Introduction to Smiley, Cushing's (and Sammy, Diabetes)-update Sammy has passed

[frijole]

Fecal samples?! Are you sure they were testing for cushings? My dog has had cushings for 3 yrs and that has how long I have read here and this would be a first. Kim

[Smileyspeople]

Well, I think so. But I'll go back and pull "old bills." Thats pretty much all the documentation we have in the absence of trying to get their full charts.

[Harley PoMMom]

Usually the test used to dx cushings is the LDDS. IMO, I would not start the Trilostane yet, Smiley just doesn't seem to be showing the symptoms and without the proper tests being done, I truly believe yous are doing the right thing holding off using the Trilostane until you find out exactly what is wrong with Smiley.

Usually cushpups have excessive drinking and peeing, accidents in the house, ravenous appetite, pot-belly appearance, weakness in the hind legs, some have hair loss, some become lethargic.

Usually cushpups liver enzyme values are elevated...ALP and ALT, also their cholesterol may be high.

Could you check for any of these tests (LDDS, UC:CR) or values (ALP, ALT) and see if they are elevated, the liver values I think are on the chem.5 test you had done.

Hugs.
Lori

[gpgscott]

Hi Dorothy,

If I was not certain of the diagnosis and the Dr. has not explained clearly to me about the treatment and objectives I also would not commence a treatment.

The test which was done was an ACTH or stim. You can tell that by the use of cortrosyn which is a synthetic agent that stimulates the adrenal glands. You need the results of that test there will be two numbers designated as pre and post. This test alone is not conclusive for Cushing's.

Many of us use an IMS (internal medicine specialist) to diagnose and design the treatment and then go back to our primary care Dr. to administer the treatment. I am placing a link the our resources forum where you can find information about diagnosis and also locate an IMS.

Scott

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Squirt's Mom]

Hi Dorothy and a belated welcome to you and yours!

I have been reading along but this is the first time I have posted to you. When my Squirt was first diagnosed in 3/08, that was the first time I had ever heard the word "Cushing's", and I thought I was gonna die on the spot! The look on my vets face was one of sympathy and compassion, so I knew that wasn't good and I just lost it. I cannot imagine having the prior experience you did with your sister's baby, then hearing that your own had Cushing's.

But I want to tell you something that has been proven over and over again here - each pup is different. They are each biologically, psychologically, and emotionally unique so no two dogs will react the same to treatment. There are medical parameters considered the "norm" but the fact is, each pup has it's own "norm". We have several pups here, in fact, who have apparently read the "rule book" and do everything they can to flaunt it! My point is, there are too many variables in each pup to make comparing one to the other for definitive expectations unrealistic. Smiley is Smiley, and no other is like him - but, of course, you already know that! So, don't fear treatment based on a negative outcome seen in another pup, even litter mates.

Smiley had the following tests:

thyroid prof 2-SA370
Chem.5 (5-6 tests)
Radiograph abdome
Cortisol 2 Samples
Cortrosyn 0.w5/via

Based on the above, Smiley has had his thyroid function checked, a blood chem work up, an abdominal ultrasound, and the ACTH (the last two items). The U/S and ACTH may well tell you if it is Cushing's or not, and which form, if PDH or ADH. If you can get copies of the actual results of the U/S and the ACTH, and post them here, we can help you determine what they say and offer more meaningful insight. Your vet should be glad to give you copies - you did pay for them, after all. Not only will those results help here, it is a good idea to keep a file at home just in case you ever have to see a different vet, like on vacation. That way, you will have all Smiley's info in hand when you walk in the door.

I think you and your hubby are very wise to take a step back and try to figure out some things before starting treatment. Especially since you feel some unease with the way it came about and with your vet. Always trust your gut when it comes to your babies! No one knows them better!

You have done a great job so far! Just take a deep breath and we will look at all the info together, then help you decide how you want to proceed. This is a unique family, too, as you will soon see. We already care a great deal about your Smiley simply because you introduced us. We care about you and Peter, too. We will offer our ideas, suggestions, experiences and hopes, and you take what you can use. No matter what you decide, we will be here and support you all the way. You don't have to take this journey alone. We do understand.

Hang in there!
Hugs,
Leslie and the girls

[gpgscott]

an abdominal ultrasound
Leslie and the girls

Dorothy just a quick note here to comment on Leslie's observations. It is not clear to me that this was an ultrasound and in fact it would be unusual as most general practice Drs. do not have U/S equipment. I take this to be an xray. You need to find out.

Scott

[acushdogsmom]

"Radiograph abdome" = abdominal x-ray (which is not an ultrasound)

"Cortisol 2 Samples" = is most likely in reference to an ACTH stimulation test, which tells you if the dog has low, normal or high cortisol production.

High cortisol production is consistent with a Cushing's diagnosis, but other conditions can cause elevations in cortisol production, so in my opinion, an ACTH stimulation test alone is not enough to confirm Cushing's.

Smiley's diagnosis came as a surprise to us (about a month ago), especially since we felt that we were not given adequate info from our vet who did a rapid series of tests, and jumped (rather confusingly) to a compounded prescription of one of the standard Cushings meds. (I forget which one, but will look it up.) We received no guidelines or follow up calls...

I haven't yet contacted UCDavis as we are reluctant to start a medical treadmill

If you are saying that your Vet says your dog has Cushing's (based, it seems on the results of one ACTH stimulation test) gave you an Rx for trilostane to treat Cushing's and did not book any followup appointments or give you any further instructions regarding the use and need for monitoring (with ACTH stim testing) of the medication ...

please please please do contact UC Davis or a private Specialty Clinic in your area and get your dog seen by an Internal Medicine Specialist, to properly confirm the diagnosis and to properly treat and monitor your dog for te long-term if it really is Cushing's that you are dealing with. I think you may already know that's what you need to do.

I'd also like to let you know that when it is Cushing's, and if it's properly treated and monitored by a Vet who knows how to do it correctly, most dogs will live out a long and happy life on the correct dose of Lysodren or Trilostane. Mine did wonderfully well on Lysodren for more than six years. And we have many others here whose dogs are doing well on trilostane.

When the diagnosis is incorrect, or if the meds are not correctly dosed and monitored, the outcome is not always very good one, however.

[Squirt's Mom]

Scott and Cushy - thanks for catching that! It is indeed an X-ray, not ultrasound.

[Smileyspeople]

Thank you all so much for your insights, expertise, and interest. We (Peter & I) always feel more informed after reading your posts.

I'm going to be gone for a week, but (hopefully) Peter will post to the list in my absence as he's staying with the dogs. He's going to get the actual test materials from our vets so we can most this information to you. If he doesn't get to posting, I'll get to the info when I get back.

Its our plan to make an appointment at UC Davis for Smiley before beginning any treatment. Thanks to all of you for steering us in this direction. We are grateful to you for giving us a starting point to understand the process.

Back soon...Dorothy

[Harley PoMMom]

Please get Peter to post!

We do not bite!