New to group

[cekehm]

Hello, I just joined looking for some support and information. I have an 11 year old bearded collie, Max, who was just diagnosed with cushings this week. This happened through a specialist that we saw for an unrelated problem, and I am waiting to meet with my regular vet, which I will be doing tomorrow. Max has all the signs and I feel terrible that I did not recognize this. I am also very new to a message board and admit that I am having some trouble understanding how it works! I have two other dogs, Missy - a 12 year old bearded collie, and Frankie, a 3 year old Dane mix. Looking forward to making new friends :)

[goldengirl88]

Welcome to the group. Please don't be hard on yourself for not recognizing the symptoms of Cushing's. Mostly everyone attributes the symptoms to old age. There are even many clueless vets. You will get great support and help here. First thing we will want you to post the tests you had done confirming the Cushing's. It is a good idea to get copies of everything from now on and make a file. Please then post the abnormal numbers along with the normal scale given by the lab as they are all different. We need to see the numbers to know what is going on and help you. This disease is not curable, but can be managed by a vigilant owner . There are two drugs used for this, Trilostane, and Lysodren. It is best to find an experienced vet who knows how to treat Cushing's or there can be problems. You will need to educate yourself as much as possible as you will be the only advocate for your dog. Never put blind faith in anyone including vets.Could you give us a little history on your dog? Has there been any other illnesses? What symptoms did your dog present with that preceded the diagnostic testing? How much does your dog weigh? One caution, if you treat with trilostane start with a low dose as in 1 mg per pound. Do not start with a high dose no matter who tells you to do this. These are powerful drugs and your dogs body needs to get adjusted to, starting too high can bring trouble.

[cekehm]

wow thank you! ok more info. max weighs 55 pounds. I don't think I've gotten enough testing yet based on what you are saying. here's how I got here. 2 mos ago max began having issues where the whites of his eyes were bright red. my vet tried 4 meds and sent him to an opthamologist when nothing worked. they said it was an allergy. when I saw opthamologist, his skin around the eyes was so inflamed that he had abcesses there from the medications so he tested health of eyes, and said they were fine but he wanted him seen by dermatology. I did that this passed Monday and she could not help the eyes, but found what she believes to be a sarcoma on his right side, a bacterial skin infection (treating with antibiotics) and believed he had cushings. she did bloodtests and urine and said liver came back moderate and urine was diluted so she said it is very likely cushings. he has thinning of the skin, hair loss, and pants constantly. (he is more long haired so I always thought that was him being hot) he also has the droopy pot belly. my vet has scheduled him for surgery Monday to remove the sarcoma. He said that he would remove that and then we would discuss what to do next for cushings. I panicked and said that I'm not comfortable with surgery until I can sit and talk with him so he's coming tomorrow to see max. Max has been a very healthy dog otherwise and as of now has not been diagnosed with any other health conditions, other than that he has been diagnosed with arthritis. (although I question that now because his symptoms are a bit of stumbling and droopy walking and the more I learn this could also be cushings) I feel like I have so much to learn and just have no clue where to start! I took the guy to the dr for an eye problem and was blindsided!!!! Any advice on where to start would be greatly appreciated!!!

[Squirt's Mom]

Hi and welcome to you and Max!

Ok, first, don't take the Cushing's "diagnosis" to heart just yet. In the first place, no testing FOR Cushing's has been done based on what you have said. Second, any testing done now while he has other issues going on could very well be skewed so I would wait til after the surgery and he is well recovered before wasting my money on tests that may well be invalid.

Now, what are the names of the meds he has been on for the eye issue? If they contain steriods, that is another reason to wait on cushing's test because they can read on the tests as cortisol (the enemy in Cushing's), giving a false positive.

The signs you are seeing, the changes you mentioned, can be seen with Cushings' BUT they can be seen with other conditions as well. Cushing's is one of, if not THE, most difficult canine condition to diagnose because many other conditions mimic it and can skew the cush tests. If he hasn't, the first thing you want to do is have a general health screen and CBC to see how the organs are functioning. Clues often lie there plus these tests can rule out things like Hypothyroidism and diabetes. I would HOPE this is done before surgery anyway. ;)

So for right now, get the sarcoma taken care of and don't worry overly much about the Cushing's right now. You have some time to learn about it! :)
Hugs,
Leslie and the gang

PS. You are using the board just fine!

[KatyGirl]

I am new to the group too. I thought Katy Girl was just showing signs of old age. I had never heard of Cushing's. I too was just taking her in for teeth cleaning last Tuesday when the blood work showed liver issues. The Vet immediately looked toward Cushing's and the next three blood tests confirmed it. Now we have to decide the next step.

[cekehm]

Well it is interesting now, because he was on two steroid meds for the eyes, one being a round of oral prednisone. When he had his annual bloodwork done last year vet said liver slightly higher than normal, but lower than his sisters, and she is a year older, and nothing to be concerned about. This screening by specialist showed "moderate." She confirmed all other screens were normal, (glucose, thyroid and all others cbc etc) He behaved no differently before the prednisone than after with the panting, etc. Specialist did say she ran appropriate testing to feel he was safe for his surgery this Monday. My vet says he wants to go slow also - he's always been conservative and takes the "this is what I would do if he were my dog" approach. Thank you for the info. What testing is typically done before moving forward with treatment? After reading, I am really frightened of the medications - they seem so harsh! Has there been any success with any type of natural treatments? (are there any?)

[pansywags]

Welcome, and I am so sorry for you and your dog that you had to come here. There is a lot to learn and it can be overwhelming, I felt like I was enrolled in vet school for awhile while I was coming up to speed. Having said that, I learned more from this smart, caring forum than I did anywhere else. Like you, I was really apprehensive about the medical treatment options but I came to understand that with a knowledgeable and cautious vet supervising, they can work very well in alleviating the symptoms of Cushing's.

I wish you and Max the very best.

[cekehm]

thank you everyone, it looks like there is a lot to learn here!
I appreciate the welcomes and look forward to learning from all of you who have unfortunately been through this :(

[cekehm]

My vet saw Max today. He said he disagrees with the specialist. He said that his liver values may be elevated but he was on prednisone so they would be. He said he may have cushings but if so it's very early stage and mild. He will remove sarcoma tomorrow and recheck liver in two weeks. If still elevated he will test further for the cushings.

[Iraklis]

Hello and welcome!

I knew of this forum for months, but sadly I signed up too late...as much of the info here would have extended for sure my doggies' life...

Until you confirm Cushings, it would help to make your dogs life/environment as calm promoting as possible.
Allow exercise but do not overdo it, ex. ''forcing'' the dog to run.

Recently i've found that melatonin helps reduce the amount of cortisol in the blood. Maybe 1*1mg capsule before sleep would help.
BUT you SHOULD discuss this with your vet before doing it!!

Ask him about SAM-e pills or/and milk thistle for sure ,too!

[Squirt's Mom]

Sounds like your vet is thinking on the right track! :cool::cool::cool:

Cortisol is the bodies natural response to stress of any kind, internal or external. Our own bodies react the same. So when something like this sarcoma is present it is expected that the cortisol will be elevated. That's why any testing done when another issue is present can cause false-positives. My own Squirt tested positive when it was a tumor on her spleen causing the elevations in cortisol. Once that was out, her cortisol returned to normal. So I agree with your vet. Get this taken care of, let him recover completely, THEN if needed look into Cushing's.

Now, when will the surgery be? We will be with you all the way!

As for melatonin - yes, it does have the capacity to effect cortisol but it can't address the massive amount of excess cortisol that is present with Cushing's. People with jet lag have a cortisol imbalance causing them to sort of mix up days and nights, missing sleep because the cortisol is making them antsy. What melatonin does is reset that internal clock so that the levels of cortisol drop during the night like it is supposed to. When we are under stress and find it hard to sleep, cortisol can be elevated during those times and melatonin can help to lower the cortisol so we can sleep better. But those levels of cortisol, even tho elevated, are not as high as it is with Cushing's. So melatonin can help, but it cannot lower the levels of cortisol seen with this conditions and keep it down. Melatonin is used in combination with another supplement as treatment for a specific form of Cushing's - but the cortisol is NORMAL in this form.

My prayers and thoughts are with you and Max. Please keep in touch and let us know how things are going.
Hugs,
Leslie and the gang

[molly muffin]

I like the way your vet thinks. :)
Welcome to the forum and the crazy world of do they/don't they of cushings.

I agree with Leslie, get the skin issue taken care of and then once that is healed up and nothing going on, no steriods in his systems, then you can check for cushings or think about it, If it is even a factor still.

Baby steps, always. You have time with cushings at least to figure things out and take it slow.

Sharlene and molly muffin

[cekehm]

Thank you! I'm very sorry to hear that you learned too late your dog is beautiful :) my Max had his surgery today to remove the possible sarcoma. He is doing very well. Vet said he got everything and if it is not benign he feels will be an isolated incident. He sat with me and looked at liver values that were concerning to the specialist. He said the one value she was most concerned with was Alk Phosphatase - range 5-131. His value was 238 after oral prednisone. My vet said that typical cushiness dogs he has seen in the thousands. He did see brittle skin and we do see many signs. He will repeat liver values in 3 wks and then if still elevated he will do the testing for cushiness diagnosis. A test that is done over 8 hrs. I'm sure you are all familiar with this. Concerned by what I've been reading here that diagnosis is not easy.....

[molly muffin]

Your vet is right and has a good plan. I feel comfortable with his recognition of what liver values often look like with Cushing's and wants to take it slow and get it right. This is way more than we often see vets do so really you seem to have a knowledgable vet. This is half of the battle.
Congrats on a good successful surgery. Sounds like he got clear margins. Very good!

Sharlene and Molly muffin

[Iraklis]

As for melatonin - yes, it does have the capacity to effect cortisol but it can't address the massive amount of excess cortisol that is present with Cushing's. People with jet lag have a cortisol imbalance causing them to sort of mix up days and nights, missing sleep because the cortisol is making them antsy. What melatonin does is reset that internal clock so that the levels of cortisol drop during the night like it is supposed to. When we are under stress and find it hard to sleep, cortisol can be elevated during those times and melatonin can help to lower the cortisol so we can sleep better. But those levels of cortisol, even tho elevated, are not as high as it is with Cushing's. So melatonin can help, but it cannot lower the levels of cortisol seen with this conditions and keep it down. Melatonin is used in combination with another supplement as treatment for a specific form of Cushing's - but the cortisol is NORMAL in this form.



It is also suggested that it has some ant-tumor effects (especially pituitary tumors (http://www.lef.org/protocols/cancer/brain_tumor_01.htm)).
So If by using it you can ex. give 20mg of Trilostane instead of 25mg...why not?



I never got the chance to try it though...I was so scared of continuing loss of weight i opted for BCAA vs Melatonin...
Which actually didn't help one bit and caused a 40+euro-hole in my pocket that could be used elsewhere...

[doxiesrock912]

Great plan since any illness, infection or recover from surgery can impact test values. Let your sweetie heal and then retest.

[cekehm]

Thanks again everyone! Max is doing very well after his surgery. My biggest issue is keeping my other dogs away from him! (have another beardie - missy who's 12 and a dane mix - Frankie who's 3 and VERY curious of this incision! I'm so glad that you guys agree with what my vet is telling me. He has been my vet since Max was born and the only one I've ever trusted with any of my animals, and he has become a close friend (and makes house calls too!) Next step is biopsy results, although sounds like regardless of outcome they wont be concerned about spreading cancer (fingers crossed there) and then will figure all of this out next month! Thanks again for the feedback and information!!

[molly muffin]

That is fabulous news. House calls too, whoo hooo! That's a plus and a half. :)

Yes it does sound excellent that they don't think anything is going to be spreading. Hopefully this is the end of all your worries on all fronts!!

Sharlene and molly muffin

[goldengirl88]

Sounds like your boy is indeed very fortunate. I am so happy to hear good news. Now he is rid of that growth and you can formulate a plan when he recovers. Blessings
Patti

[cekehm]

Hi Everyone, I got Max's biopsy results today from his growth removal. The Dr called it a cutaneous hemangiopericytoma. He called it very "low grade" and said that he got a very clean margin. He said that these tend to sometimes return locally but do not typically metastasize and should it return it can be removed again. Of course I was hoping for a benign diagnosis but this doesnt sound too scary.....
Bloodwork in two weeks to recheck liver and then will determine whether to pursue cushings......hate the waiting!!!

[goldengirl88]

All in all a pretty good report for your baby. I am glad the Dr. was able to get all of it. Blessings
Patti

[molly muffin]

Clear margins are excellent! It's a good indicator that they got it all. Yay!

I'd definitely give it some time before pursuing the cushing diagnosis, just to make sure that nothing else would be interfering in those results.

Love his picture/avatar!

Sharlene and molly muffin

[goldengirl88]

I just love bearded Collie's they are adorable. How is he feeling after his surgery? I would wait too as you don't want anything skewing the results of your testing. Blessings
Patti

[cekehm]

Thanks I love beardies also, I have Max and then I also have another one - Missy, she's a year older than Max, just turned 12 on Sunday. They are a real pair! Max is doing really well from the surgery, he showed no effects from it at all, and the vet used propofol so he didnt even seem sluggish the first day from anesthesia, nor did he need any pain meds. Do you agree that 2 weeks is long enough to see some improvement in the liver values if we're not looking at cushings? I've been reading so much in here and it all seems so overwhelming and confusing! And some of the extensive things that folks are going through to keep these poor guys in order, but it looks like a lot of the cases are much more complicated with multiple issues.

[Harley PoMMom]

If the ALP (Alkaline phosphatase) is the only enzyme that is elevated, if this were me, I wouldn't be too concerned. Many things can cause an increase in the ALP level, such as any gut or thyroid issues. Are any of the other liver specific enzymes elevated, such as the ALT, GGT, AST?

Hugs, Lori

[cekehm]

They tested absolutely everything on him (was done at specialist office for dermatology - my vet said "everything"). The values you mentioned were a little high - ALT - 151 (range 12 - 118), ALK - 238 (range 5-131 - this is number my vet said he typically sees in thousands on cushing dog), GGT - 18 (range 1-12) and AST - 28 (range 15-66 looks normal here). Kidneys, glucose and thyroid completely normal.

[goldengirl88]

My Tipper's case was puzzling too as her liver enzymes etc were barely elevated when first diagnosed. There were several Dr.s that commented on her not being the normal cush dog, and not fitting that pattern. Blessings
Patti

[cekehm]

Hi, back again, it's Max's mom. To refresh, max is my 11 year old bearded collie, who was said to have Cushings by a dermatologist we saw for an issue with his eyes. She said this because she noticed skin issues, what she felt was a somewhat distended belly, and thinning hair. She also did bloodwork and urine and said his liver values were up and urine diluted. My vet was not in agreement and wanted to remove the lump and give time after oral prednisone for eye issue. We've done all that now and I got new liver report today. I'm not sure if anyone has knowledge of these numbers but hoping for any of you who are experienced with this to perhaps help me make some decisions on what to do next. My vet said that his liver values improved. He said that he is concerned particularly with one value, the ALT, which a month ago was 151 (normal 12-118) and yesterday was 118. He also spoke of his ALKP which went up slightly (was 238 a month ago and 252 yesterday - normal 5-131). He said we have to consider the 238 and 252 to be essentially the same because each test was run by a different lab. He said that the first value is normal, and the second he typically doesn't concern much about until it's in the thousands. He said that he really doesn't feel Max has cushings (no diabetes, no thyroid issues) but if I want to we could do a dex test (that might not be right but he described bringing max in for bloodwork and a steroid iv, then returning him at noon and eod for more bloodwork) and that would rule it out for sure. Any thoughts? I am looking to know if: anyone knows anything about these liver values and if you agree with what I'm being told, any idea on this test and the cost, and should I go forward with this test or based on findings is it not worth it? His symptoms are that he pants, he does drink moderate water but nothing I really noticed until the cushings symptoms were pointed out to me, and thinning hair. I don't even notice that he goes out to pee any more often than my other dogs. I'm sorry for the long message but wanted to put enough here to see what thoughts might be for next steps?

[Harley PoMMom]

Hi, As you can see I've merged your last post into Max's original thread so all information regarding Max is in one place which makes it easier for us to reflect back on his history.

Cush dogs usually drink gallons and gallons of water and then pee lakes. Their appetite is generally ravinous and they will eat anything. Does Max have any of those symptoms?

The ALT is mildly elevated, are there any abnormalities with the GGT, AST, Bilirubin, or Albumin? When a dog is suspected of liver issues a bile acid test can be performed as this tells how the liver is functioning. Has the vet mentioned doing a bile acid test? If Max were my pup, I believe that would be my next step.

Hugs, Lori

[cekehm]

Thanks! Sorry I didn't know to keep them in the same place! Ok the values you mentioned were all completely normal except the GGTP was a little elevated - 18 (norm 1-12). Its so hard to say about the water and the food. Everyone talks about exactly what you described, and yes he does drink more than he used to but I don't see it at all as excessive, and he is never restless to go outside and he goes the same amount of times per day as my other two so I just can't tell. I have a 3 year old dane mix who will stand at the water forever and drinks WAY more than Max! He is very food motivated, huge beggar, and this might sound really dumb but I'm not sure how to tell a ravenous appetite - he eats what is given to him, and he will beg and eat anything at all including what is in the cat box and the back yard lol but his food is controlled and I had a beagle who was exactly like him. My vet did not mention the test you listed above, but maybe because the values of what you listed were mostly normal? Boy one thing is for sure this is all so confusing! Lost my beagle last year and it was so simple - he lived from age 7-12 on thyroid medicine, ended up with a kidney issue, we did fluids after diagnosed for 6 mos and then he could no longer beat it and the inevitable came. No guessing and no confusion!! I will do anything Max needs I'm just not sure if we're at a place to do testing or to wait a bit to see if this turns into something more obvious. Ugh I could go on and on - my vet says if we do the test and he's positive, he's definitely not the typical cushing dog he sees but not unheard of, but that we could get things under control before it progressed - but then I read here about how dogs go the opposite way on too much medicine so I would worry about that too because it seems that if he's positive he's mild. Ok now I'm just rambling!!!

[Harley PoMMom]

Cushing's is a slow progressing disease, so one does have the time for a confirmed diagnosis. Strong obvious symptoms do play a huge part of the Cushing's diagnosis and since Max does exhibit the clinical signs of Cushing's I would not start any treatment or testing for Cushing's.

Trust me you would notice if Max was ravenous, believe me one can not miss that, they're like little hoover vacuum cleaners looking for any crumbs. :eek:

[Iraklis]

Has the vet mentioned doing a bile acid test? If Max were my pup, I believe that would be my next step.



This


wait a bit to see if this turns into something more obvious!

& this!
Don't hurry...cushings is a very slow progressing disease and treating a wrong diagnosis would be much much worse...(speaking from personal experience)

[cekehm]

Thank you for the info, I guess then from what you are saying it's best to just wait a bit. I would be afraid to treat him even if he tested positive because its so mild I'm not even sure I can recognize for sure. Also, he does have some arthritis issues so from what I read here he's also getting the benefit for that if he is heading into this so for now if he's mostly always comfortable I will wait. He gets his annual stuff in July so we can look at all his values again and maybe see where we are. Thanks again!

[Squirt's Mom]

To help you know what you are looking for that could indicate Cushing's, here is a pretty good list of the common signs from Kate Connick -

The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

[cekehm]

Hi Everyone it's been awhile. I've had some issues with Maxs sister Missy so have had to put off figuring out what to do about getting Max tested. Missy is much better - had to deal with some stomach stuff but she seems controlled on new food and an acid regimen. My vet really felt it was worth testing Max so yesterday he had his low dose dex test. (Think that's what it's called). Very happy to get the call today that his results were completely normal. According to my vet were done and he said no reason to look further. I've gotten very fond of reading about your beloved pets and following your stories and probably will continue to do so. I feel very fortunate to have found this site even though it seems that right now we escaped this dreadful condition. Thank you for all of your advice and wisdom and the best of luck to everyone.

[Harley PoMMom]

Max doesn't have Cushing's!! That is great news and I am so happy for you both!!

You and Max are considered family here so please do keep us updated when you can. ;)

Hugs, Lori

[molly muffin]

That is excellent news!!! Congratulations! Oh yea, no leaving just because Max doesn't have the dreaded C word. :)

Glad that Missy got fixed up and is on a good path now too. :)

Sharlene and molly muffin

[Iraklis]

Excellent news!

[goldengirl88]

Fantastic!!!!!!

[cekehm]

So I felt very fortunate a few months back when we got the results of our Max's low dose dex test and they were completely normal. I grew so fond of this group however, I continue to follow and read all about your wonderful pets and your stories. Just makes me wonder one thing......does the results of this type of test actually rule out cushings? I see so many of you say that some of the diagnosis of this condition comes from the symptoms not necessarily the tests. Max does have some of the symptoms but is it safe with the test above to assume that they are more age related? Of course my vet would never treat him on symptoms alone but I see that some of you are using herbal things on your pets and just wondered if Max is displaying symptoms but tested negative if he could benefit from any of these. All so confusing!

[Squirt's Mom]

MODERATOR NOTE: I have merged your post with questions concerning testing / diagnosis and herbs into Max’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[lulusmom]

There are two reasons why Max's low dose dex test was normal. 1) He doesn't have cushing's or 2) he has early stage cushing's but the feedback loop between the pituitary and adrenal glands is still working. If a dog is overtly symptomatic, a vet will usually wait and retest in another three months. I just reread your thread and back in April you mentioned that you weren't sure if you could tell if a dog had a voracious appetite, that Max drank less water than your Dane and that he was not peeing any more than usual. What symptoms does Max have that are worrying you? How long had it been since Max had prednisone when the last blood chemistry was done?

Glynda

[cekehm]

Hello Everyone, I joined back in 2014 when my boy Max was thought to have cushings. He tested negative then. He was just retested this week and the test is now positive. I would like to get some opinions from you guys who know the most about this disease. I'm trying to make the decision on how to proceed.

Since 2014, we have come into a few more things with Max. He had an abdominal ultrasound in May which showed some tumors on the liver. His liver enzymes were high but function normal. The vet looked at the liver again this week and there has been no change. The enzymes however were significantly higher. The only thing that seems to be potentially related to his liver is some chronic diahrrea. He has been on flagyl off and on for a few mos and the vet just ordered tylosin as a maintenance med. I plan to switch over the next few days.

Max also has been found to have pretty significant proteinuria. Kidney function also normal. He has been taking enalapril but it hasn't helped. He was also determined hypertensive a month ago and started amlodipine. His bp was 210 before starting that and his last bp reading was 130. Not sure if related, but his water consumption went back to near normal after the bp med was added.

He also struggles with some issues with his back legs. We were always chasing arthritis but when the specialist evaluated him her thoughts were that his joints were fine and his back legs had some muscle atrophy.

At this point I'm trying to decide whether to treat the cushings or to treat the symptoms. My vet uses trilostane. I've read that it is not good for the liver. I'm just trying to determine whether there will be significant benefits to treating the cushings vs just continuing to treat his symptoms. At this time, his heavy breathing and water consumption have gone back to normal based on the bp med. Max is a happy dog with a great appetite (which I now know the reason for!) and he doesn't seem to be in any pain or discomfort. If anyone has any advice I'd be thrilled to hear it!

[molly muffin]

If you can get the BP under control, that will help hopefully with the protein loss. We are fighting the same battles, high bp, protein loss, high liver enzymes. I'm treating with trilostane and I find that getting the cortisol lower, is helping the bp and protein loss medications work better. It is a delicate balancing act though and we do ultrasounds about twice a year to make sure that nothing is changing.