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Thread: Our 9 year old mutt, Penny, in the dx process - sweet Penny has passed

  1. #1
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    Default Our 9 year old mutt, Penny, in the dx process - sweet Penny has passed

    Our female dog, Penny, is around 9 years old, 44 lbs and a rescue. Speculation is Shepard, Sharpei and Heeler and probably some other things mixed in. She has had some small, hard bumps under her skin and several have been removed and biopsied as benign over the last two years.

    Over the past 6-8 months she has begun showing vague symptoms including panting and lack of energy. More recently, she drinks and urinates excessively and has the beginnings of a potbelly although her weight has fluctuated a bit. Right now she is down a couple pounds. She had a complete blood work up a couple months ago and all was normal except extremely high triglycerides. Blood sugar was normal. So the vet changed her to a higher fiber diet. Recent six weeks or so, she is always hungry. Unless we limit her, she will drink until she throws up.

    So I took her back to the vet and they did a urine test to screen for Cushings. A week later the results came back as normal (???) so after more discussion we decided last week to do the ACTH stim test anyway. The results came back yesterday as positive for Cushings.

    The vet wants to do an abdominal ultrasound tomorrow morning and has mentioned the drug trilostane over the phone.

    So right now I am researching and researching and want to be prepared for the vet appointment in the morning.

    Thanks to the knowledgable folks I found here earlier today, one thing I know I should do is get copies of all her test results.

    Sorry about the late-in-the-day posting. We are in Hawaii. There aren't many veterinary specialists here as the Big Island is very rural. I think we are seeing the most knowledgable (and only accredited) vet here.

    I would appreciate any and all advice on questions to be sure to ask, other tests, etc.
    Mahalo,
    Nancy

  2. #2
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    Hello and welcome to the forum. You said the UC:CR came back as normal but the ACTH was high?
    So, her liver enzymes were fine, not high? ALKP, ALT, etc.

    If you do go with trilostane, don't go over 1mg/1lb maxium to start with. Just safer.

    Don't limit water. I know you don't want her to make herself sick, but if this is cushings, then their bodies can't regulate temperature, their kidneys work over time and it is very hard on them and they have to drink the water to stay hydrated. It isn't that they drink and then pee, it's that they pee and then they have to drink.

    Usually, and its by no means an always, the drinking and urinating will be one of the first things to clear up.

    Did they ever mention if the hard bumps were calicinosis cutis? It's small hard calcium deposits which cushings dogs are prone to. (a skin scraping should tell you for sure if that is what it is)

    So glad you found us. Some of the others will be around soon to check in.

    Sharlene and molly muffin
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  3. #3
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    Default

    Thanks for the reply.

    Yes, that is correct. Her liver enzymes are all normal and her uc:cr test was normal. But the symptoms match so much, we did the ACTH test anyway and it was high. I'm not sure of the exact numbers since test results were told to me over the phone. We will see the vet in the morning for the first time since the results came back and I will get copies of everything, including her biopsy results on the skin bumps.

    Not to worry. We don't really limit her water, we just have to tell her to take a break and she will stop. It's almost like she gets to drinking and doesn't think to stop. She always has access to water.

  4. #4
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    Hi Nancy,

    Welcome to you and Penny! Glad you found us and we will help in any way we can.

    Cushing's can be difficult to diagnose and is frequently misdiagnosed. Severe stress and other non-adrenal illnesses can create false positive results on all tests for Cushing's which is why, for the Urine Cortisol/Creatinine Ratio (UC:CR), the urine sample is collected at home and taken to the vet's office.

    With the ACTH stimulation test a percentage, although low, of dogs will have a false positive result for Cushing's. When the (UC:CR) results are normal the consensus among the top canine endocrinologists is that it is very unlikely the dog has Cushing’s.

    Increases in drinking/urinating can be attributed to other non-adrenal illnesses such as an UTI or even diabetes insipidus. Diabetes insipidus, which should not be confused with Diabetes mellitus, is a rare disease, but we have had a couple of dogs on the forum who have indeed been treated for the disorder. The usual treatment for DI is with desmopressin. If Penny's urine is diluted a regular urinalysis may not be sensitive enough to pick up any bacteria so an urine culture and sensitivity test should be done.

    Getting copies of all test results and posting any abnormal values with their reference ranges and units of measurement may help us to provide you with more meaningful feedback. Is Penny on any other herbs/supplements/medications?

    Again, welcome to the forum and please do not hesitate to ask all the questions you want.

    Hugs, Lori

  5. #5
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    Welcome the forum. What a great place to live.Sorry your baby is having troubles. Were there any other issues going on with Penny when she was first tested for Cushings? If so this can skew her numbers by giving a false positive. She certainly is showing some symptoms of Cushings, but as stated earlier it is the one of the hardest diseases to diagnose. Has you dog been tested for diabetes or thyroid problems? They have some of these symptoms also. I see you are having an ultra sound done. Is that a high definition machine being used? You will want to be asking if the adrenal glands are enlarged, what the liver, spleen, and gallbladder look like and any problems in the abdominal cavity they can see. If your dog has Cushings and is treated with trilostane like Sharlene mentioned please start low at only 1mg per pound as we have had several dogs on the forum lately have problems because they were started too high. Unfortunately a lot of vets are unfamiliar with this disease and it's management on these drugs so please come on here before doing anything you are not sure of and ask questions. Also if your dog is put on trilostane do not under any circumstances let the vet talk you into raising the dose before thirty days is up as the cortisol continues to fall for that time and sometimes more. You want to start low so your dog can adjust to the falling cortisol and to this new drug she has never had in her system. Starting low minimizes risks of your dog having problems. Blessings
    patti
    Tipper and Tipper's Mom


    "The greatness of a nation can be judged by the way its animals are treated."
    Mahatma Ghandi

  6. #6
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    Penny's ultrasound shows nothing abnormal. Everything is actually extremely normal. No enlargement of her liver, no tumors, spleen and kidneys all look great.

    The vet is going to consult with a couple of internists on the mainland to get another couple of opinions.

    I will be receiving copies of her test results via email later today. He wants to write up the ultrasound report and include that.

    Bottom line is she has the symptoms, but her blood work, thyroid, liver enzymes, blood sugar, etc are all normal with the exception of very high triglycerides. She is not diabetic. Urine test was normal, ACTH stim test slightly high.

    If it isn't Cushing's, what might it be?

  7. #7
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    I know Tipper had high triglycerides and with the Cushing's dogs they have an awful lot of fat mobilized in their systems. Her fish oil worked well, but you have to be careful with it too as it is adding more fat even though it is a good fatty acid. I am conservative on how much I give her and it really helped but took a while to bring them down. Penny's report sounds good and it sound like nothing seen to worry about right now. Hope your Dr.'s find out what is going on with her. How did she do for the US? Blessings
    Patti
    Tipper and Tipper's Mom


    "The greatness of a nation can be judged by the way its animals are treated."
    Mahatma Ghandi

  8. #8
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    Hi:
    Just checking in to see how Penny is doing? Have you gotten her written reports
    from her tests yet? I am curious to see her numbers. Blessings
    Patti
    Tipper and Tipper's Mom


    "The greatness of a nation can be judged by the way its animals are treated."
    Mahatma Ghandi

  9. #9
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    Update. Discussions with two different internists suggest we wait before trying the medication. We will keep an eye on her symptoms and try the LDDS test in about six months.

    I am disappointed in the vet and staff that I still have not been given copies of her test results.

  10. #10
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    Default Re: Our 9 year old mutt, Penny, in the dx process

    That is extremely disappointing that you have not gotten those reports. What are
    they saying is the reason they have not gotten them to you? I would be talking to
    someone in charge to get this expedited. Blessings
    Patti
    Tipper and Tipper's Mom


    "The greatness of a nation can be judged by the way its animals are treated."
    Mahatma Ghandi

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