PDA

View Full Version : Coolidge...


Coolidge
04-24-2009, 02:17 PM
Hi all. Took me a while to find this, and I was panicking.

Coolidge is now showing all signs of her Cushings. It's been since the middle of October since she was loaded, and only one dose of Lysodren on Jan 1st.

She is scheduled for her ACTH test next week. Everyone mentioned doing the Uof Tenn adrenal panel. Just noticed there are several adrenal panels for dogs. Which one am I to tell the vet to have done?

Appt is for this Weds. Need answers prior to then.

Thanks again for all your help.

Becky and Coolidge (Possible DX 2008)

frijole
04-24-2009, 02:25 PM
Hi Becky and welcome.

Could you start from the beginning. Was the dog diagnosed or not in Oct? I'm not sure about your comment about lysodren. Normally dogs load and then they take the drug weekly. You are saying the last pill was in January? That would be why the symptoms are coming back.

Do you know if your vet has much experience with cushings? You shouldn't have to tell him what tests to do. Can you get records from Oct and see what tests he already did? That would help. Also the results (numbers) on the tests.

Tell us more about your Coolidge - age, type, weight, symptoms. This will help us help you.

Thanks
Kim

stardeb55
04-24-2009, 02:25 PM
Becky, you want the full adrenal panel which is explained at letter "G" on the follow link.

http://www.vet.utk.edu/diagnostic/endocrinology/general.php

Debbie

Coolidge
04-24-2009, 02:30 PM
So long of a story, sorry. She was diagnosed in Sept 2008, but had other issues that could have skewed things. Lepto, UTI's., etc. This all happened after her loading in October. She loaded relatively fast, and wound up almost Addisonian. Really, really low numbers.

My vet wanted her to have an ACTH test at the end of Dec, which she had and showed it was coming back. So she had me begin maintenance. Jan 1st was her first and last maintenance pill. She became very lethargic. In mid Jan, I took her to UW-Madison's vet school, they did an ultrasound of her adrenals, both were of normal size. They told me to hold off treating her until she really showed signs. Which she is.

Everyone on the old caninecushings.net recommended that when this time came, to have my vet send the bloodwork to UTN for their adrenal panel.
The time has come and there is a variety (listed below). Please tell me which one????

Adrenal Function
Cortisol-ACTH Stim Dog, Cat Serum Adrenal Function $30.00
Cortisol-Dex Supp/ACTH Stim Dog, Horse Serum Adrenal Function $35.00
Cortisol-Low Dose Dex Supp Dog Serum Adrenal Function $35.00
Cortisol-High Dose Dex Supp Dog Serum Adrenal Function $35.00
Cortisol-Dex Supp/TRH Stim Test) Horse Serum Adrenal Function $35.00
Cortisol-(Overnight Dex Supp) Horse Serum Adrenal Function $30.00
Adrenal Panel (ACTH Stim) Dog, Cat Serum Adrenal Function $135.00
Adrenal Panel (Combined Dex Supp / ACTH Stim) Dog Serum Adrenal Function $155.00
Adrenal Panel Ferret Serum Adrenal Function $65.00
Adrenal Panel Rabbit Serum Adrenal Function $65.00
17 Hydroxyprogesterone (ACTH Stim required) Dog Serum Adrenal Function $30.00
Aldosterone baseline Dog, Cat Serum Adrenal Function $15.00
Aldosterone
(ACTH Stim required) Dog Serum Adrenal Function $30.00

Coolidge
04-24-2009, 02:33 PM
Thank you Debbie!

ventilate
04-24-2009, 04:15 PM
Do you have the results of the stim tests and of the test you had done to confirm cushings, it could be possible as your vet said that the results could have been skewed due to all that was going on at the time. That could explain why your dog had the reaction it did to the one dose of lysodren, may be your dog does not have cushings. Did the UW Madisons confirm that your dog had cushings? or just do the ultrasound. What signs and symptoms does your dog show?
I am sure someone that knows about the UT panel will be along shortly to tell you which test, that can also confirm cushings. The UT panel is useful when people want to treat with trilostain as that drug is know to increase the other sex hormones in the dog and if there is any possibility that your dog could have atypical cushings it is very helpful to know what the baseline hormones were before starting the trilo. IMO it would would be agood idea to have the UT Panel anyway even with treating with lysodren that does not elevate the sex hormones but you get more bang for your buck you still get the confirmation of a cushings diagnosis and the added bonus of being sure your dog is not atpyical:D
Hope this helps some
Sharon

Coolidge
04-26-2009, 03:27 PM
If she does in fact have cushings (which I assume this full panel will tell me definitively), and we load her, do we have to do another full panel after loading? Or can I have my vet just send off the results of the ACTH followup to her normal lab?

Any insight greatly appreciated. Coolidge is now up all hours drinking and peeing.

frijole
04-26-2009, 03:44 PM
You just said, "if she does have cushings" and I am pretty sure in earlier comments you said you loaded with lysodren... have you been thinking the dog was misdiagnosed originally? Are you wanting to test the adrenal hormones to see if she has atypical cushings? If so the treatment might be handled with flax, melatonin and lignons which are certainly cheaper than chemo drugs.

I do not know if you do the same panel for monitoring progress. I am sure someone with knowledge on atypical cushings will join in the discussion. I'm glad that you are having this test done. Good luck! Kim

stardeb55
04-26-2009, 03:52 PM
Becky, you really just need a regular stim test to monitor your Coolidge while on lysodren. I e-mailed Dr. Oliver about how necessary it is to repeat a full panel, & how frequently, several months ago. His response was maybe in a year as the lyso will control all other associated sex hormones except for estradiol, if Coolidge should happen to have an elevated estradiol. Estradiol is difficult to control because it is also produced in non-adrenal tissue, such as adipose (fat) tissue, the gonads, & a couple of other places. This is where the use of melatonin & lignans comes into the picture, to help control the estradiol. Harley had everything elevated on his full panel at diagnosis a year ago. I have yet to have a full panel repeated, especially after what Dr. O wrote. I may have the estradiol rechecked at Harley's next stim which is due in early July.

Hope this helps.

Debbie

PS- I know it's a real pain, but with the loss of the old cc.net, would it be possible for you to re-post Coolidge's test results? We will be moving to a new "home" within the next week or two which is great news. Even better news, anything that has been posted in our temporary home can be transferred over to the new site, so none of us will have to repost.

Lulusmom
04-26-2009, 04:43 PM
Hi Becky.

I am sure glad that you found us. I remember Coolidge and I also remember fearing that he had been misdiagnosed. As luck would have it, I found a cached page from your thread which had one of my posts on it which will update the other members. I'll see if I can find some more information that might help too.

I've just reread your thread and I've decided that I haven't changed my opinion since the last time I posted to you. I still wonder about the accuracy of a cushing's diagnosis based solely on the results of a questionable LDDS. With the Leptospirosis being diagnosed shortly after, I would certainly question if the whether the LDDS results were false positive. It is also highly unlikely that a cushdog's liver enzymes would return to normal after a regimen of antibiotics. I was hoping that the ultrasound would at least support the LDDs but adrenals are normal.

Both of my cushdogs were switched to Trilostane which I truly regret. Had I done a full adrenal panel prior to starting treatment, I would have known that my little Lulu also had atypical cushing's in additional to pituitary dependent cushing's. We switched back to Lysodren in the last few months. I waited until both were totally symptomatic and then did an acth stim test to make certain that their post stim numbers were at least 22 or 23 before loading them with Lysodren.

If I were in your shoes, I would be highly suspicious of the original diagnosis and would want a lot more evidence than one questionable LDDS. Based on my own experience with switching meds twice under the guidance of a phenomenal internal medicine specialist, I sincerely think you should wait until full blown symptoms return and then have your vet request a full adrenal panel from the University of Tennessee. It is known that Trilostane always elevates one or more of the adrenal intermediate/sex hormones and if a dog has atypical cushing's, Trilostane is not an appropriate treatment as it will makes matters worse and some symptoms will never resolve. I know this first hand because Lulu is atypical and after two years on Trilostane her intermediates were off the charts. Because of this, a lot of us members feel that a full adrenal panel should be done for every dog prior to initiating treatment with Trilostane.

I think that everybody else has already given you this same information in one form or another but I thought it was worth a repeat.

Glynda

Lulusmom
04-26-2009, 04:50 PM
Here is the contents of page 7 of your thread. My post was the only one on page 8. Sorry but that is all I could find.


01-23-2009, 05:37 PM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
Posts: 36
Images: 1

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Results of the urine test are in. The bacteria is e-coli.

Anyone here know how a dog can contract that????

I realize it's not Cushings related, but this is a knowledgeable board.

Thanks for any answers!!!

Coolidge
View Public Profile
Find all posts by Coolidge
View Gallery Uploads

01-23-2009, 05:41 PM
stardeb55
Senior Member Join Date: Apr 2008
Location: Chandler,AZ
Posts: 1,324
Images: 5

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

E. coli is a gram negative rod, & it's probably the most common bacteria associated with UTI's in both people & dogs. There's really no specific explanation as to how a pup may contract it as it is usually part of the normal gut flora. You just need to make sure that the "bug" is sensitive to any antibiotic that is administered.

Debbie

stardeb55
View Public Profile
Find all posts by stardeb55
View Gallery Uploads

01-23-2009, 06:02 PM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
Posts: 36
Images: 1

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

They had her on the doxycycline for a month for the lepto. That was followed by two weeks of amoxicillin. Since neither of them knocked it out they have told me that I have to give Coolidge a new drug, followed a week later by another cystocentises to see if it's working, and if it is, another three weeks of drugs. if not, yet another drug...repeat in a week.

My concern is this, we have well water. If the well water has the e-coli in it, and Coolidge has been drinking this, what is the point of giving her the meds?
With Cushings weakening the immune system, she would continually be getting the UTI (which come to think of it, she has...)


Perhaps I should have the well water tested first and then treat it and her.

Thanks!

Coolidge
View Public Profile
Find all posts by Coolidge
View Gallery Uploads

01-23-2009, 06:07 PM
stardeb55
Senior Member Join Date: Apr 2008
Location: Chandler,AZ
Posts: 1,324
Images: 5

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

I'm in total agreement about the well water. I think you definitely need to get that checked out as a possible source. Also, all they have to do is a sensitivity where they check a number of antibiotics against the bacteria was found i the urine & pick one of the antibiotics that the urine is sensitive to. This switching drugs back & forth sounds a little silly to me, if they just do the sensitivity. This might be worthwhile to ask the vet.

Debbie

stardeb55
View Public Profile
Find all posts by stardeb55
View Gallery Uploads

01-23-2009, 06:14 PM
AlisonandMia
Moderator Join Date: Nov 2007
Location: Brisbane, Australia
Posts: 2,984
Images: 16

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

No it won't be the well water. If that water did contain E.coli it would likely be causing GI problems - which would probably be more likely to be affecting you rather than Coolidge - dogs generally handle these things better than humans.

E. coli infections of the urinary tract have almost always ascended from the outside - probably caused by contamination by bowel bacteria that has got into the urethra so the drinking water will not be an issue. E.coli (various strains) are part of normal mammalian gut flora but will cause a problem if they get into the usually-sterile urinary tract - particularly if there is any immune suppression. Females are more prone to this problem than males although it can and does happen quite frequently in males, particularly in dogs.

If this current round of antibiotics doesn't clear the infection I would think the best thing to do is to have the cysto done and get a culture and sensitivity done on the sample - which means they grow any organisms present and test to see what antibiotics they are killed by. This would be vastly preferable (and probably cheaper) than on-going trial and error.

Alison

If you do have E.coli in your well water that means you have some fecal contamination of the water either from human or animal waste.

Here's a link to some info on e. coli: http://en.wikipedia.org/wiki/Escherichia_coli - there is section on UTI's.

--------------------------------------------------------------------------------
Last edited by AlisonandMia; 01-23-2009 at 09:47 PM.

AlisonandMia
View Public Profile
Find all posts by AlisonandMia
View Gallery Uploads

01-23-2009, 06:58 PM
maggiebeagle
Senior Member Join Date: Jan 2007
Location: LaPorte, Texas
Posts: 271

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Some of us have found that giving our pups cranberry pills or juice helps prevent a reoccurence of UTI's. Research has shown that it helps prevent the attachment of the bacteria to the wall of the bladder. Maggie has been UTI free for two years while taking cranberry pills.
Some of us have speculated also thatg with the more dilute urine our cushpups have, the antibiotic doesn't reach the proper therapuetic levels in the urine and takes longer to do its work. I agree with Debbie, your vet should have susceptibility data on the E. coli and should be able to pick one that will work.
Virginia and Maggie

maggiebeagle
View Public Profile
Find all posts by maggiebeagle

01-26-2009, 08:19 AM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
Posts: 36
Images: 1

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Thanks for your help. We will get to the bottom of this glitch in Coolidge's treatment. Speaking of..

The vet school was covering as many bases as they could. They treated Coolidge for parasites as well. Some powder substance that I gave her for three days. Other than the difficulty of adding powder to dry food (didn't want to give her wet food because that would really give her diarrhea).

Still awaiting the lab reports for the IBD and Pancreatitis.

ps. My backyard abuts a corn/soy field. I live 1/4 mile away from the biggest landfill in SE Wisconsin. The odds of something being in the well water are pretty good. Whether or not it is the source, who knows. Better safe than sorry.

Coolidge
View Public Profile
Find all posts by Coolidge
View Gallery Uploads

01-26-2009, 09:02 AM
gpgscott
Forum Administrator Join Date: Feb 2007
Location: SC
Posts: 3,995
Images: 19

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Quote:
Originally Posted by Coolidge
ps. My backyard abuts a corn/soy field. I live 1/4 mile away from the biggest landfill in SE Wisconsin. The odds of something being in the well water are pretty good. Whether or not it is the source, who knows. Better safe than sorry.

Unrelated to Cushing's this comment is disconcerting, I bet if you contact your local EPA office you may find that this landfill would be responsible for periodic testing of your water.

Scott

Coolidge
04-27-2009, 05:40 AM
I'll try to get together a short synopsis of test results starting with her "original" diagnosis.

I have it at work, will post from there. THanks again!


Just to clarify, the specialist/internist didn't run the tests in the normal course of treatment, and what I learned from this board, I didn't have any controlled test results to show a before and after. Just an after. The ACTH test was only done after Coolidge was loaded. There wasn't one done before. And she didn't prescribe any prednisone for Coolidge, and after loading Coolidge had very very low numbers, and THEN she prescribed the prednisone. So in reality, we had no idea what Coolidges numbers were at before she was loaded. And since she loaded in a relatively short time, there was a question of whether or not Coolidge did have Cushings. It peeved me that we trust those with the knowledge and put our furkids into their hands.

I'm just trying to dot my i's and cross my t's now. Follow procedure and what people on this board recommend from experience. (That's why I panicked in not being able to find you all).

Coolidge
04-27-2009, 08:00 AM
Found the note I wrote to you all in January, hope this sheds light on my questioning her diagnosis.

9/2/2008, Took Coolidge into vet due to her increased appetite, drinking, urination.

9/5/2008, results come back from vet bloodwork. Elevated ALP. (results not included here, trying to locate). Vet states that she believes the Coolidge has Cushings, and that I should take her to a specialist to confirm. She also states at that time that if it is Adrenal gland Cushings, not to do surgery; and that if pituitary, not to do the lysodren.

9/8/2008, take her to see an internal medicine specialist. This specialist’s area of interest is Addisons. I figure she’s had experience with Cushings animals. Coolidge, it turns out, would be the 2nd Cushings patient at the clinic.

Vet does palpitations, ultrasound, and LDDST. Reading the notes, liver is normal reading (NR). However, ultrasound shows adrenals as bilaterally plump. Please note the size differences between these.

9/13/08, horrible diarrhea for three days. We wake up to piles of yellow bile throwup everywhere. Coolidge is very lethargic. I even was considering putting her to sleep that morning, especially with the possibility of Cushings. I figured if this was any indication of what she was to be going through, I didn’t want to put her through it.

We take her to the emergency vet hospital. They tell us that the diarrhea and vomiting isn’t a symptom of Cushings. And that we should run bloodwork, which we do. Their notes on the other hand say they recommended hospitalization and we refused, which they never did, or we would have agreed to it. (Hindsight, they never tested for lepto at this point.)

It is at this visit that we find out the results of the ultrasound and LDDST. The Emergency Vet says the results show Coolidge has Adrenal Cushings. He then says that it’s always good to have a second opinion, and the 2nd vet says “no, Coolidge has pituitary cushings”. They then call the specialist who ran the tests and she says, “I don’t think Coolidge has Cushings at all.”

LDDST (9/09/08)

Cortisol Sample 1 4.9
Cortisol Sample 2 3.0 (High)
Cortisol Sample 3 1.6 (High)

ULTRASOUND (9/9/08)

Adrenal Glands –L: 4.57 x 1.17cm; R: 3.09 x 0.89cm
Interpretation: Adrenal Glands are bilaterally plump.


We took the meds for Coolidge and took her and her football size lump of SubQ fluids home.

10/1/08, Took Coolidge back to specialist due to diarrhea again. (She wrote in the records that it was for recheck). She is now drinking 3 gallons of water a day, needing to go outside every 30 minutes. Her appetite is increasing. Specialist does not mention doing an ACTH Stim test at this point.

10/9/08, Have our other dog into emergency vet due to rock eating incident. Specialist asks if I have put Coolidge on lysodren yet. Told her that I was hesitant in doing so due to the fact she really didn’t strike me as being certain Coolidge has Cushings. She says that Coolidge does have Cushings and that I really should start the meds. I ask her for prednisone, she says that at the low dose she is giving Coolidge, prednisone is not necessary. (Hindsight, the dosage Coolidge was on was by no means a low dose 750 mg/bid).

10/13/08, we begin the loading phase for Coolidge. Was told to look for decreased water consumption and decreased appetite. Neither occurred during loading phase.

10/17/08. Coolidge begins having soft stools again.

10/18/08, Coolidge is acting a little strange, almost lethargic. I call the vet, she is not there. Receptionist relays to the vet that I am stopping giving Coolidge her pills. Vet relays through receptionist that I should continue.

10/19/08, Gave Coolidge her morning dose of Lysodren. She spent the afternoon with diarrhea and vomiting. Took her off loading and scheduled an appt.

10/20/08, Coolidge has her ACTH Stim test. As a precaution, specialist now gives me the prednisone with instructions to give Coolidge 2 tablets the next day and until further notice or that I see that she is having any signs of distress.

10/21/08, I call the vet for results. They aren’t in. Vet will call when in. Vet calls at 8:30 that night to tell me that Coolidge’s numbers are now low and to continue giving Coolidge the prednisone if she looks like she’s having problems. I tell her that she appears to be doing fine and that I would be giving Coolidge 1 tablet the next morning and that would be it. (Total Pred: 3 tablets.)

ACTH Results

Cortisol Serial 2 (ACTH)
Sample 1 0.9 (low)
Sample 2 0.6 (low)


11/4/08, Coolidge has been having difficulty walking the past few days. This along with horrible diarrhea again. She also is very lethargic. Specialist thinks she may have lepto and wants to test for it. She takes a blood sample. Forgets to take urine sample. I have to go in again later that week and drop off the urine sample. Gives me meds to give Coolidge just in case it’s lepto.

11/06/08, Coolidge log indicates that her thirst and appetite is starting to decrease. Hindsight? She’s been on the doxycycline for lepto for two days.

Super Chem Blood Test Done
ALK Phosphatase is high at 732 IU/L
Glucose is low at 51 mg/dl

It’s at this time that the urine tests show she has tested positive for five of the seven serovars of lepto.

Her urinalysis shows low specific gravity (1.006) and high pH (8.5)

11/12/08. After daily calls and messages left at the AEC, I finally get a call from the specialist. Coolidge does have a mild case of Lepto. She doesn’t tell me that it’s contagious, that I should be taking special precautions with our other animals. Nothing.
On the other hand, Coolidges water intake is now down to 14 cups a day and her appetite was back to normal a few days earlier!!! Yippee…

11/20/08, It’s been a month since Coolidge was loaded, I called and asked for another ACTH Stim test. Her appetite has started to increase. Stim test done.

ACTH Results

Cortisol Serial 2 (ACTH)
Sample 1 56 nmol/L
Sample 2 73 nmol/L (low) (220-550 is norm)

Fed up, I change vets.

Buffaloe
04-27-2009, 08:49 PM
Hi Becky,

We had a very long and difficult diagnosis with my dog. Finally, my primary gp vet did a great thing which directly led to our confirmed diagnosis. He contacted the lab at U. of Tennessee and explained everything we had previously done and asked what test(s) they recommended. They recommended the following test which we had performed:

Adrenal Panel (Combined Dex Supp / ACTH Stim) Dog Serum Adrenal Function $155.00

It is a combination LDDS/ACTH stim test and includes a full adrenal panel. After we got the written results, we contacted Dr. Oliver and at that point he succinctly told us he believed Shiloh had a primary adrenal tumor. I'm just saying, either you or your vet could contact the people at U.T. and see what test(s) they prefer given your situation.

I sure don't know what is going on with Coolidge. I'd say his left adrenal gland is pretty darn plump and is quite a bit larger than his right.

What kind of dog is he and how much does he weigh? I sure do wish you and Coolidge all the best.

Ken

Coolidge
04-28-2009, 05:08 AM
Coolidge is a German Shepherd/Newfie Mix, who at the beginning of all of this weighed 100+ pounds. She is now at 84 and holding.

Her weight loss was another issue in January. Which is one of the main reasons we went to UW Madison. She lost nearly 5 pounds immediately after the ACTH test at the end of Dec. And continued to lose until shortly after the UW visit. I'm working on getting the results of the other tests since January.

Her adrenal glands (at least as of the middle of January) were of normal size. And yes, I did question the bilaterally plump (which to me meant they were both plump and of equal plumpness). One was quite larger than the other. Perhaps this is what got the one vet to say she had Adrenal Cushings.

I'll ask my vet about checking with them before tomorrow.

Thanks for the help!

Squirt's Mom
04-28-2009, 09:02 AM
Hi Becky,

I gotta tell you....reading Coolidge's history is just scary. You seem to have had quite a farce of vets going on here, contradicting each other, giving poor advise, failing to communicate with you, not seeing Coolidge as an individual... How sad. :( You and Coolidge have payed for it, too, in more than one way. :( If it were me, and were possible, I would be looking for some fresh eyes to look at her. Give all her signs, changes, etc but with no mention of a previous diagnosis or testing. It seems sometimes docs, both human and animal, get locked onto an idea and develop tunnel vision. I think you are on the mark to question her initial diagnosis! :cool::cool:

Since we don't have all the info from the other site, can you refresh my memory on how long it's been since she was tested for hypothyroidism and diabetes (DM and DI)? The signs you mention can indicate Cushing's but they are also connected with some other conditions such as those above. The weight loss is not usually seen with Cushing's, more often seen with diabetes, tho some cush pups do present with this sign. How long has it been since she had what Dr C calls a SuperChem - a full blood workup? You said "Her adrenal glands (at least as of the middle of January) were of normal size"; I am understanding by this that she had another U/S since the one listed 9/08 and that the adrenals had returned to normal size. Is this correct? If so, it makes sense to me that, with all she had going on when first diagnosed with the iffy LDDS, the adrenals could have been larger due to the extra work they were having to do in dealing with the physiological stress Coolidge was under at the time. (But that is my logic only, no medical backing. ;) ) The IMS who wrote the adrenals were "bilaterally enlarged" in 9/08 sounds like the one Squirt first saw who didn't think it necessary to let anyone know she had a tumor on her spleen. Got their heads somewhere else rather than on our babies or they just don't care! :mad:

Have you had your water checked? Having lived in a house where the water supply was contaminated, take some advice if you decide to do that...get samples from someplace like the outside faucet, someplace drinking pipe isn't used and no filtering process should be going on. There may be no difference between a sample from a source like that and the kitchen faucet but, then again, there could be. There was for me. BUT, like Alison said, the humans were the ones sick, not the dogs. So if you and your family don't have any issues then the water may not be the problem. I don't know enough about bacterias to know if some may target animals and not humans from the same source.

Keep your chin up, Becky. You are doing a great job in trying to find out what is wrong with Coolidge. :) Your perseverance not only in getting to a correct diagnosis but in trying to learn all you can, is admirable.

Hugs,
Leslie and the girls

Buffaloe
04-28-2009, 05:18 PM
Hi Becky,

What a great mix, german shepherd and newfie! I'm sure she is one heck of a dog.

As I understand it, you had two ultrasounds, one in November and another at UW in January. Both said the adrenal glands were pretty much normal in size. That should rule out an adrenal tumor. I think the reason the emergency vet thought she had an adrenal tumor was because of the size of her Lt. adrenal gland (4.57 cm x 1.17 cm) on her November ultrasound. Unfortunately, this can be tricky stuff.

If it was me, I'd call the lab at U.T. and explain things to them (hopefully, in an organized fashion :eek:) and ask what test they recommend. I would think that they might be able to tell more from the combination LDDS/ACTH with the adrenal panel than just the ACTH with the adrenal panel. Of course, I'm not sure but the U.T. people could tell you. I can tell you this...the written results we got after the combination test were very complicated. I contacted Dr. Oliver myself and he was great and told me that based on the test results, he thought Shi had an adrenal tumor.

I'm sorry you are having such a tough time figuring out exactly what is ailing Coolidge. I went through a similar scenario for two months and it consumed my life, all the while Shi was getting worse and worse. I hope you can find the right veterinary professional to help you. I felt like a couple of the vets I took Shiloh to just looked at me as some surfer dude off the street with an older, sick dog who wasn't going to live very long anyway. Finally, my primary gp vet came through. But, I seriously stepped on some toes and I had to follow up on things myself to get all of the information.

Hang in there Becky, hang real tough and do what you gotta do to take care of Coolidge. I'm confident it is something treatable and she can be a happy, healthy girl for many years to come. From my experience, working with the lab at U.T. and Dr. Oliver is a big cut above.

Ken

AlisonandMia
04-28-2009, 05:36 PM
I've just put up one of the threads regarding "Atypical Cushing's" - it includes links info on the the testing (near the bottom):

http://www.k9diabetes.com/forum/showthread.php?t=845

Alison

Coolidge
04-28-2009, 06:13 PM
Help. Coolidge is supposed to be fasted before the test. Does this mean water as well? She can't go long without it! Answer needed, as the fast goes into effect shortly.

stardeb55
04-28-2009, 06:17 PM
Water is fine.

Debbie

Coolidge
04-29-2009, 05:30 AM
I know I sound like a nut case. Just want to make certain I have everything in order so there is no chance for skewing the tests.

I just remembered that the last ACTH test done at the end of Dec required fasting as well. (I'm pleading senior moment.):o (None of the other ACTH tests were done with fasting.)

I just want an answer. I'm hoping this test will explain everything. The most expensive part of this is the shipping. Go figure.

I will keep everyone informed of the results of the tests.

Thank you everyone! I'd be lost without this board.

Roxee'sDad
04-29-2009, 06:28 AM
Hi Becky,
Wow, what an epic you and Coolidge have been thru. I have nothing to add except good thoughts and prayers that you and Coolidge finally get a proper diagnosis and poor Coolidge gets a well deserved break.

Were all keeping our fingers and paws crossed.

John (Roxee's Dad)

Squirt's Mom
04-29-2009, 08:59 AM
Hi Becky,

You are doing just fine! Nut cases are always welcomed as I need all the company I can get! :p

I am sure UTK will be able to help Coolidge get the right diagnosis if this is Cushing's. That is one fine bunch of folks at UTK! Especially Dr O and his staff.

Squirt has had to fast for one of her ACTHs but not the others. I'm not sure what the difference is as to why they fast sometimes and not others. Seems like others have experienced this as well.

Like Ken said, hang real tough! We are hanging with you and are here anytime you need us.

Hugs,
Leslie and the girls

Coolidge
05-07-2009, 08:12 AM
Well, it's been a week since they sent the samples to UT. I called my vet out of concern that no results have been forthcoming.

They called UT and they said they were "in the works". I'm glad I had this done, but I now know that they aren't the people I'd send any more samples to after her next loading phase. With Coolidge's low counts last time, we wouldn't have the luxury of waiting a week to put her on steroids.

Hopefully will hear back from them tomorrow or Monday. This waiting sorta, well, sucks - for both Coolidge and I. She's getting slower and her head hangs low. Would be nice to see her back at her perky self.

Thanks for all your support!

stardeb55
05-07-2009, 08:29 AM
I thought one of us had mentioned that it take 10-14 days to get UTK panel results back. How they handle their testing is they go through their freezers every Monday, collect up all sample received from the previous week, & start running panels on Monday. You are exactly right, this is why you don't send your routine stims to UTK. Routine stims need to be done by one of your regular vets so you get them back in a timely manner for med monitoring purposes. I'm contemplating having a repeat panel run on Harley at his next stim in July, but I will clearly indicate to my vet the stim is to be done locally, the remainder of the panel is to go to UTK. I also intend to make sure that UTK does not run a cortisol as I'm not going to pay twice for the same test.

Debbie

PS-Being a lab tech, I can understand why UTK has to batch their panels in this manner. I'm sure that the necessary supplies/reagents to do this testing are hideously expensive, so the more tests they run at once, the less the expense, & the less you have to pay as the owner. I shudder to think what a panel would cost, if they were being run one at at time.

Coolidge
05-11-2009, 12:55 PM
The results are in. Just got a call from my vet. Cortisol levels were normal before and after.

However, the Hydroxyprogesterone and Progesteronewere elevated. My vet spoke with Dr. Oliver, who stated that Coolidge does in fact have ATYPICAL CUSHINGS.

He recommended a treatment of Flaxseed and if that didn't work, melatonin.

Now to research the atypical cushings.

I will post test results after I receive them. Thanks again for all your help!

stardeb55
05-11-2009, 01:23 PM
A couple of things. FSO & melatonin are usually used together. I can think of no one in this group who has an Atypical pup that is not using both of them, & that includes my Harley. This is per the treatment recommendation sheet from UTK. There should be one of these recommendation sheets that came with Coolidge's results. It would be a good idea if you could get a copy.

When it comes to the FSO, most of us are using some type of product that is purified lignans. Lignans are the active ingredient that works. The purified lignans allow you to make sure that you are giving a consistent, standardized dose, where the FSO is hit & miss about dosing. Also, a lot of Cushpups have liver issues, & adding the extra oil to their diet is not ideal. You might take a look a vitacost.com as I know they have a purified lignan. Several members are also using crushed flaxhulls from flaxhulls.com, but I'm not sure about the dosing on this product.

Debbie

Lulusmom
05-11-2009, 01:45 PM
Hi Becky,

I am so glad that you finally have a correct diagnosis. YAY!!!! Sorry for getting excited about your baby having Atypical Cushing's but I am pretty jazzed that it looks like he never had typical cushing's. That would certainly explain the apparent sensitivity to Lysodren. Having said that, I want to make it perfectly clear that not all dogs with normal cortisol are sensitive to the drug. The dogs involved in the original studies of the drug (then called o.p.-ddd) in the early 1940's were very healthy with normal adrenal activity. Many proved to be resistant to o.p.-ddd as they received very large doses of the drug for up to a year with no ill effects.

Please make sure that your vet gives you a copy of the treatment recommendations sheet that usually is attached to the panel results. I don't recall any other member advising that recommended treatment was solely flaxseed. Most of us atypical parents were given appropriate dosing for both melatonin and flaxseed oil with lignans. Since fso has a negligible amount of lignans, a lot of us have opted to leave the fso behind and go with purified lignans or the pressed flax hull lignans. Website links for the two latter products can be found on the utk website.

We'll be waiting to see the actual results of the panel and will be anxious to see how Coolidge responds to his new treatment. Just keep in mind that, often times, treatment with melotonin and/or lignans can take up to 3 to 4 months to see improvements so patience really is a virtue with atypical cushing's. :D

Glynda

P.S. I see that Debbie posted way ahead of me so sorry for the duplication. I'm at work and it really ticks me off when work gets in the way of my posts. :D

Wylie's Mom
05-11-2009, 01:52 PM
Atypical...That's great news!:D

Did you get a copy of the actual results? I agree with Debbie - just using one of the two doesn't make sense - get the actual treatment recommendations that UTK provided. They will list treatment option numbers and those numbers correspond to this list (on their website):

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing's.pdf

-Susy

Coolidge
05-11-2009, 02:30 PM
Well, my vet is snail mailing the results to me. I guess I could call and have them faxed to me.

She was pretty specific about what Dr. Oliver said. He wanted to start on the Flaxseed (powdered, not oil) and if that didn't cut back on Coolidges problems, to go to the Melatonin. He said that the last item to try was the Trilostane and only at maintenance doses (no loading). He agreed with the UW Vet school that Coolidge was hypersensitive to the lysodren and should be switched in that event.

However, I need your assistance in understanding Atypical Cushings. All I know is that instead of having excess cortisol (steroids) which left unchecked could lead to liver/kidney/heart problems; she has excess sex hormones. The first thing I thought of was, well, what kind of problem is that? ;) But obviously there must be some ill effect from that as well. Can anyone share their insight with me?

The following link was interesting, but didn't tell me what I needed to know, at least in lay terms.


http://veterinarynews.dvm360.com/dvm/Veterinary+news/Newer-tests-shed-light-on-causes-treatment-of-adre/ArticleStandard/Article/detail/485128

stardeb55
05-11-2009, 03:42 PM
Excess production of the associated hormones, usually estradiol, progesterone, & 17-OH can cause the same sorts of liver damage that the excess cortisol will do. I almost sure that skin & coat issues are a common problem, too.

I'm not doubting your vet's word, but I think there may be a misinterpretation of what Dr. Oliver has said, this is why it's important to get a copy of that treatment recommendation sheet. The following link is the treatment recommendation straight from the UTK website, it might be good to review. I would also suggest you take a look at the enclosed link for Dr. O's article on steroid profiles.

http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Hope this helps.

Debbie

Coolidge
05-11-2009, 03:59 PM
What I would give for a webpage that listed the complications of atypical cushings. Something that people can understand.

So basically she is in the same boat she was before, other than a final diagnosis.

I will still have to watch her closely, liver and other organs can still be affected.

I will have them fax me a copy tomorrow.

In the meantime, thank you thank you thank you. The expertise on this board is unsurpassed.

gpgscott
05-11-2009, 04:38 PM
Sorry I have not posted to you earlier, it has been a crazy period.

Yes, get the treatment recommendation.

It will most likely be melatonin and lignans.

It is not a profound treatment like Lydosren or Trilo and that is because these other hormones although profound in their effect over time are not as immediately affected.

My Moria has been on melatonin and lignans now for almost 2 years. She is 15 years old. She is responding well to the treatment.

Scott

Coolidge
05-12-2009, 03:20 PM
Results are in:

Cortisol:
Baseline: 24.2 ng/ml (Normal 2.1-58.8)
Post Acth: 83.1 ng/ml (Normal 65-174.6)
Androstendedione:
Baseline: 0.03 ng/ml (Normal 0.05-0.57)
Post Acth: 0.80 ng/ml (Normal 0.27-3.97)
Estradiol:
Baseline: 63.4 pg/ml (30.8-69.9)
Post Acth: 54.2 pg/ml (27.9-69.2)
Progesterone:
Baseline: 0.13 ng/ml (0.03-0.49)
Post Acth: 1.60 ng/ml (0.10-1.50)
17 OH Progesterone:
Baseline: 0.11 ng/ml (0.08-0.77)
Post Acth: 2.22 ng/ml (0.40-1.62)
Aldosterone***
Baseline: 76.1 pg/ml (11-139.9)
Post Acth: 141.4 pg/ml (72.9-398.5)

*** Normal range values for male and female dogs (N=72 baseline, N-23 post ACTH)

Dr. Oliver's Comments: Most hormone levels are normal, but both progestin's are modestly increased at stim. Consider items 2 or 3 or 5 on the treatment option sheet attached.

Feel free to comment. Thanks. (Am I the only one who thinks these "abnormal" findings are extremely mild, and that Cushing's really isn't the cause for her problems?")

Please note that I just realized his recommendation is different from what my vet told me he said. Have asked for clarification.

stardeb55
05-12-2009, 04:19 PM
Could you post exactly what items 2,3,5 are? Yes, the elevations are mild compared to some that I've seen. The standard treatment of melatonin + lignans is pretty mild, so it might be the best thing to try. If it doesn't help, at least, it can't hurt.

Debbie

AlisonandMia
05-12-2009, 04:30 PM
This is the UTK's treatment recommendation sheet: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing%27s.pdf

Alison

Coolidge
05-13-2009, 05:19 AM
The treatment, according to Dr. Oliver would be:

2) Melatonin or
3) Melatonin implants or
5) Lysodren maintenance dose

I'm thinking (and waiting for it to be confirmed) that my vet pointed out that Coolidge is very sensitive to lysodren. So he probably recommended at that point to switch it to flaxseed or melatonin or Trilostane. However, reading up on the trilostane, we really don't want to go there because its not recommended for dogs with the higher progesterones. So I think the flaxseed and melatonin will be our course of action.

So she's mildly atypical cushings. Seeing what she is going through and being mild, I don't envy what you are all going through. Coolidge is experiencing a hiccup in her road of life. Others are experiencing tidal waves.
You all are tremendous in your love for your furkids.

ps. I'm having the vet check all of Coolidges records to find out if Coolidge was ever specifically tested for Diabetes.

Coolidge
05-13-2009, 05:59 AM
I've probably asked this before, but what does one do with extra lysodren that they aren't going to use?

I have 15-20 500mg pills I halved for Coolidge. Before it expires, I'd like to find a home for it.

Wylie's Mom
05-13-2009, 01:55 PM
Regarding the Lysodren - I would donate them to an animal rescue or shelter if they could use it or see if your vet could donate them to a client.

I'm thinking that the flaxseed lignans are not necessary... I believe it is primarily for the patients that have increased estradiol levels. But see what the others think about this or double check with Dr. O.

-Susy

Wylie's Mom
05-13-2009, 02:26 PM
Becky,

I was trying to get more background information on Coolidge... here's the first page of your cc.net thread:

http://74.125.95.132/search?q=cache:ylfNyYI9fOIJ:www.caninecushings.net/forums/showthread.php%3Fp%3D88310+%22coolidge%22+site:www .caninecushings.net&cd=20&hl=en&ct=clnk&gl=us

You had posted on 01/02/2009:
"Results of the ACTH stim test following the loading phase was 0.9 and 0.6 ug/dl. (That was the 20th of October)...Latest are Sample 1 (5.5 ug/dl) and Sample 2 (8.8 ug/dl)."

This is from your first post on this thread:
It's been since the middle of October since she was loaded, and only one dose of Lysodren on Jan 1st.

I'm confused - I just want to make sure - please confirm that we are sure Coolidge does not have regular Cushing's? The "within range" cortisol levels on the UTK panel are not due to the Lysodren?

-Susy

AlisonandMia
05-13-2009, 06:54 PM
I'm thinking (and waiting for it to be confirmed) that my vet pointed out that Coolidge is very sensitive to lysodren. So he probably recommended at that point to switch it to flaxseed or melatonin or Trilostane. However, reading up on the trilostane, we really don't want to go there because its not recommended for dogs with the higher progesterones. So I think the flaxseed and melatonin will be our course of action.

If Coolidge is indeed particularly sensitive to Lysodren this does not mean that she can never take it - it could simply mean that she is best served by a much-lower-than-usual dose. Occasionally an individual dog does seem to be inordinately sensitive to Lysodren (or Trilostane for that matter) and in those cases unusually low doses are used - which is actually a good thing rather than a problem. If nothing else it saves money.

I believe that Trilo can lower progesterone but that it raises 17 OH Progesterone so would probably cause problems on that front. It also lowers cortisol and if her cortisol levels are so nice and normal then Trilostane could very well result in a low-cortisol situation much as you saw with the Lysodren overload.

When just a maintenance dosing of Lysodren (no loading) is used in Atypical Cushing's the aim is to give a dose that is sufficient to just gently damp down the adrenal overactivity but not to actively erode adrenal tissue which is what the aim is with a dog with Cushing's where the cortisol is elevated. When this is done a low-end maintenance dose is usually trialled at first, particularly with a larger dog. I believe Dr. O usually advocates 25mg/kg per week to start with and for a dog that could be sensitive to Lysodren starting considerably lower would probably be the way to go. Your vet could consult with Dr. O should it look like Lysodren treatment is in the offing and he could advise based on Coolidge's history and your concerns.

It is possible that Coolidge went very low after just one dose of Lysodren simply because she did not actually have elevated cortisol to begin with. Larger dogs often need a smaller mg/kg dose than do smaller dogs and will often load very fast on the regular 50mg/kg so that may have been a factor too.

I do share Susy's thought that the normal (very normal) cortisol levels on the UTK panel may be because the adrenals have not yet regenerated fully after the Lysodren overload. If that is the case then the production of other hormones may still be lower than it was pre-treatment too. How long adrenals take to regenerate is a real how-long-is-a-piece-of-string thing so time will tell if this is the case. Fingers crossed that what you have now is indeed a true picture though.

Alison

Coolidge
05-14-2009, 03:00 PM
She underwent lysodren loading in Oct of 2008. She wound up with very, very low numbers on the ACTH test immediately following the loading.

Another followup ACTH test at the end of November showed the numbers till low.

Another followup ACTH test (Coolidges thirst had increased two fold) was done at the end of Dec. Numbers were rising, (don't have them but will get them), so my new vet thought we should begin maintenance. Gave her one pill on new year's day. Period. She immediately became very lethargic.

Mid Jan she had an ultrasound done at UW Madison Vet School. Adrenals were normal. (She was taken there because she had lost over 20 pounds between Oct and Jan 1st.)

While there, they discovered Coolidge had a UTI. Took three different antibiotics to get rid of it. Thirst decreased.

Never had a ACTH stim test done before Coolidge was loaded because the "specialist" said it wasn't necessary. She was basing her decision off of the Creatine Test and the LDDST. So I had no ACTH preloading numbers to reference.

So, it's now the middle of May. It's been over 4-1/2 months total since her last lysodren tablet. Can lysodren stay in the system that long?

added:

Crap. Can a dog have both atypical and pituitary based cushings at the same time? Just when I thought we had "the final answer"?
If things aren't bad, what is causing her symptoms? She was tested for Diabetes at the end of December.

All I know is this. I have spent $3000 on tests that have given me absolutely no answers.

stardeb55
05-14-2009, 03:03 PM
Lyso normally peaks about 48 hours after the dose is given. Frankly, I don't think there's any way that Coolidge would even still have a trace amount of lysodren iin her system after this extended period of time, even if she is highly sensitive.

Debbie

Wylie's Mom
05-15-2009, 02:59 PM
Crap. Can a dog have both atypical and pituitary based cushings at the same time? Just when I thought we had "the final answer"?

Yes, it's possible (my pup is one of them:p). I'm not a vet, but given the recent UTK panel & given how little Lysodren was used & how long it's been since Coolidge had any of it... I would think he does not have regular Cushing's...just a non-vet's opinion;).

-Susy

stardeb55
05-15-2009, 03:04 PM
Yes, Harley is another Atypical + Pit Cushing's. I'm in total agreement with Susy that I, too, think that the problem for Coolidge from the beginning was Atypical, not Pit Cushing's, thus the bad reaction to the Lyso.

Debbie

Squirt's Mom
05-15-2009, 03:26 PM
Hi Becky,

Another PDH/Atypical parent here. :)

Based on Coolidge's reaction to the Lyso and the UTK panel, I think you are dealing with Atypical only! YEAH! If I were you, I would not let the vet use any Lyso for now. Try the melatonin and lignans first for a good while, then if it seems the signs are not controlled, check the cortisol again. But I feel you may have just lucked out and Coolidge is simply Atypical! :D Just another "non vet" opinion! ;)

Hugs,
Leslie and the girls

Wylie's Mom
05-15-2009, 03:39 PM
I think it's still questionable whether the flaxseed lignans are necessary... he doesn't have elevated estradiol levels - I'm not absolutely positive, but I thought the lignans were more for controlling the estradiol levels:confused:.

-Susy

stardeb55
05-15-2009, 03:40 PM
Susy, I believe you are 100% correct about the purpose of the lignans.

Debbie

Harley PoMMom
05-15-2009, 08:07 PM
On the Treatment Option Considerations Paper I got back for Harley it has under option # 3:

Note: Melatonin and flaxseed oil with lignans are used together when estradiol is increased.

I seen from older sheets that it used to say may be used together, so, I guess Dr. Oliver changed it?

Coolidge
05-16-2009, 10:50 AM
Just thought I would post the results of the ACTH stim test done at the end of December, when my new vet said I should start Coolidge on maintenance.
Of course one test lab does it in ng/ml and this one did it in ug/dl. (Math has never been a strong suit).

December Results:

Pre-ACTH: 5.5 ug/dl (norm: 2-6)
Post- 8.8 ug/dl (norm: 6-18)

However, I noticed that the notes in the reference range (from Idexx) says 1-5 is the desired pre and post cortisol on lysodren therapy (which I assume means that's the numbers you want to keep it at during maintenance.

Perhaps that one pill put her over again.

The endocrinology report on her thyroid (done also at the end of Dec) has everything in the normal range except for:

Free Thyroxine (FT4) 7 pmol/l (8-26 norm)
Free Triidothyronine (FT3) 1.5 pmol/l (4.5-12 norm)
T4: 2% (Norm 0-20%)
T3: 3% (Norm 0-10%)

The thryrogobulin antibody results were:
<20% Negative
20-35% inconclusive
>35% positive


The endo guy at Michigan State said "The free fractions are borderline to low, but total fractions look good. TSH is not elevated and the specific TgAA is negative. Hence, not real indication of primary thyroid disease."

I don't know about all of you, but I'm getting pretty tired of "we will treat it as if" and "not real indication". It's like it's purely a guessing game at the expense of our animals. One would think this guy on this test would have said, hmmm, that FT3 number is really low, I wonder what is causing that... and do a Dr. House on Coolidge. Where is Dr. House when you need him?

Coolidge's panting, drinking, hunger, and urination is getting worse by the day. Her cough is getting huskier and more frequent.

I'd like to think that one day we will have this all resolved. And a final determination made. I'd like to think it's just Atypical, and we do the melatonin routine. I will keep the lysodren just in case we do need to go there. But I will tell Hope Safehouse, a rescue in our area, that I have pills in the event a pup needs some. I will be able to share.

stardeb55
05-16-2009, 02:02 PM
In theory, with a post of 8.8, on dose of lyso should not have caused an Addisonian crisis. I still think the real problem is that Coolidge never had PDH to begin with, & that's why there have been so many problems with the lyso.

Debbie