Possible Cushings?

[loriez]

Helloall...I have a 5 yr/old Pomeranian named Rosco,who back in Jan. had calcium oxalate bladder stones removed. He has since been on special food to help control urine PH. UA results 7 wks ago showed a ph of 5.5( they want it between 6.5-7) and vet said we should recheck again 6 wks later. Also at that time, Alk phos. level was high in the 400's,and vet mentioned possible Cushings. So a few days ago,re-checked UA,showed PH of 5.0,he recommends rechecking in another month,then if no improvement,starting potassium citrate supplements to help with the urine PH. I asked what about the Cushings? Should we test for it? He said at this time no,as he only had excessive panting at times,and testing can cost from $600-$800. I feel uneasy with this response,if a disease is suspected,why wait to test for it? I think it's time for a new vet !! Anyone have any advice as to what I should do? I live near Cleveland Ohio. I know that Cushing dogs have bladded/urine ph problems. Thanks, Lorie

[Squirt's Mom]

Hi Lorie and welcome to you and Rosco! :)

From your first post, I would say your vet is to be trusted. A Cushing's savvy vet knows that the signs are vital not only in diagnosing but in monitoring once treatment has begun. An experienced vet who has a pup who is showing few signs and/or signs that are not strong at all, will not start treatment until they are present. So, take a deep breath and thank your lucky stars you have a vet who knows this and isn't pushing you to start your baby on these drugs until they are needed, IF they are ever needed. ;)

Should you ever need to know, Kate Connick has a great list of the most common signs for Cushing's on her site.
http://www.kateconnick.com/library/cushingsdisease.html

The best thing about Cushing's, other than getting to meet great folks like us :D, is that it is a very slowly progressing condition, taking years before any damage begins in most cases. This means you have more than enough time to see about Roscoe's kidneys and get control of the PH while you learn about Cushing's. Then, if the day ever comes when you learn he does in fact have it, you will be a pro! ;)

So for now, I would follow your vets advise and save my money on those cush tests. We have seen ALK values in the 5000's+ and there could be any number of causes for the panting. ;)

Hope this helps!

OH! We would love to have you stick around...we get attached to babies right off the bat, ya know. ;)

Hugs,
Leslie and the gang


Cushing's is one of, if not THE, most difficult of canine diseases to diagnose. The signs are shared with many other conditions like diabetes, hypothyroidism, liver, and, yes, kidney issues to name a few. So it is an important part of the diagnostic phase to rule all other possibilities out. Cortisol, which is abnormally elevated in cush pups, is one of the body's natural responses to stress, both external and internal. My Squirt tested positive for PDH, the pituitary and most common form, based on five Cushing's tests - BUT a tumor was found on her spleen and once it was removed, her cortisol returned to normal. All of those tests had determined she had PDH but that wasn't the case; that tumor was causing her cortisol to elevate, not Cushing's. ;)

[loriez]

Thanks so much Leslie ! But I feel that if testing is not done,then it will be too late by the time he diplays more sympoms. Isn't it better to catch it early on and treat it early on ? This ia ll so new to me. I contacted a Holistic vet and he recommends testing sooner rather than later ?? I don't know what to do ??

[lulusmom]

Hi Lorie and welcome to you and Roscoe.

I am very familar with oxalate stones as two of my dogs have had them. We also had PH problems but more importantly, they were not drinking enough water. If the urine is dilute enough, stones can't form. Soooo, we discontinued kibble and started feeding everybody a commercially prepared raw food. I either add a little bit more water to the food or I add chicken broth from boiled, skinless chicken breasts. They really love that. I read that a good number of dogs with stones will reform stones within three years. It's been over three years and no recurrence for either of them....knock on wood. :D

Dogs with cushing's do get oxalate stones but so do healthy dogs. My little Pomeranian, Lulu, had two bouts of stones requiring surgery only 11 months apart. I'm pretty sure that's because she had cushing's. She was diagnosed with cushing's at 3 years old while right in the middle of testing for cushing's. My other dog, a Maltese, did not have cushing's but he is a male and a breed that is commonly seen for oxalate stones. Pomeranians are even higher up on the list.

You have mentioned three things (panting, oxalate stones & high alk phos) that can be related to cushing's but more often than not, they are not. I've had Poms most of my life and they panted from time to time, mostly in the summer months, on a walk, from pain and from being too fat (my bad). Is Roscoe's panting a recent thing and have you noticed a pattern? Most dogs who form oxalate stones do not have cushing's. Roscoe is like my Buster, he's in the majority, being a male and a Pomeranian. Lastly, high alkaline phosphatase is not exclusive to cushing's. Noncushdogs can have transiently elevated alkaline phosphatase for any number of reasons and sometimes for unknown reasons.

Most dogs with cushing's go undiagnosed for a very, very long time. Most don't see a vet until symptoms become more of a problem for the owner than the dog. i.e. drinking voluminous amounts of water, peeing buckets in the house and foraging for food, that petowners . Unless your holistic vet is concerned about concurrent conditions being exacerbated by excess cortisol, I don't understand why s/he is urging you to rush to test based on so few symptoms. Even if all tests pointed to cushing's, a cushing's savvy vet would not prescribe treatment without a confirmed diagnosis and and they would not confirm a diagnosis in the absence of overt symptoms.

As a rule of thumb, it is not better to diagnose and treat cushing's early if a dog doesn't have the usual symptoms. There is no cure for cushing's so the goal of treatment is not cure but rather to remedy the symptoms. It is these symptoms, usually the water intake and a voracious appetite, that a pet owner uses as a gauge to determine if treatment is effective. Lysodren and Trilostane are the most effective drugs for cushing's and both are very serious so to treat a dog with either of these drugs in the absence of symptoms is not a good idea.

As for what to do, if I were you, I'd listen to your gp vet and concentrate on getting the PH down. Also, make sure the urine is more dilute. A cushdog's kidneys usually lose their ability to concentrate their urine so their urine is already dilute and urine specific gravity (USG) is low. Did your vet test USG? If so, can you post the results here? I'd also check liver values again in three or four months.

How is Roscoe's coat? My Lulu's torso has been bald for years but she is still a cutie and she has lots of sweaters for the cooler months. :D

Glynda

[loriez]

Wow, I am soo grateful for the responses so far. Lulu's mom, Rosco's USG was 1.016.When he was first diagnosed with Caox stones, I took him to a holistic vet for a nutrition consult. Dr recommended either royal canine s/o, or home cooked meals,so I decided to home cook,it was a chicken/rice recipe I got from Dr. He was on that for couple mos. But this last time with the ph being lower,my GP vet told me to switch back to royal canine to see if that made a difference. Well,ph got lower. Rosco drinks plenty of water,but I am going to start adding more water to his kibble. He likes kibble better than the canned food. It wasn't until June when the GP vet told me he might suspect Cushings that I really started to pay attention to him. He does pant alot. I am curious to see if it will subside once the weather cools down. Has lulu been taking potassium citrate to help with PH ? What do u feed your caox dogs and where did u find recipe?
I think the holistic Dr feels that I am unhappy with the GP vet so he was recommending a specialist ( where he works at at times) to help me out. I even bought PH testing strips at home,which are obviously in-accurate because I got a totally diff. reading than the lab got. So, I will just hope for the best. Also, do you give your caox dogs any specific treats? My holisitic vet told me he can have regular treats,but as long as royal canine or home cooked meals were his main source of food,it should be ok. Thanks again !!

[addy]

Hi and Welcome,

I am so glad you found us.

Our holistic vet was pushing me to treat my Zoe when her symptoms were hair/coat/skin and really nothing else. She tried to scare me into treatment by telling me all of my pup's hair would fall out in a month. I ran as fast as I could in the other direction, took my pup off all the supplements she was on so I could get a clearer picture and then took her to a specialist. I still waited a year to treat her dispite her high cortisol.

You don't have to rush in to anything. We are here to help anyway we can.

Hugs,
Addy