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Thread: Doxy Just Diagnosed on Friday

  1. #1
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    Default Doxy Just Diagnosed on Friday

    I am brand new here, our almost 16 year old dachshund Maggie, or Weenie as we call her, was diagnosed on Friday after the LDDS test on Wednesday. Here's the history:
    Maggie will be 16 in October. She has always had a huge appetite and for years has had a big belly. Her weight has been about 17 pounds since she was about 4. For the past 2 summers, we haven't walked her because she seemed heat intolerant. This summer, she started panting a bit when she gets overly excited, over exerted or hot. It is 106 where I live today. This is new. She seems to drink a little more than normal, but she and our Golden Retriever together only drink about 5 cups of water per day. She occasionally pees in the house, but she has never been well house broken. She may get up once during the night to pee, sometimes not at all. She has no hair loss, in fact the slight hair loss on the back of her legs that she had some years ago has grown back for at least 2 years. Her skin is good, although she has had a couple of infections that were treated easily with topical antifungals. All of her legs are weaker than they used to be, but I have attributed that to spinal problems from being a Doxy..her back has gone out a few times over the last 3-4 years, and the vet said that she has nerve damage to her limbs from her spine. She can still run, but can't jump up on the couch anymore. She is, after all, almost 80 years old.
    Last year in June before her dental cleaning she had routine lab work. Everything was normal except a mildly elevated ALP of 360 and ALT of 260. Repeat liver enzymes in August showed an increase in the ALP to 408, with the ALT down to 171. In November, the ALP was 375 and ALT 175. We had started her on Denamarin prior to the November lab. In March, her ALP went up to 904 (we had stopped the Denamarin) and the ALT 244. In April, again off the Denamarin, her ALT was 947 and ALT 209. She had a brief ultrasound that month as well that showed an enlarged liver but no masses. On July 10, Maggie started limping on her right forearm, so after 2 days, we took her to the vet, who examined her, took xrays, said it was arthritis. He looked at her labs which included the elevated liver enzymes and a urine specimen that showed dilute urine, and said that he thought she may have Cushings. The following week on July 20, she had a non-fasting LDDS. The results were pre-test 13.8. Four hr post injection: 5.0. Eight hour post injection: 4.2. I spoke to the vet on Friday after researching the treatment options and thought it better not to treat Maggie at this time due to her age. He agreed, but is willing to treat her if we decide to go that route. I spoke to a very experienced vet at UC Davis as well who said that "Unless Maggie's quality of life was unacceptable, I wouldn't treat such an elderly dog."
    I am here to ask for feedback from all of you. Is Maggie too old to treat? Are her symptoms really significant at this point? She isn't uncomfortable, but I realize that this disease may be doing damage that we cannot see. I want her to have a good quality of life, but if she can be successfully treated, should we start and see how it goes? As a RN, I am used to dealing with humans and some elderly people are strong enough to go through chemo and other difficult treatment, and some do very poorly. I am torn.
    Any suggestions and experiences with older dogs like Maggie would be appreciated.
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    Last edited by Burlene K; 07-25-2016 at 12:28 AM.

  2. #2
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    Default Re: Doxy Just Diagnosed on Friday

    Hi and welcome to you and Maggie!

    First let me just say that the fact that Maggie is almost 16 years young is quite a testament to what a great job you have done in making the right decisions for her so far. Cushing's is typically a slow progressing disease, and the decision whether to treat or not depends on a number of factors: age of the dog, apparent discomfort, and severity of symptoms (both external and internal).

    The goal of treatment is to control the troublesome symptoms (things like excessive thirst, urination, hunger, panting) and since the damage of untreated Cushing's usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly and my primary concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I probably wouldn't.

    It doesn't sound as though Maggie's outward symptoms are problematic to either of you and it seems that, mainly, only the abnormal lab values are what brought the Cushing's treatment into play. In the absence of strong, obvious symptoms it certainly makes it harder to judge if treatment is working. Another reason that makes it difficult in deciding to treat is that it's not pleasant for any dog to go through the trauma of multiple vet visits and the many monitoring tests that are required for treatment and for a senior dog it can be worse. Also, if a dog is already suffering from arthritis, Cushing's treatment may cause more discomfort as that elevated cortisol does have anti-inflammatory properties.

    I'm very sorry for the reasons that brought you here but I'm glad you found us. You and Maggie are family now and we're all here to support you in your decision to treat or not.

    Hugs, Lori

  3. #3
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    Default Re: Doxy Just Diagnosed on Friday

    Thank you. Our goal is for Maggie to be happy and comfortable for as long as possible. Going to the vet is so stressful for her and considering the high rate of adverse affects of the meds, we are going to stay the course for now.
    Are there any supplements that have helped relieve any of the the symptoms of Cushings? Any diets that would be beneficial? We are working on reducing Maggie's weight to 14 pounds just to make it easier for her to get around. She's carrying alot of weight on those short legs!
    Also, Maggie is due for her yearly dental cleaning. Any problems with anesthesia in Cushings dogs? The vet says no, but I'd like to hear from this group.

  4. #4
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    Default Re: Doxy Just Diagnosed on Friday

    Some members have told us that Cushex and Adrenal Harmony Gold worked very well in controlling symptoms but only for a short time period. Now, Cushex and Adrenal Harmony Gold have no controlled clinical testing whatsoever to back up their claims (we know this because we have contacted the manufacturers and we have been told that no testing has been done).

    Concerning the diet, there really isn't a "set" diet for a cushdog, it should be tailored to that individual dog's needs. However, because of the effects of excess steroid on protein and fat metabolism, a good quality protein, moderate fiber and a low fat diet is recommended.

    My boy, Harley, had a dental cleaning along with having 3 teeth extracted when his Cushing's was not controlled and he did fine with the anesthesia. I, too, was very concerned about him and the anesthesia. His vet assured me that if he would show signs of distress that they could bring him out of the anesthesia really fast.

    One other question I have were the adrenal glands visualized on the ultrasound?

    Lori

  5. #5
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    Default Re: Doxy Just Diagnosed on Friday

    I do not have the report, it was a "brief" ultrasound done 3 months before her diagnosis to check out her liver since her enzymes were elevated. It was not a truly diagnostic abdominal ultrasound. Do you think that I should ask for one?

  6. #6
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    Default Re: Doxy Just Diagnosed on Friday

    Hi, Lori's got you covered already so I'm just stopping in to say welcome to you and Maggie! You're doing a great job with that little lady. Give her some ear scritches from me.

    Hugs,
    Shana

  7. #7
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    Default Re: Doxy Just Diagnosed on Friday

    Thank you all!

  8. #8
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    Default Re: Doxy Just Diagnosed on Friday

    Quote Originally Posted by Burlene K View Post
    I do not have the report, it was a "brief" ultrasound done 3 months before her diagnosis to check out her liver since her enzymes were elevated. It was not a truly diagnostic abdominal ultrasound. Do you think that I should ask for one?
    I am always in favor of having an abdominal ultrasound performed in dogs that are suspected of having Cushing's. I believe it gives the vet an opportunity to get a good look at surrounding organs to rule out any non-adrenal problems that might be contributing to or even causing the symptoms and lab abnormalities that are usually associated with Cushing's.

    However, they are expensive to have done and not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting. The technician, most likely, will perform their own and therefore, it should be those most experienced with capturing good windows and images. That would be a board certified radiologist or board certified Internal Medicine Specialist. Likewise the one interpreting it should be the most experienced as well, and that's generally one of the 2 above.

    Hugs, Lori

  9. #9
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    Default Re: Doxy Just Diagnosed on Friday

    I have an appointment to speak to the vet on Friday and will ask about a more thorough ultrasound. I do have a couple of questions.....
    I read in an earlier post that the LDDS test should be done fasting. Maggie had hers done right after a full breakfast. Also, except for the "elevated" cortisol noted in the LDDS, the only other labs out of range are her ALP and ALT. The ALT came down from last year and her ALP has decreased from about 950 to just a little over 700 in the past 3 months. She has no protein in her urine and as far as I know, her blood pressure is normal. I am wondering about this diagnosis, especially since Maggie has such mild symptoms and none of the true hallmarks.. no polydipsia (she drank about 1 cup of water today) or polyuria, no hair loss, no skin infections. She has some limb weakness due to disc disease and arthritis confirmed by xray. At the age of almost 16, I don't expect a dachshund to not have some back problems. She still runs in the yard. Since her "diagnosis", I have attributed things that are normal in a 16 year old dog to Cushings, and yet nothing seems to be preventing Maggie or us from enjoying her life, especially after reading some of the other stories here of much worse symptoms. I am so glad that we didn't jump to treat her, given that Cushings progesses slowly and may not cause her eventual passing.

  10. #10
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    Default Re: Doxy Just Diagnosed on Friday

    Hi and welcome from me, too~ At her age, and with the few symptoms mentioned, I would let her live out whatever time she has left untreated...the vet visits, testing, monitoring are nerve-wracking and very stressful on us and our babies. You know her better than anyone else and if she seems content, I would let her be...
    Joan, mom to my Angel Lena, Angel Gable, Angel Phoenix, Angel Doree, Cooper, Sibble, and now Raina.

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