Murphy, 13 year old Yorkie newly diagnosed

[csmyth0124]

Hi all. I just found your forum and was reading some of your posts and decided to register and see if I could get some input. My yorkie is 13 years old and has been extremly healthy adn active for years without any major problems. In fact, most people think he is about 5 years old. He can run circles around my sheltie who is 6 years old. Anyway, He started having problems holding his urine about a year ago. We got one of those diapers that wrap around his waist. It worked well and he didnt seem to mind so that was that. Then he started having this horrible begging problem. He was acting like he was starving all the time. The at the vets office we were told he had the beginnings of cataracts and he had some benign skin nodules. We just took this all for old age. He also started getting a little pot belly. Again, we thought that he was getting old and we all go throught that expanding middle area. Then about 3 or 4 months ago he developed ear infections that just wouldnt clear up. We kept treating with antibiotics and then all of a sudden he started having itching skin infections which wont clear up either. After numerous rounds of antibiotics, I was speaking with the groomer who said we should have him checked for cushings because she had heard that it started with skin infections. I called the vet and asked if we could check him for Cushings. He agreed but also asked if he could check him for thyroid as well and also check his chemistries and a CBC. He did a low dose Meth stimulation test( not sure if that was the name). He called the next day and said that I was right. It was Cushings. He said the base line was 6 then after the injection if went to 4.4 and then at 8 hours it was 7.8. He said it was from a patuitary tumor. He said all his chemistries and the thyroid were fine except for his Alk Phos which was 3.69 (normal was 1.31) and his Creatinine was 1.9 and BUN was 35 (Normal was 23) He said we need to watch that. He wants to start him on Trilestane 40mg. I ordered it from Arizone and it should be here by the end of next week. After reading a lot of the posts on here I have noticed more symptoms that murphy has gotten. Things like discoloration on his abdomen. He has a small area on his back that the hair is thinning. He has been crankier than usual. and the itching is getting worse and worse. I have also noticed that he has more nodules than he had last week around his neck. very strange. I am glad to hear that this disease is very slow growing. With Murphy being an active healthy dog otherwise we would love to have him around for a long time. he is our little buddy. If any of you can offer any advise please feel free. Let me know what I can expect and things to watch for.
thank you all so much

Cindy & Murphy

[StarDeb55]

Welcome to both of you, Cindy & Murphy! I know it's a tough decision about treating a senior as I went through the same thing with my, now, 14 yr. old Shih Tzu, Harley, a little over a year ago. I must warn you that we ask lots of questions of new members, but all of the information you are willing to provide just helps us to give you the most appropriate feedback that we can from the group's collective experience.

You have given us a good start by telling us about Murphy's symptoms which do, indeed, indicate possible Cushing's. The repeated infections are usually due to the overall immune system suppression caused by Cushing's. I need to ask one question concerning the ear infection & irritated skin treatment. Was any type of steroid containing medicine used to treat either condition? I ask because there is one type of Cushing's, iatrogenic, that is medication induced. Also, you have indicated that thyroid has been ruled out. How about diabetes? Both diseases share a lot of symptoms with Cushing's.

The low dose dexamethasone suppression test is considered to be the gold standard for diagnosis of Cushing's, but it does have a serious drawback. The test can show false positives in the presence of non-adrenal illness. This is why it is imperative that a positive low dose result must be confirmed with a second test, most commonly an abdominal ultrasound which will take a look at the adrenal glands. The US is also a good investment as you will get a look at all of Murphy's internal organs to get a better idea of his overall health. I do have one more question about the low dose results, a baseline of 6 appears to be a little higher than normal which can indicate stress on the pup's part. Does Murphy get very stressed during vet visits?

If you wouldn't mind, could you get copies of all of Murphy's test results & post the numbers for us, including normal ranges & reporting units such as ug/dl, ng/ml, etc. Most members do keep files on their babies at home as you never know when you might need them, especially if you end up at a strange vet.

I can't help with using Trilostane as I'm a Lysodren parent. I have successfully treated 2 pups with lyso, now. My 1st boy, Barkley, was treated with lysodren for nearly 8 years, crossing the bridge at 15 yrs. old. When it comes to either drug, they are both serious medications, that need to be administered following standard loading/dosing protocols. We have seen it repeatedly on these forums where an inexperienced vet does not follow standard protocols, "flies by the seat of their pants", & the pups pays the price. The is one very important point you need to know about Trilo usage. There is another form of Cushing's, Atypical, that involved elevations in one or more of the 5 other intermediate sex hormones produced by the adrenal glands. Trilostane is known to elevate the levels of these intermediate hormones. The only way to diagnose Atypical is to have a full adrenal panel run by the Univ. of Tenn., Knoxville, which is the only lab in the US, if not the world that is doing this testing. We have been strongly encouraging new members with newly diagnosed pups who are considering Trilostane treatment to have a UTK panel done prior to initiating treatment.

I would urge you to take a step back before beginning treatment with either drug, lysodren or Trilostane. Take the time to become an educated owner as you are Murphy's only voice & advocate. The best thing you can do for him is to learn all you can about all aspects of Cushing's, so you can be an active partner with your vet in Murphy's treatment & care. Along those lines, please take a look at the important information & resource section of the forum where you will find a wealth of links that will lead you to any information concerning any aspect of Cushing's disease that you need to know. There is no need to be in a huge rush to get treatment started as Cushing's is a slowly progressing disease that literally takes several years to do it's damage to a pup's internal organs.

Looking forward to hearing more about Murphy. Let us know how you proceed, as we are here to help in any way we can.

Debbie

[Harley PoMMom]

Hi Cindy and Murphy,

Welcome from me too. Altho it is sad the circumstances that brought you here, I am glad you found this forum...these people are amazing.

As Debbie has said I too strongly recommend the UTK full adrenal panel done on Murphy before starting Trilo.

When my Harley was dx'd with cushings in 3/09 his previous vet wanted to start him on Trilo. On the urging of the people of this forum I had the full panel done on Harley before starting the Trilo and found out that one of his intermediate sex hormones is very elevated, so NO Trilo for him, completely different treatment to manage his Atypical cushings.

Alot of vets. have never heard of Atypical cushings or the UTK full adrenal panel. Harley's new vet wasn't aware of either one but she is now.

Lori

[csmyth0124]

Thanks for the quick response to my post. As for the steroid that was used it was Prednisone 5mg x 5 days and then every other day til gone. We had 20 pills, He was only treated with it two times and was given a long acting injection once but that was about 2 months ago. As for the diabetes, I was told that was normal. I will get the results from the vet tomorrow and try to get them all posted here. All of the tests were quite expensive. Just the labwork alone was $275.00. Does anyone happen to know how much it would cost for the Full Adrenal Panel that you are speaking of from Tennesee? With the economy like it is, If it is much more than this , I'm afraid it would be just too much for us. I was very surprised at the cost of the trilostane. The vet said he thought it was between $50 and $60 a month. We found out that it was more like $25. That is very doable for us. The only reason I am wanting to get going on this is that Murphy is miserable with the itching. He has a staph infection right now of his skin that is being treated with cephalexin 250mg. twice daily for 10 days. I tis horrible!! We bath him in a special shampoo Douxo and a spray to help with itching called Douxo calm but he is still miserable. Also do you have the address that this adrenal panel is sent to in Tennesee? I'm not sure if the vet will have that. Actually now I'm getting really scared after hearing your answers. Not sure what to do now.

[StarDeb55]

Cushing's is not an easy, simple disease to diagnose as there is no single test that is 100% diagnostic for the problem. Since both medications are so serious, you want to make absolutely sure you have a confirmed diagnosis. Giving either medication to a pup who does not have Cushing's can be disastrous. This is why you want to take a little bit of time & make sure of what you are dealing with. Cushing's can be scary when you get the initial diagnosis, but knowledge is power. The more you learn & understand about what is going on, the fear will lessen. We will be here for you & Murphy every step of the way.

The following link will give you all of the information you need to know about the full adrenal panel. Please look at section G. I believe UTK charges $155, plus you would be charged for the injection given to do the test, the processing of the blood samples, & the cost of shipping. Make sure your vet sends the sample directly to UTK, & not the lab the vet uses for his routine bloodwork.

http://www.vet.utk.edu/diagnostic/en...gy/general.php

Debboe

[Squirt's Mom]

Hi Cindy and welcome to you and Murphy!

I, too, would advise you to take it slow right now and be sure that what you are dealing with is pituitary Cushing's, PDH. Since you are considering Trilo, I strongly recommend Murphy have the UTK panel done before starting any treatments.

Let me tell you my Squirt's story, short form. She was diagnosed with PDH in 3/08 via the LDDS (the test Murphy has had) and that diagnosis was confirmed with the HDDS, ultrasound and an ACTH. Just to be on the safe side I had the UTK panel done and sure enough she is Atypical, too, so Trilo was no longer an option for us. On the treatment sheet from UTK, Dr O recommended another ultrasound, which we did. A tumor was on her spleen! The tumor and part of her spleen were removed in 9/08. Her cortisol has returned to normal since the tumor was removed, leading her docs to now say that the initial diagnosis of PDH is "highly questionable." Squirt is now being treated only for the Atypical, a much easier condition to treat as well as less expensive.

So even with every test supporting a diagnosis of Cushing's, it is still possible for those tests to be an indication of a problem NOT related to Cushing's with elevated cortisol (PDH).

Squirt's is just one story of just how difficult and complex Cushing's can be to accurately diagnose. This is why we cringe when we see someone starting treatment based on one test. Lysodren and Trilostane are powerful and not to be used lightly as they can result in permanent damage. Once the treatments have started, further testing is difficult as the meds will skew the test results unless there has been at least a 30 day wash-out period. So not only would you have spent extra money on meds you may not even be able to use, Murphy could suffer longer and/or sustain injury to the adrenals.

We don't say these things to cause you extra worry or to down-grade your vet. We caution you because we care, because we have been where you are, because we have seen pups suffer needlessly, because we know first-hand how complex Cushing's is. We say these things because we want the very best outcome for Murphy and you.

Take your time to learn all you can, ask lots of questions and we will do our best to help you along. You don't have to take this journey alone.

Hang in there!
Hugs,
Leslie and the girls

[StarDeb55]

Cindy, I just realized something that is very important. By any chance, was Murphy on the prednisone or had he recently had one of the steroid injections when the low dose test was done?

Debbie

[frijole]

Cindy

She is asking about the prednisone for the same reason I am... because it would totally scue the results. Also - taking prednisone for extended times can CAUSE cushings.

Please hold off on giving drugs and read our questions. There are reasons we are asking. It is to help us understand how to best help you and Murphy. Dogs are often misdiagnosed and suffer as a result.

Thanks!
Kim