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**frijole** · 04-25-2009, 04:49 PM

Re: Newly diagnosed, our beloved Buddy

Hi Karen! Guess what - I'm from Columbus NE! You sound like you have a house full of critters. How wonderful. I can't wait to learn more about Buddy.

My dog Haley is now over 15 and was diagnosed 3 yrs ago and has been on lysodren the entire time. I understand your hesitancy to use what might seem like harsh drugs. I assure you that unfortuneately there is no herbal cure or I would certainly have gone that route and the drugs are not nearly as nasty as what I read early on.

You came to a fantastic site for information. That's how I landed with this group as well. We are simply cush parents that have been down the same path and want to share our many and varied experiences with others.

As you will learn, cushings is a serious disease if not treated. Do you know if it is pituitary, adrenal or atypical cushings? It might help if you tell us more about the testing that was done to diagnose. Believe it or not there are times we see misdiagnosis so we never assume.

Atypical cushings can be treated with flax, lignons and melatonin. Adrenal can sometimes be "cured" with surgery and pituitary requires treatment, typically with either lysodren or trilostane.

While you might just be dealing with abnormal thirst now - at some point that thirst will end up as urine all over your house.

Sorry but thats what happens. And it isn't Buddy's fault... what is happening is that his body is over producing cortisol and it is causing him to be very thirsty - he needs to hydrate his body. Don't limit his water intake as that can hurt him as he needs it.

Probably when you did the tests you found that his liver enzymes (alk phos) were elevated. Most of have this. Liver is the gateway to all major organs and when cushings goes untreated organs can and will eventually fail. It varies but it can be that they go blind, develop diabetes, or have kidney or heart failure. This isn't a decision you have to make immediately and you are wise to read as much as you can about the disease and ask us as many questions as you want.

So tell us about Buddy, his symptoms, the tests that were done. That will help us help you and him. I am so glad you found us.

Hugs from Haley and I
Kim (frijole)

**Kakesie** · 04-25-2009, 05:43 PM

Re: Newly diagnosed, our beloved Buddy

Hi Kim & Haley,

Thanks so much for your reply!!! We just talked to our vet yesterday, (Friday) and now I wish I had asked more questions. The first thing we noticed about Buddy is that he is losing his sight.

The vet did a general check-up on him and said his liver, kidneys, heart, lungs, bloodwork, urinalysis, etc. all looked good, but that something was elevated, (cortisol?), and they wanted to test for Cushing's disease. So we had to bring him back after he had fasted and they did a "Low Dose Dex Supp Test" - took blood samples first thing in the morning, at noon and late afternoon.

Our vet didn't say if it was pituitary, adrenal or atypical cushings. She just said in dogs 75% are pituitary & 25% adrenal and that it's exact the opposite in ferrets. So I think she just assumed it was pituitary.

She consulted with vets in Kansas City who said life expectancy once diagnosed is 2-3 years with treatment OR without treatment. She explained that the problems with trying to reduce the cortisol production with lysodren or trilostane is that it needs to be closely monitored and can easily go too far, pushing the dog into Addison's. Her mentor in Kansas City said if they keep yo-yoing, they sometimes purposely destroy the pituitary gland putting them permanently into Addison's and then treat them with steroids. She also said the treatment and the monitoring is extremely expensive.

Although I'm want to do whatever I can to help our baby, I just lost my job and we're having a hard time making ends meet as it is.

I really appreciate SO much your reply and any one else who writes. It really does help to have other dog lovers who care as much as we do and understand what we're going through!

Thank you very much!!!
Blessings to you and Haley, Kim
Karen & Buddy

**Kakesie** · 04-25-2009, 05:55 PM

Re: Newly diagnosed, our beloved Buddy

Quick add-on,

In skimming the other posts, I can see there's a lot of additional information I need to get from my Veterinarian! Does this site have a list of "Cushing's-Knowledgable" Veterinarians? I like our veterinarian, but I have learned so much more about our other dog's disease from the Mega-Esophagus support group. I really do think online support groups can help each other out so much and I'm very glad I found this site!

Thank you for being here!
Karen

**BestBuddy** · 04-25-2009, 05:59 PM

Re: Newly diagnosed, our beloved Buddy

Hi Karen and Buddy.
A lot of us get the test results and keep them in a file. It's good to have the numbers to compare if you have more tests and also in an emergency if you have to see another vet to have all the info on hand. The most expensive part of cushings is the initial testing and monitoring to get the right treatment and dosage. Welcome and keep us up on how it's going.
Jenny

**frijole** · 04-25-2009, 06:17 PM

Re: Newly diagnosed, our beloved Buddy

Karen

I can tell you that there are no internal med vets in our entire state - K State sends some folks to Omaha a few times a month. I would ask friends who love their dogs equally for info on their vets OR call the folks at your local animal shelter (animal lovers) and find out what vets they feel have the most experience and explain your situation. Like I said, mine wasn't a seasoned cushings expert but he was caring enough to learn and wanted to help me save my dog.

Whoever your vet is calling in Kansas City is NOT correct. I suspect your vet did what my first one did (the one I fired) She said she was getting advice but she was just speaking with someone at the lab that she sent the tests to. NOT the same.

Get a copy of the LDDS test that was done. This IS the best first test to have done so that is great. There will be 3 numbers. Those 3 numbers are what your vet (or the lab) should read and use to indicate if its adrenal or pituitary OR if more tests should be done.

That comment about 2 to 3 yrs is untrue. Most of our dogs that seek treatment die of OTHER causes - mostly old age.

Yes you have to monitor when giving the drug but heck, any drug should be monitored and it is the job of the vet to help you do so. They have protocols to follow. (and we can give them to you if you want

) The key is for the vet to take the initiative to learn about this and help you. Of course we would be here as a reference and answer questions as well.

Don't worry - all will be fine. Lets start by getting the numbers and make sure your dog has cushings. As Jenny stated the expense is the testing at the beginning - it gets better after that. There are organizations that help out with expenses but I don't have the link. Perhaps someone else has it.

So glad you found us. Hang in there - you aren't alone. Give Buddy a big hug ok?

Kim

**Lulusmom** · 04-25-2009, 06:20 PM

Re: Newly diagnosed, our beloved Buddy

Hi and welcome the forum.

I am so sorry for the reason that brought you here but I'm glad that you found us.

It would help us greatly if you could round up copies of the test that your vet did to diagnose Buddy. It's a very difficult disease to diagnose which makes it the number one disease that is misdiagnosed. As Kim already mentioned, dogs with cushing's usually drink to excess to keep up with the frequent urination. Excess steroids effect the kidneys ability to concentrate the urine so if the dog doesn't drink more fluids that it is getting rid of, it doesn't take long to dehydrate and get very sick. Since your vet said that the urinalysis was fine, I am wondering if he checked the urine specific gravity. This is usually low with cushdogs as the urine is dilute. Increased water intake can be attributable to any number of diseases so I am wondering if Buddy has any other symptoms that are associated with cushing's such as an increased appetite, loss of coat, change of coat, panting, weakness...especially in hindquarters or recurrent infections?

Has Buddy's blindness come on over a long period of time or is this something that you have recently noticed? There is a condition called SARDS (Sudden Acquired Retinal Detachment Syndrome) which comes on quickly and a dog can go blind over night or in a week's time. Researches think there is a connection between Cushing's but they don't know what it is. What they do know is that a lot of SARDS dog are diagnosed with cushing's one to six months of going blind. Those that don't almost always test positive for elevated adrenal hormones within a month to a year after going blind. Excessive thirst and urinations are a symptom of abnormal adrenal hormones/steroids other than cortisol.

Just so you know, a dog can live out their normal life expectancy if the cushing's is controlled with proper treatment. I suspect that a lot of vets tell pet owners that 2 to 3 years after diagnosis is all you can hope for based on the fact that most dogs are pretty senior when diagnosed. One of my cushdogs, however, was only three years old when diagnosed and she is now seven. I have no idea what Buddy's breeding is but 8 years isn't that old for a lot of breeds so I poo-poo that 2 year prognosis bunk.

Looking forward to hearing lots more about Buddy.

Glynda

**stardeb55** · 04-25-2009, 06:37 PM

Re: Newly diagnosed, our beloved Buddy

Welcome, Karen!

Please disregard these statements about 2 year survival with or without treatment. It's nothing but hogwash!!! My 1st Cushpup, Barkley, was successfully treated with lysodren for just about 8 years, crossing the bridge at 15.

I think you may have misunderstood some of the things your vet has told you, so my responses to clarify are in blue.

The vet did a general check-up on him and said his liver, kidneys, heart, lungs, bloodwork, urinalysis, etc. all looked good, but that something was elevated, (cortisol?)
On general labwork, the first thing that will usually tip off a vet to look for Cushing's disease is an elevated alk phos which is one of several liver enzymes. Most of the liver enzymes are usually elevated in our pups as the liver takes a beating since it has to process the extra cortisol produced by the adrenals.

Our vet didn't say if it was pituitary, adrenal or atypical cushings. She just said in dogs 75% are pituitary & 25% adrenal
Statistically, your vet is correct. You can't just assume that it's pituitary. Sometimes the low dose test will differentiate between the 2 forms, but not always. It is also extremely important to have any positive result on a low dose test confirmed by a second test such as an abdominal ultrasound or the high dose dex. The LDDS is considered to be the "gold standard" for Cushing's diagnostics as the test can yield a false positive result in the presence of non-adrenal illness. This is what makes Cushing's one of the most frustrating diseases to diagnose as there is no single test that is 100% specific or sensitive. An abdominal US would be the better choice to confirm as not only do you get a look at the adrenals, but you get a look at all of Buddy's internal organs, thus getting a better idea of his overall health.

She explained that the problems with trying to reduce the cortisol production with lysodren or trilostane is that it needs to be closely monitored and can easily go too far, pushing the dog into Addison's.
This is possible, but not likely as long as you are working with a vet who is well-experienced in treating Cushpups, following the standard loading/dosing protocols for either med. Vets who lack the knowledge & experience have a tendency to start guessing, "flying by the seat of their pants', etc., & this is where things can get really bad really fast. The other important job of the experienced vet is to work with you, teaching you what you need to know in using either med, including the signs of a possible low cortisol emergency, provide you with prednisone in case this might happen, & answer all of your questions & concerns.

Her mentor in Kansas City said if they keep yo-yoing, they sometimes purposely destroy the pituitary gland putting them permanently into Addison's and then treat them with steroids. She also said the treatment and the monitoring is extremely expensive.
I think you may have misunderstood this, as the pituitary gland is not affected in an Addisonian crisis, it's the adrenal glands. How badly the adrenal glands are affected is strictly determined by how much drug has been administered, how quickly a problem is caught & treated, with quick treatment in an Addisonian crisis, most dogs recover quite nicely without ever going permanently Addisonian. Just to point out, most vets in Europe prefer to totally destroy the adrenal glands when treating Cushing's, then treat the Addison's, feeling that it is the easier problem to treat. I can't deny that the initial treatment phase is expensive. I had to take out CareCredit to help me cover Harley's expenses when he was diagnosed a year ago, & am still paying on his bills. I use lysodren, so really can't speak to the expenses involved with Trilostane. What I will tell you is, with lysodren, once you have the dose stabilized the treatment costs will decrease substantially, with necessary testing either being done only quarterly or maybe even just twice a year. You can shop around for the either med to try to get the best price you can.

Cushing's is a very slowly progressing disease, so you can take a month or two to thoroughly review everything, educate yourself on the disease, possibly get a second opinion from another vet, then make the best informed decision you can on Buddy's behalf.

Debbie

**Kakesie** · 04-25-2009, 06:40 PM

Re: Newly diagnosed, our beloved Buddy

Wow, you guys are AWESOME!

Within minutes of posting I had my first reply and now several more! Bless you Kim, Glynda & Jenny.

I have HOPE - maybe two to three years isn't his "death sentence"!

First thing Monday I will contact my vet and get copies of the test results with the numbers.

His breed - Well, you can see photos of him on my profile. The vet we took him to when we first got him thought he might be a Grosser Munsterlander. She showed me a photo in a book and he does look like that. Otherwise I'd say possibly a cross between pointer and black lab.

Thank you all so very much!!!
Karen & Buddy

**Kakesie** · 04-25-2009, 07:08 PM

Re: Newly diagnosed, our beloved Buddy

Yes, I probably did misunderstand many of the things my vet said. It hit me all so fast and I went home without any of the test results or anything on paper. I will try to get better information on Monday.

Thanks so ALL of you, (you too, Debbie). I'm over-whelmed by the support and kindness of all who replied!

Bless you all!
Karen

**Carin** · 04-26-2009, 06:33 AM

Re: Newly diagnosed, our beloved Buddy

Originally posted by stardeb55 View Post

Cushing's is a very slowly progressing disease, so you can take a month or two to thoroughly review everything, educate yourself on the disease, possibly get a second opinion from another vet, then make the best informed decision you can on Buddy's behalf.

Debbie

I just wanted to second what Debbie said. I think a lot of us come to a Cushing's diagnosis with a certain amount of panic, which makes it hard to process all the NUMBERS and other information we're bombarded with. It's very helpful to realize that this is not a disease where you need to make life-or-death decisions in the first day or week or month when you get the diagnosis. You do have time to find an experienced vet and plan an approach to treatment.

Also, I think the idea of keeping a list of vets that we can vouch for as being Cushing's-experienced is great. It would be particularly helpful for new members to have a sticky post they can go to right away without having to search archives to see if anyone has recommended a particular vet. Another forum I'm on for laryngeal paralysis keeps a database of surgeons experience in treating the disease, with contact info for the forum members who've had first-hand experience with that vet.

Carin

**Lulusmom** · 04-26-2009, 07:22 AM

Re: Newly diagnosed, our beloved Buddy

Posting information received from Buddy's mom, Karen, via PM

Regarding Buddy's symptoms:
Excessive Thirst - YES. Excessive Urination - YES. Panting - YES. Increased Appetite - Not really, although he IS overweight. Weakness...especially in hindquarters - Not really, maybe a little when hopping up to get into the SUV. Changes in Coat - NO. Hair Loss - NO. Recurrent infections - NO.

Blindness - YES. Detatched Retina - I don't think so. Vet looked into his eyes and she should've seen a detatched retina. She said the vessels in the back of his right eye were atrophied, but okay in his left eye. Onset has been over past several months.

Regarding Buddy's breeding:

He is a mixed breed. You can see photos of him under my member name: Kakesie. Someone dumped him in the country when he was about 9 months old and a friend of mine picked him up and that's how we got him.

When we took him to the vet, she thought he looked like a "Grosser Munsterlander". She showed me a photo in a book and he does look like one. She said there were some people who were breeding them south of town, (which is where he was found), but I suspect he isn't a purebred or he wouldn't have been dumped. Either that or someone wanted him as a hunting dog and he's a big 'fraidy cat. He's scared of everything, so I'm sure he'd be spooked by a gun.

I had never heard of a Munsterlander, so my best guess would've been a cross of black lab and pointer maybe. He is black with white speckles and a curled plumy tail. He has a longer, feathery coat, similar to that of a golden retriever.

**Squirt's Mom** · 04-26-2009, 08:51 AM

Re: Newly diagnosed, our beloved Buddy

Hi Karen,

Just wanted to add my welcome!

You've been given some great info already and I don't have much to add tho I do concur with everything that has been said, especially about the difficulty diagnosing Cushing's and the need for further testing before you start treatment. Lysodren and Trilostane are BOTH powerful drugs and should not be administered until a diagnosis has been confirmed via several tests. At the very least, I would like to see Buddy have an ultrasound (not Xray). The "normal" bloodwork and urinalysis is a bit concerning since you will usually see changes there if the pup is Cushinoid. Once you are able to post the test results, that will help, tho.

I know all this is terribly confusing right now, but I promise in no time you will understand quite a bit. On that understanding your knowledge will grow, and with knowledge comes confidence. Hey, if I can start to grasp a bit of this stuff, any one can!

And we are here to help you all we can anytime.

Some tricks you can use to help you remember what is said at the vets office are:

* take a notebook and pen, and take notes; if the vet is going too fast, ask them to slow down explaining you are trying to do all you can to learn
* take someone with you to listen and/or take notes with you
* take a recording device (be sure to let the vet know they are being recorded

)

I am really glad to see you and Buddy here and hope to learn more about you both in the future!
Hugs,
Leslie and the girls

PS. some links to help you get started on your cush education

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html
(especially easy to read and understand...written in laymen terms and has good list of signs)

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article....2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing�s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/Fe...ctSheet052.asp

**LuvMyMunchie** · 04-26-2009, 10:44 AM

Re: Newly diagnosed, our beloved Buddy

Hi Karen,

I wanted to offer my belated welcome to you and Buddy. You've been given lots of information to mentally digest right now and at this point I can't think of a thing to add. I'm mainly here right now to offer my support.

Will be watching for your updates.

Louise

**Kakesie** · 04-26-2009, 01:20 PM

Re: Newly diagnosed, our beloved Buddy

A HUGE THANK YOU to all of you, (most recently Carin, Leslie and Louise), for all your information, advice and support! And thank you to the many who have read our story but just didn't have anything to add to what these knowledgable people have already said. I can tell you all love your doggies like my daughter and I love ours and so you understand how hard it is when one is diagnosed with a serious illness. I think the kindest people in the world are dog / animal lovers and I've found a wealth of wonderful people here! Thank you to each one of you!

Thank you, Glynda for posting the information I sent to you about Buddy's breed and symptoms. I will be contacting the vet on Monday to get copies of his test results so I will have numbers to refer to.

Thank you, Leslie, for the great list of Cushing's links you gave me!!!

I second what Carin said about having a list of good veterinarians. In fact, I think I'll start a separate thread about that subject.

Bless you all and your doggies!
Karen, Saralisa, Buddy & Dolly

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Newly diagnosed, our beloved Buddy

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