Our Pug Peggy Sue may have Cushing's/ Peggy Sue has passed

[rolfecms]

Hello everyone,

We think our 12 year old pug Peggy Sue may have Cushing’s Syndrome. We were researching online last night and came across information that led us to believe that’s indeed what she has - and then we found this web site so I thought I’d post. We have scheduled an appointment with an internist on Thursday Aug 15 - wish it could be sooner because we don’t want Peggy Sue to suffer any more than she already has due to one misdiagnosis after another.

She exhibits most of the clinical signs of this disorder -

• Very thirsty; drinks lots of water
• Lots of urination (she uses her litter pan frequently)
• Ravenous all the time - she stands by her dish and barks endlessly or scratches at the door where her food is kept
• Pants very easily and often
• Has developed an abnormal pot belly
• Has gained weight which has made it somewhat difficult for her to walk very far
• Is somewhat lethargic

Peggy Sue’s health issues started back in October of 2015. She was having some trouble with her hind legs so the doctor prescribed Meloxicam for arthritis.

Then she began panting without apparent reason. One evening she became very restless when her panting would not stop, so my wife rushed her to the emergency room.

With simple observation she was diagnosed with arthritis of the spine and was given a steroid shot and prescribed Gabapentin. Soon after we took her to her regular doctor who advised us of possible courses of action and to continue the existing treatments until we returned from vacation in mid May.

In late May her regular doctor performed some tests and took x rays. He diagnosed tracheal collapse and eliminated the Meloxicam because 1) he didn’t feel she needed it and 2) her liver numbers were higher than normal. He advised us to feed her less and to begin a daily SAMe supplement for her liver toxins.

In June we had an appointment with a surgeon to discuss her issues and the course of action. Upon observing Peggy Sue the doctor ruled out trachea collapse. To resolve her panting he recommended a bronchoscopy with possible laryngeal sacculectomy, procedures that could cost $5K+.

Peggy Sue seemed to be doing better so we thought we’d take a wait and see approach while continuing the Gabapentin. Then we decided to slowly wean her off that medication - which we did without adverse effects, but of course we are still faced with her symptoms.

This past weekend we discussed getting another opinion with a friend who had experience with her pets’ health issues. Her comments caused us to do our own research which quickly led us to Cushing’s. We wish we’d done this work months ago, but better late than never.

We’ll update you once we’ve met with the internist. Thanks for this forum and any advice you’d like to share with us.

[DoxieMama]

Hi, welcome to you and Peggy Sue! I'm so glad you've found us. Cushing's is difficult to diagnose, one in which all the other possibilities must be ruled out first, but what a runaround you've had!

Do you happen to have copies of any of the tests done on Peggy Sue? If you do and could list those values which are abnormal, along with their reference ranges, that will be helpful.

I'm glad you'll be seeing an IMS, and hope they will be able to provide an accurate diagnosis for what's going on with her!

Shana

[Squirt's Mom]

Hi and welcome to you and Peggy Sue!

I love the name! I, too, have a Pug and her is named Sophie. They are such sweet and funny little dogs, aren't they? Sophie is the nurse and comic relief in our house. Any time someone is not feeling well, Soph is there to give kisses and keep a close eye on things. And out of the blue she does the goofiest things! When a stranger approaches, she takes that bully dog stance and acts like a big ole baddy but the second it looks like they might pet her, she starts wiggling so hard her skin can't keep up. She's never met a stranger!

You have done a great job of trying to find out what is going on with your sweet girl and just may be on the right track finally. As Shana said, Cushing's is hard to diagnose, a process of ruling out as much as anything...and you already have a bit of that done! And you have made a wise move in choosing to see an IMS. The tests that are most often used to diagnose this condition are the LDDS, ACTH, and abdominal ultrasound. There are few others but these are the ones most vets choose...not all three are always done but you now have the names of the tests they may want to do so they won't sound like more Greek. If an abdominal ultrasound is chosen, make sure they use a high resolution machine if at all possible.

Now is the time to start making a habit of asking for copies of the actual test results - not invoice but test result numbers. It is a good idea to start a file to keep at home. For one it can come in very handy should Peggy Sue ever need to see a different vet and for another it will help you answer our many, many questions. For folks who don't know us, we can seem like a nosy bunch!

I'm glad you found us and look forward to learning more as time passes. I want you to know a couple of things right now - Cushing's is not a death sentence. With the correct diagnosis and proper treatment our babies can, and often do, live out their normal lifespan...and beyond. And you, your wife, and your precious girl now have a new family here at K9C - we will be with you every step of the way; you are never alone.

Hugs,
Leslie and the gang

[rolfecms]

Hi, welcome to you and Peggy Sue! I'm so glad you've found us. Cushing's is difficult to diagnose, one in which all the other possibilities must be ruled out first, but what a runaround you've had!

Do you happen to have copies of any of the tests done on Peggy Sue? If you do and could list those values which are abnormal, along with their reference ranges, that will be helpful.

I'm glad you'll be seeing an IMS, and hope they will be able to provide an accurate diagnosis for what's going on with her!

Shana

Hi Shana, thank you for the welcome! We will request her test results; thank you for suggesting that. We already made sure that her records are provided to the internist before our appointment. And I will request that any test results be provided (via email if possible).

I'll share the info as we receive it.

Clarence

[rolfecms]

Leslie,

Thank you for your very warm welcome - it's so comforting to know there are others who've been down this path with their dogs and care about those who follow!

Peggy Sue is a sweet, intelligent pug and one of two female pugs in our family (Maggie Mae is her younger cousin). Peggy Sue is very aware of her surroundings so it has made us very sad to see her overtaken by this health issue - she is so preoccupied with eating/drinking and seemingly continuous panting that there is so little time left for her to enjoy life or to be the sweet companion she once was. And her pot belly contributes both to her unsteady gait and eponymous pig appearance.

We're also frustrated that it's taken so long to get to this point - and that she's lost nearly a year of her precious life to this chronic but apparently treatable condition.

It's such a verity that you are own best advocate and no one can know or care about your pet friends better than you yourself. Asking questions of your vet are simply not enough - people need to do their own research so they'll be able to obtain the optimal course of treatment for their sick companions. Having the resources of this forum are invaluable.

Thank you for identifying the tests normally used to diagnose Cushing's (LDDS, ACTH and abdominal ultrasound) and obtaining the test results afterward. We'll share all our findings with this forum. We also appreciate that your concerns about knowing and sharing transcend any semblance of nosiness.

We'll see what the internist recommends, but given all her symptoms listed above (it seems she could be a poster child), would one of these standard tests be better than the others? We want to do all we can to positively diagnose and treat this malady but we also don't want redundant tests performed that will simply add unnecessarily to the cost.

Clarence

[Renee]

Welcome to another pug family. I have three pugs myself (and run a pug rescue). My girl, Tobey, has had cushings since 2013. We started treatment in December 2013. It's been a bit up and down, since she battles CC, but she carries on like the fighter she is!

Don't beat yourself up too much about how long it's taken to get to this point. Cushings is a very slow moving disease and most pets have it for months, even years, before diagnosis. I believe my Tobey had it going on a solid year + before we figured it all out. And even then, it took 6 weeks before we began treatment.

An IMS is an excellent start to this process, but even so, make sure you read as much (reliable) information about cushings as you can, so you are prepared at the first visit.

The 'gold standard' test for cushings is the LDDS. There are instances where it is not the correct diagnostic tool (such as when your dog has concurrent diabetes), but for the most part, you should plan on running the LDDS. When I was going through diagnostics, we chose to run the ACTH, LDDS, and eventually a CT scan. Also, plan on a comprehensive blood panel. You'll want to rule out diabetes and thyroid issues, as those can mimic cushings symptoms quite a bit.

I think you are on the right track!

[Squirt's Mom]

I wanted to be absolutely sure of what we were dealing with so I had every test available run - LDDS, HDDS, ACTH, abdominal ultrasound, and UTK panel (this test checks for intermediate hormones that can cause the same signs as elevated cortisol). I've been called a bit anal. My Squirt was a bit of an oddball - like her mom! The US showed a tumor on her spleen and once that tumor and half her spleen were removed, her cortisol returned to normal. The tumor had caused false-positives on all the testing for cortisol. However, her intermediates remained elevated meaning she had a form referred to as Atypical - normal cortisol, elevated intermediate, or sex, hormones. In time she became true Cushingoid with elevated cortisol - most Atypical pups do follow that path.

The HDDS is rarely used any more - it was used to help differentiate between the pituitary form (PDH) and the adrenal form (ADH) but the LDDS can now make that distinction. The US can also help with that determination. In PDH we typically see both adrenal glands enlarged and in ADH we usually see one very large while the other is much smaller or even atrophied.

Today, if I had to choose, I would use the ACTH and the ultrasound if funds were limited. While the LDDS *is* the gold standard for Cushing's testing, it is also notorious for false-positives if there is a non-adrenal condition present, like our spleen tumor. Because of our experience with the tumor, I always recommend the ultrasound. Others will have different recommendations based on their experiences.

[rolfecms]

Thanks for sharing Squirt’s medical history. From the size of Peggy Sue’s belly it makes eminent sense for an ultrasound together with the ACTH test. We of course want to avoid any false positives that an LDDS test alone might give. With this important knowledge in mind we’ll see what the internist recommends.

[rolfecms]

Welcome to another pug family. I have three pugs myself (and run a pug rescue). My girl, Tobey, has had cushings since 2013. We started treatment in December 2013. It's been a bit up and down, since she battles CC, but she carries on like the fighter she is!

Don't beat yourself up too much about how long it's taken to get to this point. Cushings is a very slow moving disease and most pets have it for months, even years, before diagnosis. I believe my Tobey had it going on a solid year + before we figured it all out. And even then, it took 6 weeks before we began treatment.

An IMS is an excellent start to this process, but even so, make sure you read as much (reliable) information about cushings as you can, so you are prepared at the first visit.

The 'gold standard' test for cushings is the LDDS. There are instances where it is not the correct diagnostic tool (such as when your dog has concurrent diabetes), but for the most part, you should plan on running the LDDS. When I was going through diagnostics, we chose to run the ACTH, LDDS, and eventually a CT scan. Also, plan on a comprehensive blood panel. You'll want to rule out diabetes and thyroid issues, as those can mimic cushings symptoms quite a bit.

I think you are on the right track!

Thanks for your comments, Renee. They give consolation for us to know that we've been able to get to this point as soon as we have - and before we put Peggy Sue through unnecessary and expensive treatments.

We'll make sure we read as much as we can before Peggy Sue's Thursday appointment.

[rolfecms]

Peggy Sue had her appointment today; the link to the exam summary is below.

The doctor performed the ACTH and took blood. Depending on the results (due Monday), we will return for an LDDS and ultrasound. Liver disease is also a possibility because her blood test from 5/31/16 showed the ALT liver enzymes (659) greater than the ALP's (367). The doctor said he would expect these numbers to be reversed for Cushing's.

Let's hope and pray for the best.

Peggy Sue Exam Summary with Historical Blood Test Results