Speaker 1: You were listening to Petlifradio dot com.
Speaker 2: And welcome, welcome, and have me Sunday to all.
Speaker 3: Good morning if you're out here in the west by
me or good just break it that afternoon if you
are in the east, and hope all is well with you.
We are enjoying a nice, clear, beautiful day out here.
Hope yours is the same. Very curious to know how
how everybody did Halloween wise, you know, it's interesting here.
I am promoting all the things you need to do
and all the things you need to be careful of.
Speaker 2: We talked about a lot last week.
Speaker 3: So what I usually do for my office is I
will bring some candy just for my clients. You know,
we put them out on the counter in the front.
So I had I had two bags. One was Nessi's crunch,
one of mine. I always get my favorite that way.
Don't eat him a least. I'm going to enjoy something
that's left over. And snickers. Well, I had the bags
here in my home office. Now, mind you, my dogs are,
especially my labradors, are insane when it comes to getting
into things. They are masters and I literally have to
have baby locks on cabinets because they know how to
get into cabinets, and I have to block the kitchen
door so they don't get into the kitchen if they're
in the house anyway.
Speaker 2: So I had.
Speaker 3: Totally didn't realize they were in my office. I forgot
that's safe because they never go into my office. All
of a sudden, I get a call. I forgot to
bring the bags, and there's my lab, my old lab,
thirteen and a half. Now, mind you, this guy can
barely get upstairs, but he could jump on top of
a counter for food.
Speaker 2: Anyway.
Speaker 3: He gets into about ten of those little teen nesties grunds.
Speaker 2: He's eighty five pounds.
Speaker 3: I'm not worried about the toxicity issue with milk, chocolate,
et cetera, et cetera. But you know, he doesn't like
to take things out of rappers. He thinks, you know,
I'm gonna smell it right through the wrapper. I'm gonna
eat the whole thing. So I knew this happened. I
figured some of the stuff would come out of his poop.
I wasn't too worried about it. Since then he ate
like what. So that was Friday morning early, he ate,
Friday evening, he ate Saturday, Saturday morning right ate all
these meals, and late last night I hear him up chucking,
and I hear that typical you know, that vomiting thing,
and outcome that mind He's had normal meals and normal
poops over this last day and a half, and all
of the rappers in a bunch came up in his vomit.
It's like, I'm thinking about, how does the food get
by and go through the intestine and get digested. It
all is fine and develop a nice verso and the rappers,
the Nessie's Crunch Rappers are still there in their entirety. Anyway,
I hope you guys had better luck than I did.
As I used to say to my kids, do as
I say, not as I do, because I'm the worst
lesson to learn from when I do stupid things like that. Anyway,
I'm glad you're here with me. I'm doctor Jeff Weerber,
your host for today's Ask the Vets with Doctor Jeff
here on the pet Life Radio and iHeart Radio station partner.
Speaker 2: And we're here for you. In fact, it's easy to
get ahold of us.
Speaker 3: And last week we did get a call, well actually
someone wrote in joined in in the conversation, which you
could easily do. If you are shy and you don't
want to call us at eight seven seven three eight
five eight eight eight two, you can just go online
to petlifradio dot com, click on Ask the Vets with
Doctor Jeff tab and on that page you will see
a little box that says join the conversation. Log into
our live chat during the show.
Speaker 2: Please do so.
Speaker 3: Last week we didn't get someone who called in.
Speaker 2: And also you can.
Speaker 3: Email me to Dr Jeff. That's doctor Jeff at pet
Life Radio. And you know, look, we want to make
your lives easier. Just think about all the benefits the
benefits of joining us either via phone or joining the
conversation the following hopefully you're going to get some answers
to your questions. And if I don't have the answers,
I will get them. As a general practitioner, for this
is my thirty first year, I kind of know a lot,
but when it comes to really tough things, I have
a great network of experts in pretty much every specific discipline,
so I will get an answer. Secondly, it's free, doesn't
cost you a time. My goal here is to help
you and maybe even help you save a little money
in the process, and of course we're here thanks to
our sponsors, pro Tense Pet Products and cong As a
matter of fact, when you call, not if, but when
you call, when you join in on the conversation, we
will send you out a pro Sense pet product as
well as a free Kong toy. And contoys are great
because they're therapeutic at the same time, So you have
no excuse, no excuse not to join in. So first
of all, I would love to hear about any Halloween stories,
the good ones and the bad ones, if you had
a problem, if you had a dog that got out,
if you had a cat that got out, if you
had dog that was growling at some of these kids, whatever,
we want to know about it. So again eight seven
seven three eight five eight eight eight two, you're just
kind of joining in the conversation and we'd love to
hear from you what I wanted to do. And we've
been sort of going through and until you contact me
to speak about a specific subject, which I'm happy to do.
Speaker 2: I have a game plan.
Speaker 3: My lesson plan, as you will, is if I were
a teacher, and what we're going to do now is
we're going to cover the very many endocrine diseases. These
are diseases of the hormone system of the body that
seem to go astray and ry at certain points. And
most of these are fairly easy to diagnose.
Speaker 2: Some are more difficult.
Speaker 3: Some of the growth hormone problems could be very tough,
but they're somewhat easy diagnosed, not always easy to treat.
Speaker 2: Very fewer curable.
Speaker 3: However, we can control them. There are great medications, great
choices we have. Some, believe it or not, are pretty
much curable. When you're done, you don't have to do
a thing. But those are the rare ones. But we'll
get to all of them. So what I wanted to
do is, we have a land in our body called
the adrenal gland. It is basically attached to the crania
poles of our kidneys, and the adrenals have different zones
within the gland and they're responsible for the sex hormones,
for the mineralid corticoids. Those are the hormones if you will,
that will control the mineralid corticoids, which are like our
calcimine phosphorus balances, and so you know that's very important
for the body. Sodium potassium also very important to the body,
and also the glugle corticoids, which are the steroids that
are body secretes. Basically, I'm sure you've heard of a
drug pregna zone or any of the corticosteroids that are
used to treat many conditions and pets in different dose
ranges depending on whether we need an anti inflammatory component
or whether we need to have an iminosuppressive component, So
there's some different dose ranges. The adrenal plays a major function,
and the signal for the adrenal to work usually comes
from a gland in the brain called the pituitary gland,
and there's a number of feedback mechanisms where the body
is able to read what's already there and then with
a healthy gland make necessary adjustments and whether it's going
to make them on its own or make them as
a result of secretion from the pituitary gland. So the
petutary gland sort of is the master gland that dictates
for the adrenal what to do.
Speaker 2: Well.
Speaker 3: There are two conditions that we frequently see and also
the effects are a little bit different where concerning the
adrenal gland. Where one is an over secretion of the
adrenal gland, and the other one is an under secretion,
and the one that we see more commonly is the
over secretion, and we call this Cushings syndrome or cushions
disease technically. And the Cushing's syndrome is actually where the
problem is coming from the brain, the petuitary gland, and
the petuitary land is overfiring, over signaling the adrenal gland
to secrete it's glucocorticoids, not really listening to the rest
of the body when the body says, hey, slow down.
We got plenty of cortisol running around our blood. We
don't need anymore. It just keeps on firing and signaling,
and that is Cushing syndrome. Cushions disease is where the
problem is actually coming from the gland. The adrenal gland itself.
Ptuitary has nothing to do with it. It's all coming from
the gland. There's a functional increase of secretion coming from
the adrenal and that's Cushing disease. The reason why there
is somewhat of a difference is that when it comes
to treatment, when you can I clearly identify Cushion's disease,
it might be easier, well not easy, but it can
be treated by removing the adrenale. Obviously, that can require
the hands of an excellent technical hands of a surgeon,
but can be done. Whereas, obviously if the peturit arry
is the problem, so it's really by definition Cushing's syndrome,
you can't do that. So that's that we have to
rely on medical therapy. So what are the symptoms? And
this is what's so important because a lot of the
symptoms that we see with some of these hormone diseases
are very similar. For example, a dog comes in and
it's classic cushings. I got a funny story about my
early days in practice with this condition, and it is
a dog that comes in and the complaint, the chief
complaint from the owner is my dog is drinking water
like crazy and peeing like crazy. Now there is another
disease we're going to get to, not probably not this week,
but maybe in a couple of weeks, and that's diabetes.
Two types of diabetes, diabetes melodists and diabetes and simpetus.
And guess what they too present with dogs that are
drinking and being like crazy. So cushions disease typically we
call it pupd polyuria that's excessive urinating, and polydipsia, which
is excessive at drinking. Other things we see with cushings.
We see kind of like the body is changing. The
skin is getting kind of thin and oily. Sometimes we'll
see hair loss that's not associated with scratching the skin,
the belly looks bloated. Basically, a lot of the changes
we see are the same changes we're going to see
in a dog that we have to treat with an
excessive amount of cortico steroids for whatever disease they may have.
So when I'm sure you've seen people that had to
be on steroids for a long time, it's similar type
of changes take place in the body. So you get
that thin, sometimes greasy looking skin, thinning hair, big, bloated belly, pup,
the excessive drinking, excessive pin and you say to yourself,
oh my god, this is classic cushings. Now, to this point,
you still don't know whether it's cushions disease or a
cushing syndrome, but it's cushings. So now the fun begins,
and that fun is we need to start doing some
tests to see where are problem is and to try
to make a determination because the disease actually is not curable,
but it is treatable, it is controllable, and we have
many cases that dogs with cushings that are just doing
just fine. There is actually a relatively new drug. When
I say relatively in vetterney world, that means that it's
not like yesterday, but it's been around for probably seven.
Speaker 2: Or eight ten years.
Speaker 3: Maybe it is a major improvement over the drug that
we used to use back in the day when I
started practicing. So there's some new things out there that
are great. Also, testing, one of the tests that we
used to use is still used often, but there's no
other test of many of the experts like a little
bit better, so we use that one too, And this
other test, the one that's a little bit better, might
actually help us determine the difference between cushion disease and
cushing syndrome. And of course, with the advent of ultrasound
in the hands of an amazing ultrascenographer, the adrenal gland
sitting bite by that kidney is often visible and it
can be measured, and a determination can be made merely
an ultrasound whether we're dealing with the adrenal problem.
Speaker 2: Or the pituitary problem.
Speaker 3: So there's a lot to do, a lot to talk about,
and we will as soon as we come back from
our quick break, So stay tuned. We're learning about cushings
disease in dogs predominantly, and we'll be back in just
a few and we'll talk about testing and we'll talk
about treatment, and we'd love to hear from you if
you have any questions about your dog that may have
or might your concern might have cushings or is currently
being treated. We'd love to hear from you and get
your input as well. Here at eight seven seven three
eight five eight eight eight two. We'll be back in
just a minute.
Speaker 1: We'll be right back right after these messages. Stay tuned.
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Speaker 1: Every week only on Petlifradio dot com. Let's Talk past,
Let's done, pet Talk about Life Radio, Hetline Radio.
Speaker 8: At live radio dot com.
Speaker 2: And welcome back and thanks for being here.
Speaker 3: And you're here with doctor Jeff Werber, your host here
on Ask the bect for doctor Jeff here on pet
Live Radio. And before the break we were talking getting
a little science here education about a disease we commonly
see in dogs, I shouldn't say commonly with innive medicine
or in medicine in general, we get to use the
term it's not uncommon. Now usually if you look at
it double negative. Well, if something is not uncommon, you'd
say it is common. But common means it happens a lot.
In medical ease, when we say it's not uncommon, it's
just this means uncommon is something you rarely see. So
if it's not uncommon, it's not that we don't We
don't not rarely see it.
Speaker 2: We don't see it a lot.
Speaker 3: It's not common, so you kind of Yet, you have
to be very careful in using the term. So when
we see something it's not uncommon, I mean, yeah, we
see it. We see it, you know, kind of frequently,
but not not a ton. But it's not surprising. It's
not like you know, my old expression I've shared with
you before that you're running along the beach, and I'm
gonna use Malibu because I'm here in southern California. Say
you're running along the beach in Malibu and you hear
hoof beats chasing you from behind. Are you thinking horses
or zebras? So you're not thinking zebras, so you're thinking
horses now. So therefore, when I say something is not uncommon.
Speaker 2: It's not a zebra. It doesn't mean you're gonna see
it every.
Speaker 3: Day, but it's not something And oh my god, you know,
I got to call a Guinness Book a World Records
here because I got a case of cushings. So we
are talking about the testing. First of all, you have
the clinical disease, clinical disease. Once again, you have the
dog typically that's drinking water like crazy, therefore peeing like crazy.
Their skin is very thin. It's they have a bloated
belly appearance, sometimes a sway back. They're losing a little
bit of muscle tone, some hair loss, and we call
it endocrine alopecian. The reason why we say endocrine is
because usually the endocrine alopecies alopecia meaning hair loss, they
are more symmetrical and they're not associated with scratching. So
if you look at the skin itself, it's you don't
see scabs and sores things like you would typically see
with allergic condition.
Speaker 2: And if you're sort of like.
Speaker 3: You know, if you were to mentally don't do this
at home, folks, But if you are mentally going to
chop the body in half along the longitudinal access the
right side will look almost exactly the left side like
mirror image. That's what we call bilaterally symmetrical. And that's
what we see with these kinds of alopeches with our
endocrine diseases. If they are going to be endocrine and alopeches,
so testing so we have a we get a good history.
And the first thing, of course we're going to do
is do a basic blood test. And one of the
things that we pretty much often see when we do
our basic blood tests is going to be an elevated
alkaline phosphatase. Now, the ALKN phosphatase is one of the
four major liver enzymes that we often look at, and
we know that dogs that are on certain medications like
corticosteroids also like phenobarbitol, but like steroids, when that dog
is on chronic pregnosoon for some reason, or prenis alone
or dexamethosone or you name it, they're going to have
an elevated alkalin phosphatase. Well, when we have a dog
with cushings, where in essence, the body is giving itself
too much cortisome, we're going to see an elevated alkan phosphatase.
Then I mean elevated like high normal is like one
hundred to one hundred and thirty, depending on the lab
you're gonna use. We're talking dogs that present with values
over one thousand, eight hundred. I had a dog as
high as twenty five hundred, I mean three thousand.
Speaker 2: It's ridiculously high.
Speaker 3: So given the presentation, the PUPD, the skin changes, those
sway back, all that stuff, and an elevated alkalin phosphatase
that is highly suggestive. Note that we did not say
it's diagnostic. These are things that are highly suggested. And
the reason I say that is we've had dogs that
present a typically where they have all the PPD, the
drinking and the peeing, they have their skin the body changes,
but their alkaline phosphase is totally normal. Are you going
to stop there and say no, it's not cushings, Of
course not. It just means that one major test, that
major clue isn't there. So that outcomes one of the
real tests that we do to determine the drug ivan
determine the disease, and that is called wether one of
two back in the day, and it's still used. Nothing
wrong with using it is called the a ctight response
test the adreno cordicotropic hormone response test.
Speaker 2: How does this work? Well, this is basically the following.
Speaker 3: We know that a dog that is going to have
a stimulation of the adrenal is going to have a
normal increase in its output of the hormone. So basically,
the ACTS typically comes from the pituitary gland in the
brain signaling the adrenal gland to fire and it releases
it's hormone, it's cortisol. But dogs with cushings, as I said,
they don't look at your normal type of release of
the cortisol from the adrenal gland. They go gangbusters. So
we know what the normal dog does. So what the
actate response test does is we give a certain measured
amount of the corticotropic hormone and then depending on what
we use in which technique we use, whether it's given
IVY or I AM, but once to two hours later,
we then go ahead and remeasure the cortisol level of
the blood and if it is off the charts high,
then we assume cushings. Another test that seems to be
a little bit more in vogue now is called the
low dose dexmethisone suppression test. As I also mentioned, typically
dogs respond is like a feedback mechanism continually going on
between the petutary land, the bloodstream, the amount of cordothol
the blood stream, and the firing of the adrenal gland.
So what happens is if we give the body a
measured amount of cortisome in the form of dex methisome,
then the normal dog, sensing and seeing the body has
plenty of cortisol on board, will shut down and stop secreting,
and therefore the adrenal gland will not secrete anymore of
its own cortosol. Basically the pituitary and the adrenal combined,
whichever whether it's your cushions disease crushing syndrome, is basically saying, hey,
we got enough, we don't have to work, sit back
and relax, but dogs with cushions don't.
Speaker 2: So what we do is, even though we're suppressing.
Speaker 3: With the decimethisoone, we are still seeing firing and based
on some calculations and measurements, this test, it's a blood
test taken. We inject the steroid, we take a follow
up at four hours and at eight hours and then
at eight hours they depending on the levels, you can
determine that whether the problem is coming from the actual
adrenal land meaning Cushing's disease or to the pituitary land
meaning Cushing's syndrome. So that's why a lot of the
internet is like it because it helps us. And then
of course, if we really want to try to suppress,
then you go in and do a high dose dexamethisone
suppression test with a high dose basically of the normal.
If it's a normal suitary problem, it's going to suppress
and then we'll know if it's still not listening to us,
most likely then we have a adrenal problem. So if
those tests are abnormal, then we and have a suspicion.
We can do the next step, and that is well
to really confirm, let's go to the ultrasound machine. And
with the ultrasam machine again in the hands, a lot
of general practitioners may not have the skill or the
quality of ultrasound machine to actually make this determination, but
certainly the intern is do and that is let's go
ahead and check out the adrenal gland at the kidney
through the ultrasound and see doesn't look huge.
Speaker 2: So if the.
Speaker 3: Assumption is everything checks out that we have cushions disease,
now it's time to treat, and the treatment options are
quite a few. There is a drug that we all
used to use years ago called lycodron. The chemical name
was either might attain or OPDDD, and that was a
drug that would actually suppress the adrenal gland. It would
actually eat the adrenal gland up, and in fact one treatment.
In Europe, what they do is they used to give
the opdd so much that they used to obliterate the
entire gland and then treat the dog as an Addisonian,
which is the disease we're going to talk about next week,
which is an under secretion of the adrenal gland. That's
Addison's disease, and Addison's disease. Dogs are pretty are actually
much easier to treat. So in some places in Europe,
I think in Sweden, their treatment of bushings is to
let's make them into an Adisonian and treat We.
Speaker 2: Never did that here.
Speaker 3: We tried to tighter exactly tight trade I should say
how much.
Speaker 2: OPDDD could be given.
Speaker 3: There's a newer drug called Trilastain was first used in
Canada a lot now under the trade name Veteral that
most of us are using, and that is again measured
by weight, and its goal is to again decrease the
amount of output put out by the adrenal gland and
thus monitor these dogs via the actate response test. So
even if we made the diagnosis originally using the low
dose dex methosone suppression test, we monitor our success on
the veteral using the act response tests, and that drug
is very safe.
Speaker 2: Dogs do very well on it.
Speaker 3: And of course if we have confirmation via our testing
and our ultrasound that our problem is most likely the
adrenal tumor itself, then of course in the hands of
a qualified surgeon, that adrenal gland or the adrenal glands
can be removed. And then again we're going to have
an Adisonian and then we treat accordingly as we would
in Addison's which we're going to cover next week. So
the options are many. These dogs can live somewhat normally.
We do see some complications, however, in that many of
these not many. Some dogs that have it cushions might
also have diabetes going on at the same time, it's
a disease we're going to cover in a few weeks
that diabetes melodis. Now we get complicated because it's almost
like the treatments are opposing each other because the anti
insulin effect of high dose steroids. And then we really said,
now we're giving you know, we have a disease that
is secreting too much steroid. We get this anti insulin
effect because of the steroid. That's where it gets very,
very comp and these dogs are a lot more difficult
to adjust, but it can be done. I'm in the
midst of treating one right now. We've been you know,
kind of going on for a while ago Lucy who
has both diabetes and cushings just to throw us a
hell of a curve when it comes to treating these
endocrine disorders. So again, to recap cushing disease, it's a
drenal and or pituitary problem. It's an over secretion and
the body is presenting too much cortisol. The changes in
the blood will usually dictate that. Behavior changes will dictate
that the skin how these dogs present and look, we'll
dictate that. And so our job is to minimize that
secretion to regulate it as best we can. We have
a number of drugs or surgery available to us, but
don't fret because it is a condition that we can
and often do, work with. So if you have any
questions about Cushing's disease, Cushing syndrome, if you have a
dog who's being treated or has been treated, or you've
had a dog in the past, we would love to
hear from you, find out how how it went. Get
your input because other listeners are going to learn from you,
just like taking learn from me, because you've been there,
done that. Here, I am been treating this for years.
I've never, in all my years of being a pet
dad a dog dad, have had a dog with Cushion's
disease or diabetes. For that fact, I shouldn't jinx myself.
But so we want to hear from you to see
how things are going for you. How is it working out,
Are you happy that you're treating? Do you have any
doubts that maybe you shouldn't have? This is what we
want to know. So I want you to give us
a call next week or send me an email and
I'll share it on air. To Drgeff at Petlife Radio
dot com or you can give us a call next week.
We'd love to hear from you as we're going to
be talking about Addison's disease, which is the opposite the
under secretion of the adreno gland. And you can give
us a call at eight seven seven three eight five
eight eight eight two. Thanks for joining us here. I'm
your host, doctor Jeff Werber. Thanks again to our sponsors
Pro Sense and Kong, and we will see you here
next Sunday.
Speaker 1: Let's Talk Pets every week on demand only on petlight
radio dot com.