Dog in for Cushing's Test negative (9 y/o Bichon) - still urinating/drinking a lot

[kimchis_mom]

Hi everyone, I have been reading this forum with interest over the past few weeks. My baby 9-year-old Bichon has been unwell lately. He started out exhibiting signs of lethargy, a bit of agression and general non-bubbliness that is so out of character for him. We thought maybe it was because he was getting older but then he started to urinate everywhere--bedrooms, kitchen etc. He was previously completely housetrained. I took him to the vet, suspecting it was a urinary tract infection. 2 urinalysis and a full blood panel later, no signs of bacteria suggesting UTI. Almost everything was normal in his blood report except:
Anion Gap: 22.8 (ref: 10-22)
ALP 420 (ref: 10-150)
ALT 88 (ref 5-60)
Cholesterol 20.95 (3-8)

He also presented with a low thyroid. We later performed a thyroid mini panel and his T4 and free T4 came back suggesting hypothyroidism, while his TSH was normal. The doctor THINKS he has hypothyroidism.

That still doesn't explain his urine problem. When we did the urinalysis a month ago, his specific gravity was at 1.020 and just a few days ago, it dipped to 1.006. I've taken him to the vet today to perform the low dose dex test.

The vet mentioned a possibility of diabetes insipidus as well. I am so scared and stressed at the prospect of not knowing. My question is: is it likely he has Cushing's if his specific gravity is THAT low? Also, there was no protein detected in his urine...does that also point to something else other than Cushings?

Aside from the PU/PD, my dog is not really exemplifying too many Cushing's signs. He is eating about the same, not losing hair (although he did have a clip a few days weeks ago and it's still slowly growing back). The trouble I am having is that so many of his symptoms (cholesterol, behaviour) can be attributed to his likely hypothyroidism...so it's hard to figure out what's causing what.

At the same time, the dilute-ness of his urine indicates there must be something going on besides the hypothyroidism...do you think cushing's is also likely?

[Harley PoMMom]

Hi and welcome to you and your precious boy from me and my boy Harley.

Since your furbaby is not displaying many of the symptoms of Cushing's, if it were me, I would hold off on any Cushing's tests.

Cushing's is a really hard disease to diagnose and strong symptoms are a huge part of the diagnosis. Non-adrenal illnesses can create false positive results in Cushing's tests, so can stress especially in the LDDS test.

If I were to get a thyroid panel done on any of my furbabies I would have it sent to Dr. Jean Dodds, DVM. Here's some info about her:


The main reason for sending Dr. Jean Dodds / HEMOPET the serum samples instead of having the testing done locally, is that HEMOPET is the only group routinely offering expert clinical interpretive diagnostic comments that take into account the age, sex, and breed type of the animal. This often means an expected normal reference range for an individual pet that differs from the test lab's generic broad reference range. Practitioners usually are unaware of these differences, which have been established by published research and Dr. Dodds' many years (46 years this year - 2010) of clinical and research experience
http://www.hemopet.org/services.html

Here is a link that has some good info on hypothyroidism: http://www.dogaware.com/health/hypothyroid.html

Is your furbaby drinking a lot of water? If so, then this may be why his urine is diluted.

We are here for you and your precious boy so ask all the questions you want and we will answer them the best we can.

Love and hugs,
Lori

[kimchis_mom]

Hi Lori and Harley,
Thank you for your reply! This is really so confusing and stressful! Here are the reasons I think Kimchi might have Cushings:
high liver enzymes
very high cholesterol
increased thirst
increased urination
mild potbelly (definite increase in weight. He went from 16 to 20 pounds in a matter of 6 months, even though he didn't appear to eat more. This may also be caused by a hypothyroid though...)
lethargy/depression
loss of lustre in coat

He does not, however, have these symptoms:
excessive appetite
panting
hair loss (slightly thinner yes, hair loss no)

I'd like to believe that he just has a simple case of hypothyroid but i really can't rationalize the water consumption and dilute-ness of his urine! 1.006 is extremely dilute and is big change from his result of 1.020 1 month ago.

The other thing my vet suggested is possible Diabetes Insipidus...

I am thinking about my next course of action. I am going away for 2 weeks at the end of next week so I really want to expedite his diagnosis. If his low dex test comes back positive, should I re-confirm with a creatinine urine ratio test?

And if it comes back negative, should I simply treat his hypothyroid and wait? And how can I reconcile his urine specific gravity?

[Harley PoMMom]

I was wondering if you could do us a favor and check your emailbox (or spam folder) for a communication from us. Once you respond to that email, your membership will be finalized, and anything that you post will become visable on the the forum immediately. Until that time, your replies must be manually "approved" by a staff member before they are visable to the public -- so there may be a bit of delay between the time that you write your replies and the time that you actually see them...Thank you so much. :)

A lot of the symptoms you have mentioned are shared between Cushing's and Hypothyroidism...confusing, huh??? :eek:

If this were me, the next diagnostic test I would do is an ultrasound. Now, the ultrasound has to be done on an optimal machine and read by a qualified person...usually not found in your regular GP office.

Your vet/GP can give you a referral to a place to have this done. The ultrasound can show abnormalities in almost all the internal organs and especially the adrenal glands. Most times the ultrasound can confirm the cushing's diagnosis and whether it is ADH or PDH.

My Harley's first ultrasound picked up his pancreatitis, I didn't know at that time that Harley had pancreatitis but the ultrasound showed that he had prior bouts of pancreatitis. :eek::eek: I was shocked to say the least. I recommend the ultrasound 100%.

Hope this helps.

Love and hugs,
Lori

[apollo6]

Dear Kimchi mom
First, welcome . You have come to the right place. Take your time reading about cushing before you jump the gun. Cushing is a very tricky disease and can sometimes mask other conditions.
I have attached a link that is a brief explanation of cushing, with pictures of a cushing dog, tests that can be done.

http://www.kateconnick.com/library/cushingsdisease.html

I had a full blood panel, an ultrasound, urinalysis , and a ACHT STIM test done before I came to the conclusion that my Apollo had cushing. It took me a while before I took action.
Hugs Sonja and Apollo
p.s in your profile give us your name and where you are from to help with resources in your area, also we'd love you to download a picture of your fur ball in your profile.

[kimchis_mom]

Thanks for the advice! The vet had mentioned an ultrasound but I thought it was just a ploy for more $$, seeing as it is so expensive! It really does seem like there is some value to that. I will investigate once I get the results back, hopefully tomorrow.

Re: my account, I did input my activation ID information but I am unable to edit my account. Was there an issue with my registration?

I am really glad I found you all! What a great supportive group:)

[Harley PoMMom]

Re: my account, I did input my activation ID information but I am unable to edit my account. Was there an issue with my registration?


No issues at all! ;):) Your membership is now finalized so now there will NO delays between the time that you write your replies and the time that you actually see them, again welcome to our family!

Harley's first ultrasound was done at the University of Penn. This is a 2 hour drive, one-way for me. Harley's GP does have an ultrasound machine in their office but his vet informed me their machine would not pick up the things that the Univ. of Penn. did. Adrenal glands are very tiny and a person that is operating the machine has to know what they are doing to get the best possible picture and they have to know how to read them too...like I mentioned usually not found in your regular GP office.

I'm sure the "others" will be along soon to welcome you and give advice/support...just remember we are always here for you and your sweet boy.

Love and hugs,
Lori

[kimchis_mom]

Hi everyone,
I got the results of the low dose test for my baby, kimchi, and the results came back normal. The vet tells me this rules out cushing's 95% but my dog is still drinking more and urinating more. Based on his blood panel we were also able to rule out a host of other diseases. We have now put kimchi on hypothyroidism meds, seeing as 2/3 tests in his thyroid panel indicated hypothyroidism. Does anyone have advice on what I should do? Can his behaviour be attributed to hypothyroidism alone? I would appreciate any insights. Thanks so much

[mytil]

Hi,

Here is a link with additional information on thyroid conditions you may want to take a look at http://www.k9cushings.com/forum/showthread.php?t=2256.

Let us know if your vet ran a check on any of these to determine further about the hypothyroidism...


Baseline T4 Test: The most common test run is the baseline T4 test. A blood sample is drawn and tested by radioimmunoassay to determine the level of T4 thyroid hormone in the bloodstream. The T4 hormone is produced only in the thyroid gland and dogs with a failure of the thyroid gland will have a lowered level of this hormone. However, there are other conditions that can cause a lowering of T4 so if this screening test is positive for hypothyroidism another more specific test is often done to confirm the diagnosis.

Baseline T3 Test: Another screening test that can be run is the baseline T3 test. T3 is another form of thyroid hormone found in the bloodstream. This test can be used as a screening test instead of T4. The T3 test is not as accurate in early cases of hypothyroidism and occasionally will be normal when the T4 level is reduced. For these reasons, this test is not often used; if it is used, it is in combination with the TSH level or TSH stimulation test.

Has your vet ruled out diabetes or a urinary tract infection? My understanding is that increased water intake and urinating are not classic signs of hypothyroidism. What is your vet prescribing for Kimchi?

Terry

[motivate4change]

Hi there..your baby is absolutely adorable! I LOVE BICHONS!!
I am so sorry he is ill..but he is going to get better, always have faith...
He feels your love and he knows u are getting closer to finding out whats causing his illness!
I have a 13 yr old poodle named Jack...and what u are describing about Kimchi's moods reminds me of my Jack when his blood sugar was too high..before his diabetes diagnoses, 9 yrs ago.
PLEASE go with the possibility of diabetes and have him checked for that!
If his urine is diluted it is because he is drinking alot of water, which he may be doing due to having too high of sugar in his bloodstream and cells, (and not enough insulin/or no insulin at all in his bloodstream to regulate the amount of sugar in his blood, which is the cause of diabetes.)
Dont allow your vet to charge you for all kinds of expensive testing and guess work until you completely check your baby ] out for diabetes!
Diabetes can be easy to regulate...and, at times, it may be difficult, but once u have a diagnoses, at least you know where to begin with treatment and lifestyle changes.
I added you on as a friend here, so please keep me posted!
By the way, if you are not comfortable with your vet, find another one who is knowledgable with diabetes, who also has a "bedside manner" and is communicative, caring and not trying to do every test in the book before ruling out diabetes. Your baby has almost all of the symptoms of having high blood sugar.
Please let me know what happens...I have faith that you will soon get the answers you need to live a happy life with your baby!!
My best to u, and please, stay in touch!!!
Love,
Kim
P.S. U can get more info on the following website:
www.petswithdiabetes.com.yuku.com

[motivate4change]

I am new to these boards and trying to post to Kimchi's mom!
I am sorry that u are going through so many different tests with Kimchi, and I dont understand why your vet didnt FIRST look much more closely at testing your baby for DIABETES.
I do believe in my heart, that this is what is going on with him.
He has all the symptoms of diabetes! Diabetes will cause all kinds of other problems when it is not regulated with the proper type and amount of insulin. Please, please, please, have your baby tested for all type of diabetes. My baby, Jack, has diabetes and the symptoms of your Kimchi closely resemble what my Jack went through before he was diagnosed.
Please keep me informed of what happens next..and if your vet only seems to want money, please find a new vet who has alot of knowledge of treating dogs with diabetes!
Your new friend and support system,
KIM:)

[kimchis_mom]

Thank you all so much for your thoughts! Regarding his hypothyroidisim, his Tetraiodothyronine came back low, at 8.8 (re: 11-45). His TSH was normal, but after a thyroid panel, we found that his T4 and free T4 were also indicative of hypothyroidism. I have read that TSH is not the most reliable indicator of true hypothyroidism so I was comfortable starting him on a trial of thyroid medication.

However, his dilute urine, peeing and drinking still baffles me!

I initially thought diabetes too but his glucose levels came back completely normal. There was also no glucose detected in 2 urinalysis (the last of which was taken just last week.) His kidneys are normal and there was no bacteria in his urine. We also did a urine culture and I have yet to get the results of that, but based on the lack of bacteria in the initial urinalysis, I am doubtful we will find anything in the culture.

Now that the Cushing's test also came back negative, I honestly don't even know where to look. My little guy has become more insistent on going out for walks now...I'm not sure if this has to do with the hypothyroid meds giving him more energy? In any case, we take him out about 5 times a day and also have newspaper around the house for him to pee on...his behaviour just doesn't seem right

[kimchis_mom]

Just called the vet's office. Urine culture came back negative.:confused:

[littleone1]

Hi and welcome from Corky and me.

You might want to call Dr. Jean Dodds. She is a very well-known authority on hypothyroidism. I know many of the symptoms are similar to those of Cushings. Corky has been taking Soloxine for over 10 years now.

You can call Dr. Dodds M/T/F between 10 A.M. and 6 P.M. Pacific time. Her number is 310-828-4804. She has always been very helpful when several of us have called her. I hope you give her a call and let her know what your concerns are.

Terri

[Squirt's Mom]

Hi and a belated welcome to you and your baby! :)

I wanted to share something with you about hypothyroidism that I have experienced in my own treatments. When they first put me on meds, I lost about 10lbs. in fluids...I peed buckets for weeks! The same thing happens every time my dose is increased - I pee and pee and pee! :o:rolleyes: I am not saying that is the norm for other humans (I am certainly NOT normal! :p ) or for dogs, but that is what happens with me.

An abdominal ultrasound during the course of testing saved my Squirt's life by finding a splenic tumor. This test will let the docs see many of his organs and their condition, which could provide some insight to what is going on with him.

I think I would have him tested for DI first, tho. This isn't a common form of diabetes so it isn't usually looked for in general testing.

Here are some links about DI:

http://www.vetinfo.com/canine-diabetes-insipidus.html

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2556

http://www.dogdiabetessite.com/canine/diabetes/insipidus.html

Hugs,
Leslie and the girls :D - always

[Lpeach1969]

It took a year and every test under the sun to diagnose my 13 year old cocker with atypical cushings. He had a urinalysis, urine culture, blood panel, xray, ultrasound, LDD, and finally the sex hormone panel from the University of TN. After the LDD came back negative I was in shock b/c I knew he had all the symptoms of cushings. The sex hormone panel was just over $400, but it finally gave me some answers. It was so worth it! He is now on trilostane once a day (for the mean time - several blood test need to be done to make sure the levels are regulated) and he is not drinking/urinating like he did and I can tell he feels better. Hopefully he will continue to improve. Just don't give up!

[kimchis_mom]

LPeach1969, thank you so much for your thoughts! Ironically, today was the first day I started to look into atypical cushings. There is definitely a lot less by way of literature out there on the atypical form of cushings. Can you share a bit more about your dog's symptoms before you came to the diagnosis? Mine is drinking/urinating more, not eating more, does not have too much in terms of hair loss (he had a clip a few weeks ago and it's actually growing in nicely), is not panting but has very dilute urine! I'm talking 1.006 urine specific gravity.

The vet is leaning towards looking into diabetes insipidus and pyschogenic polydipsia.

I've put a call in to ask about the atypical cushings test. I live in Canada and am not sure whether there is a lab here that does the test. If anyone is aware, please let me know! in the meantime, it's a lot of confusion and frustration while we try to figure this out