Lulu 11 y.o. Pom has gone over the Rainbow Bridge to meet Jojo
Now that I have a few minutes to myself, I thought I’d take the time to start a new thread and introduce my two cushdogs to those of you that may not know them. I was fortunate enough to have found a complete cached version of Lulu and Jojo’s thread right after caninecushings.net was taken offline. It doesn’t seem possible that I became part of the family over two years ago. Lest I ever forget how phenomenal the members were that welcomed me, supported me, educated me and adopted me and my two furbabies as part of the family, I only have to go as far as my hard drive. If I think about the early days too much, I get teary eyed and I downright sob if I actually go back and reread all of the wonderful posts. Here’s my very first post and a few others that will give you a good idea of who Lulu and Jojo are.
Jojo was such a mess and had every symptom in the book so I thought I'd include all of his test results.LulusMom
09-19-2007, 11:43 PM
Hello All. I'm brand new to the forum and wanted to take a few minutes to say high and tell you all that I can relate. I have a six year old Pom that was diagnosed with Cushings three years ago. It took a good year and half and three vets to diagnose her. By that time, she had already been diagnosed with Hypothyroidism and had had two surgeries for bladder stones, was sucking up water like a Hoover, peeing like a racehorse, panting like a freight train and eating like a 400 lb Sumo Wrestler. Bad hair days, or lack thereof, was an every day thing. That was an awful lot of stuff going on for a tiny little girl and it eventually broke my bank but it never broke her spirit. The doctor gave me the details on Lysodren which scared the heck out of me but it was the drug of choice so we moved forward with the loading phase. Lulu got through it just fine and after testing went onto her maintenance dose twice a week. Because Lulu is barely 5 lbs, I got her Lysodren through a compounding pharmacy. It was that pharmacy that recommended that I talk to my vet about switching Lulu to Trilostane which has less side affects than Lysodren. I brought it up with my vet and he agreed. Lulu has been on Trilostane for almost a year now and is doing great. Because Cushings is normally an older dog disease, Lulu was a stumper for two out of the three vets because of her young age. Lulu will never get her gorgeous coat back but she's the most adorable Pom in the world with her cute little buzz cut. My husband and I are fostering our first rescue baby, an 8 or 9 year old Pom mix. Now what are the chances that our first foster would be diagnosed with Cushings? Well he was and since we fell in love with him immediately, we are paying the medical bills for his meds and testing. I could not imagine his rescue group footing the bills when so many other babies need to be rescued. His name is JoJo and he is on his fifth day of Lysodren and doing fine so far. JoJo was a train wreck when we got him. He had Kennel Cough, horrible, horrible conjunctivitus, both ears infected, was newly neutered and had dental with numerous extractions. On top of that he was drinking water like crazy and peeing everywhere. I go through piddle pads like crazy. He's been through such an absolutely horrible time and we hope to get him stabilized and shower him with love for the rest of his life. When you already have three dogs and four cats; love animals as much as we do; fall in love with fosters in a matter of days, perhaps we should reconsider fostering. ;-) I should have thought of that before I picked up that adorable kitten and Italian Greyhound last night. Oh well, they say it's cheaper by the dozen. We can only hope so. Night all.
A lot has happened since then but I am happy to say that both kids are well controlled and have had consistently great stim tests for the last nine months. Jojo’s last stim test was three months ago and his results were pre 3.0 and post 3.4. Jojo’s pu/pd never resolved with either Lysodren or Trilostane. We tried the DDAVP (desmopressin) eye drops twice, hoping that we could finally diagnose him with central diabetes insipidus but the drops did nothing. We keep plenty of water down at all times as well as hospital water proof pads. Since becoming a member Lulu has had emergency dental surgery, dislocated her hip requiring surgery and has had at least two scarey but relatively short seizures. I’m hoping that she stays seizure free for the rest of her life. She lost what little coat she had gained with the Lysodren treatment while on Trilostane treatment. She’s been back on Lysodren for, I believe a year now, and still no sign that she’s going to grow feathers again. Lulu has PDH with elevation of “all” adrenal steroids/hormones. Her last stim test was the day after Christmas and her results were pre 2.1 and post 2.8. YAY!!! She also had her little tiny teeth cleaned a week ago and came home like nothing ever happened. Everybody at the vet’s office loves her and she very rarely spends any time in a cage when she’s there. She barks and they jump. A vet tech told me the last time we were there that she had one of the surgeons wrapped around her finger. It seems that every time he passed her cage, she’d bark and spin around until he picked her up. The tech said he couldn’t stand it and had to pick her up. Glad to see that I’m not the only one that has made her into the monster she is today.LulusMom
09-21-2007, 11:41 AM
Hello Again.
Just wanted to update you on Jojo and give you his diagnostic info as promised. He was tested and diagnosed on 8/21. As I mentioned, Jojo was rescued from our local shelter. He was cowering in the corner of the kennel, shaking like a leaf. It's so loud and horrible and most of these little guys are just terrified. His coat was matted so badly that he had to have been in terrible pain. They shaved him down and obviously, their groomer is not a cosmetologist...if you know what I mean. But at least he got some relief. One of our local "little" dog rescues saved him and immediately took him to a teaching veterinarian hospital. They neutered him, extracted some teeth and cleaned the rest. That was on 8/2. Pre-exam notes: Increased Water Consumption and Urination Frequency. I don't know what some of these tests are but here are the ones that did not come back normal on his initial exam.
ALKP = 261.00 (normal range 23-212) Suspect Endocrine vs Metabolic disorder
ALT = 220 (normal range 10-100) Suspect Endocrine vs Metabolic disorder
WBC = 28.6 (normal range 6-17) Chronic inflammation could be a source of either otitis externa vs severe dental disease
Segs, Neutrophil,% = 79.00 (normal range 60-77) Chronic inflammation from otitis externa vs severe dental disease
Eosinophil,% = 1.00 (normal range 2-10) Absolute elevated at .286 culd be indicative of Atopy or another alergic reaction
Urine Bacteria = Positive Small clusters of cocci bacteria seen on microscopic exam.
Radiographs: VD and Lat Abdominal Radiographs obtained. On the lateral view, the liver extends beyond the last rip with rounded borders. The urinary bladder is enlarged and full of urine taking up most of the abdominal cavity. It is difficult to appreciate the kidneys as the contrast is insufficient. On the VD view, the boarders of the liver are difficult to evaluate. The spleen appears to have sharp boarders. The bladder is occupying the majority of the abdominal cavity. Th small intestines are distended with gas and fluid. The stomach is full of fluid.
Diagnosis: Hepatomegaly could be caused by Cushings disease or other Metabolic or endocrine disorder.
On 8/8, Jojo was taken back to the hospital with Kennel Cough. Abnormality in water consumption and urination noted. Overall condition on that date were:
1. Coat & Skin = Alopecia Dorsal Lumbar & Thoracic Midline, Left Dorsal Thoracic, left Ventral Thoracic, Right Dorsal Lumbar and Ventral Abdominal Midline
2. Ocular = Conjunctiva/3rd Eyelid infected inflammation Right and Left Ears
3. Otic = Brown Exudate, right and left ear
4. Oral/Nasal = Undershot Jaw - Nasal discharge found
5. Abdominal - Distended bladder found
Radiograph results were abnormal. On the VD view the cardiac silhouette appeared larger than normal. The lung patters shows calcified bronchioles. On the lateral view, the VHS 11.7 which is larger than the previous measurement 8/2 at 10.1. Lund patterns consistent with age as bronchial calcification. No evidence of pulmonary edema or pleural effusion present. Vessels appear wnl on lateral view. The trachea appears wnl with no evidence of collapse. Diagnosis - Cardiac Enlargement
Test results that were abnormal are:
WBC = 27.3 (normal range6 - 17) Chronic inflammation. R/O secondary to previous dental disease/cleaning vs. other
MCHC = 33.80 (normal range 34-38) Not of concern - no indication of anemia
Segs, Neutrophil, % = 84.000 (normal 60-77) Chronic inflammation
Lymphocyte, % = 5.000 (normal 12-30) Absolute 1365 wnl
Easinophil, % = 5.000 (normal 2-10) Absolute elevated at 1365. R/O allergic reaction vs other
Interpretation of Ultrasound: Cardiac US: Thickened anterior leaflet of the mitral valve. Mitral regurgitation confirmed with pulse wave dopler. All other me
ABD: Enormous bladder. Prostatic urethra dilated. Mild dilation of renal pelvi. Otherwise wnl. Unable to examine adrenals, kidneys, LN and liver due to patient behavior (another way of saying the Jojo's an enormous puss).
Assessment - tentative diagnosis is Alopecia, Endocrine; Conjunctivitis; Sinusitis; Alopecia, Endocrine; Canine Castration; Metabolic Disorder; Otitis Externa; Periodontal Disease Grade 3.
Exam Note: Presented with excessive productive cough. Multiple areas of alopecia worsening since last visit; Clear nasal discharge found on nares. PU/PD R/O Cushings vs. Hypothyroidism; Conjunctivitis R/O infectious vs sinusitis vs other; Cough R/O collapsing trachea vs secondary to cardiac disease vs infectious (Bordetella) vs inflammatory (secondary to intubation on 8/3) vs other.
And now the exam that we were waiting for done on 8/20
Urine Specific Gravity = 1.006 (normal range 1.016-1.08)
Cortisol, Baseline = 7.8 (normal range 1-6)
Cortisol, 4 hr post Hi Dexm = 3.000 (normal range (0.1-0.9) 50% below baseline therefore suppressed which is consistent with PDH
Cortisol, 8 hr post Hi Dexm = 2.8 (normal range 1.499-1.5) PDH confirmed
Prescribed Ketoconazole 200mg tablets which was declined by owner. Vet discussed with owner that Trilostane is not FDA approved and recommended treatment with anipryl or ketoconazole.
You all know Jojo's recent medical history better than anyone else. There's a bit more to the story about how we ended up on Lysodren but will have to finish later. JoJo tried to bury his food this morning instead of diving in head first like he usually does. I need to get him in for testing today so gotta run for now. Hopefully, we are on our way to maintenance. Keep your fingers crossed.
I’ll try to keep ya’ll updated on Jojo and Lulu and I’m hoping that it may be a good long time before I have anything to report. I am finally getting comfortable with letting them go six or nine months before their next stims so unless something happens in the meantime, my bank account gets a break.
Glynda, mom to cushdogs, Lulu and Jojo; noncushdogs, Jasper and Buster; kitties, Mimi, Moki, Maggie & Izzy; and forever mom to foster babies at the bridge, Otis, Mabel (cushdog) and Baquita.
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Perhaps Jojo has decided to at least pretend to play by the rules. 
That is just great news all around regardless!
I didn't get the sense that they've treated many cushdogs so I came straight home, called our trusty IMS at VCA and we have an appointment tomorrow at noon for stim tests. Nice try but no banana.
