It's me, Mooniesmom, looking for help for a friend

[Julie]

Hi all,

Glad to see all of you again. I used to be Mooniesmom on the other forum. Quick update on Moonie, she is doing super well, and is going on three years with cushings come September. She finally adjust to her blindness and is totally amazing to watch. She turned 13 in January.

Anyway I've come to ask for help for a friend. Her dog is PU/PD and has some elevated liver enzymes. Muscle weakness. Interestingly he is having some cognitive issues, which Moonie did too at the beginning. They ran a LDDS on him and these are the results.

Time 0 = 103nmol/L

Time 4 hr = 40 nmol/L (1.44 ug/dL)

Time 8 hr = 39 nmol/L (1.4 ug/dL)

She said lab normals were '40'. They are telling her it's most likely not cushings, but kidney related. None of his kidney values are elevated at all. U/A normal.

What do you think of the LDDS test results? From what I read about interpreting the results this indicates cushings.

[StarDeb55]

Julie, the chart I keep available to read low dose results is telling me that these results are inconclusive, repeat test in 6-8 weeks. I would like one of the other members to confirm how I'm reading the low dose results. If it's at all possible, can you get us some more specific info about the general lab work including the tests that were elevated? Was the urine specific gravity within normal range? Elevated liver enzymes can be cause by lots of things, so it's really hard to offer much of an opinion at this point.

Debbie

[Julie]

It was just the alk phos that was elevated. Specific gravity was not normal. I don't know what it was, she just said it was 'dilute' and that makes sense given the pu/pd. She is very in tune to this dog, and I have a feeling she caught this very early, like I did with Moonie. His symptoms/bloodwork read exactly like hers. Nobody even thought of cushings until two months after I saw her first symptoms, which were not the normal ones.

[acushdogsmom]

Hi Julie!

Good to hear that Moonie is still with you and doing well! :D (We worry when we don't hear any news!)

Do you have any pictures that you can post in an album here? Each member can create several photo albums at this site. To make an album or two of your own, go to your user cp and click on "pictures and albums" (left side of your usercp page) then follow the prompts.

As for your friend's dog's results on the LDDS test, I think I'd agree with Deb that those numbers are inconclusive, even though in my own cushdog's records I see that the LDDS 4-hour and 8-hour normal reference range is apparently "0-10 nmol/L" (not 40). But different Labs may have slightly different normal reference ranges.

We've got the IDEXX diagnostic charts in our Resources Forum, here:
http://www.k9cushings.com/forum/showthread.php?t=217

Specifically, here's the link to the LDDS chart:
http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-low-dose-dexamethasone-protocol.pdf

There, just as Deb said, they say that 1–1.5 μg/dL at 4-hours and at 8-hours is:

Inconclusive, consider repeating in 6–8 weeks

I am pretty sure though, that I've seen other LDDS Lab interpretation sheets that say that less than 1.4 μg/dL at 4 and 8 hours can be interpreted as negative for Cushing's.

If it were my dog, I think I'd want an ACTH stim, to see how high the adrenal cortisol reserves/cortisol production capacity may be and I'd also want an ultrasound done.

And I think I'd want the Vets to explain to me why they would think "kidney related" when the kidney values are normal.