What should we expect?

[Louie's Mom]

For those who don't know our story, Louie was diagnosed with Cushing's disease about a year ago, but his diagnosis was somewhat borderline and I've never really considered him a Cushing's dog, because he never behaved like one.

His is a very long story, but the short version is that Louie has several other conditions which would normally be treated with steroids and, therefore, he is not a good candidate for treatment of Cushing's. That's a big piece of the reason I haven't more aggressively pursued this diagnosis, as it's kind of a moot point for us, anyway. He either has it, or he doesn't, and if he does there's not much we'll be able to do.

I'm noticing lately that he is drinking more water, and I am starting to suspect that the borderline diagnosis was just an early diagnosis. It matters little, really, since I can't treat him, but I'm wondering if others here have had similar situations and, if so, could give me some advice regarding what we can expect over these next few years-- assuming that Cushing's is indeed one of his problems.

Thanks for any thoughts and/or advice.

Laura (with Louie)

[gpgscott]

I'm noticing lately that he is drinking more water, and I am starting to suspect that the borderline diagnosis was just an early diagnosis. It matters little, really, since I can't treat him, but I'm wondering if others here have had similar situations and, if so, could give me some advice regarding what we can expect over these next few years-- assuming that Cushing's is indeed one of his problems.

Thanks for any thoughts and/or advice.

Laura (with Louie)

Hi Laura,

I don't know where you are located but summer is upon most of the country (New England excepted) and is it possible the increased uptake of water is due to elevated temps. And have you been measuring the amount over a period of time so you can compare?

You might want to consider the UTK panel, if Louie has hormones other than cortisol out of range a treatment for those hormones could help his condition.

Scott

[Squirt's Mom]

Hi Laura,

Here is a link from our Resources section on complications with untreated Cushing's -

http://www.k9cushings.com/forum/showthread.php?t=195

With Louie's lymphangiectasia, I can understand your priorities for treatments. Upsetting his balance could be catastrophic!

Having said that, you might talk to your doc about Anipryl. It will help control the signs but probably won't address the elevated cortisol, tho it can in a small percentage of pups. Anipryl does have the capacity to cause some digestive upset and can cause anorexia according to the manufacturer.

http://www.pfizerah.com/PAHimages/compliance_pdfs/US_EN_AR_compliance.pdf

Percentage of Dogs with Adverse Events Reported in Clinical Field Trials
Adverse Event Anipryl (n=404) Placebo (n=67)

vomiting 26% 21%
diarrhea 18% 10%
hyperactive/restless* 12% 6%
anorexia 8%

Just a thought as it may not be an option for Louie at all.

The treatments for the other hormones Scott mentioned would be melatonin and lignans, but I would have the UTK panel done first, and be sure Dr Oliver at UTK knows all of Louie's problems and current meds.

He is such a sweet little fellow, it is a shame for him to be so ill. You do an great job with him, tho, and he is so lucky to have you as his mom.

Hugs,
Leslie and the girls

[lulusmom]

Hi Laura,

I could not remember the circumstances surrounding Louie's cushing's diagnosis so I went looking for your old thread on cc.net. I found a few pages so far and saw that you asked this same question a year ago. I'm still looking but in the meantime, here is Alison's response to you:

07-03-2008, 11:17 PM
AlisonandMia
Senior Member Join Date: Nov 2007
Location: Brisbane, Australia
Posts: 3,010
Images: 16

Re: Not going to treat (at least for now)

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

Sorry to hear that Louie has so many problems and it does sound like he possible "needs" his Cushing's at the moment - or at least doesn't need his cortisol level messed with right now.

The two year thing with treated Cushing's dogs is not really true. It comes from the fact that many Cushing's dogs are already quite old and/or have other conditions, some are terribly compromised by the disease before they start treatment and sometimes the treatment is not administered properly either. Many, many treated dogs live for years - one member is here with her second Cushing's dog and her first one lived for 8 years on treatment before dying of something unrelated. Well managed, an otherwise healthy Cushing's dog can be expected to live out is normal life span and some even exceed it.

Untreated, however is a different story but it seems to depend on just how severe the Cushing's actually is and probably how well the individual dog handles the cortisol levels. Things like diet may play a small part too. Two years seems to be around how long many of them last, however. It sounds like Louie, because of the lymphangiectasia, would very likely be on corticosteroids if he didn't have Cushing's and so you would be facing the same situation.

One thing you could consider down the track if you can get him somewhat stable and feeling well day to day is to treat the Cushing's - maybe just reducing his cortisol level to a level a bit higher than is usually desired for a treated Cushing's dog and be prepared to step in and give him some steroids occasionally if his lymphangiectasia flares up. That way his total corticosteroid dose over time could be kept to a minimum which is usually what is attempted with steroid therapy.

Good luck and please stay in touch and let us know how you and Louie are getting along.

Alison

[jrepac]

Certainly, get the testing done for Louie.
But, anipryl might be of some help....even if it does not fully control cortisol levels.
It would not interfere w/any exiting corticosteroid (sp?) based treatments, I suspect...but confirm w/your vet.

A few of us have had some luck with it ....I've been using since sept...mine was a 'borderline" case as well...but we may be crossing the border shortly.....

Jeff

[lulusmom]

Dang it, I couldn't find all of your thread but enough to get the general gist of things. Louie was diagnosed by UC Davis a year ago this month. Alison and I both had some questions as to the validity of the testing given the multitude of issues that Louie was having at the time. We had asked you to post the results of the tests that were done by your vet to confirm the diagnosis; however, I don't believe you ever did. Is there any way possible that you could do that now?

You mentioned in one of your post on 7/4/08 that a lot of the symptoms that you attributed to Cushing's appeared to resolve after a regimen of cyclosporine. On 7/21/08 you were questioning the diagnosis yourself and mentioned that it was possible that test results weren't really clear, the vet was on the fence and it wasn't until an LDDS was done that the diagnosis was confirmed. That raises my eyebrows because at that time, any number of Louie's problems could have caused a false positive result LDDS result. With all his problems, I would imagine that an abdominal ultrasound was done. If so, can you check to see if there was any mention of the adrenals?

Louie's cushing's symptoms seemed to have come and gone in the past, depending on what other condition was being treated. That in itself is suspicious as he's never been treated for cushing's since being diagnosed over a year ago. The progression of cushing's is a very graded process but I would certainly think that you would be seeing more symptoms by now. It is also quite possible that the increased water intake you are seeing is due to other factors. Polydipsia is not a symptom that is exclusive to cushing's. Urinary tract infections, kidney disease, liver disease, diabetes mellitus and even high blood calcium concentrations (hypercalcemia) caused by dehydration can increase a dog's thirst.

I'm not sure I've ever told you this but I think Louie is absolutely adorable with those amazing ears. I should have such good hair days. :D His little face never fails to make me smile. I'm so glad you found us and are posting once again. I'll be looking forward to hearing more about Louie's test results.

I've pasted your two posts from last year below.

Glynda

07-04-2008, 01:00 AM


:Laura:
Member Join Date: Jun 2008
Location: Sacramento, California
Posts: 41

Re: Not going to treat (at least for now)

Thanks, Alison. I envision something along the lines of what you suggest, where if we can get him more stable with the lymphangiectasia and other inflammatory processes then we can try to get his cortisol levels down somewhat. I hope that will be possible.

I am a bit intrigued, as he did initially improve quite a bit on the cyclosporine and many of the improvements were in areas where we see Cushing's symptoms-- the dark spots on his skin, the cysts, the lesions on his skin, his energy level-- all of those things were dramatically improved for a time. So it's possible he'll feel quite a bit better at the increased dose.

Thanks, by the way, for merging these threads together. It has been a while since I posted and I thought you all might have forgotten all about Louie by now!


07-21-2008, 12:37 AM


:Laura:
Member Join Date: Jun 2008
Location: Sacramento, California
Posts: 41

Re: Not going to treat (at least for now) - Louie - Chinese Crested

Hi,

I just posted but don't know what happened to my post. It's late, so maybe I hit the wrong button.

Thanks for your replies. I don't yet have his actual test values in hand. I am fairly certain that the ACTH stim test was done at least once before the LDDS was administered at Davis but do also recall that the vet was on the fence for a while about his results until the LDDS was done, so the earlier results were likely not all that clear. I do know that he had concentrated urine once, then dilute, and so on.

Up until now I've pretty much been trying to let the experts do their jobs, as there are plenty of them and that's what they are trained to do. But I do have to wonder to what degree its possible that this diagnosis of Cushing's disease isn't firm. I will see if I can get all his test results faxed to me this week so that I can get more detailed opinions here. Was really just looking to answer the general question tonight about how strong an indicator of Cushing's the appetite really is.

Thanks again,

Laura

[jrepac]

Ah if only Cushings were easy and clear cut to diagnose...it is not...multiple vets and multiple tests are par for the course

[Louie's Mom]

Thanks, everyone. It makes me happy that so many here remember us.

Indeed I did ask a similar question a year ago and I hope you will all forgive me, as we have had so many other things on our minds with him that Cushing's just had not been front and center, so there's much I don't remember about this disease at the moment.

I will try to get the results of Louie's Cushing's testing from the vets at UC Davis so that I can post them here. It was quite a while ago and I'm sure things have changed since then, however we did have enlarged adrenals on ultrasound at the time-- bilaterally, which would point toward pituitary involvement, if I remember correctly.

I don't plan at the moment to have him tested again, as it's likely to be an academic exercise, given that we have no plans to treat for it, and with all of his health problems we really have to be judicious about where we spend money on testing.

I am, though, interested in hearing more about anipryl and will be doing some research via google and pubmed to see what I can find on that.

Glynda, thank you for your kind words about Louie's ears :) Sadly, his ear fringe has taken a bit of a beating from the rabies vaccination induced immune-mediated disease that he suffered, which caused quite a bit of necrosis at the ear pinnae. However, his ears have stopped bleeding and his skin has begun to heal, so all the fur that's left to grow back is growing in again. The avatar pic of him was taken in December 2007, just a few months before he really started to decline.

Will be back when i get the Cushing's test numbers. Thanks all.