Mypuppy:Princess (10 yr. old Lab on Trilostane) - has crossed the rainbow bridge

[StarDeb55]

I would also like to welcome you! You have already been given good information, so I will not repeat it. What I will tell you is that my 1st Cushpup, Barkley, was successfully treated with lysodren for almost 8 years, crossing the bridge at 15. Your pup is not too old to treat, & with treatment can live a happy, healthy life reaching his expected lifespan.

Debbie

[mypuppy]

Lori, first hand, thank you for such reassurance that there is some hope for my pup, Princess by the way. And my name is Jeanette. Princess is a chocolate lab, and she has simply been a wonderful, most well-behaved dog since we brought her home at 3 months old. I am a stay at home mom and while I send of the kids and hubby off to school and work, my four legged baby and I have kept each other company for almost 7 years now, and it's the best feeling in the world to have that companionship day in and day out, through daily chores, etc. She is my shadow. This is why the abrupt diagnosis just broke my heart thinking, this is the end for her. I have been doing nothing but breaking down in tears and visualizing my life without her--it's unbearable! I'm usually not one to be so pessimistic, but with the information or mis-information I have received, I can't but help myself feeling this down in the dumps...After joining this forum, I'm happy to say I'm starting to feel a bit different.

Now getting to your some of your questions. We first started with a CBC and urinalysis: These were the out of range results:
ALT (SGPT) - 225 (high)
AMYLASE - 388 (low)
T4 - 0.5 (low)
HGB - 18.6 (high)
NEUTROPHIL SEG - 80 (high)
LYMPHOCYTES - 10 (low)
EOSINOPHIL - 0 (low)
ABSOLUTE LYMPHOCYTE - 830 (low)
ABSOLUTE EOSINOPHIL - 0 - (low)
UA - 1.0045G prior to water deprivation test
UA - concentrated to 1.035 after water deprivation test.

Her regular vet performed water deprivation test to rule out DI (diabetes insipidus). He basically left the finaly diagnosis as psychogenic polydipsia (behavioral???). He never even suggested further testing for Cushings or even hypothyroidism and basically concluded his final diagnosis as psychogenic polydipsia (behavioral??) I asked him for copies of all medical records and labs and referred myself to an internal medicine vet at a veterinary hospital an hour away from home. I scheduled her in immediately, gave the specialist copies of all her tests, she performed an abdominal ultrasound to view her adrenals, kidneys, spleen, etc, and the ultrasound came back normal. At that point the specialist recommended to have her tested for Cushing's/Addison's with the ACTH stimulation test, which came back positive for pituitary Cushings. She also had a Free T-4 to rule out hypothyroidism, but still awaiting results on that test. Her symptoms are excessive thirst, urination, panting, excessive appetite, looking for cool place to lay. She is not on any meds or supplements at the present time and is not suffering from any other illness as far as I know...This is where we are at this point. I am scheduled to follow up on Monday with the specialist regarding treatment with trilostane, but I have a million questions before committing. Again, thank you and everyone on this forum for reaching out to me so kindly...It means the world to know there are so many of you out there willing to share your experiences, knowledge with others. I truly appreciate everyone's generosity here. Will update tomorrow after talk with specialist....

[acushdogsmom]

Jeanette - I just want to say that I am sooo glad that you found us!

Cushing's is not a death sentence! Really, it isn't. I may have already said this, but you need to know that my dog lived for more than 6 years in the care of a Specialist after being diagnosed with Cushing's. And once we got the treatment well underway, all of his symptoms disappeared and he seemed to get younger right before our very eyes. He was a Bichon Frise and he died suddenly (nothing to do with the Cushing's) when he was 16+ yrs old.

Our Internal Med Specialist once told me that if she had to choose a disease for her own dog to have, she'd choose Cushing's, because it really is treatable and the dog can live out a perfectly normal lifespan for the breed with proper treatment and monitoring.

Again, I'm gonna guess that it's the Specialist who thinks that you should treat Princess (and the GP Vet who wasn't exactly optimistic) - and if that's the case, I think you've already got a great start, getting Princess into the care of the Specialist. Since the Specialist is an hour away, maybe she can refer you to a regular GP Vet near where you live with whom she works well - someone who will have confidence in her treatment plan for Princess and who can be available to you if you ever need a Vet close to where you live.

[mypuppy]

Dear Leslie and the girls, I'm Jeanette and mypuppy is Princess. Thank you for all the information you provided, but most importantly, the comforting words which have just encouraged me to face this battle with a whole new different and positive outlook and realizing it is not as final as I visualized due to the lack of info. and due to the lack of support from regular vet who discouraged me from seeking treatment. The internal medicine specialist suggested treatment with trilostane. Princess is weighing about 70 lbs righ now. A 15 lb. drop from a year ago. Waiting on Free T4 results to r/o hypothyroidism. She is not currently on any meds or supplements. The internal medicine specialist prompted testing for Cushings. Had it not been for my gutt feeling to further evaluate, I may have never known about Cushings and may have just accepted the regular vet's final diagnosis of psychogenic polydipsia. Still can't believe we may have total missed it. I did post the initial test results on a previous thread to another post. I hope you can look through and read it and give me your thoughts. I am awaiting copies of the ACTH results which confirmed Cushings. Will post soonest I receive from vet. In the meantime, a world of thanks once again for your kind support. thank you.

[StarDeb55]

Jeanette, with the information you have posted today showing us Princess' results, some red flags have been raised for me. First of all, weight loss is not common with cushpup, just the opposite is the normal, weight gain due to the pup's voracious appetite. Weight loss is more common with diabetes mellitus, (regular diabetes), was diabetes ruled out?

Next, the general lab results show only a single abnormal liver function which is the SGPT. Most cushpups have multiple liver function tests that are elevated including the alk phos, ALT, AST, & cholesterol. In fact, an elevated alk phos is usually one of the primary things that will tip a vet off to look for Cushing's. Just to let you know, I'm a medical lab tech with 29+ years experience, so I'm very used to looking at these kinds of results. If you have only done an ACTH, along with the normal abdominal ultrasound, this concerns me, also. It is possible that a Cushpup's adrenal glands may be normal on an ultrasound, but more commonly the glands are either bilaterally enlarged, one gland may be enlarged with the other one of normal size or possible shrunken. Also, an ACTH does not differentiate between pituitary or adrenal forms of the disease, the ultrasound should have done this. Differentiating the types can be very important because surgery for an adrenal tumor may offer a permanent cure, & with Princess' age, if I were in your shoes, I would jump at surgery in a minute, if my pup were a good candidate. Also, trilostane is not the ideal drug to treat an adrenal tumor.

I'm not a vet, but after having had 2 pups with Cushing's, along with everything I have learned from the other members of this forum, I'm just concerned about Princess' diagnosis being accurate. These are just my thoughts & I hope they help you to formulate some questions for your treating vet. Cushing's is a slowly progressing disease, so you have plenty of time to make 100% sure you have an accurate diagnosis before you begin treatment. The accuracy of the diagnosis is critical as administering either trilostane or lysodren to a non-cushpup can make them seriously ill, & in the extreme, possibly life-threatening.

Debbie

[Harley PoMMom]

Hi Jeanette and Princess,

I know exactly how you felt when you heard those words " Your pup has cushings." I was terrified, in shock, crying my eyes out, didn't know what to do and then it hit me and I thought what the heck is cushings?

Thank God I found this forum, Jeanette, these people on this forum are so knowledgeable about this cushings disease, they helped my boy Harley and me tremendously and I know they will do the same for you.

One thing I am doing is reading all I can about this dratted disease, we have a wonderful Resource Thread Section where you can get alot of information.

http://www.k9cushings.com/forum/foru...aysprune=&f=10

She also had a Free T-4 to rule out hypothyroidism

That's a good thing to do.

Her symptoms are excessive thirst, urination, panting, excessive appetite, looking for cool place to lay.

These are symptoms of cushings but with a low T4 one just doesn't know, non-adrenal illnesses can skew ACTH and LDDS tests.

Cushings can not be diagnosed with just one test and a ACTH test can't tell if it is pituitary or adrenal cushings. When my Harley was first showing signs in Feb. 2009...well since then he's had a LDDS test, 2 ultrasounds, 2 endogenous tests, UTK full adrenal panel, 2 CBC and 2 Chemistry blood work panels, ACTH stim test, and he has pretty much all the symptoms of a cush pup. Did I go overboard with the testing...no I don't think so, I wanted to make absolutely, positively, without a shadow of a doubt that my boy was diagnosed properly.

Harley has an IMS that is 2 hours away, so we only see her for his ultrasounds which are every 6 months, Harley's regular GP confers with the IMS and with Dr. Oliver, whose specialty area is endocrinology. It is very important to find a GP and/or IMS that you can be a team player with, someone that you feel confident in and it would be exceptional if you could find someone that is cushings savy. But alas...the best of luck with that. That is why we read and learn as much as we can.

So if there are any questions you have, ask away and we will try to answer them for you, just remember you are not alone on this journey we are here for you and Princess.

Hugs.
Lori

[mypuppy]

Dear Debbie, Wow! Thanks for all your concerns. Of course, it just plants a seed in my mind to question whether Princess was diagnosed correctly with Cushings. I am due to speak to her specialist today, and of course, will certainly bring up all your important points. In the meantime, I just got back from her regular vet with copies of the last lab results (ACTH stim test, Free T4 and TSH) which of course, until I speak to the specialist can't make any sense of what I'm looking for. If you have time, would you mind reading these results and give me your input. Here they are:

PRE-ACTH CORTISOL - 16.6
POST-ACTH CORTISOL - 50.0
FREE T4-ed (ng/dl) - 1.2
FREE T4-ed (pmol/L) 15.4
cTSH 0.45 (high)

Comments: Increased canine TSH values may occur in dogs with untreated primary hypothyroidism. Sick euthyroid dogs are expected to have low normal TSH concentrations. Secondary or tertiary hypothyroidism (pituitary or hypothalamic lesions) are reported to occur in less than 5% of hypothyroid dogs.
-------------------------------------------------------------------
What does all this mean in ENGLISH??? I am quite confused. Again, I appreciate any comments at your leisure. In addition, would you mind explaining which test determines the type of Cushings? Not sure now if it is provided in the above test results??? I would consider surgery in a heartbeat if it were the adrenal based Cushings, but again, not sure at this point. As for treatment, you mean to say that trilostane is used only to treat pituitary Cushings and not adrenal? And lysodren is used for adrenal Cushings? Lots of questions for specialist today....Thanks you so much for reaching out to me and for the valuable information you have provided..Regards. J.

[StarDeb55]

Jeanette, I'm at work, so I don't have much time. I will respond more in detail when I get home this afternoon. I need the normal ranges for the thyroid testing, & the reporting units for the ACTH, without those 2 items, it's a little hard to give detailed input.

Debbie

[mypuppy]

Debbie, I appreciate your reply from work, and of course no pressure on this end. here are the reference ranges for the tests:

Pre-ACTH (resting) cortisol: 2 - 6
Post - ACTH cortisol: 6 - 18
Equivocal post -ACTH cortisol: 18- 22
Post - ACTH cortisol consistent with hyperadrenocorticism: >22
Post - ACTH cortisol consistent with hypoadrenocorticism: <2
Desired pre- and post - ACTH cortisol on lysodren therapy: 1 - 5

------------------------------------------------------------------------
THYROID PANEL #6 - FREE T4 (EQUIL. DIALYSIS)

FREE T4-ed (ng/dL): Result: 1.2 Reference Range: 0.7 - 3.7 ng/dL
FREE T4-ed (pmol/L):Result: 15.4 Reference Range: 9.0 - 47.4 pmol/L
-------------------------------------------------------------------------
THYROID PANEL #6 - cTSH

cTSH: Result: 0.45 - Reference Range: 0.05 - 0.42 ng/mL - Flag: H

Let me know if you need anything further, but that's basically all of it from her last tests. Thanks again. Jeanette...

[Squirt's Mom]

Hi Jeanette,

In looking at the results you have posted, I am a bit concerned about the Cushing's diagnosis right now. I am always nervous when a diagnosis has been made based on one test. Cushing's is complex and often difficult to confirm even with several tests. The ultrasound didn't show any of the adrenal changes which are typical and the chem results just don't indicate the usual liver involvement we see with our cush babies but each of those precious souls is different and we have seen some really strange things!

There is one more test I would recommend, the full adrenal panel from UTK (Uni. of Tenn. in Knoxville). This tests looks at the other hormones involved in Cushing's besides cortisol. Those hormones are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone and they cause the same signs as conventional Cushing's. Since you are considering Trilostane, and Trilo always elevates one or more of these hormones, I strongly suggest you have this done before starting Princess on the med. Once you start it, the med will skew the test so you would need to do a wash-out (no meds) to get a clean picture of these hormone levels. Here are some links on this form of Cushing's called Atypical Cushing's:

Atypical Cushing’s*
(Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone – an elevation in one, all, or any combination of these hormones, without elevated cortisol.)

http://veterinarynews.dvm360.com/dvm...date=&pageID=1

Beware of false positives, negatives in canine hyperadrenocorticism testing
http://www.vetcontact.com/en/art.php?a=132&t

UT Panel
Explanation of hormones
http://www.vet.utk.edu/diagnostic/en.../treatment.php

Cost sheet
http://www.vet.utk.edu/diagnostic/en...logy/index.php

Dr O’s credentials
http://www.vet.utk.edu/faculty/oliver

The full adrenal panel will also check the cortisol again. It is done just like the ACTH; your vet will make the blood draws then send the sample directly to UTK. Don't be surprised if your vet is not familiar with this type of Cushing's, many aren't yet.

My advise to you right now is to take your time before starting Princess on any treatment. Do your best to make sure there is nothing else going on that could make the cortisol levels rise as a normal response to physiological stress. My Sweet Bebe is one that falls into that group - a splenic tumor caused her cortisol to rise and caused all her tests (LDDS, HDDS, ACTH, ultrasound) to support a diagnosis of pituitary based Cushing's (PDH). But once the tumor was out, the cortisol returned to normal and her docs now say the original diagnosis of PDH is "highly questionable". I did have the UTK panel run as well, thankfully, as Squirt is Atypical. So, don't rush into treatment. I didn't, even tho I was urged to, and I am so glad I took the time to try to make sure all the bases were covered first.

Keep your chin up! You are doing a wonderful job! Princess is lucky to have been found by you and to be in such loving hands.

Hugs,
Leslie and the girls