Littleberry, diagnosis issues

[littleberry]

Re: Littleberry, diagnosis issues

Hi, [update] the low dose Dex test was positive for Cushings and the vet want's to do a ultrasound next.

The only problem is her drinking ,eating and peeing is not far from normal Do you think I'd be wise to get the Tenn. tests even though the low Dex is positive [I'm remembering the warning not to use Lysodren yet as there isn't anyway to judge loading in her].

I'm just spinning right now until the ultrasound is done. Not much else to go on other than weekly ear inflamation and thinning coat with only"slightly" more drinking and peeing..

[Squirt's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

Got it back this time, huh? I hope it didn't cost you a cent!

If you are planning to use Lyso instead of Trilo, then the UTK isn't quite as important, tho I think every pup should have one done as part of the diagnostic phase. IF you think there is any possibility that you will use Trilo instead, then the UTK is necessary, IMHO. Trilostane will cause at least one of the other hormones to raise, but Lysodren will treat all but one of those other hormones, and sometimes is effective on that one (Estradiol) as well. So as long as you will use Lyso, the UTK panel isn't as important. I would certainly have the ultrasound regardless.

Could you please get copies of the results of the LDDS and post them here along with the units of measurements (ug/dl, mnol/L, etc) and the normal levels listed by the lab. Different labs use different measurements and norms so it helps to provide those when posting results. If you don't mind sharing, those will help us give you better feedback.

You are absolutely correct about the value of the signs in treatment. They are vital not only in treatment but in diagnosis as well. If Littleberry isn't showing signs that are consistent and strong, then waiting to start treatment is the best thing. My Squirt was diagnosed in 3/08 but because her signs were mild, we didn't start Lyso or Trilo and still haven't, tho she is on treatment for Atypical (diagnosed via the UTK panel in 8/08).

Thanks for the update and look forward to seeing those test results if you can. How is Littleberry doing? You are doing fine, honey, so just hang on, ok? Don't forget that Cushing's is slow progressing condition so you have time to make sure of what you are dealing with and to determine the best approach for your baby.

Hugs,
Leslie and the girls

[Wylie's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

I'm not clear on the specifics of an LDDS (never did one with Wylie), but I think you would need an ACTH stim test at some point before treatment. I think it would be fine to wait till after the ultrasound. The ultrasound can tell you so much. But, if you can afford it, I would do the UTK full panel instead of the ACTH stim. Sure, if you're not intending to use Trilostane, you won't have to worry about increasing the intermediate hormone levels, but what if those hormone levels are already increased? Now, I admit, I may be more hypersensitive about this. I wish I had done the UTK panel earlier on. If I had know that Wylie was Atypical in addition to regular Cushing's, I could have treated both at the same time instead of waiting to find out that he was still having symptoms after several months of treating the regular Cushing's. That's just my opinion, I have no idea of what the chances are that your pup would also be Atypical.

Please post the LDDS results (although I wouldn't be much help in deciphering it, others can).

[littleberry]

Re: Littleberry, diagnosis issues

Squirt's Mom and Wylie's Mo, thanks so much for all your help and support.
I'll try to get complete report for the LDDS so I can post it here [when she goes in for ultrasound].

Littleberry is napping more but otherwise as active as usual ...she's not particularly interested in food. She has to be encouraged to eat her meals and if there is paper towel under the food dish, she pulls it out and tries to cover the food with the towel instead of eating it. She does "eventually" eat [after guarding for awhile].

[Squirt's Mom, I'm curious what type of treatment Squirt is getting for Atypical ??]

[Squirt's Mom]

Re: Littleberry, diagnosis issues

Hi Littleberry,

Squirt is on melatonin (3mg 2X/day) and purified lignans (40mg 1X/day) for the Atypical.

A little history: Squirt's first ACTH was a post of 18.2; the cortisol level on the UTK panel was 32.8 post; after the UTK panel we had another ultrasound and a splenic tumor was found, which was removed along with part of her spleen; the ACTH 3 mos. later showed a post of 14.2. Her docs and I are hoping the tumor was causing the elevated cortisol, I am REALLY hoping that was the case! We will be having another ACTH soon so that should tell us what we need to know.

The melatonin has properties that will help to lower cortisol, too. It and the lignans work to control the elevated hormones associated with Atyipcal - the intermediate and sex hormones.

I hope this helps.
Hugs,
Leslie and the girls

[littleberry]

Re: Littleberry, diagnosis issues

Just finished "ultrasound" of Adrenal glands and results are:
Left : length 0.62 c
width 0.64 c

Right: length 1.00 c
width 0.64 c
The vet said it means that the cause is in the Pituitary but she won't need medication for now, as her symptoms are mild.
------------------------------------------------------------------
LDDS [Dex test] results :

Cortisol Pre ... 13.2 ug/dl
Cortisol 2 ....... 3.1 "
Cortisol 3 ....... 3.6 "

Interpretation of LDDS:

Normal: Cortisol level less than 1.4 ug/dl 8 hrs post-dex

If the 8hr post dex cortisol level is greater than 1.4 ug/dl the following can be used to differentiate pituitary dependent hyperadrenocorticism [PDH] from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH.
2 Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.

[if neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.]
Note" Aprox. 5% of dogs with PDH have normal results. False positives may occur with stress/nonadrenal illness.
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[to be honest the above is somewhat confusing but the vet said the LLDS is positive for Cushings and then the ultrasound test revealed it is Pituitary caused]
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Squirt's Mom, fingers crossed for Squirt's next test !!

[Squirt's Mom]

Re: Littleberry, diagnosis issues

Thanks, sweetie! I have really been trying not to let myself hope the cortisol is still normal, but it's been no use. There is a great well of hope in my soul. Usually I am one to prepare for the very worst, but this time I can't seem to let myself go there. So I really appreciate the good wishes!

Hugs,
Leslie and the girls

PS. Littleberry is a doll! I love the avatar!