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**frijole** · 04-24-2009, 02:25 PM

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

**stardeb55** · 04-24-2009, 02:25 PM

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

**Coolidge** · 04-24-2009, 02:30 PM

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

**Coolidge** · 04-24-2009, 02:33 PM

Re: Coolidge...

Thank you Debbie!

**ventilate** · 04-24-2009, 04:15 PM

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

**Coolidge** · 04-26-2009, 03:27 PM

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.

**frijole** · 04-26-2009, 03:44 PM

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

**stardeb55** · 04-26-2009, 03:52 PM

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.

**Lulusmom** · 04-26-2009, 04:43 PM

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.

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

**Lulusmom** · 04-26-2009, 04:50 PM

Re: Coolidge...

Here is the contents of page 7 of your thread. My post was the only one on page 8. Sorry but that is all I could find.

01-23-2009, 05:37 PM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
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Re: Coolidge - 9yo GSD/Newfie

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Results of the urine test are in. The bacteria is e-coli.

Anyone here know how a dog can contract that????

I realize it's not Cushings related, but this is a knowledgeable board.

Thanks for any answers!!!

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01-23-2009, 05:41 PM
stardeb55
Senior Member Join Date: Apr 2008
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Re: Coolidge - 9yo GSD/Newfie

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E. coli is a gram negative rod, & it's probably the most common bacteria associated with UTI's in both people & dogs. There's really no specific explanation as to how a pup may contract it as it is usually part of the normal gut flora. You just need to make sure that the "bug" is sensitive to any antibiotic that is administered.

Debbie

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01-23-2009, 06:02 PM
Coolidge
Member Join Date: Jan 2009
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Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

They had her on the doxycycline for a month for the lepto. That was followed by two weeks of amoxicillin. Since neither of them knocked it out they have told me that I have to give Coolidge a new drug, followed a week later by another cystocentises to see if it's working, and if it is, another three weeks of drugs. if not, yet another drug...repeat in a week.

My concern is this, we have well water. If the well water has the e-coli in it, and Coolidge has been drinking this, what is the point of giving her the meds?
With Cushings weakening the immune system, she would continually be getting the UTI (which come to think of it, she has...)

Perhaps I should have the well water tested first and then treat it and her.

Thanks!

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01-23-2009, 06:07 PM
stardeb55
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Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

I'm in total agreement about the well water. I think you definitely need to get that checked out as a possible source. Also, all they have to do is a sensitivity where they check a number of antibiotics against the bacteria was found i the urine & pick one of the antibiotics that the urine is sensitive to. This switching drugs back & forth sounds a little silly to me, if they just do the sensitivity. This might be worthwhile to ask the vet.

Debbie

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01-23-2009, 06:14 PM
AlisonandMia
Moderator Join Date: Nov 2007
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Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

No it won't be the well water. If that water did contain E.coli it would likely be causing GI problems - which would probably be more likely to be affecting you rather than Coolidge - dogs generally handle these things better than humans.

E. coli infections of the urinary tract have almost always ascended from the outside - probably caused by contamination by bowel bacteria that has got into the urethra so the drinking water will not be an issue. E.coli (various strains) are part of normal mammalian gut flora but will cause a problem if they get into the usually-sterile urinary tract - particularly if there is any immune suppression. Females are more prone to this problem than males although it can and does happen quite frequently in males, particularly in dogs.

If this current round of antibiotics doesn't clear the infection I would think the best thing to do is to have the cysto done and get a culture and sensitivity done on the sample - which means they grow any organisms present and test to see what antibiotics they are killed by. This would be vastly preferable (and probably cheaper) than on-going trial and error.

Alison

If you do have E.coli in your well water that means you have some fecal contamination of the water either from human or animal waste.

Here's a link to some info on e. coli: http://en.wikipedia.org/wiki/Escherichia_coli - there is section on UTI's.

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Last edited by AlisonandMia; 01-23-2009 at 09:47 PM.

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01-23-2009, 06:58 PM
maggiebeagle
Senior Member Join Date: Jan 2007
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Re: Coolidge - 9yo GSD/Newfie

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Some of us have found that giving our pups cranberry pills or juice helps prevent a reoccurence of UTI's. Research has shown that it helps prevent the attachment of the bacteria to the wall of the bladder. Maggie has been UTI free for two years while taking cranberry pills.
Some of us have speculated also thatg with the more dilute urine our cushpups have, the antibiotic doesn't reach the proper therapuetic levels in the urine and takes longer to do its work. I agree with Debbie, your vet should have susceptibility data on the E. coli and should be able to pick one that will work.
Virginia and Maggie

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01-26-2009, 08:19 AM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
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Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Thanks for your help. We will get to the bottom of this glitch in Coolidge's treatment. Speaking of..

The vet school was covering as many bases as they could. They treated Coolidge for parasites as well. Some powder substance that I gave her for three days. Other than the difficulty of adding powder to dry food (didn't want to give her wet food because that would really give her diarrhea).

Still awaiting the lab reports for the IBD and Pancreatitis.

ps. My backyard abuts a corn/soy field. I live 1/4 mile away from the biggest landfill in SE Wisconsin. The odds of something being in the well water are pretty good. Whether or not it is the source, who knows. Better safe than sorry.

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01-26-2009, 09:02 AM
gpgscott
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Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Quote:
Originally Posted by Coolidge
ps. My backyard abuts a corn/soy field. I live 1/4 mile away from the biggest landfill in SE Wisconsin. The odds of something being in the well water are pretty good. Whether or not it is the source, who knows. Better safe than sorry.

Unrelated to Cushing's this comment is disconcerting, I bet if you contact your local EPA office you may find that this landfill would be responsible for periodic testing of your water.

Scott

**Coolidge** · 04-27-2009, 05:40 AM

Re: Coolidge...

I'll try to get together a short synopsis of test results starting with her "original" diagnosis.

I have it at work, will post from there. THanks again!

Just to clarify, the specialist/internist didn't run the tests in the normal course of treatment, and what I learned from this board, I didn't have any controlled test results to show a before and after. Just an after. The ACTH test was only done after Coolidge was loaded. There wasn't one done before. And she didn't prescribe any prednisone for Coolidge, and after loading Coolidge had very very low numbers, and THEN she prescribed the prednisone. So in reality, we had no idea what Coolidges numbers were at before she was loaded. And since she loaded in a relatively short time, there was a question of whether or not Coolidge did have Cushings. It peeved me that we trust those with the knowledge and put our furkids into their hands.

I'm just trying to dot my i's and cross my t's now. Follow procedure and what people on this board recommend from experience. (That's why I panicked in not being able to find you all).

**Coolidge** · 04-27-2009, 08:00 AM

Re: Coolidge...

Found the note I wrote to you all in January, hope this sheds light on my questioning her diagnosis.

9/2/2008, Took Coolidge into vet due to her increased appetite, drinking, urination.

9/5/2008, results come back from vet bloodwork. Elevated ALP. (results not included here, trying to locate). Vet states that she believes the Coolidge has Cushings, and that I should take her to a specialist to confirm. She also states at that time that if it is Adrenal gland Cushings, not to do surgery; and that if pituitary, not to do the lysodren.

9/8/2008, take her to see an internal medicine specialist. This specialist’s area of interest is Addisons. I figure she’s had experience with Cushings animals. Coolidge, it turns out, would be the 2nd Cushings patient at the clinic.

Vet does palpitations, ultrasound, and LDDST. Reading the notes, liver is normal reading (NR). However, ultrasound shows adrenals as bilaterally plump. Please note the size differences between these.

9/13/08, horrible diarrhea for three days. We wake up to piles of yellow bile throwup everywhere. Coolidge is very lethargic. I even was considering putting her to sleep that morning, especially with the possibility of Cushings. I figured if this was any indication of what she was to be going through, I didn’t want to put her through it.

We take her to the emergency vet hospital. They tell us that the diarrhea and vomiting isn’t a symptom of Cushings. And that we should run bloodwork, which we do. Their notes on the other hand say they recommended hospitalization and we refused, which they never did, or we would have agreed to it. (Hindsight, they never tested for lepto at this point.)

It is at this visit that we find out the results of the ultrasound and LDDST. The Emergency Vet says the results show Coolidge has Adrenal Cushings. He then says that it’s always good to have a second opinion, and the 2nd vet says “no, Coolidge has pituitary cushings”. They then call the specialist who ran the tests and she says, “I don’t think Coolidge has Cushings at all.”

LDDST (9/09/08)

Cortisol Sample 1 4.9
Cortisol Sample 2 3.0 (High)
Cortisol Sample 3 1.6 (High)

ULTRASOUND (9/9/08)

Adrenal Glands –L: 4.57 x 1.17cm; R: 3.09 x 0.89cm
Interpretation: Adrenal Glands are bilaterally plump.

We took the meds for Coolidge and took her and her football size lump of SubQ fluids home.

10/1/08, Took Coolidge back to specialist due to diarrhea again. (She wrote in the records that it was for recheck). She is now drinking 3 gallons of water a day, needing to go outside every 30 minutes. Her appetite is increasing. Specialist does not mention doing an ACTH Stim test at this point.

10/9/08, Have our other dog into emergency vet due to rock eating incident. Specialist asks if I have put Coolidge on lysodren yet. Told her that I was hesitant in doing so due to the fact she really didn’t strike me as being certain Coolidge has Cushings. She says that Coolidge does have Cushings and that I really should start the meds. I ask her for prednisone, she says that at the low dose she is giving Coolidge, prednisone is not necessary. (Hindsight, the dosage Coolidge was on was by no means a low dose 750 mg/bid).

10/13/08, we begin the loading phase for Coolidge. Was told to look for decreased water consumption and decreased appetite. Neither occurred during loading phase.

10/17/08. Coolidge begins having soft stools again.

10/18/08, Coolidge is acting a little strange, almost lethargic. I call the vet, she is not there. Receptionist relays to the vet that I am stopping giving Coolidge her pills. Vet relays through receptionist that I should continue.

10/19/08, Gave Coolidge her morning dose of Lysodren. She spent the afternoon with diarrhea and vomiting. Took her off loading and scheduled an appt.

10/20/08, Coolidge has her ACTH Stim test. As a precaution, specialist now gives me the prednisone with instructions to give Coolidge 2 tablets the next day and until further notice or that I see that she is having any signs of distress.

10/21/08, I call the vet for results. They aren’t in. Vet will call when in. Vet calls at 8:30 that night to tell me that Coolidge’s numbers are now low and to continue giving Coolidge the prednisone if she looks like she’s having problems. I tell her that she appears to be doing fine and that I would be giving Coolidge 1 tablet the next morning and that would be it. (Total Pred: 3 tablets.)

ACTH Results

Cortisol Serial 2 (ACTH)
Sample 1 0.9 (low)
Sample 2 0.6 (low)

11/4/08, Coolidge has been having difficulty walking the past few days. This along with horrible diarrhea again. She also is very lethargic. Specialist thinks she may have lepto and wants to test for it. She takes a blood sample. Forgets to take urine sample. I have to go in again later that week and drop off the urine sample. Gives me meds to give Coolidge just in case it’s lepto.

11/06/08, Coolidge log indicates that her thirst and appetite is starting to decrease. Hindsight? She’s been on the doxycycline for lepto for two days.

Super Chem Blood Test Done
ALK Phosphatase is high at 732 IU/L
Glucose is low at 51 mg/dl

It’s at this time that the urine tests show she has tested positive for five of the seven serovars of lepto.

Her urinalysis shows low specific gravity (1.006) and high pH (8.5)

11/12/08. After daily calls and messages left at the AEC, I finally get a call from the specialist. Coolidge does have a mild case of Lepto. She doesn’t tell me that it’s contagious, that I should be taking special precautions with our other animals. Nothing.
On the other hand, Coolidges water intake is now down to 14 cups a day and her appetite was back to normal a few days earlier!!! Yippee…

11/20/08, It’s been a month since Coolidge was loaded, I called and asked for another ACTH Stim test. Her appetite has started to increase. Stim test done.

ACTH Results

Cortisol Serial 2 (ACTH)
Sample 1 56 nmol/L
Sample 2 73 nmol/L (low) (220-550 is norm)

Fed up, I change vets.

**Buffaloe** · 04-27-2009, 08:49 PM

Re: Coolidge...

Hi Becky,

We had a very long and difficult diagnosis with my dog. Finally, my primary gp vet did a great thing which directly led to our confirmed diagnosis. He contacted the lab at U. of Tennessee and explained everything we had previously done and asked what test(s) they recommended. They recommended the following test which we had performed:

Adrenal Panel (Combined Dex Supp / ACTH Stim) Dog Serum Adrenal Function $155.00

It is a combination LDDS/ACTH stim test and includes a full adrenal panel. After we got the written results, we contacted Dr. Oliver and at that point he succinctly told us he believed Shiloh had a primary adrenal tumor. I'm just saying, either you or your vet could contact the people at U.T. and see what test(s) they prefer given your situation.

I sure don't know what is going on with Coolidge. I'd say his left adrenal gland is pretty darn plump and is quite a bit larger than his right.

What kind of dog is he and how much does he weigh? I sure do wish you and Coolidge all the best.

Ken

**Coolidge** · 04-28-2009, 05:08 AM

Re: Coolidge...

Coolidge is a German Shepherd/Newfie Mix, who at the beginning of all of this weighed 100+ pounds. She is now at 84 and holding.

Her weight loss was another issue in January. Which is one of the main reasons we went to UW Madison. She lost nearly 5 pounds immediately after the ACTH test at the end of Dec. And continued to lose until shortly after the UW visit. I'm working on getting the results of the other tests since January.

Her adrenal glands (at least as of the middle of January) were of normal size. And yes, I did question the bilaterally plump (which to me meant they were both plump and of equal plumpness). One was quite larger than the other. Perhaps this is what got the one vet to say she had Adrenal Cushings.

I'll ask my vet about checking with them before tomorrow.

Thanks for the help!

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