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Thread: Newly diagnosed with Cushings

  1. #1
    Join Date
    Oct 2019
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    3

    Default Newly diagnosed with Cushings

    Hi all - our 4 year old pup Winnie was recently diagnosed with Cushings. It started with some urine leaking while she slept which was initially thought to be general incontinence. However, she began to eat and drink excessively and gained some weight. After a urinalysis and some bloodwork our vet diagnosed her with Cushings. This all seems to have happened almost overnight. Winnie was always a very active (and somewhat anxious) dog, and she's now just very lethargic and generally just seems like she is depressed. She has been on 30mg Vetoryl (twice a day) for a few months now. It has helped curb the thirst and overeating, and therefore helped with the leaking, but Winnie still just isn't herself. She doesn't get excited to do anything anymore.

    She only seems to have about half of the symptoms that I've read about - she doesn't have hair loss, skin infections, or pot belly... plus she seems to be extremely young for a Cushings dog. Her blood work seemed to have been "borderline" but her urine cortisol creatinine numbers were very high from what i understand. I got the idea that perhaps her baseline blood numbers were a little high because she's such an anxious dog and we decided to go to another vet for a 2nd opinion. After our first visit with the new vet he strongly seems to think that Winnie doesn't have Cushings after all, based on her physical appearance and the "borderline" blood numbers coupled with what he said were normal liver enzyme levels, I believe. He instructed us to stop the Vetoryl and get back on a different medicine for incontinence. However, she immediately regressed and is now back to drinking/eating like crazy and having lots of leaking issues - i dont think these are signs of estrogen incontinence. She's leaky because shes drinking so much. She is still very lethargic and not playful (she WANTS to play but just seems that she can't). She also doesn't seem to want to sit down - i'm unsure if her legs are in pain or something else is hurting her. She also sometimes breathes heavily when resting.

    I'm just very frustrated with this whole thing. I know it can take a while to get a good balance with the medicine but the fact that I don't even have a doctors' consensus as to the diagnosis is making things much more confusing. I don't know what to even try next. Has anyone had any similar experience? She's only 4 years old - i can't imagine that we can't get this figured out...

    FWIW - we haven't had an ultrasound but i'm thinking of just demanding that we get one done. If it's not Cushings then it has to be something else affecting the adrenal gland I imagine...

    thank you!

  2. #2
    Join Date
    Apr 2009
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    York, PA.
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    10,649

    Default Re: Newly diagnosed with Cushings

    Hi and welcome to you and Winnie!

    I am so sorry for the reasons that brought you here but glad you found us and we will help in any way we can. If you would post the results of all tests that were performed on Winne it would enable us to provide you with better feedback, we need only to see those values that are marked abnormal with the reference ranges and units of measurement. Besides the urine cortisol creatinine, were there other diagnostic testing done to validate the Cushing's, such as an ACTH stimulation or low dose dexamethasone suppression (LDDS) test? How much does Winne weigh? It is my understanding from your post that she is no longer taking the Vetoryl, is this correct? And if so, how long has it been since she has had her last dose of Vetoryl? Also, while she was on the Vetoryl were any monitoring ACTH stimulation tests performed, and if so, would you post those results? Was an urine culture done to make sure that Winnie doesn't have an UTI?

    Cushing's is one of the most difficult diseases to diagnose and often is misdiagnosed because there isn't one test that can accurately identify it. That is why multiple tests are recommended so that a diagnosis of Cushing's can be confirmed. We sure do understand how confusing this all can be so know that we are here to help you and sweet Winnie. Again, welcome to our family!

    Lori

  3. #3
    Join Date
    Oct 2019
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    3

    Default Re: Newly diagnosed with Cushings

    Thank you so much for getting back to me! Nice to be able to speak to someone with experience on the issue. Below are results of the tests in chronological order. She's had the ACTH and Dex tests done which you'll see.

    Right now Winnie is about 54 pounds or so, but she has fluctuated a lot. She was 52 pounds in March 2019 before she had any symptoms and was up as high as 58 pounds in May 2019 before she was regulated on the Vetoryl. I assume this is because she was eating so much... she's always been a picky eater until the Cushings diagnosis.

    Blood Draw (taken 4/6/2019)
    Cholesterol = 402 (HIGH) - Reference Range 92-324
    CPK = 43 (LOW) - Reference Range 59-895
    WBC = 3.9 (LOW) - Reference Range 4.0-15.5

    Urinalysis (taken 4/27/2019)
    Specific Gravity 1.001 (LOW) - Reference Range 1.015-1.050

    Urine Cortisol/Creatinine Ratio (taken on 4/30/2019)
    Result = 106 (HIGH) - Reference Range is 13 or lower

    Dexamethasone Suppression Test (taken 5/2/2019)
    Sample 1 = 6.9 (HIGH) - Reference Range 1.0-5.0
    Sample 2 Dex = 6.7 (HIGH) - Reference Range 0.0-1.4
    Sample 3 Dex = 3.4 (HIGH) - Reference Range 0.0-1.4
    (samples taken 4 hours apart)

    *Started on Vetoryl - 60mg / day on 5/3/2019*

    ACTH Stimulation (taken on 5/20/2019)
    Pre-Sample = 9.1
    Sample post ACTH stim gel = 11.9
    HIGH. Reference Range 1.5-9.1
    (samples taken 2 hours apart)

    ACTH Stimulation (taken on 7/23/2019)
    Pre-Sample = 1.7
    Sample post ACTH stim gel = 2.9
    (Samples taken 2 hours apart. Vet says this is "good regulation".

    Urinalysis (taken on 7/23/2019)
    Specific Gravity = 1.002 (LOW)

    *Changed Vetoryl to 30mg twice a day on 7/24/2019* Our vet said the spacing out will help with the urine leaking better, which it did.

    Then basically last week I went for a 2nd opinion and the other vet said that he doesn't think it's Cushings based on a few things I mentioned earlier. I took her off the Vetoryl per his instruction on 9/28/2019 and she's regressed significantly since then. She's eating/drinking much more and having more accidents. I actually spoke with the vet this morning and he is having me set up an ultrasound. He said we may have to put her back on the Vetoryl for now until we can get the ultrasound results back, depending how long it will take to make an appointment.

  4. #4
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,100

    Default Re: Newly diagnosed with Cushings

    Hi and welcome to you and Winnie!

    Something for you to be aware of - we here on the forum have observed an oddity about Vetoryl and one of our Admins has done some rather extensive research, finding that we were not the only ones to notice this oddity. She found studies supporting what we have seen - that larger dogs often need a much smaller dose than recommended to control the cortisol while smaller dogs often need a much larger dose than recommended. Here is a link about this that you can share with Winnie's vet(s).

    https://drive.google.com/file/d/155a...PED8x1Zbl4UQZo

    So while 60mg a day fits with the new recommended starting dose (1mg/lb) for a dog Winnie's size, her size may also mean she needs a much smaller dose, maybe half of that 60. Just something to discuss with her vet once the vet has read the information I posted above.

    I'm glad you found us and am looking forward to seeing those test results that were used to diagnose Winnie's Cushing's. Keep your chin up! You are in great hands here with us.

    Hugs,
    Leslie
    "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
    Join Date
    Oct 2019
    Posts
    3

    Default Re: Newly diagnosed with Cushings

    I'm so happy we found this forum, you all are so helpful already! I entered the diagnostic results in my post above if you wanted to take a look. These resources are super helpful! It makes so much sense that we've been over-medicating her based on her recent behaviors. Hopefully whatever damage has been done by the overmedicating can be reversed.... I fear she's almost in Addison's territory since her numbers dropped so much

  6. #6
    Join Date
    Jun 2019
    Posts
    17

    Default Re: Newly diagnosed with Cushings

    Hi,

    My dog was diagnosed with cushings in May this year. She has been on incurin (prescription drug) for several years now because she started leaking urine when she was sleeping. She is only on 0.5mg a day after starting out on 1mg. I dont know if your vet would try your dog on this? Looking back i do believe my dog has had cushings for at least two years but the symptoms were put down to other thing at the time.

    I also got her the ultrasound as the LDDS could not confirm which type of cushings she had though there was no way i would have opted for an operation had it been adrenal.

    From what i have read taking the dog off vetoryl for a couple of weeks usually allows the cortisol to rise again and then the vetoryl can be reintroduced at a lower dose.

    I am so glad for this forum as it gave me the guts to question my previous vet and make the decision to move to a vet with more knowledge and who is keen to ask my opinion on how my dog is doing.

  7. #7
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,100

    Default Re: Newly diagnosed with Cushings

    ACTH Stimulation (taken on 7/23/2019)
    Pre-Sample = 1.7
    Sample post ACTH stim gel = 2.9
    (Samples taken 2 hours apart. Vet says this is "good regulation".
    This is within normal range for a pup being treated with Vetoryl. That normal range for the post number just so you know is 1.45ug/dl - 5.1 ug/dl. That post, or second number, can go as high as 9.1 ug/dl if and ONLY if all signs are well controlled. The ranges posted from the labs do NOT pertain to a dog being treated for Cushing's - they represent a normal/non-cush dog. Winnie's pre number of 1.7 is getting in the too-low range for a pre but the post number is the critical number.

    In the lab work posted she doesn't present with some of the lab values we normally see such as very elevated liver enzymes, particularly the ALP (or ALKP). In addition to elevated CHOL we often also see abnormal levels of the BUN, TRIG, GLUC as well as abnormal levels of eosinophils, lymphocytes, and monocytes.

    It seems the only tests run to diagnose Cushing's were the UC:CR and the LDDS - both good tests but NO test can 100% diagnose Cushing's. It takes a battery of tests PLUS signs to arrive at a semi-solid diagnosis. Fun, huh? Even knowledgeable canine endocrinologists admit Cushing's is one of the most difficult and confusing canine disease. YAY!

    Winnie is younger than the typical cush pup however one of our admins had a Pom who was confirmed at the age of 3 so it can happen. But Lulu was almost textbook for the disease and Winnie is not.

    You said this came on almost overnight - that does not happen in Cushing's. It is a very slowly progressing condition taking years to do any damage that is truly observable. Most people think their dog is simply aging, not sick, and are surprised when the vet runs normal labs for something like a dental then tells them Cushing's seem likely. In your shoes I would definitely want the abdominal ultrasound - and make sure it will be performed on a high resolution machine so all the organs, like the tiny adrenal glands, can be seen as clearly as possible. And I would want to make sure ALL other possibilities for the signs you are seeing have been ruled out before I restarted treatment for Cushing's...at any dose. DI, diabetes insipidus or water diabetes, can cause the excessive drinking, urination, and leaking. Polyphagia, or excessive appetite, can be caused by many other things in addition to Cushing's. But that's me - my first cush pup was diagnosed with Cushing's but they found a tumor on her spleen that caused all the cush test to return fals-positives. Once the tumor was removed those tests returned to normal. She later did develop true Cushing's but she did not have it when first diagnosed with it. My second cush pup was completely misdiagnosed due to a host of diseases and conditions that also caused false-positives. Her necrosis proved her adrenals were normal, ruling out Cushing's as one of the conditions she had lived with. So don't rush into believing Winnie has Cushing's - take the time to rule out other things. Cushing's disease is rarely life-threatening but treating a dog with these powerful drugs for Cushing's when they don't actually have the disease can be.

    Keep reading and asking questions...we will be here!
    Hugs,
    Leslie
    "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.

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