Update on Thumper

[Lovetodream88]

Originally Posted by KatysMom

I'm not aweotzm1, no surprise there, but PetMD article, "Cushing's Disease in Dogs," [n.d.?] has section, "Diagnosis" that includes (emphasis added):

"The most common test used to diagnose Cushing’s disease in dogs is the low-dose dexamethasone suppression test (LDDS). A blood sample is taken to measure a dog’s baseline cortisol level and then a small amount of dexamethasone is administered by injection. Blood cortisol levels are measured four and eight hours after the dexamethasone is given..."

Hope this helps.

Callie has both types of Cushings and they did not require her to stay for 8 hours. I believe she only stayed for 4 hours. Her blood was also sent out to the University of Tennessee where they can test for both types of Cushings.

[Lovetodream88]

Originally Posted by aweitzm1

You are correct they are doing the dexamethasone test which takes 8 hours. I was told that there is another test only 2 hours long but the vet prefers this one. She said there are pros and cons to both.

Will he be sending any out to Tennessee? They have testing that only they do and that is where I recommend sending it for testing. They don't just test for one tpe they test for both. https://vetmed.tennessee.edu/vmc/dls...s/default.aspx

[aweitzm1]

Originally Posted by Lovetodream88

Will he be sending any out to Tennessee? They have testing that only they do and that is where I recommend sending it for testing. They don't just test for one tpe they test for both. https://vetmed.tennessee.edu/vmc/dls...s/default.aspx

He did not state if they will be sending it out to Tennessee. I will ask when I speak to him prior to the test.

[Lovetodream88]

Originally Posted by aweitzm1

He did not state if they will be sending it out to Tennessee. I will ask when I speak to him prior to the test.

I personality would recommend it. Also sometimes it takes awhile to get a Cushings diagnoses and may require retesting. That's very normal. Callie ended up having to be tested twice, a year apart and I have heard sometimes it can take longer.

[Wylie's Mom]

If you think *at all* that your Vet isn't super duper experienced with Cushings* (and almost ALL generalist Vets are absolutely not proficient!) - I would recommend 1000% that you demand the bloods be sent to U of Tenn - TRUST ME!!! It really will not cost much more at all - yet the difference in the results and the richness in info you'll receive will be enormous!

IF you end up w/ 'intermediate' or 'borderline' initial results at your Vet - which is entirely possible - then you'll have to draw blood again (charged for it) and send it out for testing again to U of Tenn anyway, so then you'd be paying for the same tests twice. Happens alllll the time.

U of Tenn website: https://vetmed.tennessee.edu/vmc/dls...uidelines.aspx

Info on difference btwn ACTH and LDDS tests:

ACTH stimulation is a good screening test in the first instance and is the test of choice for diagnosing iatrogenic Cushing’s and monitoring anti-adrenal therapy. It has a lower false positive rate than the low-dose dexamethasone suppression test but a significant false negative rate. It will reliably diagnose about 85% of PDH cases but only 50% of ADH cases. It is quick and simple to perform and is less affected by stress and non-adrenal illness. The initial values are useful as a reference to monitor effectiveness of treatment.

Low-dose Dexamethasone screening test is more sensitive than the ACTH stimulation test in confirming HAC. Diagnostic sensitivity is almost perfect (>95%) meaning that false negative results very seldom occur giving us tremendous confidence in a negative test result. Unfortunately, false positive results are common especially when there is concurrent non-adrenal illness or other sources of stress. Positive results of the low-dose dexamethasone test should be regarded with suspicion in dogs known to have significant non-adrenal illness. Ideally, the test should be postponed until any identified non-adrenal illnesses have been resolved or stabilised.

[aweitzm1]

Hi All,


Just to give everyone an update I dropped Thumper off at the Vet last night for the Cushings Testing today. Vet recommended the 8 hour test over the 2 hour test as it is more comprehensive.


I did ask about sending the blood work to the University of Tennessee but he never heard of the test they perform. He sends it to his regular lab and said he has never had an issue with it.


I called this morning and he did fine over night. He was resting and ate his breakfast. I will pick him up the evening. I was told the Vet will call me with the results tomorrow.


If he does have Cushing's the Vet said we can only treat the symptoms to give him the best quality of life. He only likes on drug called Vetoryl. My concern is that the pamphlet he gave me said do not give to dogs with Kidney Disease.


He said he does not like the other 2 drugs used to treat the condition as it has more harmful side effects. He did not give me the name of the drugs.


Additionally, when I called the Vet Help Line I use they explained a lot to me and said Vetoryl is the best drug on the market. My only concern she said was that the average life span is 3-4 years with Cushings but the Vet said they can live a long life on daily medication.


I am nervous and confused at the moment I don't know what to think. The vet also suggested possibly doing an ultrasound to look at the adrenal glands and kidneys. I was planning on getting Thumper one in August but may push it up.


Will post once I have the results and I know a game plan.

[KatysMom]

Hi Ashley/aweitzm1,

Thank you for the update on Thumper.

With what seems like conflicting information, I would be confused too.

Wylie's Mom has posted what seems like a pretty comprehensive overview of Cushings, including a section "Info on difference btwn ACTH and LDDS Cushings tests."

Would your vet take kindly to information print out and drop off together with a note--all explaining that you are a bit anxious ... still have questions?

I have some links regarding what I believe are related to the University of Tennessee studies. If I can round out the information on the testing, will post further.

Thank you for being such a lovin' mama to Thumper.

[KatysMom]

Originally Posted by Wylie's Mom

If you think *at all* that your Vet isn't super duper experienced with Cushings* (and almost ALL generalist Vets are absolutely not proficient!) - I would recommend 1000% that you demand the bloods be sent to U of Tenn - TRUST ME!!! It really will not cost much more at all - yet the difference in the results and the richness in info you'll receive will be enormous!

IF you end up w/ 'intermediate' or 'borderline' initial results at your Vet - which is entirely possible - then you'll have to draw blood again (charged for it) and send it out for testing again to U of Tenn anyway, so then you'd be paying for the same tests twice. Happens alllll the time.

U of Tenn website: https://vetmed.tennessee.edu/vmc/dls...uidelines.aspx

Info on difference btwn ACTH and LDDS tests:

ACTH stimulation is a good screening test in the first instance and is the test of choice for diagnosing iatrogenic Cushing’s and monitoring anti-adrenal therapy. It has a lower false positive rate than the low-dose dexamethasone suppression test but a significant false negative rate. It will reliably diagnose about 85% of PDH cases but only 50% of ADH cases. It is quick and simple to perform and is less affected by stress and non-adrenal illness. The initial values are useful as a reference to monitor effectiveness of treatment.

Low-dose Dexamethasone screening test is more sensitive than the ACTH stimulation test in confirming HAC. Diagnostic sensitivity is almost perfect (>95%) meaning that false negative results very seldom occur giving us tremendous confidence in a negative test result. Unfortunately, false positive results are common especially when there is concurrent non-adrenal illness or other sources of stress. Positive results of the low-dose dexamethasone test should be regarded with suspicion in dogs known to have significant non-adrenal illness. Ideally, the test should be postponed until any identified non-adrenal illnesses have been resolved or stabilised.

Wylie's Mom's post is pretty clear.

I located two related articles written in more or less vet-speak that your vet may or may not be familiar with.

See 2008 article written in moderate vet-speak, "Newer Tests she light on causes, treatment of adrenal disorders," by Johnny D. Hoskins, DVM, PhD, DACVIM. This article highlights points from a 2007 lecture by Dr. Jack W. Oliver "Steroid Profiles in the Diagnosis of Canine Adrenal Disorders."

See also related article, seems likely the 2007 lecture referenced and in real vet-speak, Jack W. Oliver, DVM, Ph.D, Knoxville, TN, "Steroid Profiles in the Diagnosis of Canine Adrenal Disorders."

Hope this helps; thoughts and prayers with you and Thumper.

[Wylie's Mom]

Originally Posted by aweitzm1

Just to give everyone an update I dropped Thumper off at the Vet last night for the Cushings Testing today. Vet recommended the 8 hour test over the 2 hour test as it is more comprehensive.

I did ask about sending the blood work to the University of Tennessee but he never heard of the test they perform. He sends it to his regular lab and said he has never had an issue with it.

I called this morning and he did fine over night. He was resting and ate his breakfast. I will pick him up the evening. I was told the Vet will call me with the results tomorrow.

If he does have Cushing's the Vet said we can only treat the symptoms to give him the best quality of life. He only likes on drug called Vetoryl. My concern is that the pamphlet he gave me said do not give to dogs with Kidney Disease.

He said he does not like the other 2 drugs used to treat the condition as it has more harmful side effects. He did not give me the name of the drugs.

Additionally, when I called the Vet Help Line I use they explained a lot to me and said Vetoryl is the best drug on the market. My only concern she said was that the average life span is 3-4 years with Cushings but the Vet said they can live a long life on daily medication.

I am nervous and confused at the moment I don't know what to think. The vet also suggested possibly doing an ultrasound to look at the adrenal glands and kidneys. I was planning on getting Thumper one in August but may push it up.

Will post once I have the results and I know a game plan.

I hate to be so blunt, my friend, but if your Vet hasn't heard of the U of TENN for its world-renowned Veterinary Endocrine Testing Lab -- then I really cannot express how seriously I believe you should *not* be letting this Vet treat your dog any further for Cushings. Cushings is an *extremely* complex, systemic disease that -- as I said in my post further above -- very, very few generalist Vets are equipped properly at treating.

The U of Tenn doesn't do just "one test" - they do several specialized Cushings-specific tests that your Vet cannot do locally at any available lab.

There are not just 2 other drugs to treat Cushings. The meds to treat are: Lignans, Melatonin, Vetoryl/Trilostane, Lysodren, Ketoconazole, and Selegiline. When someone tells you something is "the best med on the market" -- I would be extremely hesitant to ever believe that type of generalized, blanket statement -- that's my opinion as a nurse. I would *never* have said that to a patient. The best med is the one that works properly for the patient.

My Wylie was 4.5yrs old when diagnosed w/ Atypical Cushings - and lived to be 12. He was on Lysodren (this is a 'chemo' med, also used in Cushingoid dogs) - never had a single side effect from it. He took a loading dose for a while - then his maintenance dose was MWF only. He lived an awesome life!!!

An ultrasound is not a bad idea - but I would not do it w/ that Vet. I would definitely find an Internist who is experienced with managing Cushings -- get properly titrated on Cushings meds (can take several months, btw!!) -- and then find a generalist Vet for maintenance. That's my best advice, having been through inexperienced Vets with a Cushings dog myself - and wasting a ton of money there first.

[Lovetodream88]

Originally Posted by Wylie's Mom

I hate to be so blunt, my friend, but if your Vet hasn't heard of the U of TENN for its world-renowned Veterinary Endocrine Testing Lab -- then I really cannot express how seriously I believe you should *not* be letting this Vet treat your dog any further for Cushings. Cushings is an *extremely* complex, systemic disease that -- as I said in my post further above -- very, very few generalist Vets are equipped properly at treating.

The U of Tenn doesn't do just "one test" - they do several specialized Cushings-specific tests that your Vet cannot do locally at any available lab.

There are not just 2 other drugs to treat Cushings. The meds to treat are: Lignans, Melatonin, Vetoryl/Trilostane, Lysodren, Ketoconazole, and Selegiline. When someone tells you something is "the best med on the market" -- I would be extremely hesitant to ever believe that type of generalized, blanket statement -- that's my opinion as a nurse. I would *never* have said that to a patient. The best med is the one that works properly for the patient.

My Wylie was 4.5yrs old when diagnosed w/ Atypical Cushings - and lived to be 12. He was on Lysodren (this is a 'chemo' med, also used in Cushingoid dogs) - never had a single side effect from it. He took a loading dose for a while - then his maintenance dose was MWF only. He lived an awesome life!!!

An ultrasound is not a bad idea - but I would not do it w/ that Vet. I would definitely find an Internist who is experienced with managing Cushings -- get properly titrated on Cushings meds (can take several months, btw!!) -- and then find a generalist Vet for maintenance. That's my best advice, having been through inexperienced Vets with a Cushings dog myself - and wasting a ton of money there first.

I 100% agree with Ann. My vet has a dog with Cushings so I feel lucky. I would have definitely had blood sent out to the U of Tenn. As much as we trust our vets its extremely important we also educate ourselves to know what we should be doing. When we mentioned the U of Tenn to you and I posted the link I think I would have printed the paperwork at least for your vet to look at and for you to push for.

[aweitzm1]

I spoke to the Vet today and Thumper was negative for Cushing's Disease. That is the good news. The bad news is that the doctor feels his kidneys may be getting worse. If it is not the kidneys it can be one of two things diabetes insipidus or psychogenic polydipsia. I am speaking with my main vet on Friday when he is back in the office to discuss those two possibilities. (Though my fear is that the kidneys are getting worse)


I am not sure which diagnosis I am hoping for. At this point I just want answers instead of all this guessing.


I scheduled Thumper for an ultrasound on Tuesday evening. The vet that does it is not my normal vet at the practice so I am going to consult with the both of them once they view the imaging.


I was told if the vet doing the procedure feels the images need to be viewed by a specialists they will send the results out and consult with a board certified internist. It all depends on what is found.


I am extremely worried about Thumper. He is my baby and I am not ready to lose him.

[KatysMom]

Originally Posted by aweitzm1

I am extremely worried about Thumper. He is my baby and I am not ready to lose him.

Thank you taking the time to post an update

I'm sure you are worried. I hope you (and Thumper) take some comfort in your commitment to see him through this!

Cranking up the thoughts and prayers for you both.

[Wylie's Mom]

Originally Posted by aweitzm1

I spoke to the Vet today and Thumper was negative for Cushing's Disease. That is the good news. The bad news is that the doctor feels his kidneys may be getting worse. If it is not the kidneys it can be one of two things diabetes insipidus or psychogenic polydipsia. I am speaking with my main vet on Friday when he is back in the office to discuss those two possibilities. (Though my fear is that the kidneys are getting worse)

I am not sure which diagnosis I am hoping for. At this point I just want answers instead of all this guessing.

I scheduled Thumper for an ultrasound on Tuesday evening. The vet that does it is not my normal vet at the practice so I am going to consult with the both of them once they view the imaging.

I was told if the vet doing the procedure feels the images need to be viewed by a specialists they will send the results out and consult with a board certified internist. It all depends on what is found.

I am extremely worried about Thumper. He is my baby and I am not ready to lose him.

Oh Ashley - I know you're so worried - so sorry for all you're going through. Thinking of you and Thumper every day.

If it is DI, it's treatable - especially if it's nephrogenic (due to kidney malfunction); it'd be treated w/ medications.

The diagnosis is via bloods (most of which you probably have..?), urinalysis, and a specific water-deprivation test. A CT/MRI may be recommended *if* they think it's neuro related (pituitary etc) for some reason.

No sources recommend an ultrasound for diagnosing DI -- did they tell you why they are still recommending this...?

https://vcahospitals.com/know-your-p...ipidus-in-dogs

https://www.petmd.com/dog/conditions...idus?page=show

[aweitzm1]

Originally Posted by Wylie's Mom

Oh Ashley - I know you're so worried - so sorry for all you're going through. Thinking of you and Thumper every day.

If it is DI, it's treatable - especially if it's nephrogenic (due to kidney malfunction); it'd be treated w/ medications.

The diagnosis is via bloods (most of which you probably have..?), urinalysis, and a specific water-deprivation test. A CT/MRI may be recommended *if* they think it's neuro related (pituitary etc) for some reason.

No sources recommend an ultrasound for diagnosing DI -- did they tell you why they are still recommending this...?

https://vcahospitals.com/know-your-p...ipidus-in-dogs

https://www.petmd.com/dog/conditions...idus?page=show

They want to do an ultrasound to see how the kidneys look. That will determine if the KD is getting worse. If it hasn’t changed than more testing for the other possible reasons.

[aweitzm1]

I thought I would get back to everyone about Thumper and his issues with drinking too much water.

After a month of testing the vet believes he has psychogenic polydipsia. Pretty much its all in his head. .

We checked for both Cushing's Disease and Diabetes. Did a urinalysis, ultrasound, urine culture, and blood pressure tests.

The only issues found were the blood pressure slightly elevated (vet felt that could have been due to the stress of all the tests but put him on BP medication 2x a day just in case) kidneys were high normal (not perfect and showing signs of very early Kidney Disease, but no significant change since last year's results when he was first diagnosed) Adrenal glands one was high normal and the other slightly abnormal. LDDS test for Cushing's was high normal so he can still develop Cushing's Disease or could be too early to determine.

If Thumper's continues to over drink we are going to do the ACTH test next month just to completely rule out Cushing's Disease. Vet wants to give Thumper time to destress from all the vet visits and testing. He suggested limiting water at night.

I am going to do the ACTH test either way because I want to completely make sure he is ok but so far I am happy that this is just a mental issue. Other than the drinking he is a happy boy.

I am exhausted from all the back and forth to the Vet. I spent over $1,000 on testing and was at the vet every week. I myself need this month to also decompress from the stress of worrying about my baby.