Introduction to Smiley, Cushing's (and Sammy, Diabetes)-update Sammy has passed

[Smileyspeople]

Let's see...Smiley is a ten year old n. male Chinese Crested powderpuff with Cushings. Sammy(aka Xami) is a twelve???year old n. female rescue with diabetes. Sam's diabetes is controlled (usually successfully) with 2 units insulin twice daily.

Smiley's diagnosis came as a surprise to us (about a month ago), especially since we felt that we were not given adequate info from our vet who did a rapid series of tests, and jumped (rather confusingly) to a compounded prescription of one of the standard Cushings meds. (I forget which one, but will look it up.) We received no guidelines or follow up calls...just the knowledge that my sister's golden retriever had died a painful death after three years of Cushings treatments much money (and two operations.)

Its not exactly that we went into denial...we just went into overload. (I'm giving you the abbrieviated version of this series of events...which involved finding expensive "problems" with all four of our dogs as the result of routine pre-dental procedures.)

Smiley is much loved...as are the rest of our pack. I have believed for sometime that he had a weak endocrine system. (Less by schooling than by observation.) He's had an ear hemotoma repaired by suturing, skin problems "cured" by clavamox. (He's now allergic to this pill.) And he also has an an ongoing luxating patella problem in his back legs...which became calcified until recently (and therefore allowed him fairly good mobility.) Now...of course, his legs really can't support him.

So...the little guy is still shining his bright little eyes out into the world. Still very much controlling the hearts and minds of all the canines in the household, and of course, the humans. But we are quite uncertain about beginning treatment, or what course to take. We are fairly sure (based upon his past) that he will not tolerate meds well, but do want to give him a quality life for whatever time he has left.

That's the story. I haven't yet contacted UCDavis as we are reluctant to start a medical treadmill...but that's kind of the direction we are going. We don't feel that our vets (where we were clients for over ten years) will honor our sensibilities. (I guess that's the way I would put it.) Example: the last conversation we had with them about Sammy (who has been on insulin for four years) was the "guess" that she might have a heart problem and require a pacemaker. This based upon a series of seizures...which (IMHO) seem to come about when she gets frightened. (She's blind and doesn't like noise.)

I ramble...but the Qs are: ethics of putting a sickly elderly dog with Cushings through a lot of treatment. Where to find vets we can work with. ANd so on...

Over to you.

[gpgscott]

Welcome,

It is very hard to watch them grow old.

The treatment itself for Cushing's should not be an imposition on an elder which is in reasonable control of their normal functions, it should bring relief in many areas and cause concern in others.

You should see improvement in body mass distribuation, better energy, improved skin and haircoat and an improved state of mind as they are not constantly thinking about either eating or eliminating.

The diagnostics can be exhausting, and we have seen members go through much un-necessary stress for the pup and cost for the parent.

So let me ask you for more information.

You have said you have a diagnosis and are treating, I presume with Vetoryl also known as Trilostane. Please confirm this and also let us know the names dates and results of the testing done. Please also let us know Smiley's wt. and the dosing of the current treatment.

I am sorry to hear about the bad experience with your sisters pup and can understand that it makes you pause. We will talk straight to you and tell you our personal experiences in the hope it will help you make the best descision for your little one.

Best to you all.

Scott

[Harley PoMMom]

Hi Smiley and Smiley's Mom,

Welcome to our cush-family, so sorry for the circumstances that have brought you here, but I am grateful that you have found this forum with these amazing and very knowledgeable people.

I also am so, so sorry to hear about your sister's golden retriever that passed, it is heart breaking to lose our furry best friends.

I am a newbie here myself, others will be along to give you their advice, these people have a vast knowledge of collective cushings experience under their belts, so you came to the right place for answers to your questions.

May I ask you what your name is, "Hey you" is so impersonal, and we are so friendly.

Hugs.
Lori

PS. I just looked at your pictures and you have an absolutely beautiful family.

[Smileyspeople]

Not a problem, although I will be happy to answer to "Hey, you" or any other name! I'm Dorothy (not from Oz, however.) Thanks for replying. I've read various posts and am getting up to speed. My sainted spouse (Peter) is very close to Smiley, and will understand the various test results better than I as he's been researching Cushings since we heard that Smiley had it.

Part of the overwhelming nature of the problem is that we also have Smiley's nephew...Emmett, who may be a candidate for Cushings also. We are close to our dogs (duuuh, aren't we all) so the total picture of 3 out of four critters with these illnesses is shocking. Also, Furby (the one "healthy" one) didn't get the prelim test when he had his checkup so...who knows. (They all have the same grandfather.)

We're feeling quite abandoned by our vets...but I think Peter will make an appointment, go in...and try to get them to spend the time to communicate info to us. This forum is a godsend...but you all know that.

[Smileyspeople]

Scott: Let me get the info from Peter and post it for you. I appreciate all the info, thanks for responding.

Here is the info from Peter. I'm hoping that he will get into this forum as I may not do the greatest job of passing on the info, but he will.

Smiley's weight: 21 lbs.

Trilostane dosage as prescribed by vet, (or perhaps as compounded by drugstore, we aren't sure) 18 mg capsule, by mouth, two times daily. (We didn't get any additional instructions, nor follow-up call.)

6/11/2009

Smiley had the following tests:

thyroid prof 2-SA370
Chem.5 (5-6 tests)
Radiograph abdome
Cortisol 2 Samples
Cortrosyn 0.w5/via

In consultation with several other clinic vets, the atteding vet phoned a prescription to the compounding pharmacy. The pharmacy then called us that they would deliver it the next day. We got the meds, but didn't give them to him.

Please note that we haven't yet started Smiley on this dosage ...our reluctance has been based on a lack of confidence, info, or knowledge. Peter now thinks the dosage *may* be way too high for Smiley's weight. Our reluctance to begin treatment, however, was (and is) based upon the fact that we haven't wanted to start a course of action without knowing more about causes, effects, etc.

His symptoms (described by Peter) are weight gain, bloated stomach w/fat unevenly distributed around neck &side. Panting. Skin rashes, small nodules over much of body. Hair isn't falling out as far as we can tell. He has a good appetite but not ravenous. Has a normal water intake.

Smiley had an ultrasound (abdominal) on 6/17/2009. (We just found the invoice for it...$431.24...the vets office has a "traveling vet" who comes in with the equipment on a cart about once a week.) So this would be in addition to the radiograph mentioned above.

[BestBuddy]

Hi Dorothy (not from Oz) I'm Jenny (and I am from Oz)
I just wanted to welcome you and your clan. You are really doing it tough with more than one dog and I do know that diabetes even when regulated is a bit of work.
Jenny

[Harley PoMMom]

Hi Dorothy and Peter,

If you suspect that Emmett has cushings there is a very non-invasive test that you can do at home and take to your vet it's called the urine cortisol:creatinine ratio (UC:CR).
Ideally 3 morning pooled urine samples are collected by the owners at home and refrigerated and then taken to the vets office. Dogs with elevated cortisol have increased excretion of cortisol in their urine. This excretion can be compared to creatinine excretion, which should be fairly constant in dogs with normal renal function. False-positive elevation of the UC:CR (i.e. elevation not related to Cushing's disease) can occur in dogs with gastrointestinal, renal, lower urinary tract, liver, neurologic, or immune-mediated diseases or congestive heart failure. Although the UC:CR is more frequently elevated than it is normal, when it is normal, you know that your dog does not have Cushing's disease and that you need to look for another possible cause for the dog'sclinical signs.

We're feeling quite abandoned by our vets

Oh Dorothy, we do know how you feel there. When Harley was first dx'd by his former vet by JUST a LDDS test, I wanted more tests run, mainly the full adrenal panel and an ultrasound, Harley's former vet felt that I was "second guessing" his dx and sent Harley and me on our way...I was with this vet for 20 years. He did, however, give us a referral to an IMS, so I am grateful for that and you know what...his dx of Harley's type of cushings was wrong...Harley has Atypical Cushings. Alot of us have seen, still see an IMS for our cushpups, especially if there is multiple problems going on within the pup.

When you post the test results, please post the units the lab uses and the reference ranges too.

Will be looking for your updates! And routine pre-dental procedures, Good job.

Hugs.
Lori

[Smileyspeople]

I do love Oz folks...have Crested friends in NZ...funniest sense of humor! Thanks for the response, now that I know you're around, I *know* that this is a 24/7 forum!

[Smileyspeople]

Our vets took fecal samples at the time of the dogs annual checkups.
Both Smiley and Emmett did not have Cushings ruled out by the results. (Furby was non-cooperative in producting the necessary sample so...who knows)

We were told not to worry, that the tests really didn't indicate Cushings. Emmett is totally asymptomatic and has always been incredibly healthy (He's an 8 y/o this October.) Emmett is intact as he had been a showdog . (He loved it, we didn't) Now...the vet has suggested that he be spayed as it might "mask" Cushings. (He's not breeding and is very much an indoor dog, always supervised. So we haven't seen any reason to "alter his attitude" until this recent spate of veterinary activity took place.

And yes, they have all always had annual (or twice yearly) dentals. Generally have done well for a breed with a history of teeth problems.

[Harley PoMMom]

Hi Dorothy,

I am a relatively new member here, but I do alot of reading about cushings, and I have never come across anything that said that you can test for cushings with fecal samples...urine samples, yes the UC:CR test. You might want to double check this. Fecal pertains to poop.

Hugs.
Lori