Littleberry, diagnosis issues

[Squirt's Mom]

Re: caninecushings.net site is down - nice to be here

Hi Littleberry,

Glad to see you made it here! I posted to your thread at cc.net...I'm the one who's ACTH was in the freezer! LOL

Hope you are feeling a bit more settled now and not quite as angry. Tho lord knows you had reason!

Like Glynda said, the more info you can give us about your baby the better. Does she have any other conditions that you know of? Is she on any other meds, supplements, herbs at the moment? How much does she weigh?

This can be a frustrating, scary process at first but you will get through it. There will be folks here to help you along. And you don't have to do alone, either. There may not be as many of us here at the moment, but all it takes is knowing one other person out there knows what you are going throught to make it a bit easier.

Hang in there,
Hugs,
Leslie and the girls

[gpgscott]

Re: caninecushings.net site is down - nice to be here

Hi Littleberry,

Very sorry the cc.net is down and very glad you are here.

It stinks that the first LDDS sample was lost, and I agree with Cushy, unless you have an extremely small on you should not have to go for the neck, I am familiar with doing with with cats but not dogs.

The Ldds can return negative for Cushing's and the pup have what is called Atypical Cushing's, this was our case and many other members as well. Atypical Cushing's is when hormones other than and sometimes also including cortisol are elevated.

Please let us know of the results of the LDDS.

Best to you both. Scott

[Lulusmom]

Re: caninecushings.net site is down - nice to be here

Hi again.

I just wanted to expand on Scotts comments about atypical. Miniature and Toy Poodles are at the top of the list of breeds that are over represented for atypical cushing's and pseudo cushings, also known as alopecia X. Both of these conditions involve an imbalance of adrenal steroids other than cortisol, which is common in typical cushing's. With the primary symptom being loss of coat, the breed being a Poodle and lacking the normal voracious appetite and excessive drinking and peeing, I would suspect that pseudo cushing's may be involved. Many dogs with this condition present with dermatological issues, like loss of coat, and liver abnormalities such as elevated liver enzymes and enlarged liver, which could be the cause of a slight pot belly. Perhaps the abnormal bloodwork you mentioned probably involved elevated ALKP and/or ALT?

http://www.michvma.org/documents/MVC...s/Nichols2.pdf

Now here's the deal. In the absence of overt symptoms like huge appetite and excessive drinking and peeing, it is generally not recommended to treat with conventional and serious drugs like Trilostane and Lysodren, even if the LDDS were to be positive for cushing's. So if it were my dog, I would forego the LDDS and have a full adrenal panel done by the University of Tennessee Knoxville (UTK). They test both baseline and stimulated values for all adrenal steroids, inclulding cortisol, so you kill two birds with one stone. Not all vets are familiar with atypical of pseudo cushing's which is a shame because there are a good many dogs out there that go undiagnosed or worse yet, misdiagnosed.

I am providing a link to UTK general information page which has information regarding proper handling and shipping of blood sample. If you choose to discuss this with your vet, I recommend that you share this link with him/her. I am also including a link to their treatment consideration page which has some great information. Please take the time to read through it.

http://www.vet.utk.edu/diagnostic/en...ts_info_07.pdf
http://www.vet.utk.edu/diagnostic/en.../treatment.php

If pseudo cushing's (usually only elevated progesterone and/or 17 oh progesterone) is ultimately diagnosed, the good news is that melatonin is the recommended treatment. This is inexpensive and can be purchased over the counter at just about any health food or drug store.

I have two cushdogs, one of which has pituitary dependent cushing's with elevation of all adrenal steroids. They are both Pomeranians, which is also a breed that is predisposed to adrenal steroid imbalances. My first cushdog, Lulu, was diagnosed and is still treated by an internal medicine specialist. They always request a full adrenal panel from UTK before confirming their diagnosis, especially if the dog is a breed commonly known to have adrenal hormone abnormalities, like Poodles and Poms. Internal medicine specialists are generally more experienced and knowledgable in diagnosing and treating cushing's so this may be something you might consider. If you don't know of one in your area, I am providing a link that might help.

http://www.acvim.org/websites/acvim/index.php?p=3

I hope this helps. I also hope that your head isn't swimming too badly and you can still feed yourself. I remember when my first one was diagnosed....oh my gosh, I was dazed, confused and probably a threat to myself but didn't know it.

Glynda

[acushdogsmom]

Re: caninecushings.net site is down - nice to be here

I love Glynda.

I also thought that this might be helpful and interesting reading for you:

Newer tests shed light on causes, treatment of adrenal disorders
By:Johnny Hoskins, DVM, PhD, Dipl. ACVIM
DVM Newsmagazine, Jan 1, 2008

http://veterinarynews.dvm360.com/dvm....jsp?id=485128

Page 1 of article:
http://www.dvmnews.com/dvm/article/a...ID=1&sk=&date=

Page 2 of article:
http://www.dvmnews.com/dvm/article/a...date=&pageID=2

Page 3 of article:
http://www.dvmnews.com/dvm/article/a...date=&pageID=3

[littleberry]

Re: caninecushings.net site is down - nice to be here

Thanks everyone for posting about Cushings, have to be off this Easter morning and hope be back to read all the posts tonight.

So much great information, thank you !!!!

[gpgscott]

Re: caninecushings.net site is down - nice to be here

I misunderstood your earlier post to say you were awaiting results from the second LDDS not waiting to perform another.

I also agree with Glynda that I would want to skip the LDDS particularly given the symtoms you are describing and go straight the the UTK full adrenal panel. Between the links provided by Glynda and Cushy you should have plenty of reading.

Scott

[littleberry]

Re: caninecushings.net site is down - nice to be here

Wow, I have so much reading to do, forgive me if I've missed anyone's question.

Lulusmom, that's such good information on pseudo Cushing, and one of the abnormal bloodwork items she has is ALT = 191.
I'll try to feel out my Vet on the other tests, dealing with doctors is like walking a fine line ... trying to be tactful and not wanting to appear to know more than the Vet .
Is there a separate test for "progesterone"? Do you know if it has a
different name?

Here are the bloodwork items I've copied...
Bun = 17
Glu =142
Alp report say's "can't measure"
T-pro= 8.9
Alt =191
Cre =1.2
Pcv/hct =60

[littleberry]

Re: caninecushings.net site is down - nice to be here

acushdogsmom, thanks for those great links [I have a lot of reading to do]
The Vet couldn't get enough blood from her legs, so he had to use her neck. When they tried the leg, they did as many sticks to find the vein as in the neck, sadly.

gpgscott, I'm going to have to ask the Vet about hormone testing for Atypical Cushings as she doesn't drink excessive water or pee too often yet. She does drink more than she did last year but she was never much of a water drinker in the past.

Squirt's Mom, [you must have read my thread on the Cushings board, lol .. I'm not so angry now and the Vet did blame it on FedX ]
She's 10yrs old, 17 lbs and the only suppliments I give her is flax oil and fish oil and she takes a Thyroid pill, which really pumps up her energy level!

rhodesian46, she didn't have Ultrasound test yet, he said that would follow the Dex test. [I posted the lab results in the previous post.]

CarolW, thanks for the tips on Yahoo's Cushing site [I'll save it, you can never have too much advice].
Hope Kwali enjoyed the birthday and Kumbi's "un" birthday, lol ].

[littleberry]

Re: caninecushings.net site is down - nice to be here

rhodesian46, I forgot to answer about the blood pressure. I didn't know they took blood pressure on dogs but I'll will definitely ask about it.

[CarolW]

Re: caninecushings.net site is down - nice to be here

CarolW, thanks for the tips on Yahoo's Cushing site [I'll save it, you can never have too much advice].
Hope Kwali enjoyed the birthday and Kumbi's "un" birthday, lol ].

I feel the same way - partly, too, that having multiple sources is ALWAYS a good idea. However, the CCAC list, I imagine, would be VERY tough for a human whose dog has just been diagnosed with Cushings - being so very overwhelmed, the CCAC list is not going to help a lot with that. To put it MILDLY! They load you up with a ton of links. All good (as far as I've investigated), but they are ABSOLUTELY NOT a first line of Help-The-Human aid. Whereas, your forum DOES do that - really helps the human, and it also has a lot of more detailed stuff when need be.

So as I see it, the CCAC list and your online forum have two quite different functions. No question, the CCAC forum has really excellent information, and a large variety of it, and they are ultra-careful, too.

But I'd generally recommend to a newcomer to Cushings going first to your online forum, and staying there, also, even if they later also join CCAC.

P.S. I did get notices onto my Home page and Links page about finding cc.net's temporary home, here. I don't have the techie knowlede to include the direct link (my pages wouldn't validate with W3C that way), so I direted to the the k9diabetes forum and said to look for Canine Cushings.

Mon, 13 Apr 2009 06:16:48 (PDT)

[Lulusmom]

Re: caninecushings.net site is down - nice to be here

Hi again.

Progesterone is just one of the six adrenal hormones that the UTK tests for. Your vet would need to request the full adrenal panel. I'm not sure why the ALP could not be measured but that particular liver enzyme is usually elevated with both typical and atypical cushing's.

Glynda

P.S. Has your dog been spayed?
P.S.S. The adrenal hormones/steroids tested by UTK are cortisol, androstenedione, estradiol, progesterone, 17oh progesterone and aldosterone.

[Wylie's Mom]

Re: caninecushings.net site is down - nice to be here

Hi Littleberry,

Just wanted to let you know - under my GP vet's suggestion, I skipped the LDDS test and went straight to the ultrasound. Every case is different - I don't know your history other than what's posted on this site. I'm glad we did the ultrasound and I don't feel that I've missed out by skipping the LDDS.

I do, however, wish I had done the UTK panel earlier on. IMO, I think this test should be routine if cushing's is suspected (and if cushing's was suspected, but later ruled out).

When my pup had a gall bladder attack, they ran bloodwork and the ALP & ALT could not be measured (with their in-house equipment). They had to send the sample to Antech Lab - the levels were basically "off the charts" @ 7634 U/L & 1896 U/L. Did your vet sent the bloodwork out to a lab?

My vet has a hard time finding the veins in my pup's legs also. I often find bruising after his ACTH stim tests - I put a heated moist washcloth over the area 2 to 4 times a day for 5-10 minute intervals. I heat the washcloth with hot tap water & nuke the damp towel for 10-15 seconds and test how hot it is before putting in on the pup's shaved legs. I do this for a couple days - I think it helps.

It looks like, because of the cushing's site glitch, all eyes are on you!

-Susy

[littleberry]

Re: Littleberry, diagnosis issues

Wylie's Mom and Lulusmom,
I found out that the Alp levels were 179 last year and are approaching 2000 this year. I think that's why he wrote "can't measure" next to Alp.

[This Poodle is spayed ]

I asked if we could do the ultrasound test while waiting to retake the Dex test and he wanted to have the Dex Suppression test results first.

[Lulusmom]

Re: Littleberry, diagnosis issues

It appears that you have chosen to go ahead with the LDDS as opposed to the full adrenal panel so I want repeat a few things and give you some additional food for thought.

If the LDDS is positive for cushing's, an experienced vet would normally take a wait and see approach with a dog that does not have the most common symptoms, being polyphagia (eats like a pig) and polydipsia & polyuria (guzzles great volumes of water and pees buckets). There are only two truly effective treatments, Lysodren and Trilostane.

Treating with Lysodren is definitely not recommended because the aforementioned symptoms are the only guage you have to determine if a dog is loaded. Loaded means that the Lysodren has effectively eroded enough of the adrenal cortex to stim the flow of excess cortisol. With no signs to use, you can overload a dog and the dog can get very, very sick when cortisol is too low.

While I have my own issues with Trilostane, I would much rather see a vet prescribe Trilostane for a dog that lacks the normal voracious appetite and excessive drinking and peeing. Unlike Lysodren that has a cummulative effect for up to 48 hours, Trilostane has a short half life with its effects lasting only about 12 hours. A dog that starts showing signs of cortisol withdrawal or cortisol that is too low will usually bounce back very quickly after withholding the dosing. There is very important information about this drug that some vets are not aware of....it alway increases one or more of the other adrenal hormones with long term use. Anybody with a Toy or Miniature Poodle or any Nordic Breed (Pomeranian, Husky, Spitz, etc), should never treat with Trilostane without first doing a full adrenal panel. One of my Poms had elevated sex hormones and I made the big mistake of treating her with Trilostane for two years. Those elevations skyrocketed due to the Trilostane.

If the LDDS is negative, you will have spent the money for that test and you still won't know if it is the sex hormones that are causing the problem. An ultrasound is a fabulous diagnostic tool; however, abnormalities in the liver and the adrenal glands are not always caused by excess cortisol. The other adrenal sex hormones, particularly estradiol, can adversely affect these organs as well. So in other words, ultrasound findings can be consistent with typical cushing's; however if the LDDS and/or the ACTH stimulation test is negative, it's a pretty good guess that it's the sex hormones that are the problem.

I am not a medical professional, I'm just a cushmom two times over with bad experiences with less than knowledgable vets. My first one was diagnosed in 2005 and since that time, I've read more stuff on this disease than all the print I read a half a century prior to that. Oops just gave away my age. I'd like to blame my poor vision on almost five years of computer glare but I am of that age when your arms get too short...if you know what I mean. Seriously and sincerely, please arm yourself with knowledge so you can become an excellent advocate for your baby girl. It's not an easy row to hoe but if I can become my vet's worst nightmare, so can you..your vet I mean.

Here are some additional links to sites on pseudo cushing's/alopecia X.

http://www.marvistavet.com/html/body_alopecia_x.html

(You will see Adrenal Hyperplasia-Like Syndrome mentioned in this site. This is referring to the intermediate/sex hormones I have been talking about.)
http://www.vet.utk.edu/hairloss/alopecia.html

No matter which route you take, we'll be with you every step of the way.

Glynda

[littleberry]

Re: Littleberry, diagnosis issues

Lulusmom, I appreciate your advice, knowing you've been through this before. I'm going to be extra cautious when I reach the point of medications ... they sound so dangerous. I'll go ahead with the LDDS, since I've already paid for it and it will start the ball rolling, [sort of]. Most likely next week, her neck is looking normal now.

I'll definitely ask for a full adrenal panel before proceeding with chemical treatments. [I had to ask for the bloodwork that turned up the Cushings suspicions or she'd still be treated for low Thyroid ... wasting time]. For full adrenal panel, I'm hoping my Vet can send samples to the U of Tennessee instead of traveling there.

I'm still in the weak in the knees - trying to cope stage, walking the fine line between being a little dog's advocate and not step on the toes of my long time Vet.
Guess everyone's been there too!!