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  #1  
Old 04-24-2009, 02:17 PM
Coolidge Coolidge is offline
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Default Coolidge...

Hi all. Took me a while to find this, and I was panicking.

Coolidge is now showing all signs of her Cushings. It's been since the middle of October since she was loaded, and only one dose of Lysodren on Jan 1st.

She is scheduled for her ACTH test next week. Everyone mentioned doing the Uof Tenn adrenal panel. Just noticed there are several adrenal panels for dogs. Which one am I to tell the vet to have done?

Appt is for this Weds. Need answers prior to then.

Thanks again for all your help.

Becky and Coolidge (Possible DX 2008)
  #2  
Old 04-24-2009, 02:25 PM
frijole frijole is offline
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Default Re: Coolidge...

Hi Becky and welcome.

Could you start from the beginning. Was the dog diagnosed or not in Oct? I'm not sure about your comment about lysodren. Normally dogs load and then they take the drug weekly. You are saying the last pill was in January? That would be why the symptoms are coming back.

Do you know if your vet has much experience with cushings? You shouldn't have to tell him what tests to do. Can you get records from Oct and see what tests he already did? That would help. Also the results (numbers) on the tests.

Tell us more about your Coolidge - age, type, weight, symptoms. This will help us help you.

Thanks
Kim
  #3  
Old 04-24-2009, 02:25 PM
stardeb55 stardeb55 is offline
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Default Re: Coolidge...

Becky, you want the full adrenal panel which is explained at letter "G" on the follow link.

http://www.vet.utk.edu/diagnostic/en...gy/general.php

Debbie
  #4  
Old 04-24-2009, 02:30 PM
Coolidge Coolidge is offline
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Default Re: Coolidge...

So long of a story, sorry. She was diagnosed in Sept 2008, but had other issues that could have skewed things. Lepto, UTI's., etc. This all happened after her loading in October. She loaded relatively fast, and wound up almost Addisonian. Really, really low numbers.

My vet wanted her to have an ACTH test at the end of Dec, which she had and showed it was coming back. So she had me begin maintenance. Jan 1st was her first and last maintenance pill. She became very lethargic. In mid Jan, I took her to UW-Madison's vet school, they did an ultrasound of her adrenals, both were of normal size. They told me to hold off treating her until she really showed signs. Which she is.

Everyone on the old caninecushings.net recommended that when this time came, to have my vet send the bloodwork to UTN for their adrenal panel.
The time has come and there is a variety (listed below). Please tell me which one????

Adrenal Function
Cortisol-ACTH Stim Dog, Cat Serum Adrenal Function $30.00
Cortisol-Dex Supp/ACTH Stim Dog, Horse Serum Adrenal Function $35.00
Cortisol-Low Dose Dex Supp Dog Serum Adrenal Function $35.00
Cortisol-High Dose Dex Supp Dog Serum Adrenal Function $35.00
Cortisol-Dex Supp/TRH Stim Test) Horse Serum Adrenal Function $35.00
Cortisol-(Overnight Dex Supp) Horse Serum Adrenal Function $30.00
Adrenal Panel (ACTH Stim) Dog, Cat Serum Adrenal Function $135.00
Adrenal Panel (Combined Dex Supp / ACTH Stim) Dog Serum Adrenal Function $155.00
Adrenal Panel Ferret Serum Adrenal Function $65.00
Adrenal Panel Rabbit Serum Adrenal Function $65.00
17 Hydroxyprogesterone (ACTH Stim required) Dog Serum Adrenal Function $30.00
Aldosterone baseline Dog, Cat Serum Adrenal Function $15.00
Aldosterone
(ACTH Stim required) Dog Serum Adrenal Function $30.00
  #5  
Old 04-24-2009, 02:33 PM
Coolidge Coolidge is offline
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Default Re: Coolidge...

Thank you Debbie!
  #6  
Old 04-24-2009, 04:15 PM
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ventilate ventilate is offline
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Default Re: Coolidge...

Do you have the results of the stim tests and of the test you had done to confirm cushings, it could be possible as your vet said that the results could have been skewed due to all that was going on at the time. That could explain why your dog had the reaction it did to the one dose of lysodren, may be your dog does not have cushings. Did the UW Madisons confirm that your dog had cushings? or just do the ultrasound. What signs and symptoms does your dog show?
I am sure someone that knows about the UT panel will be along shortly to tell you which test, that can also confirm cushings. The UT panel is useful when people want to treat with trilostain as that drug is know to increase the other sex hormones in the dog and if there is any possibility that your dog could have atypical cushings it is very helpful to know what the baseline hormones were before starting the trilo. IMO it would would be agood idea to have the UT Panel anyway even with treating with lysodren that does not elevate the sex hormones but you get more bang for your buck you still get the confirmation of a cushings diagnosis and the added bonus of being sure your dog is not atpyical
Hope this helps some
Sharon
  #7  
Old 04-26-2009, 03:27 PM
Coolidge Coolidge is offline
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Default Re: Coolidge...

If she does in fact have cushings (which I assume this full panel will tell me definitively), and we load her, do we have to do another full panel after loading? Or can I have my vet just send off the results of the ACTH followup to her normal lab?

Any insight greatly appreciated. Coolidge is now up all hours drinking and peeing.
  #8  
Old 04-26-2009, 03:44 PM
frijole frijole is offline
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Default Re: Coolidge...

You just said, "if she does have cushings" and I am pretty sure in earlier comments you said you loaded with lysodren... have you been thinking the dog was misdiagnosed originally? Are you wanting to test the adrenal hormones to see if she has atypical cushings? If so the treatment might be handled with flax, melatonin and lignons which are certainly cheaper than chemo drugs.

I do not know if you do the same panel for monitoring progress. I am sure someone with knowledge on atypical cushings will join in the discussion. I'm glad that you are having this test done. Good luck! Kim
  #9  
Old 04-26-2009, 03:52 PM
stardeb55 stardeb55 is offline
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Default Re: Coolidge...

Becky, you really just need a regular stim test to monitor your Coolidge while on lysodren. I e-mailed Dr. Oliver about how necessary it is to repeat a full panel, & how frequently, several months ago. His response was maybe in a year as the lyso will control all other associated sex hormones except for estradiol, if Coolidge should happen to have an elevated estradiol. Estradiol is difficult to control because it is also produced in non-adrenal tissue, such as adipose (fat) tissue, the gonads, & a couple of other places. This is where the use of melatonin & lignans comes into the picture, to help control the estradiol. Harley had everything elevated on his full panel at diagnosis a year ago. I have yet to have a full panel repeated, especially after what Dr. O wrote. I may have the estradiol rechecked at Harley's next stim which is due in early July.

Hope this helps.

Debbie

PS- I know it's a real pain, but with the loss of the old cc.net, would it be possible for you to re-post Coolidge's test results? We will be moving to a new "home" within the next week or two which is great news. Even better news, anything that has been posted in our temporary home can be transferred over to the new site, so none of us will have to repost.
  #10  
Old 04-26-2009, 04:43 PM
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Lulusmom Lulusmom is offline
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Default Re: Coolidge...

Hi Becky.

I am sure glad that you found us. I remember Coolidge and I also remember fearing that he had been misdiagnosed. As luck would have it, I found a cached page from your thread which had one of my posts on it which will update the other members. I'll see if I can find some more information that might help too.

Quote:
I've just reread your thread and I've decided that I haven't changed my opinion since the last time I posted to you. I still wonder about the accuracy of a cushing's diagnosis based solely on the results of a questionable LDDS. With the Leptospirosis being diagnosed shortly after, I would certainly question if the whether the LDDS results were false positive. It is also highly unlikely that a cushdog's liver enzymes would return to normal after a regimen of antibiotics. I was hoping that the ultrasound would at least support the LDDs but adrenals are normal.

Both of my cushdogs were switched to Trilostane which I truly regret. Had I done a full adrenal panel prior to starting treatment, I would have known that my little Lulu also had atypical cushing's in additional to pituitary dependent cushing's. We switched back to Lysodren in the last few months. I waited until both were totally symptomatic and then did an acth stim test to make certain that their post stim numbers were at least 22 or 23 before loading them with Lysodren.

If I were in your shoes, I would be highly suspicious of the original diagnosis and would want a lot more evidence than one questionable LDDS. Based on my own experience with switching meds twice under the guidance of a phenomenal internal medicine specialist, I sincerely think you should wait until full blown symptoms return and then have your vet request a full adrenal panel from the University of Tennessee. It is known that Trilostane always elevates one or more of the adrenal intermediate/sex hormones and if a dog has atypical cushing's, Trilostane is not an appropriate treatment as it will makes matters worse and some symptoms will never resolve. I know this first hand because Lulu is atypical and after two years on Trilostane her intermediates were off the charts. Because of this, a lot of us members feel that a full adrenal panel should be done for every dog prior to initiating treatment with Trilostane.

I think that everybody else has already given you this same information in one form or another but I thought it was worth a repeat.

Glynda
 

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