully won't happen anyway, and just to be on the safe side, perhaps pick up after him in the yard if this is presently your job. It seems like the amount of drug in the feces isn't much if any but I'm sure someone here will know about that for sure.

Hang in there!
Hugs,
Leslie and the girls

Kelley 05-14-2009 01:43 PM

Re: Barney - 8yo Jack Russell Terrier
 
Barney goes in for his LDDS tomorrow morning, but I'm not quite sure why they are doing it. From what you've all said and everything I've read it dosen't seem necessary. The vet told me that the vets at the U of F were in disagreement as to weather or not Barn has Cushings, so they want to do another test for sure. I'll post the results as soon as I know!

Thanks for everything!

stardeb55 05-14-2009 02:21 PM

Re: Barney - 8yo Jack Russell Terrier
 
Kelley, none of us are vets, but Barney's UTK panel clearly indicates that he is both Pit Cushing's + Atypical. As I mentioned when I first posted to you, the IMS who diagnosed Harley told me she did not need the LDDS, she could make the diagnosis on the UTK panel results + an abdominal ultrasound. I, frankly, don't understand why the vets think they have to do the LDDS. I do need to point out to you that even though the LDDS is considered to be the "gold standard" for diagnosing Cushing's, the test has one big problem. It can show a false positive in the presence of non-adrenal illness.

Kelley 05-14-2009 02:30 PM

Re: Barney - 8yo Jack Russell Terrier
 
That's why I'm so confused Debbie :confused:
I don't' understand why we're doing the test but the vet said it's necessary. I'm going to ask about starting with another ultrasound instead, we'll see what they say.
I'll keep you updated.

Wylie's Mom 05-14-2009 03:00 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

I've never posted on your thread before, but I wanted to tell you that I had the UCCR & ACTH stim done initially with my former vet. My current GP vet saw the results (plus low urine specific gravity, elevated liver enzymes from former vet records & clinical signs) and she suggested I go straight to getting an ultrasound. I remember she had mentioned that the other vets in her practice always do the LDDS, but she felt that it was unecessary (at least, in my case). I'm not sure why, but now I'm guessing that it was because I had already done the ACTH stim test. (If I had found this site earlier, I would have done the UTK panel in lieu of the initial ACTH stim test.;))

Basically, I'm with Debbie - use the $$$ for the ultrasound.

-Susy

Squirt's Mom 05-14-2009 03:27 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

The ACTH is a stimulation test while the LDDS is a suppression test. The ACTH test shows what cortisol the adrenals have in reserve. Alison, I think it is, describes the ACTH as squeezing the adrenals like a sponge to get all the cortisol out. That is the post number we see with an ACTH. With the LDDS the adrenals are suppressed to see how they handle being told to stop releasing cortisol. In a normal dog, one which doesn't have Cushing's, the adrenals will respond by slowing down. In a cush pup, the adrenal glands won't stop releasing cortisol even tho they have been suppressed by the dexamethasone. So the ACTH simply shows the amount of cortisol in the adrenals while the LDDS shows how well the adrenals are functioning. Since some of the docs involved in Tee Jay's case question the initial diagnosis, perhaps this is why they want another LDDS...to see how the adrenals are functioning now. I'm not saying they are right or wrong to want this, but thought I might offer an idea as to why.

From my own experiences with the ACTH and Squirt, her levels got high until that tumor was removed, then it went down dramatically. We hear about non-adrenal illnesses sometimes causing elevated cortisol and I didn't fully understand that until last year when all that was going on with Squirt. Now I do understand that sometimes an illness or problem other than Cushing's can cause cortisol levels to be in the range for a Cushing's diagnosis based on the ACTH only. If we had proceeded to treat with Lyso based on the UTK panel cortisol reading of 32.8 ug/dl instead of having the ultrasound (further testing), no telling what may have happened or if she would still be here.

It is extremely frustrating and can get expensive, but making absolutely sure of what you are dealing with first will make the journey much easier down the road...that's my thinking anyway. ;)

Hang in there!
Hugs,
Leslie and the girls

Kelley 05-20-2009 07:19 AM

Re: Barney - 8yo Jack Russell Terrier
 
I got a call from the vet today and the results of the LDDS test were negative. I don't have the results yet, but she said they were all within normal range.
She called the University of Florida for some advice. The vet there plans to get in touch with the University of Tenn. for some advice and direction.
I asked her to explain to me why the positive results on the other test don't mean he has Cushings for sure. She said the levels on the first test do show all the signs of Cushings, however, he has no other "clinical signs". His adrenal glands are perfectly normal and the LDDS test was normal.
I asked her if we could at least start the melatonin and FSO as recommended on the first lab test. She said she didn't have a problem with starting the FSO but would hold off on the melatonin.
What are everyone's thoughts on this? The vets seem really stumped.

Thanks so much,
Kelley

stardeb55 05-20-2009 02:21 PM

Re: Barney - 8yo Jack Russell Terrier
 
Kelley, melatonin will suppress the production of cortisol to a certain extent, just not as much as lysodren or trilostane. So if Barney is indeed normal, then I can understand the reluctance to even use melatonin. I think a consult with Dr. O & his colleagues at UTK is an excellent idea. Dr. O is more than willing to consult with attending vets or correspond with owners concerning their questions. A number of us in this group have actually e-mailed him with questions & concerns regarding our pup's treatments. He responds very promptly, & is an absolute angel when it comes to offering his help & advice.

Is their any possibility you can get a copy of those LDDS results & post the numbers for us?

Debbie

Wylie's Mom 05-20-2009 03:35 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

If you go ahead with the FSO - you might want to just get the lignans. Many FSO's don't have much of the lignans (if at all). Please read the treatment option sheet (same one that I PM'd you earlier):

http://www.vet.utk.edu/diagnostic/en...hing's.pdf

Most of us use the Flaxseed Lignans from Vitacost and some are trying out the Flaxhulls listed on the sheet.

I see that Lysodren was also listed as options (both maintenance or regular) on your UTK comments. Do you and/or your vet have reservations on trying Lysodren?

-Susy

Kelley 05-20-2009 04:35 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Debbie-I'll get the results when I get back home tomorrow; I'm out of town. I'll post them when I get them. Maybe I'll email Dr. O myself and see what he says! Would that be stepping on my vets toes at all?

Hi Susy-The reason the vets have reservations about the Lysodren (as well as all the other treatments) is becuase they aren't comfortable with his diagnosis of Cushing's yet. I'll be sure to use the ligans, thanks again for the info you sent me.

Harley PoMMom 05-20-2009 04:52 PM

Re: Barney - 8yo Jack Russell Terrier
 
Hi Kelley,

When Harley was diagnosed with atypical cushings, my vet never dealt with such a case, she was very happy that I was consulting with Dr. Oliver via e-mail, even asked me to forward the e-mails to her. My vet has even called Dr. Oliver herself and consulted him about Harley.

IMO, If consulting with Dr. Oliver would make you feel better about Barney 's diagnosis, treatment or just make you feel better, I would do it.


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