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Thread: Hello all, looking for advice with our baby Minnie

  1. #1

    Default Hello all, looking for advice with our baby Minnie

    Hello everyone,
    We were just told today that our little 5yr old Yorkie has the pituitary type Cushing's syndrome. She had a clean vet visit including blood work back in March of this year. In July she began to gain wait (1 1/2 lbs), drinking alot, peeing alot, infrequent accidents in the house that are very unlike her.
    She went from sleeping in our bed all night to sleeping on the floor (could get onto the bed any more) and wanting to go out almost every 90 minutes to 2 hours. Panting alot, and eating alot. Previous to July she loved to take long walks and now frequently refuses to walk very far. We took her to the vet late in July and they stated her liver enzyme levels were slightly elevated. We had her on an anti-biotic and a liver supplement for 2 weeks. The vet suspected a possible UTI. She showed improvement over the next two weeks and became fairly active again, but this was very short lived.

    Last week all of the symptoms returned. She even had a small bout of blood tinged diarrhea. On Monday they did another liver enzyme level test and her GGT levels were high ( i'll get the actual #'s from the vet tomorrow) I believe he said her ALP was 91 ( in the normal range?) . The Vet even stated he didn't expect Cushings because this ALP # is typically 10 times as high in his typical Cushing's patients. They also found blood in her urine and have prescribed another 2 weeks of clovomax anti-biotic (sorry my spelling may be incorrect).

    On Tuesday we took her for the LDDS test. The vet stated her system didn't suppress like it should have and the results are pointing to the pituitary Cushing's

    Since the phone call we have been devastated. Finding this website helped us feel a little better. Everything we've read so far states life expectancy is 2 to 3 years. I'm hoping we've caught this early enough to begin treatment and have her for much longer than 2-3 years.

    She's never had any other illnesses.

    We're hoping to discuss treatment options over the next couple days. If we're not comfortable with our current Vet, i was able to find an Internal Medicine specialist close by from a link here in the forum. Thank you!

    I've tried to read and learn as much as possible about Cushing's over the past couple days and i'm sure this forum will be invaluable.

    Any advice or suggestions will be greatly appreciated!!

    As soon as i have more specific info regarding her liver enzyme tests and the LDDS test i will post it.

  2. #2
    Join Date
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    Default Re: Hello all, looking for advice with our baby Minnie

    Hello and welcome to you and to sweet little Minnie! I have only a moment free to write, but I wanted to let you know that I’ve moved your post to our main Discussion forum where more of our members are likely to see your questions and have the chance to respond. I’m sorry that Minnie is having these problems, but so very glad you’ve found us. So once again, welcome, and I’ll return later to write more.

    Marianne

  3. #3
    Join Date
    Jan 2016
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    Glen Cove, NY
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    Default Re: Hello all, looking for advice with our baby Minnie

    Hello and welcome to you and Minnie. Good for you to already have a game plan in mind! Once you post those numbers from the blood work and testing, it will be easier for folks here to try to help. With the blood work, only the highs and lows with the reference ranges. Could you also let us know how much Winnie weighs...
    Joan, mom to my Angel Lena, Doree, Gable, Cooper, Angel Phoenix and now Sibble.

  4. #4
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    Default Re: Hello all, looking for advice with our baby Minnie

    Hi and welcome to you and Minnie!

    The LDDS is notorious for giving false positives for Cushing's when any non-adrenal condition is present. My own Squirt tested positive on the LDDS, HDDS (no longer used), ACTH, and UTK panel (used to test for elevated intermediate hormones as well as cortisol) but they were all false positives because of a tumor that was found on her spleen with an ultrasound. The fact that Minnie has an on-going UTI gives me enough pause as to the accuracy of the LDDS that I would NOT start treatment for anything right now. I would give her a chance to get completely cleared of the UTI and then if you are seeing signs - thin and darkening skin, pot belly, panting for no reason, voracious appetite 24/7, excessive urination, excessive thirst, accidents in the house - I would test again. I could not trust the LDDS that was just done. Any stress, internal or external, can cause the ACTH to be falsely elevated so that test would also be unreliable as far as I am concerned right now. It is also very unusual for Cushing's signs to suddenly occur. They usually happen very slowly over years leading most parents to think their pup is simply aging.

    It will help us to see those test results, as Joan said, because we would expect to see certain abnormalities in a cush pup. The test results will help us get a better idea of what may be happening. We are NOT vets but we have seen thousands of test results in cush pups and others who were thought to have Cushing's yet proved not to later on down the road.

    I want you to know that Cushing's is very very rarely a pressing condition so there is no need to panic over waiting for the UTI to clear or to get a more definitive diagnosis. It is a slooow progressing disease taking years to do any real damage. And that 2-3 year thing? pftttttt...that is based on outdated info. Vets are better educated these days, we have more treatment options, parents are better educated and demand better care from the vets (so they HAD to catch up! ), and most dogs are diagnosed much later in life when they had no more than a few years left anyway. There are rare complications that can shorten their lives but those are rare. My own baby was diagnosed at 7 and lived to be a bit older than 16, passing from age and not Cushing's. We have had pups here live 12 years with Cushing's! So you just put that nonsense in the trash and don't think about it any longer. You and Minnie are in the best place to learn all you need in order to be her staunchest advocate and care taker IF IF IF she does in fact have Cushing's.

    You are not alone, ever. We will be here anytime to talk, listen, and help in any way we can. Never hesitate to ask any questions and feel free to prowl through the threads to learn and be sure to check out our Helpful Resource section where you will find loads of great info. I am glad you found us and look forward to learning more about sweet Minnie as time passes.

    Hugs,
    Leslie

    http://www.k9cushings.com/forum/foru...Cushing-s-Dogs
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  5. #5

    Default Re: Hello all, looking for advice with our baby Minnie

    Thank you so much!!

    She is on day 3 of her antibiotics, so we'll plan to wait until they are finished and do another urine test before a 2nd LDDS test.

    I'm actually waiting to hear back from the initial Dr that saw us and scheduled the test and that will be my 1st question. Why submit her to that test when her system is already stressed with the UTI?

    She has had some of the other symptoms beginning of a pot belly, thirst, urination, panting. No skin issues yet. Frequent urination with accidents at night. Muscle weakness. Lethargic

    Could some or all of these be attributed to a UTI?

    Thank you again for giving us what we really need right now...some hope!!

    I'll get copies of all of her tests going back to her annual check-up in March that was supposedly good.

  6. #6

    Default Re: Hello all, looking for advice with our baby Minnie

    Quote Originally Posted by Joan2517 View Post
    Hello and welcome to you and Minnie. Good for you to already have a game plan in mind! Once you post those numbers from the blood work and testing, it will be easier for folks here to try to help. With the blood work, only the highs and lows with the reference ranges. Could you also let us know how much Winnie weighs...
    Minnie is just over 10lbs at her last visit. She was 9lbs at her annual checkup in March. We were actually just starting to put her on a diet dog food thinking some of the issues (panting, no longer jumping on beds or furniture) were caused by this sudden weight gain that actually seemed to happen from mid June to mid-July. She's always been one to leave food in her bowl for a day or two, especially if she's getting a few table scraps. Now she eats as soon as the food hits her bowl.

  7. #7

    Default Re: Hello all, looking for advice with our baby Minnie

    Ok Here are all of the test results. Starting with the latest

    8/21/18 4:37PM HESKA LDDST 8hr post - Cortisol 3.6 1.0-6.0 ug/dL
    12:40PM HESKA LDDST 4hr post - Cortisol 1.2 1.0-6.0 ug/dL
    7:32AM HESKA LDDST Initial - Cortisol 4.7 1.0-6.0 ug/dL

    8/20/18 DriChem
    Albumin 4.3 High 2.5-4.0 g/dl
    Glucose 109 75-125 mg/dl
    ALT (GPT) 177 High 0-120 U/l
    ALP 91 0-140 U/l
    GGT 112 High 0-14 U/l
    Total Bilirubin 0.1 0.0-0.5 mg/dl

    7/23/18 DriChem ElementHT5
    Albumin 4.1 High 2.5-4.0 g/dl
    Globulin 3 2.0-3.6 g/dl
    Glucose 101 75-125 mg/dl
    Cholesterol >450 120-310 mg/dl
    ALT (GPT) 181 High 0-120 U/l
    ALP 82 0-140U/l
    GGT 50 High 0-14 U/l
    Total Bilirubin <0.1 0.0-0.5 mg/dl
    WBC 7.44 6.00-17.00
    NEU 6.62 3.62-12.30
    LYM 0.57 LOW 0.83-4.91
    MONO 0.24 0.14-1.97
    EOS 0 LOW 0.04-1.62
    BAS 0.01 0.00-0.12
    NEU % 89 HIGH 52.0-81.0 %
    LYM % 7.7 LOW 12.0-33.0 %
    MONO% 3.1 2.0-13.0 %
    EOS % 0.1 LOW 0.5-10.0 %
    BAS % 0.1 0.0-1.3 %
    RBC 7.4 5.10-8.50
    HGB 18.4 11.0-19.0
    HCT 52.2 33.0-56.0
    MCV 74.2 60.0-76.0
    MCH 26.1 20.0-27.0
    MCHC 35.2 30.0-38.0
    RDW% 13.6 12.5-17.2
    PLT 368 117-490
    MPV 8 8.0-14.1
    BUN 9.3 9.0-29.0
    CREATININE 0.5 0.4-1.4
    PHOSPHORUS 4.4 1.9-5.0
    CALCIUM 11.4 9.0-12.2
    TOTAL PROTEIN 7.1 5.5-7.6

    SODIUM 146 141-152
    POTASSIUM 3.9 3.8-5.3
    CHLORIDE 102 102-120

    Please let me know if any further info would be helpful. I think this is all i have in the way of test results.

    I forgot to mention that the vet suspected blue-green algae toxicity based on the 1st results (7/23) and prescribed 10 days of CLAVAMOX at 62.5mg and DENAMARIN 90MG.

    She is currently taking 125mg CLAVAMOX twice daily for 14 days. (Vet says we should see noticeable improvement by Monday)

    I also spoke with the Vet today and she doesn't believe there is a chance of a false-positive. And with the LDDS test along with the symptoms she believes treatment is our next course of action, if that is what we decide. She suggests a liquid form of vetoryl and wants to wait and see how Minnie is after the antibiotics are complete.

    Minnie was able to complete about half of her normal evening walk today with a little help being carried every so often. She has a little tremor in her rear legs from time to time, especially when squatting to go potty.
    Last edited by Minnie's Mom and Dad; 08-23-2018 at 07:14 PM.

  8. #8
    Join Date
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    Default Re: Hello all, looking for advice with our baby Minnie

    As Leslie mentioned, the LDDS test can yield a false positive result when a dog has a non-adrenal illness. And even though Minnie's symptoms along with some of those abnormal blood work levels are commonly seen in dogs with Cushing's I'm just leery of that LDDS result when the UTI was present during testing.

    My advice would be to have her urine cultured, waiting at least a day or two to collect urine after the completion of the antibiotics. An UTI will make a dog drink/urinate more and can also cause panting so these symptoms that Minnie is exhibiting could just be from the UTI.

    Lori

  9. #9
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    Default Re: Hello all, looking for advice with our baby Minnie

    If this were my baby, there is no way I would start treatment until the terms I mentioned were met - the UTI is completely healed and has been for a while and the signs of Cushing's are still present. These drugs are very very powerful so I prefer to always wait until diagnosis is much better defined than Minnie's is at the moment. But that's just me. If I had started treatment on my dog when she was first diagnosed she would have died from a tumor that wasn't found until an abdominal ultrasound was done. So I never take risks nor advocate anyone else take risks in starting treatment with a questionable diagnosis....regardless of what a vet may say.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  10. #10
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    Default Re: Hello all, looking for advice with our baby Minnie

    Hello again from me, too! I’m so glad you’ve been greeted by other folks, and I apologize for the delay in my own return to you. You’ve already been given a lot of helpful info and food for thought, so I’ll just go ahead and add a few additional thoughts of my own. It is indeed the case that Minnie exhibits outward symptoms and certain lab abnormalities that are consistent with Cushing’s. The excessive/thirst/appetite, panting, muscle weakness and exercise intolerance all fit, as do elevated cholesterol (although not noted as high on your list, it looks like it was high), certain white blood count abnormalities, and mildly elevated ALT. As your vet has already noted, what does NOT fit is Minnie’s normal ALP. Also, her GGT is highly elevated and has more than doubled within the past month (it is now eight times normal range) whereas only mild to moderate elevation would be expected. The normal ALP is really atypical.

    As far as the UTI, I certainly can’t argue with the fact that, ideally, you’d prefer that a dog be infection-free at the time of LDDS. However, untreated Cushing’s can result in recurrent UTIs that are very difficult to fully eradicate. So sometimes I think it’s reasonable to proceed with the testing even when a UTI is present since the dog may never fully “clear” while circulating steroid levels are significantly elevated and the dog’s immune system is compromised. However, the point is well taken that Cushing’s is normally a slowly progressing disease, and you typically should have the opportunity to at least try to eliminate the infection in order to see whether that normalizes some symptoms.

    I am not well versed enough in liver values to know exactly what to make of the rapidly elevating GGT. But if it were me, that value, in conjunction with the normal ALP, would be enough to encourage me to seek an additional opinion from your local internist prior to starting treatment. As Leslie has noted, Cushing’s symptoms typically don’t acutely emerge over a short period of time. So even though Minnie’s picture does seem consistent with Cushing’s in certain ways, there are enough question marks to make me scratch my head. One diagnostic tool that an internist might recommend is as abdominal ultrasound. Although that would involve additional expense, it might clarify whether or not there are primary issues with Minnie’s liver or gallbladder, for instance that might account for those uncharacteristic enzyme readings, or any other organ abnormalities that might account for her Cushing’s-like symptoms. Sometimes spending a bit more money upfront can make a big difference as far as arriving at a truly accurate diagnosis.

    So once again, just a few more thoughts for you to consider,
    Marianne
    Last edited by labblab; 08-25-2018 at 05:21 PM. Reason: To add.

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