Penny, Suspected Cushings Disease - Update: Penny is diabetic

[Carol]

Hello, I am new to the Cushings Support Forum which I found by accident whilst I was researching on the internet all I could regarding Cushings disease. I am not coping very well at the moment as my Penny who is a bichonpoodle aged 8yrs is suspected of having cushings disease and I am beside myself with worry that I may lose her.

It all started about a month ago when I took Penny to my vets for routine surgery to remove a couple of warts on her paws. She was active and very healthy at that time. Routinely they did a CBC biochemistry profile to make sure it was safe to put her under an anaesthetic but I was advised that they decided it was unsafe to operate on her because her liver enzymes were elevated. Here are the results. Everything was normal on the profile except for the following :

Alkaline Phosphatase 3290 U/L reference interval 22-143; S-Alk Phos 3047 U/L ref int 0-84; ALT 266 ref int 19-107 and CK 275 U/L 40-255 (I'm not sure what CK is?)

The vet then did a bile acid test which I do not have a copy of and the results they said pointed to liver disease. Then out of the blue it seemed, suddenly Penny developed increased thirst and increased urination which she never had before so they did a dexamethasone suppression test for cushings which was negative.

Then Penny had a coagulation profile done followed by an ultrasound and a fine needle biopsy to see what is going on with the liver. The results do not show cancer or hepatitus thankgoodness and they concluded she doesn't have diabetes or thyroid problems. All the report states is as follows :


There is degenerative hepatopathy with rare single cell death, mitotically active hepatocytes and increased heaptocellular turnover with cytoplasmic expansion consistent with activation of intracytoplasmic processes. The type of change present in the liver is seen with idiosyncratic reactions, response to adminstration of of some drugs including anticonvulsants and what is assume to be exposure to an environmental substance to which the animal is responding. Having said this, the majority of animals with this type of lesion had no identifiable specific cause and it is assumed that these animals are hypersentive to an environmental substance that would not affect other dogs. The changes are not typical of iatrogenic hyperadrenocorticism.
My vet said she had never seen a report like this and even she could not explain or did not know for sure what liver disease Penny has! A couple of days after the biospy Penny's health deteriorated where she is panting heavy especially in the evening with restlessness where she will go and lie on the cold ceramic floor rather than her bed. She still had increased thirst and urination, drinking 1 litre of water a day. She has suddenly lost 1.8 lbs and her back end looks atrophied and she feels like her muscles are wasting away and she is tired all the time. I talked with my vet about all these sudden symptoms and asked if the biopsy could have set all these symptoms off to which she said it wouldn't have but I am skceptical. She didn't seem to concerned about the weight loss and I asked if SAM-E and Milk Thistle would be a good idea to give Penny after I had found out about these meds on the internet. She agreed and prescribed 224mg Denosyl and I bought some over the counter Milk Thistle from the drug store and I'm giving her one 250mg capsule per day. She has had her 4th Densoyl pill yesterday. It was left last friday where the vet said that Penny is screaming cushings from her symptoms and that we should repeat the cushings test in 2 weeks which will be on march 30th.

Well I am really worried about her health deteriorating even more now and nothing is being done to correctly diagnose her and start to treat her accordingly. I read somewhere on the forum that someone said ther is no rush to start treatment if a dog has been diagnosed with cushings and it is ok to wait before deciding what treatment to follow. Is this correct? I feel like each day is life threatening to my poor baby. I am beside myself with worry and haven't slept for the past 2 nights. Then to top it all, last night Penny had a few consecutive very soft brown coloured bowel movements but to my horror there were spots of bright red blood in the stool and when I had to wipe Penny's rear end there were bright red streaks of blood on the tissue. I'm scared what this could be. This morning she had another soft bowel movement which was brown in colour with no blood this time thank goodness. She seems a little perkier today although still drinking heavily and tired and looks lethargic. Please does anyone have any help or advice. I'm really scared for Penny. I don't want to lose her. Thank you in advance for listening to my story.

[frijole]

Hi and welcome! Glad you found us. We are a collection of moms and dads to cush dogs and we have been in your shoes so please first off know that Penny can lead a normal life if she has cushings. Also know we will do our best to guide you so you aren't alone.

But first we need to know about the testing. Thanks for sharing that information. The ALK PHOS and ALT liver enzyme readings are how most of us discovered cushings. I do not know what CK means but we have a member who is a med tech with tons of experience who can add to my comments.

The liver readings could signify other diseases as well. Normally hypothyroidism, diabetes, and cushings. It is real important that we gather info from the other tests so we can help you.

First off - you said the thyroid tests came back negative. Can you please tell us exactly which test was/were done and the results? Also you said the LDDS (low dose dex supp test) was NOT cushings. Again, pls give us the results (3 numbers in this case)

I happen to give my cush dog SAME and milk thistle and so it can't hurt but honestly we need to figure out what is wrong. I assume that the glucose levels were normal and that is what ruled out diabetes?

Did the vet do a sonogram? Sometimes that is helpful to give a LOOK at what is going on inside.

I am sure others will have more questions but this will get us started. Is your vet a regular one or a specialist? I am thinking given the face he/she didn't know what to do with the last results - it might be wise to have a specialist look at them and make recommendations.

If it were cushings you would not have to start treatment right away, but given those liver numbers I would continue to try to find out what is going on. I am not sold on it being cushings yet - if the low dose test came back negative.

For now let's focus on getting the test result numbers and hopefully Deb will log on later and can answer the lab questions. Hang in there!!! Kim

[Harley PoMMom]

Hi Carol,

Welcome to you and Penny from me and my boy Harley. Cushings is a slow progressing disease so one does have the time to get a proper diagnosis for their pup.

Strong symptoms are a huge part of making the diagnosis so I was wondering, besides the excessive drinking and peeing, what other symptoms does Penny have?

On the ultrasound, were they able to see the adrenals? Is there anything on the report about the adrenal glands?

If Penny were my pup I would have your GP refer you to an IMS. An IMS has more experience dealing with special cases than a regular GP.

I realize how scary this all is, believe me, but know we are here for you and Penny. Ask all the questions you want and we will answer them the best we can.

Love and hugs,
Lori

[Carol]

Thank you so much for your input. Where to begin.

Well I do not think a thyroid test per se was done, in fact I'm sure it wasn't because when I initially asked my vet of what the elevated liver enzymes could possibly signify I asked if it could be hypothyroidism or diabetes and the vet just said no off the top of her head it wasn't hypothyroidism or diabetes.

The glucose result on the CBC profile shows 7.3 mmol/L reference interval 3.3-7.3. Would this be an idicator whether diabetes is present? A C/S & AnaO Culture was done and the results were:-
Microscopic Exam WBC +RBC+Gram positive cocci scant epithelial celis. No growth anaerobically after 3 & 5 days incubation. Enterococcus sp.

I haven't a clue what all this means only that the vet said that this interprets as a bacterial infection in the bladder that they would not treat with antibiotics as it is antibiotic resistant so it would not be worthwhile doing anthing which doesn't seem right to me but I don't feel I can contradict the vet!!

I'm afraid I do not have a copy of the LDDS test, they forgot to give me that. I will call my vets tomorrow and get a copy and let you know the results.

Regarding the ultrasound and the adrenals. I didn't get a report as such just verbal findings which were the adrenals appear to have atrophied somewhat but nothing to be alarmed about, that there were no tumours present on the adrenals.

You mention if my vet is a specialist. She is a regular vet. Is an IMS and Internal Medical Specialist? Forgive me. My vet said she might have to refer me to a specialist if she cannot determine what is wrong with Penny. Perhaps I should request to see an IMS.

The symptoms that Penny is showing right now are increased thirst, drinking 1 litre of water per day. increased urination, although it doesn't seem as bad these past couple of days. She is able to sleep throughout the night (9 hrs) without having to go pee. She pants a lot but only at night which seems strange to me. She now goes to lie on the cold ceramic floor rather than in her bed. Seems hungry all the time, begging for food. She has always been this way since being a pup ha! She has lost 1.8 lbs within a week. Her rear end looks atrophied like muscle wasted. Her stools are normal in colour but are like soft ice cream to runny. There was blood in the stool yesterday and bright red blood streaks. Today though there was no blood.

Thank you for you encouraging advise that there is no serious rush to diagnose cushings disease if it is this, but I would feel so much better if a definate conclusive diagnosis could be made so that treatment if any could be started. Thank you. I will post a photo of Penny once I have some. Carol

[frijole]

Carol, Those are all signs of cushings, hypothyroidism, diabetes... which explains the symptoms but we need to figure out what the cause is. (obvious huh?)

Has Penny taken any steroidal drugs lately? The glucose reading is right at the border. I'd think (but I am no expert on diabetes) that it would be higher if it were diabetes.

When you phone the vet, please confirm whether or not testing was done to rule out thyroid issues. This would have been an easy test to do when doing the other tests. If not then I would for sure go there next.

There are other possibilities but before we send you down multiple paths and multiple tests which cost money... I'd like to know what has already been done and the results. It really helps. And once you get the copies of all tests, go ahead and create a file as it will come in handy in the future.

Oh - a cure for runny poop is canned pumpkin. Plain, no seasoning. Only give a tablespoon. It plugs em right up. And it is very good for them too. I just put it in their food. Just finished a can of it this week. ha. If you give too much it goes the other way so less is better.

Glad you found us. Hang in there. Kim

[Harley PoMMom]

Thank you so much for your input. Where to begin.

Well I do not think a thyroid test per se was done, in fact I'm sure it wasn't because when I initially asked my vet of what the elevated liver enzymes could possibly signify I asked if it could be hypothyroidism or diabetes and the vet just said no off the top of her head it wasn't hypothyroidism or diabetes.

I would have a thyroid test done and sent to Dr Jean Dodds. She is an expert in that field.

The glucose result on the CBC profile shows 7.3 mmol/L reference interval 3.3-7.3. Would this be an idicator whether diabetes is present? A C/S & AnaO Culture was done and the results were:-
Microscopic Exam WBC +RBC+Gram positive cocci scant epithelial celis. No growth anaerobically after 3 & 5 days incubation. Enterococcus sp.

I haven't a clue what all this means only that the vet said that this interprets as a bacterial infection in the bladder that they would not treat with antibiotics as it is antibiotic resistant so it would not be worthwhile doing anthing which doesn't seem right to me but I don't feel I can contradict the vet!!

This does not seem right to me either; they can do a culture to see what bacteria it is and then specifically what antibiotic to use to treat that bacteria.

I'm afraid I do not have a copy of the LDDS test, they forgot to give me that. I will call my vets tomorrow and get a copy and let you know the results.

Good, we will be anxiously waiting to see them.

Regarding the ultrasound and the adrenals. I didn't get a report as such just verbal findings which were the adrenals appear to have atrophied somewhat but nothing to be alarmed about, that there were no tumours present on the adrenals.

Any abnormal findings on the adrenals can be an indicator of cushings, could you please get a copy of that report and post it here.

You mention if my vet is a specialist. She is a regular vet. Is an IMS and Internal Medical Specialist? Forgive me. My vet said she might have to refer me to a specialist if she cannot determine what is wrong with Penny. Perhaps I should request to see an IMS.

IMS = Internal Medical Specialist? Yes.

The symptoms that Penny is showing right now are increased thirst, drinking 1 litre of water per day. increased urination, although it doesn't seem as bad these past couple of days. She is able to sleep throughout the night (9 hrs) without having to go pee. She pants a lot but only at night which seems strange to me. She now goes to lie on the cold ceramic floor rather than in her bed. Seems hungry all the time, begging for food. She has always been this way since being a pup ha! She has lost 1.8 lbs within a week. Her rear end looks atrophied like muscle wasted. Her stools are normal in colour but are like soft ice cream to runny. There was blood in the stool yesterday and bright red blood streaks. Today though there was no blood.

Thank you for you encouraging advise that there is no serious rush to diagnose cushings disease if it is this, but I would feel so much better if a definate conclusive diagnosis could be made so that treatment if any could be started. Thank you. I will post a photo of Penny once I have some. Carol

Hypothyroidism and diabetes do share the same symptoms as cushings, that is why cushings is so difficult to diagnose. Not one cushings test is 100% accurate and sometimes not one cushings test can diagnose the type of cushings: ADH, PDH, or Atypical.

Please know we are here for you, you are not alone on this journey.

Love and hugs,
Lori

[AlisonandMia]

Is Penny on any medications and does she have any other medical issues such as allergies? Has she been on any other medications in the last year?

It seems that in the last week her appetite has increased dramatically, she is drinking and urinating a lot more all of a sudden and has lost weight and appears weak especially around the back end ... With those signs I think that repeating the test for diabetes would be a good idea. Diabetes can come on very, very suddenly - ie a dog can test negative for it one day and positive the next. Those symptoms especially the weight loss makes diabetes a possibility. Cushing's dogs tend to gain weight (although there are exceptions) if anything.

I think seeing an IMS would be a very good idea. But ask your vet to check her blood glucose as soon as you can - just in case.

Alison

[Carol]

Hello All, I'm sorry if I'm not using the correct method of replying to questions asked of all members who are trying to help me with my concern with Penny. I have been trying to navigate around the forum website but I keep getting in a muddle on how to reply to the different messages.

Alison asked what medications Penny has been on in the last year. She had been taking 1/2 Rimadyl tablet on and off in the past year for pain control due to cruciate ligament and luxating patella surgery that Penny had a couple of years ago. She also had about 3 separate monthly injections for carprofen (also Rimadyl) and on another occasoin had a weeks supply of tramadol for the control of arthritis pain. Could this have any reflection of the elevated liver enzymes.

Frijole asked about a thyroid test. I will ask my vet to complete a thyroid test on my next visit next tuesday. I will only be able to pick up the test for the cushings at that point and not before unfortunatley, so I will post the results of the cushings test once I have it.

A Dr Jean Dodds was mentined as an expert in reading thyroid tests. Where is Dr Dodds located? How would I have her check the thyroid test?

I will ask my vet about completing a culture on the urine to see what type of bacterial is present and what antiobiotic could help. although my vet did say the bacteria was from the stool?

I will also try and get a written copy of the results of the ultrasound although I'm sure there never was one completed. The specialist who performed the ultrasound just came into our vets office to do the ultrasound and we never got to see or talk to him. It was our vet who gave us verbal results after the ultrasound was completed.

I thank you all so very much for helping me with your comments and suggestions. It all helps me to be vigilant and knowledgeable when I speak to my vet next week about what tests I would like to be done.

Regards Carol

[Nathalie]

Hi Carol,

here is the link to Dr. Jean Dodds website http://www.hemopet.org/services.html#bookmark1

Nathalie

[lulusmom]

Hi Carol and a belated welcome to you and Penny.

I just finished reading your thread, and wow, to think that all of this started because of a crummy wart on Penny’s foot. Go figure. :confused: I spent my lunch hour jotting down stuff while I was reading so I hope you can follow what I’ve typed below. If not, please don’t be afraid to ask questions. It wouldn’t be the first time somebody had to translate for me. :D

I personally think that Penny’s liver enzyme elevations are more consistent with cushing’s and primary liver disease than hypothyroidism. This doesn’t mean that you can rule out hypothyroidism because approximately 10% of cushdogs are also hypothyroid. Approximately 25% of dogs with primary hypothyroidism will also have elevated liver enzymes but it’s highly unlikely you would ever see Alk Phos this high. The odd thing is that I don’t see cholesterol listed as being abnormal and this is commonly elevated in both cushing’s and hypothyroidism, especially with liver enzymes this high.

You mentioned that Penny was receiving an NSAID, carprofen, for pain. NSAID’s can have a profound impact on the liver and can cause some fairly high elevations. How long had it been since Penny had a carprofen injection or a pill prior to her bloodwork?

At least half of dogs with cushing’s will have a low T4 and the law of averages says that most of these dogs do not have primary hypothyroidism but rather sick euthyroid syndrome. This is when the T4 levels are lowered by any number of underlying conditions but the T4 usually normalize once the underlying condition has been resolved or effectively treated. T4 levels are routinely included in blood chemistry panels and since you mention that diabetes and thyroid has been ruled out, I am assuming that Penny’s T4 was normal. Can you please check your paperwork and let us know if T4 is listed and confirm that it is within normal range? Honestly, if Penny had no symptoms of hypothyroidism, such as skin and coat issues, increased appetite and general lethargy at the time the bloodwork was done, I personally wouldn’t be pushing for a full thyroid panel just yet.

You mention that the bile acid test was pointing to primary liver disease. Can you post the actual results for us? A good majority of dogs with Cushing’s will have increased post meal bile acids concentration up to 50 umol/L and in some rare cases up to 75 umol/L. Anything over 50 and definitely higher than 75 umol/L would make primary liver disease a lot more likely. I therefore assume Penny’s post bile acids are pretty high??

Liver biopsy interpretation is confusing for your vet so you can imagine what it's like for us laymen. It looks to me like steroid induced hepatopathy was ruled out which is not consistent with cushing’s. Most dogs with primary liver disease have low albumin levels and high bilirubin levels; however, not always because the liver is quite an amazing organ and sometimes these two values remain normal until the liver is 60% gone. Can you check your paperwork and let us know if these are listed and whether they are within the normal ranges? Dogs with liver disease are not always symptomatic and if they are, those symptoms can overlap with symptoms associated with cushing’s, such as increase in drinking and peeing, pot belly and even muscle wasting. Symptoms that are common with liver problems are seizures, behavior changes, vomiting, diarrhea, jaundice, intolerance to anesthesia, increase in drinking and peeing, gray-white and soft feces, abdominal extention, reduced appetite and weight loss.

The ultrasound shows a bit of adrenal atrophy which is definitely not consistent with cushing’s. This would be more consistent with addison’s and/or iatrogenic cushing’s. I noted, however, that the liver biopsy ruled out iatrogenic hyperadrenocorticism so this condition is not the causative factor. Adrenals are almost always enlarged with cushing’s so this is a very curious finding.

The LDDS was negative for cushing’s; however, it is known that 10% of dogs with cushing’s will test negative. With all these conflicting test results, it is no wonder that your vet is a bit perplexed. I must say that I was a bit surprised that she didn't prescribe adenosyl until you nudged her so I think she may be in over her head with Penny. I honestly think you should consider a consult with an internal medicine specialist. I have two dogs with cushings and both treat with an IMS that is an hour away (on a good day) from our house but it is well worth the peace of mind.

Looking forward to receiving more information on the testing that's been done so far.

Glynda

[StarDeb55]

Carol, I'm the lab tech that several other members have mentioned. Glynda, Lori, & Kim have done a terrific job already in discussing Penny's results with you. I only have a couple of things to add.

CK=creatine kinase which is an enzyme that is released when there is some type of muscle destruction or deterioration occurring. You have stated that Penny's muscles appeared to have atrophied in several places. The elevated CK result backs this up, why I can't even offer a guess, but it's definitely something to ask the vet.

Penny's glucose level appears to be borderline high to me. In the US, we are used to seeing reporting units for glucose as ug/dl. If I have made the conversion correctly. Penny's glucose on these labs was 282 ug/dl. Were these labs done fasting? Diabetes may be a possible explanation for some of this as weight loss is more common in diabetes than with Cushing's.

When it comes to the UA, do you know if the urine was collected by a direct bladder aspirate where a needle is stuck directly into the bladder & urine aspirated into a syringe? This is done to minimize the chance of any fecal contamination occurring. If the urine was not collected this way, what your vet told you is correct. The bacteria present are very likely fecal contaminates, & it would be a waste of time & financial resources to culture. I would ask that the urine be re-collected by direct bladder aspirate & the UA along with a urine culture done, just to make sure.

I know Alison has asked about medication last night. I want to specifically ask if Penny has ever been on any type of steroid containing medication, steroid injections, or steroid containing eardrops for an extended period of time?

Looking forward to hearing more.

Debbie

[Jasmine'sMom]

Hello all - I'm new here too. My maltese/poodle mix, Jasmine (approximately 9 years old - she was a rescue from Animal Care and Control in WPB, Fl) was formally diagnosed with Cushings two weeks ago. However, I'm politely butting in because I have a question concerning Penny. I noted that she's been on Rimadyl - has anyone thought about the not uncommon side effects effecting the liver from this medication? Is it possible that maybe it's the Rimadyl?

[StarDeb55]

Hi, Jasmine's Mom. Yes, Lulu's Mom did mention the profound effect that NSAID's can have on the liver in her post.

Debbie

[jrepac]

Rimadyl
Possible liver disease
Possible Cushings..

all equals one very bad combination...

My Aussie took Rimadyl after her cruciate surgeries and it was terrific; but when she later got it for arthritis...and cushings was suspected...liver enzymes were already high...it was a big no-no. Lucky she did not kick the proverbial bucket. I was pretty annoyed w/my vet actually.

Having read up on Rimadyl after that episode, I would never use it again...but that's just me...

[AlisonandMia]

Penny's glucose level appears to be borderline high to me. In the US, we are used to seeing reporting units for glucose as ug/dl. If I have made the conversion correctly. Penny's glucose on these labs was 282 ug/dl. Were these labs done fasting? Diabetes may be a possible explanation for some of this as weight loss is more common in diabetes than with Cushing's.



A glucose level of 282 does point to diabetes (at the time the test was run it was probably in its early stages). From memory the reference (normal) range for BG in dogs is 80 - 150, so 282 is quite a significant elevation. Most diabetic dogs have a BG of over 400 when diagnosed. I think it is very important to get her BG rechecked ASAP as uncontrolled diabetes can be fatal.

I'd think the liver issue is probably separate - as the others have suggested, Rimadyl could be the culprit. I think the BG is probably the main priority at this point.

Alison

[StarDeb55]

Carol, as I suspected, I think I miscalculated the glucose conversion to mg/dl. I believe the correct result is 131 mg/dl. You multiply the mmol/l x18. I got confused & made the conversion from mmol/l to ug/dl, instead of mg/dl. I am so sorry. I still think that diabetes may be the issue.

Debbie

I have asked Alison to double check my math.

[AlisonandMia]

Yes, 131 is correct (131.4 according to my calculator). Like Debbie I think that re-checking the possibility of diabetes would still be a very good idea. The sudden onset of symptoms and most particularly the rapid weight loss does point to diabetes, or at least mean that it needs to be ruled out.

Alison

[k9diabetes]

Hi Carol,

My experience comes from the diabetes side. Something you could do quickly and easily to check the possibility of diabetes is to buy urine test strips that check for glucose and do a quick urine test at home. I believe they are commonly known as ketodiastix or diastix. You don't want to use ketostix as those do not check for sugar. There are also reagent strips that check multiple parameters - those would work as well.

They are generally available at a pharmacy and are not very expensive.

That would help answer the diabetes question. And then the additional specific test results would make it easier to look at the overall picture.

I too would go with the specialist in your shoes just because they deal with more complicated problems on a daily basis.

Natalie

[Carol]

Hi All, thank you all for your input. I have to admit I'm a little overwhelmed with all the information and I'm trying to understand it all. Not knowing much about the biochemistry profile tests and how to interpret them, but I have confidence now in asking many questions of my vet at my next visit next tuesday to try and get some much needed answers.

The vet will be doing another urine, cushings test and also testing the liver enzymes again to see what levels they are. I will be asking again if there is a possibility of Penny having diabetes or hypothyroidism even though my vet keeps on saying no. They did a fine needle aspirate to collect urine the last time they did the test. I am hoping that the Denosyl Penny has been taking this past week will have helped to bring those liver levels down.

I will go to my pharmacy and buy some of those ketodiastix to check the glucose levels myself. Thank you Natalie for that.

The bile acid test results were as follows - Pre Bile Acid result 2 umol/L reference interval 0.6 Bile Acid Post 35 umol/L reference interval 0-20.

Penny had two carprofen injections in total, one in november 2009 and the last one in december 2009 plus I gave her 1/2 Rimadyl tablet once or twice in early january 2010 and none since. My vet seems to think it could be the Rimadyl or some environmental factor that is causing the liver problem ?? Could this be possible if the Rimadyl was only given once or twice? Does one or two doses of Rimadyl have an immediate detrimental effect on the liver or, only if its taken on a long term basis? I cannot see taking one or two tablets could result in liver disease. I know that I will never give it to her again if it is suspected of causing her health problems.

I will definately ask to be referred to an IMS if I am not satisfied with the outcome of the testing next tuesday.

Penny seems to have improved a little in that she doesn't appear as listless as she did. She is still has polydipsia and polyuria but it doesn't seem as bad as it was as she was asking to go out what seemed like every half hour whereas the past couple of days much less frequent say every 2 or 3 hrs and she sleeps right through the night so that's good sign I would think!?

I will keep you all posted of developments as they happen. I just want to thank you all for your encouragement, support and good advice in trying to determine Penny's health problem. I hope to get a definate diagnosis next week.
Regards Carol

[StarDeb55]

Carol, it's doubtful that you will see any significant improvement in the liver enzymes after so short a time on Denosyl. Most supplements used for liver support can take several months before significant improvement in those numbers are seen.

Debbie

[Carol]

Hi StarDeb55 - I think you are correct that there will not be a significant change in the liver enzymes with Penny only having been on Denosyl for one week. I will make a point of questioning this to my vet on my next visit. I am hoping that they will be able to diagnose exactly what is wrong with Penny as I am becoming dispondant and frustrated with them. I will be asking for a referral to an IMS if I don't get answers. My baby means the world to me and I just can't face losing her. I will keep you all posted next week of the outcome at my vets visit. Until then take care all and thank you for your welcome advice. Carol

[Carol]

Admin Note: Copied from earthflower's thread

I hope no one minds me joining in on this thread but it has given me much inspiration and encouragement for own dear little girl, Penny. (I finally managed to post Penny's picture). Hang in there Earthflower, Cody's mum.

Penny has not been officially diagnosed with Cushings disease but all her symptoms seem to point in that direction. We have a visit scheduled for tomorrow at my local vets, where Penny will be tested for Cushings.

After reading today's posting from Lulusmum regarding her own Lulu and Jojo and that she has read that the average cushdog had the disease anywhere from 1 to 6 years before being diagnosed gives me hope and encouragement that my Penny will be around for a very long time to come if she is diagnosed as having Cushings.

So I wish you all the best with your Cody Earthflower and that as Lulusmum mentioned perhaps its not too late to try and get some means to help your dear little Cody. Good luck to you and Cody. I'm sure he has a good chance of a good quality of life for years to come.

Thank you to all for being there, who give each of us advice and encouragement. I wish you and Cody all the very best. Also, all the best to everyone else and their babies.
Regards, Carol

[Carol]

Hi Everyone, Penny had a Cushings Test yesterday (LDD test) and I have just received the news today from our vets that the test result is negative, that Penny doesn't have Cushings!

Whilst this seems like good news I am extremely concerned as to what is causing Penny's health to deteriorate so fast! The vet said that it could possibly be cancer!! I am hoping NOT ! The vet has suggested that we bring Penny into their offices tomorrow so that we can discuss all her results and decide whether to see an IMS. I really feel that the IMS is the next step now but my husband wants us to go along tomorrow morning to speak with our vet first. The vet suggested that a CT scan might be the way to go now. She also suggested having another liver biopsy done to which I do not think would be valuable at this point. I got a copy of the ultrasound and it states that the gallbladder, spleen, kidneys (right and left), both adrenals, lymphnodes, pancreas, stomach, intestine and bladder are all normal.
The clinical Impression reads as follows :-

The liver was diffusely and mildly increased in size and the parenchyma was isoechoic to hyperechoic but uniform. Also, the gallbladder was not distended and did not contain inspissated bile. No evidence of a tumor or hepatoma was noted. These findings are somewhat non-specific, although likely secondary to a hepatopathy (ie drug induced etc).

The adrenal glands were bilaterally not increased in size measuring 0.52 and 0.49 cm in diameter on the left and right side respectively.
The remainder of the abdominal ultrasound was apparently normal. Iliac or mesenteric lymphadenopathy was not seen No masses were found.

Recommendation : no evidence of pituitary-dependent hyperadrenocorticism via provocative testing Consider a guided biopsy to arrive to a definitive diagnosis.

A liver biopsy was subsequently done and nothing untoward was found results of this as posted in one of my previous threads.

I asked the vet today if it could be a false negative result on the cushings and she said no. I'm afraid that time is of the essence now to get my dear Penny diagnosed and treated for whatever is ailing her. I am so scared right now and feel helpless at this moment the tears are just flowing. I am still wondering if Penny has diabetes but the vet keeps on saying no. I am at a loss.

Regards to all Carol

[Squirt's Mom]

Hi Carol,

First, welcome to you and Penny! :)

Can you share with us the signs (symptoms) you are seeing in Penny? What started this journey of discovery with her health? What problems is she having? Also, can you share any past health problems she may have had?

Is she on any meds, supplements, herbs at the moment? If so, what.

Do you have copies of the testing done so far? If so, would you mind posting them for us? One of our members is a lab tech and might can help. If you don't have copies, your vet(s) should be happy to give you a copy.

Cushing's is a very difficult condition to diagnose. It cannot be diagnosed via one test but takes several together to reach a diagnosis. There is one test that can rule Cushing's out...that is the UC:CR. Has Penny had this done?

I know you are scared, bless your heart, but you aren't alone. We will help any way we can. The more info we have on Penny the more meaningful our input will be, so please don't hesitate to write a book on her for us. ;) Our members have a wealth of experience and knowledge in many areas, not just Cushing's.

Please ask any questions you may have and we will do our best to help you understand. We may all learn something new from a question you ask! :cool:

Keep your chin up!
Hugs,
Leslie and the girls - always

[Squirt's Mom]

WOW! I just saw that you are not a new member and that we have some info already. :o So, I will read what is here and then see if there are more questions.

geez....my feeble ole mind! :rolleyes:

[frijole]

Carol,

I am at work so will just post a few quick thoughts that might help.... we often see dogs here who don't have cushings but have the symptoms. You have ruled out diabetes, hypothyroidism and cushings HOWEVER have you ruled out diabetes insipidus and atypical cushings?

Atypical cushings you must submit bloodwork to the Univ of TN. Your vet can do it and send it directly there.

I am sure others will chime in with thoughts. Hang in there! Kim

[Carol]

Hello Kim, thank you for your thoughts. I am still wondering myself if it could be diabetes. We have booked an appointment with an IMS for tomorrow afternoon so I'm hoping that they can find out quickly what is wrong with Penny. They may have to do a CT scan, goodness knows what that might cost but even though my husband and I are both out of work right now, I will do anything for my baby. I will keep you posted. Thank you for being there for me. Regards Carol.

[lulusmom]

Hi Carol,

Based on the information you have provided, I think your vet has done a very good job of trying to determine the root cause of Penny's PU/PD and elevated liver enzymes. With the baffling liver biopsy, bile acids and liver enzyme elevations more consistent with cushing's than primary liver disease but ruled out via biopsy, no evidence of hyperadrenal activity and a negative LDDS, I think Penny is a very a tough case and your vet is probably scratching her head.

While the LDDS is considered the gold standard in diagnosing cushing's, it is known that about 10% of dogs with cushing's will test negative on the LDDS. Your vet's matter of fact answer that the test can't be wrong was probably based on the fact that since none of the other tests support a diagnosis of cushing's, it is highly unlikely that the LDDS is a false negative.

I see that Kim mentioned atypical cushing's. If a dog presents as being cushingoid in every respect but blood tests such as the LDDS and ACTH stim tests, which measure circulating cortisol levels, are negative, the UTK adrenal panel is usually the next step. I'm not sure but I think that the liver biopsy would have detected the isoenzyme in the liver that is triggered with excess cortisol and perhaps some of the sex hormones. I'm also not certain that dogs with atypical cushing's have normal adrenal glands either. Hopefully, somebody may know the answer to these questions; otherwise, it's going to drive me nuts until I can find the answers on my own. :D

I'll be looking forward to your update after your consult with the IMS. Fingers and paws are crossed hoping that you can finally get to the bottom of things.

Glynda

[Squirt's Mom]

Hi Carol,

I agree with Glynda's suggestion of the UTK panel. Atypical is a form of Cushing's that does not involve elevated cortisol, so the LDDS would have been negative. The LDDS looks only for cortisol, as does the ACTH. So to check the other hormones, the UTK panel needs to be done. It will check for elevations in the other 5 hormones associated with Atypical. These hormones can cause the same signs as true Cushing's. If it were me, this would be my next step. Here are some links on Atypical and having the UTK panel done.

Atypical Cushing’s*
(Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone – an elevation in one, all, or any combination of these hormones, without elevated cortisol.)

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

Beware of false positives, negatives in canine hyperadrenocorticism testing
http://www.vetcontact.com/en/art.php?a=132&t

17-Hydroxyprogesterone
http://en.wikipedia.org/wiki/17-Hydroxyprogesterone


UTK Panel
Explanation of hormones
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Treatment Option Sheet
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing%27s.pdf

Dr O’s credentials
http://www.vet.utk.edu/faculty/oliver

Referral policy
http://www.vet.utk.edu/clinical/referrals.php

Cost sheet
http://www.vet.utk.edu/diagnostic/endocrinology/index.php

I hope the IMS can give you some answers. I too am looking forward to hearing what you learn there.

Hugs,
Leslie and the girls - always

[lulusmom]

Hi again,

I just found an article that you might find interesting. It answers my questions regarding identification of steroid induced isoenzyme and normal adrenal glands in a dog with atypical cushing's.

http://veterinarynews.dvm360.com/dvm/Medicine/Can-you-rule-out-a-steroid-hepatopathy/ArticleStandard/Article/detail/46547

I'm not sure if you ever mentioned the results of any urinalysis. I ask because most dogs with typical and atypical cushing's have low urine specific gravity and a good number of them also have increased protein in the urine. Can you check your records and post any results you might have?

[Carol]

Hello Everyone, finally I have had the answer to Penny's health problem. The second Cushings test came back negative on tuesday so I requested to see an IMS because I was extremely worried about Penny's weight loss of 4 lbs in 2 weeks!. I took her to an IMS today and he did a full CBC chemistry profile, urinalysis and culture, chest xrays and another abdominal ultrasound. The test results came back 2 hours later and Penny has diabetes! Finally, I had a diagnosis. They have started her on insulin shots straight away so now I will have to educate myself all about diabetes.

I just want to thank each and every one of you for all the wonderful advice and encouragement during these stressful past few weeks. I also wish each and every one of you and your precious babies all the very best, that each one of your babies continues to thrive with all the love and care you are giving them. Regards Carol

[frijole]

Carol,

Thanks for the update and congrats on getting an answer at long last!!! My mom's dog was diagnosed this week. We live in a small town and the vet had dx-ed 10 schnauzers this week! Wow.

Anyway - not sure if you know but we have a wonderful sister site called k9diabetes.com which you should check out. Great info and great people.

Pls do come back and let us know how you are doing. You are family now. :D Kim

[lulusmom]

Hi Carol.

Glad you finally got a diagnosis and it looks like Debbie and Alison pegged it right. I do hope you take Kim's advice and join our sister diabetes forum k9diabetes.com. Natalie, the site owner is also an administrator here and I hope she'll be by to say hi and encourage you to let her and the many experienced folks at her site help you get Penny back on track. Many of us are members there but as Kim said, we hope you will keep us updated here from time to time.

Glynda

[StarDeb55]

Carol, I'm very happy that you finally have a diagnosis, & can get Penny on the road to good health. I, too, encourage to join the k9diabetes site (http://www.k9diabetes.com/forum/) as you will find the same type of very caring, supportive people who are dealing with diabetes on a daily basis that you have found with us. Please do let us know from time to time how Penny is progressing.

Debbie

[BestBuddy]

Carol,

I have been following along and am glad you finally have a dx. So now another chapter of Penny's book is about to unfold. Diabetes is so controllable and I know you will manage very well. You will learn as you go along. I will keep a lookout for you over at K9 Diabetes.

Good luck.

Jenny

[Squirt's Mom]

Hi Carol,

This is wonderful news....well, wonderful in that you know what you are dealing with and it can be controlled! ;)

Like Kim said you are family now and I hope you will drop by from time to time to let us know how Penny is progressing...and how you are doing!

Hugs,
Leslie and the girls - always

PS. Do check out K9Diabetes....great, great site!

[Carol]

Dear All, thank you all so very much for your kind thoughts and information about the K9diabetes.com website. I have registered with them and will start to learn with eager all there is to know about Diabetes and I'm sure there will be a wealth of knowledge and experience to help me with Penny's road to recovery. I will drop by from time to time to see how everyone is doing. All the very best. Regards Carol :D

[lulusmom]

Here is a link to Carol's thread at k9diabetes:

http://www.k9diabetes.com/forum/showthread.php?t=1766