New Cushings Case (12.5 y/o Boston Terrier)

[Harley PoMMom]

The LDDS is the "gold standard" test for Cushing's but when other non-adrenal illnesses are present the LDDS is prone to false positive results. So with Jigsaw's nasal issues, I don't think the LDDS test would be useful right now. If this were me, I would have an ACTH stimulation test done, depending on the stimulating agent used, this test takes 1-2 hours to complete.

With the ACTH stimulation tests there are two blood draws taken; the first is called a pre/baseline/resting cortisol reading, the stimulating agent is then injected and after an hour or two (depending on the agent) the second blood draw is done which is known as the post.

If feasible, having an ultrasound done would probably be the next thing I would do. The ultrasound can be a very useful diagnostic tool as it can show any abnormalities with the internal organs and if the adrenal glands are visualized it may be able to differentiate between ADH and PDH. These are just my thoughts and I am sure others will be by to share theirs as well.

Love and hugs, Lori

[nvmybostons]

Thanks Lori.

She did just have a ACTH stim done on Monday but without a resting cortisol, only the post... and now she is off the Trilostane, so the ACTH wouldn't be useful, would it?

She did have an ultrasound down July 28? or so and it was normal, although I do not have the written report. I'll call tomorrow for those first thing in the morning.

Thanks for you time,

Jen & Jigsaw
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[Squirt's Mom]

Mornin' Jen,

I hope I didn't come across as defensive. The goal was to be reassuring! You have every right to question folks who are asking you specific, personal questions concerning your baby's health. You are simply being a good advocate for your sweet Jigsaw - a critical aspect in caring for our babies that you already understand. I had to learn that one. I just didn't want you to think you were chatting with folks who were flying by the seat of their pants and telling you what should and should not be. I am a member on some pages on FB that are specific and rather intensive learning pages....but folks get on there who have less experience and training that I and proceed to tell everyone how the cow ate the cabbage - more times than not, wrong. It is frustrating and at times scary, especially when the admins of the pages don't stop such things quickly. I didn't want you to feel that was the sort of place you had found with us. Question us any time you need and you will get honest answers. We are not here for us; just like you, we are here for Jigsaw...and gladly take you in the process.

Now, don't be beating yourself up over things in the past. You should know - I am the Queen of Guilt around here and I guard my throne most jealously. We all do the very best we know how to do at the time. We are trained from the time we are infants to trust those who are supposed to know more than we do, who have more experience that we do, who have more education that we do. It is often difficult to take that training and add the aspect of questioning those folks. We may not even know we can question them. There has to be some good measure of trust between us and our vets...but not blind faith. Many here have learned to their deep sadness that their dearly loved vet was in over their heads when it came to Cushing's.

You're doing a great job of putting the puzzle pieces on the board and the picture will come through as more pieces are placed. You're a good mom; don't forget that. Jigsaw knows and so do we.

Hugs,
Leslie and the gang

[spdd]

Hi and welcome to the forum. I'm a little late doing this but here it is.

I have found on this forum so much information. If it makes you feel any better, my dog was diagnosed with cushings after multiple tests and even a visit to the veterinary college. Here we are almost 4 months later and it is still questionable. Taking the vets word for it I too put my dog on Trilostane and it has been a roller coaster ever since, so please don't feel bad. Before coming on this forum, I pretty much took my vets word as gospel.... that was a big mistake on my part and unfortunately my pup has had a few episodes due to wrong information... not necessarily wrong diagnosis. We are still working on that.
Everyone on here has been absolutely terrific. From interpreting test results to telling me "mah boy" may be overdosed, the knowledge here I just don't question at all. I have been through 5 vets now trying to get my pup stabilized.
So, without rambling any further, here's hoping Jigsaw will get straightened out, and we all know that's it's a day at a time, and of course we certainly share all the emotions that go with it.

[nvmybostons]

Thank you Thank you. I really needed to hear that. You guys are truly the best!!!! I will back off the "thrown of guilt" since it is already taken. I will talk to the internist today and see what she has to say. Truly from the bottom of my heart I so appreciate the medical information you all have to share, and wow, the support is unbelievable. It is so comforting knowing that Jigsaw and I are not alone in this journey!

Jen & Jigsaw

[Boriss McCall]

Hi Jen & Jigsaw,
Welcome to the group.
My Boston Terrier has been on Trilo for the last year & it has really done wonders for him. It took us awhile to get him balanced out.
He does the reverse sneezing thing a lot. But, I haven't seen the breathing problems or goop. He does have a drippy nose occasionally & it is usually clear liquid. I think his is allergies.
I sure hope you start getting your answers soon. I know it can be very frustrating & scary.

[molly muffin]

Oh, what did the internist have to say? Anything interesting to report?

Sharlene and Molly Muffin

[nvmybostons]

Hi All,
The last 7 days has been a emotional roller coaster for me and a physical one for my sweet little Jigsaw.

So last week I did speak with the new internist about the LDDS test results in regards to only having partial results. She explained that, as it was not ideal that the lab lost a portion of the samples, she feels very confident with the results she does have (base & 4 hour post) along with her clinical signs and past history of atypical cushings that she does in fact have Cushings now. The way she explained it at the time, made sense to me, but of course because of my emotions were in play, I couldn't even begin to explain it now . As far as the ACTH pre/post samples, she stated that it is less expensive and less stressful (for some pets) to only have the post sample drawn. She stated that where she is in her treatment process, they only need the post sample. Again, the way and the reasons explained to me at the time made sense.

Jigsaw's Update. Over last weekend, while Jigsaw was off the Trilostane, the symptoms of the nasal discharge from her left nostril continued, so it was evident that this symptom was not due to the Trilostane or the decrease of cortisol. At this time it seemed to be more likely to be Aspergillis, Nasal Carcinoma, Root Abscess, etc. I restarted her Trilostane 0.1ml 16mg/ml bid last Sunday evening and her nasal symptoms and lethargy did not change. After many conversations with the internist head tech (whom I don't feel was listening to my concerns). She told me that since Jigsaw was off the Trilostane for 6 days, I would have to continue the Trilostane bid and then in 10 days another ACTH stim and if that one was good, then we could move forward on the CT, rhinoscopy, and biopsies. I just about flipped a lid. Then she told me if she does look like she has Asper, they would wake her up for General Anesthesia, wait for the Biopsies (3-5 days), then have her come back for the treatment with another general anesthesia. I was not happy! I held strong to my advocacy for my girl, so after that conversation, I thought I would call back and ask some more questions, but ask to speak to another tech or the doctor. Thank goodness, I got a tech named Kelly, what an angel!!!! She listened to all my concerns, was very empathetic of how I was feeling about how miserable and lethargic Jigsaw was feeling, and my concern of waiting another 10 days, and questioning why waiting for treatment 3-5 days, and then another general anesthesia . Kelly used to be an oncology tech, so her empathy and bedside manner was wonderful. Our communication even with me tearing up here and there was good, and she never made me feel like I was overreacting, or being a pain in the a--. The next morning she spoke with both of the internist, and shared my concerns... it was then decided by both of the internist to go ahead and proceed with the diagnostics this last Thursday. Kelly also explained why 2 general anesthetics and that is because of her age, and if everything was done at one time, she would be under anesthetic for 5-6 hours. When she explained that, I totally understood.

She went in Thursday morning, and I am so glad with Kelly's help that I stayed strong for Jigsaw to get it done sooner than later. So her CT did not show any tumors , no tooth root involvement, although when the internist came out to go over the CT results, she was very surprised to see how her left nasal passage was COMPLETELY full of snot. I have to say that I felt that with the evidence of how badly she was affected, I was then taken seriously about how badly Jigsaw felt and then the internist realized that I was not exaggerating about how she was feeling (I feel the head tech was diminishing Jigsaw's symptoms, and that is why the internist was like that in the beginning). After the report about the CT, the internist went back to surgery and completed the rhinoscopy. She did find 1 suspected aspergillis plaque at the very back of her nasal cavity. She biopsied that area, and also the mucosal wall as well (just in case). It took 5 liters of fluid to flush out all of the snot in her nose , really amazing since she is a Boston, and doesn't really have a nose..... Thursday night she was blowing liquid bubbles out of her nose, and had a hard time breathing through her nose due to the inflammation from the rhinoscopy. I thought that night and into the Friday morning, I may have made the wrong decision (we did not sleep all night)... she couldn't get comfortable and puffing through her cheeks for air, it was just heartbreaking. Friday mid-morning, she was able to maneuver sometimes to be able to get short naps. Yesterday late afternoon, the liquid from her nose stopped, and the swelling had gone down enough for her to breathe through her nose! Her and I both slept pretty good last night and slept in this morning. The internist did mention that her nose will probably be clear for the next 3-5 days, but then snot would restart, but we should have the biopsy results back by then, and figure out her treatment plan.

I can't even begin to tell you all how I am feeling now, now that she is feeling like her old self. Oh and by the way, the internist did say to me that with the other side effects that Jigsaw had to the Trilostane 0.5ml (8mg) bid (shaking/trembling), it was surprising because that is even a pretty low dose for her, and now she is back to 1.6mg bid. I feel that her Cushings is at a good place right now, knock on wood..... I will keep you updated with her biopsy results and how we proceed with the Cushings as well.

Truly thank you for the support for me and Jigsaw. Just typing and sharing all of this has been so therapeutic for me and I have learned so much from all of you. Now that Jigsaw and me are moving toward another medical issue, I have looked for a forum similar to this one for Aspergillis, and there isn't one. Bummer.

You all are amazing, special people.

Thanks again,

Jen

[spdd]

Well hasn't Jigsaw been through a lot this week, and of course you.

I am glad to hear that she is doing better after all this.

Really hoping that the biopsy results are good and the dose of Trilostane works for her

I'll be watching to see just what the results are.

[molly muffin]

Oh you poor dear. You and Jigsaw have been through the wringer and now hopefully have come out on the other side with no more of these procedures needed.
I hope they can come up with a treatment plan that will allow her to be comfortable going forward and dry up the snot, whatever is causing it.
Let us know how things continue to go as we'll always be concerned for you and Jigsaw.

Sharlene and Molly Muffin