Barney - 8yo Jack Russell Terrier

[Kelley]

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]

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]

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]

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]

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]

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]

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]

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.

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]

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]

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]

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]

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]

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.

I'm just glad you found us!

Kim

[gpgscott]

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]

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.