Hello everyone,
Daisy Mae "monster" is a 9 yr. old, 14 lb, miniature, smooth, black and tan Dachshund.
I've suspected that Daisy may have Cushing's for almost a year now since she never fully recovered from a severe reaction to Blue Buffalo Wellness dry dog food 2 years ago, but her vet insisted that it was IBD because she had chronic diahrrea. We have since changed vets to Dr. Toby Kimm of Ragged Mountain in Plainville, CT.
Aside from the diarhhea, she has a markedly increased appetite. I've had to add water to her Royal Canin Dachshund formula to make her eat slower and avoid choking. Now she's drinking a lot of water, recovering well from her first ever bacterial skin infection, and at times seems indifferent toward me. She had luxating patella surgery in 2005 and has arthritis in that rear leg now which responds well to glucosamine chondroitin MMS? (I think those are beneficial omega 3 fatty acids.)
She's just begun 20mg, once a day of Trilostane and the vet suggests that we do some imaging because she's starting to get the pot belly.
Here are the results of her LDDS test and followed by what the vet had to say in response to my email asking for clarification.
CORTISOL SERIAL 3 (OEX)
Time 1 Pre
Time 2 Post
Time 3 Post
Cortisol Sample 1 8.8
ResuIt verified .
Cortisol Sample 2 Dex - 3.7
Result verified .
Cortisol Sample 3 Dex
Result verified . 4.5
Low-dose dexamethasone suppression test: Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.
If the 8hr post dex. cortisol level is greater than 1.4 ug/dl, the following can be used to difierentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor : 1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH .
2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.
(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)
If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.
NOTE: Approx. 5% of dogs with PDH have normal results. False positives
Vets Response to my email asking for clarification of the results:
Hi Valerie, In response to your questions, we did a dexamethosone suppression test, low dose, as opposed to an ACTH response test. The better test changes about every 4 years, and now the dex suppression test is better, according to both meetings I went to last year on Cushings. From the results, there is no doubt that Daisy has pituitary dependent hyperplasia, as a more than 50% reduction at either 4 or 8 hours from the baseline indicates PDH. As for the bloating, it is along with PU and PD, a clinical sign of the disease. That being said, an ultrasound of the abdomen is always a good idea with any Cushings suspected cases. We can also take new abdominal xrays, as we have been updated to a digital system since your last visit and the contrast is much better. I am still using Trilostane at once daily dosing, as I believe the twice daily is more prone to overdose. I have had three cases in the past month where we had to go to every other day dosing as we were causing signs of Addisons Disease (weakness, megaesophagus collapsing) on the daily dose. I will scan the bloodwork in following. - Toby Kim
What else can you tell me about the results? Is she in the beginning stages of Cushing's? The pharmacy said that the 20mg daily dose was on the low end of the spectrum.
Also, is anyone familiar with the Cornell University Veterinary Hospital in Stamford, CT? Going there is an option too.
New surgery options?
There is so much information on the internet that it became overwhelming.
Thank you in advance for your help.
Valerie
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Gracie Daisy