Littleberry, diagnosis issues

[Squirt's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

I don't blame you for wanting to recover your cost on the LDDS that was lost and I am one who had alllll the testing done on my baby, Squirt. My vet was very thorough about that and I am very grateful to her for it. However, knowing what I know now compared to then, I could have saved myself about $600 by having the UTK panel done at the very first plus the ultrasound. Not to mention saving Squirt somewhere around 20 hours in the vets office waiting on draws. You might ask your vet if she would be willing to apply the cost of the LDDS that was lost to the UTK panel cost, and bypass redoing that test. Your baby would only have to be at the clinic for a few hours VS all day if she will do that for you.

As for "walking a fine line" with your vet, that is understandable to a degree. I am one who simply HATES confrontations and doesn't do well with them at all, especially with someone I perceive as an expert, which a vet certainly qualifies as. However, when it comes to Cushing's, keeping the vet happy has no place at all in the picture. It is sad, but many vets just don't have the experience or basic knowledge to deal with Cushing's properly. I am NOT saying your vet is one of these but it is an unfortunate fact that many cush parents have had to face with their own docs. We could tell you hours of horror stories about folks who loved and completely trusted their vets only to find out the hard way they were not qualified to deal with Cushing's. This is why it is so critical that cush parents educate themselves on the condition so they can work with their vets rather than trusting them blindly to do what is best. Cushing's requires team work, not a follow-the-leader approach.

Your vet is following the normal approach to diagnosing Cushing's and that is comendable! So many don't even do that! But if you can't talk with your vet for fear of what will happen, then team work will be difficult if not impossible. Just keep in mind that you are paying for their time, expertise and help...in essence, they work for you and you are the boss. No amount of schooling, degrees, practice or experience can come close to equaling your knowledge of your baby. We know our babies better than anyone and, as such, our vets should be willing to listen to us and work with us based on that intimate knowledge.

Now, having said all of that, the LDDS is a good place to start the diagnostic phase and, again, I am pleased to see your vet starting there. That says they do have experience and are following the procedures that have been established. That is very good news. AFter the LDDS is repeated, tho, I would forego the HDDS if recommended and go straight to the UTK panel. The UTK panel and an ultrasound will give you as much info regarding the possibility of Cushing's as well as get a good look at many other organs. By suggesting that you have the UTK panel done instead of repeating the LDDS, we are simply trying to help you save some money, save your baby (and yourself!) some added stress, and decrease the time for a diagnosis.

Hang in there! You are doing a fine job!
Hugs,
Leslie and the girls

PS. what is your baby's name, BTW?

Here are some links on Cushing's as well as the UTK panel and Atyipcal just in case:

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article....2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/Fe...ctSheet052.asp

Atypical Cushing’s*
http://veterinarynews.dvm360.com/dvm...date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

UT Panel
http://www.vet.utk.edu/diagnostic/en.../treatment.php

http://www.vet.utk.edu/diagnostic/en...logy/index.php

[ventilate]

Re: Littleberry, diagnosis issues

I wanted to add that the medications for treating cushings are not dangerous, it is when vets with no experience that do not follow the tried and proven protocols and do the much needed followup testing as required, and do not educate the client on what to watch for, for signs of loading or when the cortisol is getting to low, that is when things go bad. What is posted as side effects are actually when to much cortisol is reduced by to much lysodren or trilostane, many of us have never seen any of those symptoms in our dogs, I have been treating Nike for 3 years. It is true that both lysodren and trilostane are perscription medications and need to be respected as such and given as instructed by a vet that is well versed in treating cushings or an Internal Med specialist. As well even over the counter stuff like Tylenol can be fatal if not taken as advised.
Many of us use one of the medications or some of us have used both changing from one to the other. One medication is not any better or worse than the other, they are just different. So once the testing is complete and if your dog does have Cushings please dont be afraid of the medications they have saved many, many dogs lives, and truly are not dangerous or poison or toxic as some sites leads us to believe, and even if it was, one of the dangerous, poisionous, toxic drugs has kept my dog alive and well for the past 3 years
I agree with Leslie in that you have to be able to work with and talk to your vet. I was given some great advice when my dog was first diag. I spoke to my vet and told him that when I ask him questions about why he is doing this or that or why not do this or that it is not because I am questioning his expertise, it is because I need to fully understand what is going on., and the reasoning behind it. He told me he is the same way and if I have any questions or concerns or sugestions to please talk to him, He said that we both have the same goal, to keep Nike as healthy as we can and we can only do that if we work together. It had been an excellent relationship between us. As well I love my vet but I love my dog much more and will do what ever it takes to keep her well.

good luck, and please keep us in the loop
Sharon et el

[Wylie's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

Just curious, since we don’t have the history here, could you please tell us if your pup has had the UCCR (Urine Cortisol Creatinine Ratio) test or ACTH stim test done? If so, what were the results?

I like Leslie’s idea about asking to apply the credit for the LDDS to the cost of the UTK panel. I don’t think it would hurt to ask. I think it will save you time & money in the long run…and don’t worry, you’ll find plenty more items to spend that money on.

You might want to read this and give a copy to your vet:
http://www.vet.utk.edu/diagnostic/en...is%20of%20.doc

I gave a copy to my GP vet – there are many vets that do not know about this. The blood would be drawn & prepared & packaged up & sent to UTK by your vet and then UTK will fax the results and any recommendations for treatment to your vet.

I know what you mean about not wanting to step on your vet’s toes. You may be pleasantly surprised (or not) at their response. You may have to just test the waters…for your pup.

-Susy

[littleberry]

Re: Littleberry, diagnosis issues

Squirt's Mom ,

You make a very good case for UTK [and I will ask tomorrow if my Vet would do a UTK panel [for Univ. of Tenn.] instead of LDDS.

[ Hope I don't hear a "thud" on the other end of the phone].

This is a small town and everything seems to be done cautiously and by established protocol. I'm suspecting not many people question procedure ...I've already gone past their current diagnosis [Thyroid] and insisted on the blood profile that turned up possible Cushings.
I appreciate all the the links, I'm armed and almost dangerous now.

[my 17lb Poodle name is "Littleberry"]
-------------------------------------------------------

ventilate,
*I wanted to add that the medications for treating cushings are not dangerous*

Thanks for the pep talk, everyone in our shoes needs one!!! And you do make sense.

Honestly, I almost fainted when I first read the challenges one faces when dealing with the meds ... made my knees shake and wanted hide under the covers. I can't be alone in feeling this but like everyone else, I try to keep reading and keep all the tests [and abbreviations] from confusing me. Actually, dealing with the Vet is the most difficult because doctors are like everyone else ... they have a preferred way of doing things.
------------------------------------------

Wylie's Mom ,

So far the only tests I have is this blood profile...

Bun = 17
Glu =142
Alp "can't measure" [approaching 2000 was 179 in 2008]
T-pro= 8.9
Alt =191
Cre =1.2
Pcv/hct =60

Thank you for the link, I just printed it out and think I better take it in to the Vet's office along with some info from the Tenn. State Hosp.site. Looks like the sample they need and the packaging has to be very precise.

[littleberry]

Re: Littleberry, diagnosis issues

I just read the indications for the "Steroid Hormone Profile" test... is this the UTK test? Am I confusing something because I can't find UTK mentioned on the Univ. of Tenn. site.

Dr. Oliver recommends "Steroid Hormone Profile" test "when other routine tests of adrenal function, [like LDDS] are neg" but the dog still shows signs of Cushing's. So I'm guessing the Vet may feel justified in doing the LDDS test before proceeding to the UTK?

Does anyone know the exact name of the UTK test?

I just noticed there are several Adrenal tests at their site ...
http://www.vet.utk.edu/diagnostic/en...tests_info.pdf

g. Adrenal Panel for Dogs and Cats (ACTH Stim) -Test for congenital adrenohyperplasia-like syndrome (dogs, cats), or Alopecia-X, Atypical Cushings Syndrome

and

h. Adrenal Panel with Combined Dex Supp/ACTH Stim Test for Dogs
This test will provide the same information as the adrenal panel with ACTH stimulation only however it will also provide information as to whether the hormones are suppressedby dexamethasone. With this approach, results from two separate testing procedures(dexamethasone suppression test and ACTH stimulation test) are achieved with one test.

These seem like the correct tests and test "h" combines Dex Suppression with the Adrenal Panel but doesn't say whether it's the LDDS or HDDS test.

[Squirt's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

What you want is this from UTK:

Adrenal Panel (ACTH Stim) Dog, Cat Adrenal Function $135.00

The $135 is the charge from UTK, then your vet will add charges for her services.

UTK is a branch of UT...all the same but the school at Knoxville is where the veterinary school is for UT. UTK = Uni. of TN at Knoxville...I'm just too lazy to type all that.

The LDDS is a test to see how well the adrenal glands can suppress the coritsol when stimulated. The ACTH will give you the actual cortisol level; the adrenal panel will give you the cortisol level along with the levels of five other hormones - those that are involved in Atypical Cushing's. If all six hormones are elevated, then you have what Dr. Oliver (Dr O) calls "true Cushing's". In true Cushing's, or what we often call conventional Cushing's, treating the elevated cortisol will usually lower the other hormones as well, except for the Estradiol. Estradiol can be produced in areas of the body other than the adrenals and the treatments for conventional Cushing's only effect the adrenals. This is where the melatonin and lignans come into play. Now the flip side of this is that the treatments for Atypical, melatonin and lignans, can also lower cortisol to a degree.

While the LDDS can give an idea of whether it is PDH or ADH, the HDDS is usually done to give a better idea of which type, but it is still not definitive. This is why an ultrasound is so important. By looking at both adrenal glands via the U/S, you have a much better idea of where the tumor is - the pituitary or adrenals. If pituitary, both adrenal will be enlarged; if adrenal, one will much larger than the other, and the smaller one may be atrophied (withered).

So, if your vet really wants to do the LDDS, and you are comfortable with the expense etc, then have it repeated. But I would insist that the UTK panel and an ultrasound be the follow-up tests rather than the HDDS.

Hope this helps,
Hugs,
Leslie and the girls

[Wylie's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry's Mom,

This form is where you can see the $135 test that Leslie is describing - you might want to also give this to your vet along with the instructions that you have already found:
http://www.vet.utk.edu/diagnostic/en...osubform06.pdf

I'm glad you are going to ask your vet about doing the UTK panel in lieu of the LDDS repeat. I was a little worried...thinking you might feel ganged up on or pressured to do what we think. Several of us just happened to have the same opinion in this matter.

For me, there was one particular difference of opinion between what my IMS (Internal Medicine Specialist) vet wanted to do and what people here thought I should do. It was regarding Lysodren dosing. I initially went with what the IMS wanted to do, but over time it wasn't working out. Most recently, I went ahead and did what was recommended here - to do a mini-load (instead of another increased maintenance dose that the IMS wanted to do). I think I probably felt the same as you do now, about "confronting" the "expert" - I have to say... I kinda chickened out - my GP (General Practice) vet is easier to get a hold of and seems more open to trying different methods than the IMS vet, so I discussed what I wanted to do with the GP vet instead . So far, the mini-load has worked well. I'm not saying that the people here know better than any vet (although, I do think so sometimes, at least with regards to all forms of Cushing's), I'm just letting you know that I understand how you feel and I want to let you know that I did not get any less support from the people here when I initially went the IMS way.

-Susy

Oh - regarding the Instruction sheet question:

I think they need to follow the instructions under these headings, but there is a phone number at the top of the sheet that your vet should call for clarification:

1. General Information
3. ADRENAL FUNCTION:
a. Cortisol - ACTH Stim Test -DOG, CAT, HORSE.
g. Adrenal Panel for Dogs and Cats (ACTH Stim)

[Wylie's Mom]

Re: Littleberry, diagnosis issues

Wait a minute...

So far the only tests I have is this blood profile...

So, you didn't have a UCCR (Urine Cortisol Creatinine Ratio) test done? Now, I wouldn't say it's mandatory, but it is a simple (& cheap) urine test that can rule out Cushing’s (although it cannot confirm it) – this is typically the first screening test done. I have a feeling that maybe you should do this test first, but I'd like to know other people's opinion - it might me a mute point and the UTK panel would still be recommended.

-Susy

[littleberry]

Re: Littleberry, diagnosis issues

Squirt's Mom,
Thanks so much for summarizing all this information, it really makes it easier to grasp. I'll definitely want the UTK's panel done before progressing to medications. My vet did mention following the LDDS test with the ultrasound test.

[ Do you know if in "addition to" the $135 Adrenal Panel-ACTH Stim test ... I should also ask for the $30 Cortisol-ACTH Stim test that Wylie's Mom listed at the bottom of her post #37 ?]

[littleberry]

Re: Littleberry, diagnosis issues

Wylie's Mom,
I see you've been where I am now, thanks for that link, I printed out the service form. Actually I did bring a fresh urine sample in to the vets weeks ago thinking I was going to be so prepared and he didn't want to do the urine test. He said it wouldn't be useful at that point. At that time he wanted to do the LDDS before anything else.

I have a question ...
Is this test, [a.] Cortisol - ACTH Stim Test -DOG, CAT, HORSE[listed at the bottom of your last post] one of the tests I need to do, "in addition to" the $135 [g.]Adrenal Panel for Dogs and Cats (ACTH Stim) ?? I haven't seen that one mentioned before? So that makes two tests I need from the UTK?

[Squirt's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

No, you won't need the $30 Cortisol-ACTH Stim (#37). The adrenal panel will check the cortisol, too. The $135 adrenal panel is all you will need to have done for Littleberry. It will cover everything that counts for Cushing's.

The [a.] Cortisol - ACTH Stim Test -DOG, CAT, HORSE, I think, is simply an ACTH without the other hormones (intermediate and sex hormones). This is a test that is usually done to monitor once treatment begins, but your vet can probably do this in their office and through their own lab.

So, all you need to have done from UTK is the $135 adrenal panel. The rest you can forget about. UTK is listing all the tests that are available through them on that list, but they don't all apply to Littleberry or Cushing's. That's a relief, huh?

Keep up the good work and let us know how things go with your vet!
Hugs,
Leslie and the girls

[littleberry]

Re: Littleberry, diagnosis issues

No, you won't need the $30 Cortisol-ACTH Stim (#37). The adrenal panel will check the cortisol, too. The $135 adrenal panel is all you will need to have done for Littleberry. It will cover everything that counts for Cushing's.

I think I've got a grip on it now and can run it past the vet. Thanks so much!

[Wylie's Mom]

Re: Littleberry, diagnosis issues

I'm sorry I have been away - Wylie got sick.

To clarify, Leslie is correct, you only need the $135 test. What I was descibing was based on the information you were looking at when you first posed the question - the instruction sheet "CLINICAL ENDOCRINOLOGY SERVICE":
http://www.vet.utk.edu/diagnostic/en...tests_info.pdf

The $135 test includes the $30 Cortisol-ACTH Stim. In the instruction sheet, the vet has to read/perform (I believe) three sections to do the $135 test...
1 general info
3.a Cortisol (ACTH stim)
3.g. Atypical Cushing's hormones

I hope this makes better sense, sorry for the confusion.

-Susy

[littleberry]

Re: Littleberry, diagnosis issues

Thanks Wylie's Mom,
My vet appointment is. tomorrow, armed with lots of information. I appreciate all the help I've received here....what a wonderful site this is!!!

[Wylie's Mom]

Re: Littleberry, diagnosis issues

It will probably take about two weeks before you get the results back - be sure to get a copy and post the results here. Good luck!!

-Susy