Beanie, my 9 year old mutt. I come bearing lab results...

[jennie]

Hi there.
I have been lurking around here for the last week or so. Our dog, Beanie, has been diagnosed with Cushing's. It sounds like she has a very mild case of it and at the moment, we're in agreement with our vet to just watch and wait. She doesn't have any real symptoms besides drinking and peeing a bit more than average. And based on her blood work (BUN and CREA being elevated) and one of the links I found on this site, she could very well just be dehydrated (or have kidney disease) but she does also have liver issues as indicated on her blood work. I am a little confused about the results of the DEX test because it's indicative of her NOT having Cushing's. I'm not a vet nor an expert on this diagnosis so I thought I'd post the results to see if anyone has any insight. :)

While I think it's a good idea to wait until her symptoms get worse before starting on the medicine, I also don't like to see her kidneys and liver all out of whack. I asked the vet if he thought diet or something else could help with this and he said no... but he didn't seem concerned about it either. I've thought about trying to find some holistic remedies for the liver/kidney thing because I figure it can't hurt at this point.

Right now, I guess I'm wanting a second opinion on what people who have more experience with this think of her numbers and can verify that it does appear that she has Cushing's. Or if you guys think I should request another type of test or go to another vet for a second opinion or what... Our vet, though we've seen him for the past 9 years, is not as open to conversation as I wish he would be, unfortunately.

Any help or advice will be greatly appreciated. This website has already been such a great resource. Thanks!

Beanie's lab results (http://cl.ly/0f1i0H3L071R0k3k1K01)

Moderator's Note: I have manually approved your post. Please check your e-mail, especially your junk mail or spam folder, for a note from k9cushings which you need to answer ASAP, so we can get your membership approved.

[labblab]

Hello, and welcome to you and Beanie!

I am very glad you have found us. However, you are absolutely correct that Beanie's LDDS result is NOT consistent with Cushing's, and it seems to me that her kidney function is your most pressing issue. I do not understand why your vet has diagnosed Beanie with Cushing's, given her diagnostic LDDS result and lack of any overt symptoms other than increased thirst/urination. Only a very small percentage of dogs who truly have Cushing's (5-10%) are "negative" on the LDDS test. Here's an explanatory quote:



When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

Per the quoted article by Dr. David Bruyette (http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093), if Cushing's is truly suspected on the basis of combined symptoms, you could advance to performing another diagnostic Cushing's blood test, the ACTH. But in Beanie's case, given her increased thirst/urination and the known abnormalities in both her creatinine and BUN, right now I would think you'd rather put your money towards exploration of her kidney function as the source of her problem. Do you know whether your vet has measured the amount of protein that is appearing in Beanie's urine? In conjunction with the creatinine and BUN, protein "spillage" can be another indicator of how well the kidneys are functioning.

I hope that others here who are more experienced with canine kidney problems will also stop by soon to offer their thoughts. But most certainly, I would not give Beanie any Cushing's medication at this stage in the diagnostic process.

Marianne

[addy]

I just wanted to stop by and say welcome. Our members can offer a wealth of information and experience.

We are here for you whether Beanie has Cushings or not.

Hugs,
Addy

[Harley PoMMom]

Hi and welcome to you and Beanie from me as well!

My boy, Harley, had kidney issues and an important test to have done is an urinalysis. There are many valuable pieces of information that your veterinarian can obtain from analyzing a urine sample.

Urine specific gravity, urine PH, protein-loss, and sediment are some of things that an urinalysis will show, which is vital information especially with a dog that has kidney issues.

Do you know if your vet performed an urinalysis?

Love and hugs,
Lori

[Squirt's Mom]

Hi Jennie and welcome to you and Beanie! :)

Based on the tests posted, I would say Cushing's is not the problem right now. Like Marianne said tho, her kidney values should be looked into. They are a bit disconcerting.

I beg you, please do NOT start the Trilostane (Vetoryl) right now. First, Beanie has not had enough testing done to truly diagnose Cushing's; second the one Cushing's test she has had, says Beanie does NOT have Cushing's; third, Trilo can cause further kidney damage if used in a pup with those issues already present.

So, if I were you I would be seeking another opinion asap - preferably with an IMS (Internal Medicine Specialist). Your GP vet may have to refer you. ;) Nothing against your GP vet, but it appears he may be over his head with this one. ;) He has jumped to Cushing's based on a false test and prescribed a very powerful drug to treat a disease that according to this test she doesn't have.

I am very glad you found us and look forward to learning more as time passes. Know you and Beanie are no longer alone. We will be with you all the way. Please ask any questions you may have and we will do our best to answer or direct you where you can find answers.

Keep your chin up! You are already doing a fabulous job, Mom!
Hugs,
Leslie and the gang

[jennie]

Thank you all!
The vet did do a standard urinalysis at her initial well check. I will see if someone from their office will fax me the results and then I'll post them.
I went ahead and made an appt this morning with a different vet (at a different office). I don't think we have any specialists here, but I could be wrong.

[Squirt's Mom]

Hi Jennie,

Here is a link that will help you locate specialist in your area. It may be that you have to drive for a bit to reach one depending on where you are located. The closest one to me is about 45 min - an hour away.

http://www.k9cushings.com/forum/showthread.php?t=182

[jennie]

Thanks for your help!

I got 6 pages of stuff when I asked for her urinalysis. The stuff on this page may be part of her blood work and what I already posted. Not sure... there was only those two lines at the bottom about urinalysis.

beanie urinalysis...? (http://f.cl.ly/items/032i3G0t0T3U2k0v3h3N/beanieurinalysis.jpg)

[jennie]

It says protein +30... everything I've looked at online talks about 4 and 8 being high ranges... what does THIRTY mean then?! Oy!
We have an appt with another vet tomorrow (not a specialist) so hopefully he'll be able to explain some of these things instead of just trying to get rid of us. :confused:

[Harley PoMMom]

If 30+ is protein-loss then an urine protein: creatinine ratio (UPC) test is recommended. Here is a link with info about the UPC: The Urine Protein: Creatinine Ratio Test for Dogs (http://www.fetchdog.com/learn-connect/dog-resource-library/health/diagnostic-tests/The-Urine-Protein-Creatinine-Ratio-Test-for-Dogs/D/300600/P/1:5:55:601:6103/I/AR000010043)

[jennie]

Thank you!!!!!!

We took her to a different vet today and he did not think she had Cushing's. He mainly thinks she has renal failure and we're now working towards dealing with that which will include changing her diet.
He also actually sat down and talked to us which the other vet never did. He seemed to know a lot about how everything in the body works and seemed very knowledgable.
Beanie did growl at this vet but I think that's because the old vet never even looked at her while this one was trying to talk to her. :D

[Squirt's Mom]

Hi Jennie,

I am glad you have a diagnosis and that you like this vet better than the other one. Nothing like paying to get ignored, huh? :D

Please keep in touch and let us know how things are going. We have had several members here who have, or are, dealing with kidney issues. I'm sure they will be along to share their experiences with you. Here is a pretty good link that deals with kidney issues -

http://www.dogaware.com/kidney.html

I also have some links to studies if you are interested.

Hugs,
Leslie and the gang