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Old 03-04-2012, 03:41 AM   #1
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Default Finally a diagnosis of atypical Cushings .. now what do we do?

Hi:

My 9 1/2 year old yorkie who has always had an enormous appetite since we got her at 9 1/2 weeks, with a pot belly but all else normal was diagnosed with Atypical Cushings today from the University of Tennessee. We finally had an Adrenal Panel done at the same time as a basic ACTH. In under five minutes my vet told me via phone her ACTH was negative but her estradiol was elevated and positive at 78.6 baseline and 80 post acth. The only other positive was Aldosterone baseline 69.8 and then QNS post ACTH which means what? Someone told me it means they didn't have enough blood to finish the test? Could this be true and if so, why not redo it? Also another QNS came up progesterone post ACTH. Baseline 0,32. We were told that she should start melatonin 3mg twice daily. My problems are she has dry eye and is on optimune eye ointment twice a day which my vet neglected to tell me, might be a problem. And since this is a sleep promoter... will she be totally out of it all day. As it is she sleeps most of the day if she is not wanting to eat. Her signs again for nine years have been crazy eater.. if she had the chance she would eat a 100 lb bag of food, and now 9 years later hair loss. She doesn't seem to be urinating more, drinking more, she does have a buddah belly (again since she was a baby she has been fighting her weight and fluxuates from 8 to 12 pounds and has always been on reduced weight kibble. We have had urinalysis, originally come up with crystals of calcium oxalates, then did a bladder xray which showeed nothing. then next urine culture four days later, high white bloodd count and then six days later.. no antibiotic given. normal. We had a cortisol/creatine test done which they thought would be under 13 to confirm atypical cushings but it was 22. What does all of this mean and what should we do. I thought atypical and typical cushings were tumor related of one kind or the other, adrenal glands or pitutary.. my vet acted as if I was nuts when I asked if she has to be further tested for which kind of atypical cushings it is.. HELP???

These are her numbers other than what I told you.

She also had a complete thyroid panel done 90 days ago and all was normal
adrenal panel from two weeks ago approximately feb 15, 2012
Cortiso 33. 6 negative
cortisol post acth 144.5 negative
Androstenedione baseline 0.38 negative
And.... post ACTH 3.39 negative
Estradiol baseline 78.6 positive
EST post ACTH 80 positive
Progesterone baseline 0.32
prog post QNS
17 OH progest baseline 1.18 negative
17 OH progest 7.38
Aldonsterone base 69.8 positive??? it looks like normal range is 11-139 I am confused
Aldosterone post ACTH QNS

They say results inidcatee presence of increased adrenal activity (mild) Typically several steroids are elevated in both columns , but not in this case. Although, estradiol may contribute to clinical signs it is not a good indicator of adrenal activity., ;since it is secreted by pripheral tissues.. adipose, skin. .in this case the source is not known.. what does this mean??? 17 OH -P elvatios are significant (early stage HAC?) what does that mean and why are they questioning.. this entire journey seems to be inconclusive to anything. It goes om to say that some vets mayh consider initially items 2 to 4 combined if symptomatic. Okay.. I dont know what they are talking about.. Please help. thank you so much.
** Since Friday night after having one bowel movement she seems to be scurrying around from our wood floors to an area rug, sits down and seems to be having discomfort. Reese started her first melatonin pill late friday night so I would tend to doubt by sat she would already have a problem, but who knows. I did continue to give her her pills yesterday both morning and night but had a call in to my vet to see if I should stop them since it did have a warning about not taking it for a few reasons, and auto immune disease/dry eye was one. By the time my vet called back we had been out to dinner and he didnt leave an answer to my melatonin question. This morning she seemed to be struggling while urinating and still has not had a bowel movement since friday evening. She doesn't seem to be drinking a lot and all else seems the same other than the irritated vaginal area. .blackish oily areas and seems to be irritated.. I clean her very well after each urination and dry her well. her anus seems very irritated and inflamed, so I am wondering if she needs her glands suppressed.

My husband is very upset that I seem to be "looking" for more problems, but as I reminded him at the visit two weeks ago my vet did say the same, but never did anything. I guess we all got involved in the ACTH test and the adrenal panel that we neglected to remember her other issues.. now she is also rubbing her face and ears on the area rugs and seems to be having problems.. so we will be on our way to the vet once again, and I truly believe that by Monday morning, I will be on the phone with the cushings specialist from Westchester. We live on Long Island to get a specialists opinion.. I am just hoping that we have done enough tests.. feels like a hundred and he can just guide us with her ongoing treatment.

If anyone can make sense out of her numbers or once again offer any advice.. I will truly appreciate it. Thanks all.. I feel as if all of you know more than the vets.
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Old 03-04-2012, 08:48 AM   #2
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I sent a PM to a couple of people who can help you immensely with this diagnosis and good advice.

As for the Melatonin, I have a pup who has been on it for over a year now and he is doing quite well! He was diagnosed with pseudo-Cushings and had hair loss so I was advised to give him Melatonin BID. It is amazing how his hair returned and he is not sleepy at all! I was worried about that at first, but it did not bother him.
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Old 03-04-2012, 12:51 PM   #3
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Thank you sooooo much! My husband took Reese to my regular vet this morning since she seemed to be irritated on her vaginal and anal areas. Also to check her belly since it seemed overly buddah like and hard. My vet initially called me a pain in the AS*, yes to my husband, who is normally very calm and does not like to get into any conflicts (rightfully so or not) surprisingly came to my defense and said how emotional this has been for us and how it comes at a very bad time in our lives.. my husband has been out of work, and a million other problems.. so he then calmed down and instead of my husband going over all of my questions (that he was armed with on paper) he called me while he was with my husband and reese and answered everything. Although he has only had three atypical cases of cushings in his entire career he did say that he has researched it and will explain all to me from the beginning.. I must admit he made it much clearer and finally explained all of the University of Tenessess results, and all other related questions. At this point he wants to keep her on melatonin for three to four months and hope that works on its own. He was not that familiar with flax seed or hulls and lignans. .spelling is probably off, but said he didn't want to introduce too many things at once. He wanted to see if the melatonin would work on its own first. That sounds reasonable. He told me Reese's levels are not that elevated so he felt he definitely had time to do this. To my surprise he said he does NOT retest or even do an adrenal panel again but just waits to see if the symptoms subside.i.e. swollen belly, enormous appetite, some weight loss (hopefully), and hopefully the return of her regular coat. What was interesting was, although we cannot obviously go back in time, he did say that it is very possible that Reese has been atypical cushings her entire life, as two of the techs at UT told me. Believe it or not they see atypical and possibly even cushings in young dogs, even in puppies. He did not have the feeling that reese has a tumor but wanted to hold off on the ultrasound. He feels at this point it is probably too early to even see a tumor, if even there. At least based on her levels, symptoms, etc. I will wait the four months.

What I wanted to ask you and sorry for my ignorance is what is BID, in melatonin. I did get a brand Nature Made in Duane Reade and am not sure if it is time released or not. It makes no mention of that. I was told NOT TO USE time released by other posters on other sites. I am giving them to her twice a day, 3mg.. and she is NOT out of it, thank gd at all. She is a lazy girl and enjoys her sleep, but it doesn't seem as if she is sleeping any more. Her appetite is still as crazy if not worse (but that could be in my head, I will admit) but again I was told that I would not see any results until three to four months.

I was just concerned that she would be sleeping 24/7 and what kind of quality of life would that be for her. It is way too cold for REESE to even attempt to take her on walks. This girl needs the weather to be at 70 for her to have any desire to even go outside, let alone walk.

I am so appreciative of your message and much happier that my vet did call me and did check Reese too. Her anal glands were expressed and I was given a spray antibiotic for both her vaginal area and anal area. We will take it slower than I have been and hold off with the Westchester specialists.. Dr. Peterson or Dr. Sobel, until we gd forbid do not see any improvement.

Sorry for my typical long messages but as most who have babies with any form of cushings, it is very difficult to diagnose, as well as being a very difficult disease to treat. Hopefully we will find the right treatment quickly and just add this med to her daily eye ointment. Unfortunately a lot of people and dogs/cats are having terrible allergies, already. Reese suffers from those as well, but we never really gave her anything. Thankfully they were never that bad. She is a front paw licker but only for a bit before going to bed and then when she wakes up. Thankfully no sores or hair loss there. He by NO MEANS will put her on steroids, even though atypical cushings is not too much cortisol but too much sex hormones. He does not feel that antihistemines work too well, in dogs either, so prefered to tackle one problem at a time.

Again, thank you for asking people with experience to contact me. That is so sweet of you for taking the time to respond. I will update, in a much shorter version (promise) if anything changes one way or the other.

Best to all,

Randy
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Old 03-04-2012, 01:22 PM   #4
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ladyjane.. Since you made my day by responding to my post and my vet had the patience to spend time explaining all to me, I have decided that this would be a great time to post very recent pictures of Reese.

This just goes to show that no matter how much hair loss she has, she will still be our princess. She just gets to wear a lot more clothing than she ever has. As girly a mom I am.. I mean I also have three human daughters, and I love PINK, I was never too into dressing Reese up, other than bows and sweaters and coats for warmth, while outside. Now she is spending a lot of timne playing dress up and has a lot of light weight tops to sleep in.

I must admit it is more for me than for her, at this point, because it breaks my heart to see her back so bare. Thanks again to all and hopefully this will work out for us and Reese will have it as easy as possible. thanks again and enjoy the rest of this beautiful day.
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Old 03-04-2012, 01:27 PM   #5
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You do not need to be short in your postings! Your post is very easy to read and explains a lot. I just wish I had some experience that I could share with you, but I don't. I do know that a few people here have had experience ... lots are not online on weekends, so it may not be until tomorrow before you see more replies. You could do a search using the search option...type in Cushings and I am sure you will find a lot of helpful information on YT.

The Melatonin dosage is just what my foster pup is on. I am SO sorry.....BID is twice/day. I normally don't write it that way...I do apologize.

I am glad your husband set your vet straight! Sometimes people say things like that without thinking....very nice of him to call you and explain everything in detail!

Yes, Cushings can take a long time to diagnose...that I do know. It is a bit hard to understand as well....but it sounds like you are going to get the hang of it and hopefully your pupster will do well.
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Old 03-04-2012, 01:36 PM   #6
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Quote:
Originally Posted by momofreese View Post
ladyjane.. Since you made my day by responding to my post and my vet had the patience to spend time explaining all to me, I have decided that this would be a great time to post very recent pictures of Reese.

This just goes to show that no matter how much hair loss she has, she will still be our princess. She just gets to wear a lot more clothing than she ever has. As girly a mom I am.. I mean I also have three human daughters, and I love PINK, I was never too into dressing Reese up, other than bows and sweaters and coats for warmth, while outside. Now she is spending a lot of timne playing dress up and has a lot of light weight tops to sleep in.

I must admit it is more for me than for her, at this point, because it breaks my heart to see her back so bare. Thanks again to all and hopefully this will work out for us and Reese will have it as easy as possible. thanks again and enjoy the rest of this beautiful day.
Ohhhhhh Reese is a little doll!!! I love the chicken dinner picture!!

As for the hair loss, hopefully the Melatonin will help. Here are some pics that might make you feel better. Sunny D is my foster I talked about...here are some before and after pics of him ..... the Melatonin, as you can see, worked really well!

ytsonny_rashbefore.jpg

ytsunnyjan2010cf.jpg

sunnyd2.jpg

sunnyyt.jpg
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Old 03-04-2012, 04:16 PM   #7
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hi there. thanks for sharing the pics of reese, she is adorable!!! sorry reese has been diagnosed atypical cushing's but glad that at least you have finally found out what is going on with her. LJ sent me a message and hope i can help... i remember being exactly where you where and so confused. i'm glad your vet explained everything to you. i also had to have a long meeting with zowi's dr at the beginning of all of this! compared to zowi's acth results in the beginning of her treatment, those numbers are not bad at all. reese's cortisol is not elevated which is good, u of tenn usually recommends melatonin and lignans together when estradiol is elevated. is reese also going to start hmr lignans? zowi takes both melatonin and hmr lignans daily for elevated sex steroids, including estradiol, and does very well on them and isn't "out of it" or any other ill effects at all. a cheap reliable (recommended by u of tenn) source of both is found here.
Vitamins and Supplements, Natural Health Products, Organic Foods - Swanson Health Products

this link will take you to one of my threads here that have one of zowi's first acth stim results from the university of tennessee if you would like to compare.
http://www.yorkietalk.com/forums/sic...-cushings.html

my GUESS is that the eye ointment reese is on could contain steroids and that is why the vet is concerned with the continued use of it?

this is the list of treatment option considerations from university of tennessee... this is what they mean by the 2 and 4 in the comment section of the stim results.

http://www.vet.utk.edu/diagnostic/en...ings201107.pdf

i would suggest that you join this yahoo group, as it is full of information and experienced people who can answer just about everything. i am also a member there but i do not post frequently.

CanineCushings-AutoimmuneCare : Cushing's Syndrome | Autoimmune Disease

zowi had a little skin infection on top of her head that was causing her to rub her face and eyes on things. she was treated with simplicef and it cleared up in a week so possibly that could be the case with reese?

please keep us updated on how things are going. sounds like you're doing everything you can for your pretty little girl. sending hugs to you and reese.
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Old 03-04-2012, 04:18 PM   #8
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and sunny d is a little doll too!!!
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Old 03-04-2012, 05:39 PM   #9
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Hi Randy - I'm sorry you're going through so much right now. I know *exactly* what you're going thru and have been thru as my Wylie has Atyp Cushings. (and, thanks to Lj for PMing me about your kiddo)

First off...something easy...Cushings dogs (atyp or typ) are very, very prone to skin infections, especially when they're pre-diagnosis. This is bc their immune system is suppressed and a few other things. Since you mentioned she is itching - ask your vet to do a quick skin smear while you're there - he should be able to see on the slide whether there is excess bacteria present. Lots of Cush dogs get Pyoderma. A great antibiotic to treat it is Simplicef - once a day, for 3-4 weeks.

On the Melatonin: Wylie takes 3mg BID too - and he never shows tiredness on it. Even if your kiddo shows some tiredness at first, it usually goes away. Most dogs have a very easy time taking it.

We too sent our bloods to U of Tenn, they're wonderful. We started out giving melatonin and flax lignans right away. And then retested in about 3 mths. No change. So, we now have Wylie on Lysodren and Melatonin; and he is hypothyroid - so he takes meds for that too. Oh, btw, they did test Reese's thryoid, right? Many cush dogs have hypothyroid.

I can tell you, it can take a full year to get the meds titrated correctly. I know how scary that is! You feel very confused, and it's a big learning curve. Believe me though, you will get her there. The way it will prob work for you is: give the melatonin, do ACTH after 3-4 mths; if effective, great. If not, add lignans...wait 3mths...test again. If not effective, move to more aggressive meds and repeat. And you go like this until the right combo is found. Granted, cush drugs (the aggressive ones) are not great to read about...they're pretty major drugs. However, most cush owners find something that works so well, w/ very little side effect. Wylie does simply amazing on his Lysodren. He takes it MWF.....fyi, most atyp cush dogs don't have to take the aggressive meds EVERY day, which is nice. Whereas some typicals do have to take them every day (which can be a little tougher, in terms of side effects).

As far as understanding the numbers....you will get there. It takes time and a lottttt of reading, believe me. But eventually, it all clicks much better in your mind. To me, it looks like you have a very good understanding of everything already.

Yes, sometimes high cortisol levels/Cushings can be due to a tumor in the adrenals or in the pituitary. Did they ultrasound her adrenals, btw? A cushings Vet may want to do this, just to see if there have been any structural changes. But like Wylie, your Reese's issues stem from an intermediate sex steroid/hormone. Wylie's main one that is high is progresterone, but his estradiol is slightly elevated too. Btw, Wylie was only about 4 when it was diagnosed (he's now 7).

I've already typed a lot...I don't want to overwhelm you. Here are some sites that I found helpful. You've already been given the yahoo Cushings group - and that's an AMAZING site for reference documents.

Overview, basic: Cushings

No-posting forum that contains good reference info: Important Information and Resources - Canine Cushing's Forums

Good journal article, including Dr. Jack Oliver (RIP ) from UofTenn: Newer tests shed light on causes, treatment of adrenal disorders - DVM

Know that w/ treatment, some of Reese's symptoms will subside. Some cush dogs look like totally different dogs after effective treatment is started. Her hunger will normalize at least a little, if not a lot. And I'd imagine you'd eventually see a major change in energy. Wylie didn't have the pot belly, which is so common in cush. He had polydipsia/polyuria, recurrent skin/ear issues, hair loss, 'aged' look to face, muscle wasting in hind legs. All of that is much better now.

Hang in there, and just know that you'll feel better about this diagnosis as time goes on.
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