Cushing's or Hypothyroid OR something else

[dianaww]

Hi all I am so confused. Teddy is 7 and has a mild heart valve problem, diagnosed when he was 1 but has never got any louder or any worse. almost 3 months ago on 9th July, we took him for routine teeth clean to be told it couldn't be done as his white cells were very low. We have been on an almost 3 month ordeal of tests. His white cell total go from around 2.5 then 3.5 and 4.5 approx. They should be a MINIMUM of 5.5 his normal in 2008 was 8.0 total count. We have tested for all sorts of illnesses, then we had to change vets as our preferred vet is leaving the practice where we used to go. Our new vet agreed to test Teddy for Cushings, the ACTH test has come back positive and we are waiting for another test. HOWEVER, his normal blood is showing THREE times the normal cortisol level, the Cushings test confirm it is high and not right, but they don't tell you 100% WHY they are that high. He has low platelets and bruises very easily. The last 2 days we thought we were going to loose him, It could be a Thyroid problem as that causes White Cells to be low and low platelets, at this time the vet thinks he has Cushings but he doesn't have other symptoms that is usual with that, We are testing for Thyroid, but it seems all the tests he is having are not 100% reliable and definite, Our fear is we have to lower the cortisol in the blood, but if we use the drugs for Cushings and he hasn't got it, it is not good, and also if we use Thyroid drugs and he has Cushings it is not good. An Ultrasound is OK but he is a wriggler and sedation with his heart and low immunity is not totally a great idea, we are in bits ... Anyone been through anything similar ?

[dawn27]

Im sorry your baby is sick, I've never dealt with anything like this but hopefully someone who knows more about these sorts of things will be along soon with some much need advise.

I'll keep you and your baby boy in my prayers.

[dianaww]

Thank you it really does look like he has CUSHINGS now we are having an ultra sound scan next week to see if his adrenal glands are swollen, or whether anything else is going on inside him, We are devastated.

[Mollysmom411999]

I'm so sorry , my Molly had cushings and was not good, her heart, liver were enlarged and breathing was a real struggle for her..... It all happened so fast for my girl as she was in distress.... I had to make the horrible decision to free her of her pain and I still struggle with the loss of my precious girl... I pray it's not but it can be manages with drugs sometimes. Like I said I don't know much about the disease and ours was diagnosed and she was gone in the same week:*(

[ladyjane]

I am sorry your Teddy is ill. Hopefully, he will be managed well on meds. Will keep you and him in my thoughts and prayers.

[dianaww]

Hi I am so sorry to hear about Molly, it is awful that it had happened that fast, the Cortisol effects their organs that is the awful part about Cushings, I am so so sorry for you, You did the right thing for your little baby, we won't let Teddy suffer either. X

[Wylie's Mom]

I'm so sorry your Teddy is sick, poor kiddo. I know you and your vet will get to the bottom of all of this, and you'll end up feeling more confident in knowing what his issues are...you'll get there .

I have a lot of experience with Cushings. My Wylie has Atypical Cushings, which is even tougher to diagnose that typical Cushings, but we eventually got the correct diagnosis. And btw, many many Cushings dogs also have thyroid issues - they often go hand in hand and are often diagnosed at the same time. The most important thing I can tell you is that Cushings is not the worst diagnosis in the world, and that your Teddy can do amazing and thrive with Cushings! And live a long life.

Wylie was diagnosed when he was 4 (which is super young!), but he had strange symptoms for about 1-1.5 yrs before that, and my vet kept telling me nothing was wrong. His main symptoms were excessive drinking/peeing, hunger, loss of fur, muscle wasting in the hind legs (some weakness), and skin/ear infections that kept returning. He didn't "look" like a Cushings dog AT ALL - no typical pot belly or weight gain, and he wasn't lethargic - he was his usual little energetic wild man self. Anyway, we finally got him diagnosed, at which point you have to start trying Cushings meds and going thru the (usually) long period of titrating them correctly. He was also started on thryoid meds of course.

He is now 9 and he is AMAZING! Spry, crazy, energetic, healthy, strong, vivacious. He acts like a young pup. So, I can assure you that your kiddo will also be a-okay.

Sure the meds for Cushing are not great meds - they're usually quite toxic. But they are often wonderfully tolerated, are given in low doses, and dogs can do so well on them. Btw, Wylie has not one single side effect from his Lysodren.

So hang in there, and know I'm here for you. There are other folks on here who also have Cushings dogs that are doing really great!

Btw, what is the last test you're waiting on - did you also do the LDDS or something?

If you need a couple sites to read, these are my favorite:

My favorite general overview: Cushings (Hyperadrenocorticism)

Yahoo group that is PACKED with info: Yahoo! Groups

[dianaww]

Wow poor Whylie being that young, what is Atipical Cushings? Teddy has no symptoms except so tired all the time, and it has crashed his immune system, he has had a positive ACHT Test and also Low Dex test was positive the T4 Thyroid test was normal waiting on a TSH Thyroid result, but I expect that to be normal as the T4 was.

We found this all by chance three months ago, and it is thought we got it early, He will go on Vetoryl Meds, if he has it. We are having an Ultrasound Scan to see if his adrenals are swollen as they can be even if they have Pituitary tumor.

I have read and read and read about Cushings for a few weeks, Prior to all this the vets thought he may have bone marrow cancer, as his white cells have been dangerously low for 3 months we know of, and however long prior to that, So Whylie has been OK for some years, has he got it in his adrenals or Pituitary type.

His energey level is almost Zero he sleep for about 3/4 of a 24 hr period, and has a little game with his ball (Chewing it) Not anything strenuous. The only other worry I have is his has a heart valve problem, to content with. He is NOT ON MEDS FOR HIS HEART, and it has not got any worse since it was diagnosed, in fact the vet can hardly hear it, it is so quiet, so that is not as bad as a bad heart valve issue, he did see a heart specialist when he was a year old and they did a scan and dopler test and it is definitely there it is leaking and flowing back at times, but has never got worse, Unlike my other two Yorkies they lived for 2-3 years with them and then passed away. I really hope we can help our little man.



Teddys results:

ACTH Pre 306 / Post 524

Low Dex: Basel 261 ... 4 hours later after suppression 20.3 then 8 hours 94

Thyroid T4 22.4

[Wylie's Mom]

Originally Posted by dianaww

Wow poor Whylie being that young, what is Atipical Cushings? Teddy has no symptoms except so tired all the time, and it has crashed his immune system, he has had a positive ACHT Test and also Low Dex test was positive the T4 Thyroid test was normal waiting on a TSH Thyroid result, but I expect that to be normal as the T4 was.

We found this all by chance three months ago, and it is thought we got it early, He will go on Vetoryl Meds, if he has it. We are having an Ultrasound Scan to see if his adrenals are swollen as they can be even if they have Pituitary tumor.

I have read and read and read about Cushings for a few weeks, Prior to all this the vets thought he may have bone marrow cancer, as his white cells have been dangerously low for 3 months we know of, and however long prior to that, So Whylie has been OK for some years, has he got it in his adrenals or Pituitary type.

His energey level is almost Zero he sleep for about 3/4 of a 24 hr period, and has a little game with his ball (Chewing it) Not anything strenuous. The only other worry I have is his has a heart valve problem, to content with. He is NOT ON MEDS FOR HIS HEART, and it has not got any worse since it was diagnosed, in fact the vet can hardly hear it, it is so quiet, so that is not as bad as a bad heart valve issue, he did see a heart specialist when he was a year old and they did a scan and dopler test and it is definitely there it is leaking and flowing back at times, but has never got worse, Unlike my other two Yorkies they lived for 2-3 years with them and then passed away. I really hope we can help our little man.



Teddys results:

ACTH Pre 306 / Post 524

Low Dex: Basel 261 ... 4 hours later after suppression 20.3 then 8 hours 94

Thyroid T4 22.4

Yep, those numbers are elevated!!! Poor kiddo. Ya know, it's a blessing you're finding this out though bc I bet once you get his cortisol down, you'll see a whole different Teddy -- his energy will probably shoot up to normal eventually. Some dogs get extreme lethargy with untreated Cushings, so I'm not surprised to hear this about him.

Atypical Cushings is when one of the several intermediate sex hormones is causing the end result elevation of the cortisol. Wylie has 2 or 3 intermediate hormones that are causing his adrenals to release that excess cortisol. Just to show you how well they can be managed - Wylie just had his regular ACTH checkup, and his post cortisol was 3.5 . Nice and low.

Please keep us posted, and know you and Teddy are in my thoughts !

[dianaww]

Hi Oh I see how did you get that diagnosed that would of been really difficult I imagine, had Wylie been castrated or not? Teddy is so I doubt this will be the reason for his. So does Wylie have to have the same sort of MEDS that dogs with usual types of Cushings, Teddy is so tired, and the most worrying this is it has killed his immune system. His total white cell counts have been in the 2.5, 3.5 & 4.5 areas instead of his usual total of 8, the lowest they say is normal is 5.5 and that is the lowest, so at 2.5 he is nowhere near 5.5 even at 4.5 it is still too low, so he is often running a low grade fever, we are extra careful with him due to infection risks etc. I hope the US scan will show us if his adrenal glands are swollen or something else that is causing this level of coritisol.

Did Wylie have similar results to Teddy (NOT that I am suggesting Teddy has the same thing at all) He may well have standard type of Cushings, His US will be next week we hope or early part of week after. It depends when referral hospital can fit us in. It is 60 miles from us and I am very seriously ill myself, and usually don't go out I am almost totally housebound, I have to go though, and also I have a hospital appointment myself too 55 miles away, and on top of all my usual illnesses I now have a virus with all the stress, so I am hoping and praying I will make my appointment and more importantly his appointment.

I usually get really ill going 6 miles and back !!!!

[Wylie's Mom]

Aw Diana, I'm so sorry you're ill ! How stressful to have all this going on at the same time. I hope your virus goes away soon. And I hope that whatever your more serious illness is, that it eases up for you and that you heal and get better. You will stay in my thoughts and I'm sending good positive energy your way.

It took a long time to get diagnosed. Wylie's ACTH test was "borderline" aka "intermediate". When that happens, if you still suspect Cushings despite that result (which we did, based upon symptoms), you have to send blood to the U of Tennessee Vet school / endocrine lab - it's the only place in the country that can test for Atypical Cushings. At that facility, they re-do the ACTH and also test the levels of intermediate hormones to see if it's indeed Atypical. And sure enough, it turned out he has Atypical.

No, Wylie's numbers weren't like Teddy's...which makes me think Teddy is probably typical Cushings (makes things a little easier, in a way). Wylie does have similar meds to regular Cushings dogs - he is on Lysodren/Mitotane which is a chemo drug - but it is at a low dosage and he only takes it MWF. Usually what you do when you start a Cushings med is you ramp up first (give it every day for a while), then you back off a bit and see where you land with the next ACTH results (see if the cortisol is where you want it). (Sidebar: ALSO, on that note -- very important -- when you do start his new meds, you also ALWAYS want to have cortisone pills on hand in case the meds are too strong and he starts to show LOW cortisol, then you give him an external cortisone pill to stabilize him. Your vet will know what I'm talking about and go over it with you.)

I would sure hope Teddy's immune system would stabilize once you start treating the Cushings...that would be my assumption anyway since once you start getting that raging cortisol down, you really do start to see the positive changes. Cortisol at those high levels is SO tough on the entire body - from the organs right down to the skin...it effects it all.

Oh, and btw, Wylie's US showed his adrenals as pretty much totally normal, which his Internist said is pretty common...interesting, huh? You'd think it'd be enlarged when undiagnosed, but apparently this is not always the case.

It's such a complex, convoluted, insidious disease -- it took me a long time to really understand Cushings, even though my bach degree is in nursing, lol!

Originally Posted by dianaww

Hi Oh I see how did you get that diagnosed that would of been really difficult I imagine, had Wylie been castrated or not? Teddy is so I doubt this will be the reason for his. So does Wylie have to have the same sort of MEDS that dogs with usual types of Cushings, Teddy is so tired, and the most worrying this is it has killed his immune system. His total white cell counts have been in the 2.5, 3.5 & 4.5 areas instead of his usual total of 8, the lowest they say is normal is 5.5 and that is the lowest, so at 2.5 he is nowhere near 5.5 even at 4.5 it is still too low, so he is often running a low grade fever, we are extra careful with him due to infection risks etc. I hope the US scan will show us if his adrenal glands are swollen or something else that is causing this level of coritisol.

Did Wylie have similar results to Teddy (NOT that I am suggesting Teddy has the same thing at all) He may well have standard type of Cushings, His US will be next week we hope or early part of week after. It depends when referral hospital can fit us in. It is 60 miles from us and I am very seriously ill myself, and usually don't go out I am almost totally housebound, I have to go though, and also I have a hospital appointment myself too 55 miles away, and on top of all my usual illnesses I now have a virus with all the stress, so I am hoping and praying I will make my appointment and more importantly his appointment.

I usually get really ill going 6 miles and back !!!!

[dianaww]

How interesting, I have read so much about Cushings and I can see why it is so hard to diagnose, All I do know is Teddy's Cortisol is WAY TO HIGH poor darling, I was told his adrenals may be swollen, but I also wanted a US to see if there is anything else inside him they can see, that may be pushing it up and not typical Cushings. We have got this early what ever the case as he isn't a typical Cushings dog, the only real thing that seems like he is is the level or Cortisol and the 2 blood test results. Sadly my illnesses are not curable and are very bad, but Teddy helps me cope, he is such a comfort, and so now it is MY TURN TO HELP HIM .

[dianaww]

Teddy had to go and see a specialist vet on Wednesday, they admitted him, and he spent his first night away from us ever, in 7.5 years, we were really upset, but we had to have tests done, He has got several things wrong and may need more tests at another time, he has come home with very upset tummy, very loose stools with blood in, and is not happy about that, poor baby, we are home cooking 4 times a day to try to sort it out, it maybe stress related, from being away from us, and all the tests he had, it may be his slightly swollen pancreas they also found, or colitis, or even the change in diet he had 2 weeks ago, when one vet said he had CUSHINGS we changed to Chicken and Oats to make him feel more full, THE SPECIALIST VET SAYS HE DOES NOT HAVE CUSHINGS, so having OATS in his diet, is not good for pancreas problems, so we are now awaiting more test results Monday, then to see if his specialist wants us to slowly re-introduce his original food that he had eaten for 6 years, after being very ill when he was a year old, on every other food we tried, We now wish we had never changed it, but thought we were doing the right thing. He has a heart issue, on top of his valve problem, that may be causing him issues as he has fallen down a few times, his legs have gone from under him, he has landed on his head not his legs jumping off the sofa, and trying to jump onto the sofa he hit the cushion, and fell on his side, he also has a 1cm growth on his spleen, which they needle biopsied and said it is lymphoid reactive, with some blood in it, which may be normal for him, or may need more investigating, he has slightly enlarged lymph nodes in his abdomen too, and some other issues, His specialist wants to check whether he definitely has a white cell problems or not, as the WHITE BLOOD CELL tests they did were normal, the FIRST NORMAL in 3 months, they can go down again, but if they don't, then it won't be a marrow problem we don't think, but the spleen and lymph nodes are a concern, and maybe nothing, or maybe something more serious, time will tell. The heart may be a problem too, as he has a load VAGAL Heart sound, and irregular beats, he also has slight kidney changes, which they said may be the start of renal issues, all together I counted 7 issues, including his original heart valve problem, I have told him he doesn't need to catch his mum up as I now have 20+ illnesses. We love him So much he was so brave, especially after a resent nightmare at a vet we have now left, where he had 4 needles in his legs instead of one for the low dex test, and ended up swollen bruised and black and blue, and was so upset he wet himself, and the other waste item too, and cried, none of which he has done in a vets before, so we are now back with our original vets, although sadly his vet is leaving at the end of this month. We are going to give him QUALITY of life, rather than QUANTITY, it is not right or fair on him to let him go on longer if he has lost the QUALITY of life, at this time, despite upset tummy with blood in it, he is very happy, He is a battler that is for sure, but I can feel his heart beat is irregular, and he may need to have a 24hr heart ECG that will be fun, it is 60+ miles each way to the specialists, so I am shattered, as I cannot usually travel more than 6 miles at a time maximum, without ill effects, the two days in a row we did over 250 miles, but he is worth it. So it looks like he has several different illnesses. POOR BABY , Oh and they have tested his resting cortisol again, awaiting results of that, and urine culture, awaiting results of that, and also waiting for results of pancreas test, THANK YOU ALL FOR YOUR SUPPORT x

[ladyjane]

Continued prayers for you and Teddy. You sure do have a lot going on...hope it gets better SOON!

[dianaww]

Ladyjane, Thank you very much x