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View Full Version : Teddy Bear has Sards and Cushings (toy poodle - 9 y/o)



ME.Wilson
08-29-2009, 06:00 PM
Teddy Bear--toy poodle-age 9years weighs 12.9-13 pounds
2-09 developed Sards
-increased thirst and hunger
-had urine creatine ratio test -high
-ultra sound-no adrenal tumor
-had LDDT and ACTH TESTS-HIGH
-3-09 STARTED SELEGLINE. cortisal manger,and melatonin
numerous problem in the past few months
-off all meds going to start trilostane
anything I need to know before we go down this new path????
Going to have an electrolite test in week and 10 days a ACTH stim test

Squirt's Mom
08-29-2009, 06:43 PM
Hi M.E. and welcome to you and Teddy Bear! :)

SARDS is a condition that causes Cushing's signs and sometimes positives on the cush tests. However, usually the signs disappear and the cortisol returns to normal levels once the SARDS has been around for a bit.

So, the first thing is, has Teddy been retested recently for Cushing's? If so, what tests, when, and what were the actual results? Please post them if you have them along with the units of measurement (ug/dl, mnol/l, etc) and the normal ranges for the lab that did the testing. If you don't have copies at home, it is a good idea to get them and keep a file at home for him?/her?. That way if you ever have to see a different vet for any reason, like on vacation, you will have all the info in hand. Plus you will be able to answer our questions! :p

Selegiline, or Anirpyl, is good at controlling the signs and would have been a good option, IMHO, at the start of the SARDS for that reason. However, it is effective in only 25% or less of true cush pups, and that is only those with the tumor in the pars intermedia of the pituitary gland. My Squirt was on Anipryl for some time and did very well on it, but hers is an unusual case...she is a cush oddy. :p

Second, before you start Teddy on Trilo there are some things you need to be aware of about this drug. It always causes one or more of the other five hormones involved in Cushing's to elevate. In a pup that has some or all of these five naturally elevated, the Trilo is going to simply make things worse. So, for those considering it use, there is a test that is highly recommended first. It is the full adrenal panel from the Uni of TN in Knoxville (UTK). This is the only lab in the world at the moment we know of that does this testing. Your vet will make the blood draws and send the samples directly to UTK. You can find info about Atypical (the form of Cushing's in which only some or all of these five are elevated yet the cortisol is NOT elevated) here:

UT Panel
general info:
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Tests available and costs:
http://www.vet.utk.edu/diagnostic/endocrinology/index.php

The test you will want is listed in the second link:
Adrenal Panel (ACTH Stim) Dog, Cat Serum Adrenal Function $140.00

Your vet will add their charges for the draw and shipping to the cost of the test at UTK. Be sure to ask that the sample be sent directly to UTK and not through another lab. That lab will tack on their charges plus the delay can put the sample at risk.

Now for a few questions...we try not to get tooo nosy til we get to know you a bit better. ;):p How much does Teddy weigh? Are there any other health problems you know of? Is he/she on any other meds, supplements, herbs, etc at the moment? Were the only signs the thirst and hunger increases? What is meant by "cortisol manager"? Why was melatonin given? What are the "numerous problems" Teddy has had in the past few months? Why an electrolyte test? Has there been any indication of the cortisol being too low? The more we know about Teddy the better insight we will have and be able to offer more meaningful input, so don't feel shy about "writing a book"...we love details! :D

I am so glad you and Teddy Bear found us and hope to learn more about the both of you in the future.

Keep your chin up!
Hugs,
Leslie and the girls

Squirt's Mom
08-29-2009, 08:44 PM
Hey M.E.,

I forgot to give you this link on SARDS from our Resource section earlier....

http://www.k9cushings.com/forum/showthread.php?t=213

This old brain of mine, I swear! It's amazing I can remember my own name! :o

Hugs,
Leslie and the girls

Roxee's Dad
08-29-2009, 08:55 PM
Hi M.E.

I would also like to welcome you. As Leslie has asked, we are looking forward to hearing more about Teddy Bear and the test that were performed to make this diagnosis.


-3-09 STARTED SELEGLINE. cortisal manger,and melatonin
numerous problem in the past few months
-off all meds going to start trilostane

Can you explain in more detail.

ME.Wilson
08-29-2009, 10:19 PM
PRE-ACTH CORTISOL 7.7 POST29.8----on3-6-09

dex suppresson 3-13-09
pre dex 8.3
post 4hr dex 0.9
post 8hr dex1.8

pancreatic or gallbladder june 09
ALK PHOS.247
alt 306
ast 143
T4 0.6
wbc 33.3
absolute neu. 25641
absolute mon. 2997
sick, restless , very loose stool, up every 2 hours--took flagal and clavamox out of space

ME.Wilson
08-29-2009, 10:32 PM
6-29-09 blood work -cordisal manager from a
alt 351 alk phosphate 140 Holistic Vet also Melatonin
ast 143 and Selegline
wbc 21.2
absolute neut. 16324
absolute neutrophil band 1484

blood 7-14-09
alt 305 alk phosphate 138
ast 108
T4 0.8
wbc 20.4
absolute neutrophle 15504
" " band 204

ME.Wilson
08-29-2009, 10:37 PM
urine cortisol creatinine tests
3-2 , ratio 28
5-4 17
6-18 56
6-26 20
7-31 27
8-22 15
Told these numbers go up and down. Suggest by Holistic vet and regular vet Teddy Bear go on Trilstane Teddy weighs 12.9 -13 pounds

ME.Wilson
08-29-2009, 10:50 PM
ACTH stim test Teddy had --- is that different from the one everyone is talking about the full adrenial panel from UT K? ME> Wilson

ME.Wilson
08-29-2009, 10:52 PM
Sorry But I do not know which is the correct place to put questions or info. I probably put my info in the wrong place. MEW

ME.Wilson
08-29-2009, 10:55 PM
I do have copies of all tests Teddy has had. I tried to put the high results in, but I probably put them in the wrong place. MEW Teddy Bear's Mom.

Squirt's Mom
08-29-2009, 11:07 PM
Hi M.E.

Thanks for the lab/test results. If I am reading these right, there has been no further Cushing's specific testing done since March of 09, a month after the diagnosis of SARDS. It has been 5 months then that the SARDS has been in progress.

In the link I posted from our Resource section about SARDS, it says, in part,


The typical laboratory workup results often include a mild to moderate elevation in the alkaline phosphatase and cholesterol. The historical, physical and laboratory findings make one suspicious for Cushings but rarely are any of these animals subsequently diagnosed with Cushings.


The outcome for SARDS patients is irreversible blindness but usually no other systemic problems.


Unlike with a diagnosis of central blindness, there are apt to be no more widespread and serious internal problems for the animal.


A routine blood and urine work up in these patient may reveal changes which are suggestive of hyperadrenocorticism (Cushing's Syndrome). If these tests are followed up with specific testing for Cushing's (low dose dexamethasone suppression test, ACTH stimulation test) some cases will be confirmed as Cushingoid. These patients should be treated for their Cushing's syndrome, but this will not restore vision. The relationship between Cushing's syndrome and SARDS is not known.

Since the only tests that have been done were the LDDS and an ACTH, and these were done 5 months ago, it is most important to have the Cushing's specific tests repeated PLUS an ultrasound before starting treatment with either Trilostane or Lysodren.

Trilo is touted as "safe" with "none of the adverse effects sometimes seen with Lyso", but these are just not true statements. Trilo can and does cause the same problems that Lyso does when not properly administer and monitored. And starting treatment on a SARDS pup with no conclusive diagnosis of Cushing's AFTER the dog has had time to adjust to the SARDS, is dangerous.

I beg you to have your Teddy Bear retested for Cushing's with the LDDS and ultrasound. If you are determined to use Trilo, then again I strongly recommend the UTK panel. Many vets, both GP and IMS', are not familiar with Atypical or the effect those 5 other hormones can have on the pup, tho it is becoming more and more known about. I urge you to consider these steps before you give Teddy any meds.

This is in no way a negative reflection on your vet but rather an effort to help you have the very best possible outcome for your baby. A cush savvy vet is ideal, but if you have one that will work with you as a team, then you are way ahead of the game. We will try to help you be a viable member of that team by sharing with you what many of us have had to learn the hard way and at the expense of our own babies.

Hugs,
Leslie and the girls

PS. I notice you wrote "out of room" on the first post. These boxes will continue to expand as you write so there is no need for you to try to keep the wording etc within the frame. It will self-adjust as you type. Took me a bit to figure that one out!

Roxee's Dad
08-29-2009, 11:10 PM
Hi MEW,


Sorry But I do not know which is the correct place to put questions or info. I probably put my info in the wrong place. MEW

You put everything in the right place. :) We try to keep all your info, and questions in yours and Teddy's thread for ease of reference. :)

The members who know more about bloodtest will probably need to know the normal ranges as they relate to the test numbers you posted. You can go back and edit your post and put in the normal ranges. There will probably be other questions.

Teddy's weight would be good to know also.


ACTH stim test Teddy had --- is that different from the one everyone is talking about the full adrenial panel from UT K?

Yes it is different in that it checks not only the cortisol but the 5 other intermediate hormones that can also affect Teddy's health and help dictate which path of medication may be right for him.

Squirt's Mom
08-29-2009, 11:14 PM
Hey again,

You are posting just where you should be. We try to keep all the info about each pup in their own thread. That way we can look back for info previously posted and keep the story all together.

An ACTH is different from the UTK panel but that panel will include an ACTH so getting a separate one done is not necessary. The UTK panel looks at all the hormones produced in the adrenals that are involved in Cushing's - cortisol, estradiol, androstenedione, 17-hydroxyprogesterone, progesterone and aldosterone on the first test. Then, lets say that only Teddy's estradiol is elevated...you can have subsequent testing done only on that hormone and it will cost less. But the first time around, all 6 hormones will be analyzed.

To help clear up a bit of confusion on the tests, here is a list of the tests most often used:

UC:CR
LDDS
HDDS
ultrasound
ACTH
UTK panel

Each is different and looks at different aspects that may indicate Cushing's. Cushing's is very complex and often difficult condition to diagnose so it is important to have as much confirming or non-confirming data as possible.

Hope this helps a bit.
Hugs,
Leslie and the girls

PS. I see John and I were writing at the same time so forgive any duplication.

ME.Wilson
08-29-2009, 11:21 PM
What info do I take to my vet to have the full adrenial panel done at UTK? MEW

ME.Wilson
08-29-2009, 11:57 PM
Teddy did have an ultrosound 3-10-09mild decrease in liver size, does not support hyperdrenocorticism , adrenal glands normal. had elevated stim test. suggested ACTHstim test posted those results

Roxee's Dad
08-30-2009, 10:27 AM
Hi MEW,


PRE-ACTH CORTISOL 7.7 POST29.8----on3-6-09

Does indicate cushings.



dex suppresson 3-13-09
pre dex 8.3
post 4hr dex 0.9
post 8hr dex1.8

This and more information can be found in our resources section:
http://www.k9cushings.com/forum/showthread.php?t=216

Here is a small excerpt regarding the LDDS test.


While basal and 8-hour postdexamethasone
samples are most important for interpretation of the
test, one or more samples taken at intermediate times (eg, 4
hours) during the test period may also prove helpful. Approximately
30% of dogs with pituitary-dependent hyperadrenocorticism
have serum cortisol suppression at 4 hours
(_1 _g/dL or _30 nmol/l), with a rise in cortisol values by 8
hours after dexamethasone administration.1-4,32 This escape
from suppression is diagnostic for pituitary-dependent hyperadrenocorticism,


But there is a But.
In our resources section you will find additional information on SARDS and this is a small exceprt from that info: http://cal.vet.upenn.edu/projects/ophthalmology/ophthalmo_files/Tools/SARDS.pdf

“The outcome for SARDS patients is irreversible blindness but usually no other systemic problems. Over time the retina will degenerate and appear grossly abnormal due to retinal atrophy. Most of these animals remain healthy and the clinical signs of PU/PD/PP fade. Very few of these dogs actually have Cushings.”

So it is possible that Teddy does not have cushings. I think it’s worthwhile checking with a cushings savy (experienced) IMS (specialist) before treating with any cushings medications.


You may also want to take a look at Bonnie's thread (Bonnie (8 yr old Amercan Eskimo) Cushings? SARDS?.) Here is a direct link to that thread: http://www.k9cushings.com/forum/showthread.php?t=998

Squirt's Mom
08-30-2009, 11:37 AM
Hi M.E.,

If your vet is not familiar with the UTK panel then I would print out those links I gave you and take them in. The staff at UTK is very, very friendly and helpful so your vet could call them if they have any questions and UTK will be happy to assist.

The most important thing is to be sure the sample is packed correctly for shipment, and the UTK site gives the directions on how to do that as well. The following link gives info about shipping from outside the US plus phone #:
http://www.vet.utk.edu/diagnostic/endocrinology/shipping.php

Squirt's vet had never heard of this form of Cushing's nor this test, so we got to educate her a bit for a change. ;):D Dr. C, Squirt's vet, called Dr.Oliver and talked everything over with him before taking samples, etc. He is such a wonderful man!

The adrenals in true cush pups are typically either both enlarged or one is large while the other is much smaller or even atrophied. Since Teddy's adrenals were seen as "normal" one month after the onset of SARDS, this is even more reason to take the time to have the Cushing's specific testing done before any meds for Cushing's are administered.

Is the cortisol manager you speak of, the melatonin? Did your vet explain why Teddy should take melatonin? It does have a calming, actually sedative, effect so was Teddy really nervous about the blindness?

Hope you and Teddy Bear had a good nites rest!
Hugs,
Leslie and the girls

ME.Wilson
08-30-2009, 10:59 PM
Thanks for all the info. Teddy did have an Electroretinogram OU 2-09-09 Dignosis SARDS. He is managing ,and we are managing with his lack of sight. Now we need to figure out the cushings. Tomorrow I will show my Vet the info for testing the full Adrenal panel and ACTH Stim test. This the perfect time as Teddy is off of everything except Melatonin, which I will stop tonight. After the Trilostane arrived and I read the directions about not touching the pills or wearing gloves I got a very concerned about what I might be giving my pet. Does this sound like the right road? Thank you ME

ME.Wilson
08-30-2009, 11:24 PM
Cordisal Manager is a seperate pill along with Melatonin and selegline.all given by the Holistic Vet. My regular Vet wanted me to give Teddy Trilostane to start. Also the Intenist who reviewed his ultrasound wanted me to use Tilostane. The regular Vet and Holistic vet think Teddy should change because of the gallBlader?? problem, some diarrhea all over with, and blood work. I will try the adrenal Panel test at UTk. ME

Squirt's Mom
08-31-2009, 11:41 AM
I will try the adrenal Panel test at UTk.

What great news to start the day with, ME! :D WAY TO GO, mom! :cool::cool::cool:

Let us know what you learn at the vet's!

Hugs,
Leslie and the girls

ME.Wilson
08-31-2009, 06:55 PM
MY vet will do the test. Either he will send it or I will. Teddy has been off of Selegline for23 days, but melatonin for only4 days. Is that enough time? I have an appointment for Wednesday. ME--Teddy"s Mom

gpgscott
08-31-2009, 07:17 PM
MY vet will do the test. Either he will send it or I will. Teddy has been off of Selegline for23 days, but melatonin for only4 days. Is that enough time? I have an appointment for Wednesday. ME--Teddy"s Mom

Melatonin persists only for a short period, that is why it must be administered either by implant (constant) or twice daily (nearly constant)

I think a period of 4 days is barely sufficient. I would email UTK and ask their specific recomentations.

Very glad you are going forward with the full adrenal panel and hoping it informs Teddy's treatment. It has for many.

Best to you and Teddy, Scott

Squirt's Mom
08-31-2009, 08:20 PM
Hi ME,

The Selegiline has probably been out of the system long enough, but the melatonin I would give a bit more time. Melatonin and lignans are the treatments for Atypical so it could skew the results. However, if the hormones came back elevated, you would know Teddy needs more than just the melatonin. The melatonin and lignans work in conjunction with each other especially in treating the estradiol levels. Just to be safe, I would contact Dr Oliver and see what he has to say about it. Be sure to tell him what kind (regular, rapid release, extended, etc) the melatonin is, how often Teddy gets it, the dose in mg, and how long he/she has been on it.

You can reach Dr O at:
joliver@utk.edu

Tell him you are planning on having the full adrenal panel done and he will be happy to help you.

Hugs,
Leslie and the girls

ME.Wilson
08-31-2009, 09:42 PM
Thank you! That is a great idea. I just sent Dr. Oliver a quick email. Teddy is enjoying not taking all those pills.
Teddy Bear and ME--MOM

ME.Wilson
09-01-2009, 10:26 PM
I thank you all again for suggesting I email Dr. Oliver. He is so quick to reply, and suggested I wait at least 10 days since Teddy was on a low dose of melatonin. He also said maybe Teddy would no need to take Trilostane. Iwill let you know when we have the test. Has any one shipped the samples themselves to UTK? If so, what type of packaging did you use? Thanks again ME and Teddy Bear

Squirt's Mom
09-02-2009, 11:16 AM
Hi ME,

Ain't Dr O wonderful!? He has met very, very few of our babies in person, yet always takes the time to talk with us and help us understand. He is one of our true angels!

As for the shipping - the samples are considered bio-hazardous since they are bodily fluids. There so many regulations to meet in order to allow any transportation of such materials, and one little mis-step will cause the sample to be destroyed. That would mean re-doing the blood draw..at your expense. If the vet makes a mistake in shipping, the cost should fall on them to repeat it. You not only have to meet UTK's requirements, but those for your country, our country, and the actual transport company(s). In my mind, the risk is just too high to attempt this ourselves. I have had some experience with shipping costs across the border, tho, and it is astronomical! :eek: A $3 bottle of supplement from Canada cost me nearly $30 in shipping alone!

However, having said all of that, I think there are shipping instructions on the UTK site you can access. We live about 8 hrs from UTK and Squirt's sample was packed like it was going to the other side of the world!

IMHO, let your vet handle it. ;)

How is Teddy Bear doing? How are you doing?
Hugs,
Leslie and the girls

Squirt's Mom
09-02-2009, 11:26 AM
Ya know....I don't know where you are but for some reason I have placed you in Canada. :confused: :rolleyes:

So you might only have to deal with one countries regs!

ME.Wilson
09-03-2009, 07:10 PM
I live in Illinois northwest of Chicago. I need to talk to my Vet. He said his lab was too expensive, so perhaps I wanted to send it Adrenal panel and Stim blood work. Sounds like a very bad idea to me and maybe he was too busy to pay attention to all the details envolved with sending the blood .
Teddy is doing fine. I do worry everyday that something new will come up. We take one day at a time. Thanks for your input. ME and Teddy Bear

Squirt's Mom
09-04-2009, 11:21 AM
Hi ME,

Has your vet given any indication that he is having problems with you taking a proactive role in Teddy's care? Some seem to resent it when we want to be involved and some appreciate it. The appreciative kind are the ones we want! :D A lot of the resentful ones have found themselves suddenly short one client... ;)

I think I would try to have a sit down with him and find out what the problem is with sending it. It may be that he is under contract with a certain lab and has to send all samples to them first...which would increase the cost unnecessarily. Perhaps that is what he was referring to as "too expensive". If that is the case, you may be able to find a vet to do this for you that can send it direct to UTK. We have had members to do this in the past.

I know what you mean about worrying...geez do I! :eek::p I think everyone here does! That simply tells me you are a great mom who loves her baby a great deal.

Hang in there...you're doing a fine job!
Hugs,
Leslie and the girls

Squirt's Mom
10-07-2009, 02:16 PM
Hi M.E.,

Was just wondering how you and Teddy Bear are doing? Would love to hear from you when you have time to drop a line!

Hugs,
Leslie and the girls