3 yr. old Lab/Pit - working on diagnosis

[DCMuffin]

Hi everyone! My name is Aimee and we've got a 3 yr. old Lab/Pit named Kona.

I was referred here by a friend of mine whose dog was, after months and months, diagnosed with Cushings. I'm on the hunt now for some information and answers, trying to be as proactive as I can for our pup because at this point, I feel as though we're going in the wrong direction with our vet.

Here's the story. Over the course of about a year, our dog has begun experiencing some differences in her looks and behaviors. She became a bit lethargic, only having get up and go when we specifically would say "Let's go!" She started gaining weight. Slowly at first, but she has gone from 60 lbs up to 90 lbs now and has a good bit of trouble carrying that weight. We noticed that she was urinating a lot and drinking so much water, so I had her tested for a UTI. It was positive. She used to be a voracious eater and we're now to the point that we have to entice her to do so. On average, she eats approximately 3-4 cups per day, sometimes less. Along with her substantial weight gain, she has the look of a potbelly pig. About a month ago, I noticed something in the sunlight. A very thin spot on her body, towards her back end. Of course, I began looking her over and there, on the other side of her body in almost the identical spot, is another thin area, same size, same shape. Every so often, she develops small scabs on her fur. She has none now. Her skin is very dry in those thin spots and she looks dandruffy all over her body. Her fur has also taken on a wiry look in places - it just sticks straight out (she has short hair) and reminds me of the equivalent of our morning bedhead LOL. I will often find her lying on the floor or outside on the cement patio rather than her dog bed, which is odd because she's only doing it more often in recent weeks. Probably one of the very worst things that is going on with all these other symptoms is the horrible, room clearing gas she has. Honestly...I'm sure the military could use her as a weapon of mass destruction LOL. No vomiting, although she frequently gags or sounds like she's choking and no diarrhea.

We presented these symptoms to our vet. Her first thought - thyroid. So, we tested - normal. Right in the middle. She was disheartened, but we moved on. We tried probiotic and beano (the big focus has been her gas), which did nothing. Basic physical checks - normal. Next was a maldigestion profile. That bloodwork came back normal, except that she had another UTI. Along with that, she performed another test for thyroid (because she's still convinced that's what it is) and again, her numbers were smack dab in the middle - normal. She opted to do a trial treatment for hypothyroidism anyway so she has been on Soloxine now for 17 days with absolutely NO improvement at all. This is NOT hypothyroidism, I am convinced of that. She has NOT had an ultrasound or X-ray.

We go in to the doc today at 2 pm for a recheck on the trial. After much of my own research, I really feel that we also need to look into whether or not she has Cushings. I know that she doesn't fit the normal profile (she's young) but so many of her symptoms just fit. I called the office this morning to find out cost on a Cushings test because this is what I want to discuss today. They only mentioned the blood test but nothing else. My fear is that they won't do the appropriate tests. Anyone know if the maldigestion profile bloodwork would have shown elevated liver enzymes or would that test be specific for digestion?

Anyway...that's pretty much it at this point. I guess I'm just looking for some thoughts, some ideas and some knowledge so that I can deal with our vet armed with info. Our vet is good, I do like her, but my frustration is that from the very beginning, she has had her mind stuck on Kona's thyroid and I'm fearful she's not looking at the bigger picture.

Thanks so much in advance for your help here. :)

[labblab]

Hi Aimee,

Welcome to you and Kona! I am looking at the clock and realize that there's not a lot of time before you will be leaving for your vet visit. So I'll try to fight my natural tendency to blab on and on :o, and stick to a few main points. :)

First, many of the symptoms you describe indeed sound consistent with Cushing's. However, the recent of loss of appetite and horrible gas would tend to signal some other GI disturbance which may or may not be related to underlying Cushing's. For instance, in the same way that Cushpups are prone to UTI's and other infections, they also seem to be more vulnerable to pancreatitis (which can require specialized testing to reveal).

However, in terms of general blood and urine testing, we could expect to see elevated liver enzymes, high cholesterol, and dilute urine. You'll have to ask your vet whether any of her recent bloodwork revealed any of those abnormalities. Also, I am assuming that diabetes has been ruled out.

In terms of Cushing's testing, probably the easiest and least expensive initial test is a urine test: the UCCR (urine creatinine to cortisol ratio). For this test, the owner needs to collect a urine sample at home -- preferably the first pee of the morning -- and take it in to the vet for analysis. We've heard the suggestion that a pooled sample of three specimens collected over three days is even more accurate. This test can rule out Cushing's, but it cannot confirm Cushing's. A "positive" result requires further blood testing, either the LDDS or ACTH stim test. I'll attach a link here that describes the pros and cons of all three tests in more detail:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47901_VETORYL_10mg_Diag_Testing_brochure_4pg_3_1_p s.pdf

So to cut to the chase in terms of your vet visit today...I'd find out whether Kona's general bloodwork and urinalysis performed so far have revealed any abnormalities. If you don't have recent general panels, I'd start there. And then you can move on to a UCCR, LDDS, or ACTH stim test.

Marianne

[DCMuffin]

Thanks so much for your reply and the warm welcome. :)

I brought up pancreatitis to my vet towards the beginning. Her thought was that they typically see a good bit of vomiting from dogs with this, and given the fact that she has SO many other symptoms (hair loss, urination, drinking, etc), she didn't feel this was very plausible.

Here's the thing on Kona's appetite. It's not a recent change - she slowed eating at least a year ago. We thought she was tired of her food so we made a gradual switch. Nope - didn't eat that food any better. So we began enticing her. Now, if I put a bowl of dry food down, she'll sniff it and walk away, yet she sits at the dog bowl and begs all afternoon. If I mix a little wet food in, she inhales. LOL Maybe I've been my worst enemy on the food thing and she really IS hungry, just picky now that I've given her the gourmet alternative??

I'll find out about her test levels and get a copy of what has been done so far. I also need to ask if the maldigestion profile checks the same things as a regular panel - could be that they don't and that it's test specific. Just not sure.

Again, thanks so much - we'll have some discussions today and hopefully I'll have more information to report when I'm home.

ETA: The urine thing - really? Collect it at home? Don't they get stage fright and weirded out by you following them around with a container?? LOL

[Harley PoMMom]

Hi and welcome to you and Kona!

Regarding pancreatitis; my boy, Harley, did have pancreatitis. It was diagnosed from an ultrasound and confirmed with spec cPL test. I was shocked by this because Harley never displayed any symptoms of pancreatitis. Although vomiting is a very common symptom of pancreatitis it is not always present.

Has diabetes been ruled out? Many symptoms are shared between Cushing's and Diabetes such as increased drinking/urination, a pot-bellied appearance and elevated ALP levels.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[DCMuffin]

Diabetes has not been ruled out - or at least it's not been discussed so this will definitely be another discussion I will have with the vet today, along with another mention of pancreatitis. With both of these, aside from the actual pot-bellied appearance, is weight gain typically seen?

[labblab]

Aimee, weight gain is definitely characteristic of Cushing's. Weight loss is more common with diabetic dogs, even though they may initially have increased appetites. As far as the pancreatitis, it's not that I'm thinking that Kona may have chronic pancreatitis instead of Cushing's, but rather in addition to it. And that may be contributing to her pickiness about eating.

My non-Cushpup Lab girl had an attack of acute pancreatitis last spring. And surprisingly, all of her standard bloodwork was normal -- even her lipase and amylase. It was only through the cPL test (that Lori mentioned above) that we diagnosed the pancreatitis. It does apear that Cushing's dogs may be especially vulnerable to pancreatitis, so that's why I mention it as a possibility in relation to Kona.

Marianne

[DCMuffin]

I've been reading a bit on the diabetes before leaving. She definitely doesn't have any weight loss. On the contrary, her weight has ballooned. At our last vet visit, 3 weeks had passed since the one prior to it and in just that time, she had gained yet another 9 pounds. We have a large, fenced in back yard, she gets regular walks and we take her to the dog park. Her food consumption is low so those two things just don't balance out. Interesting about the correlation between Cushings and Pancreatitis - I'm just learning more and more. This has been frustrating, to say the least.

[DCMuffin]

Hey all -

Back from the vet. Thankfully, it's clear to her now that the thyroid trial was a bust. When I walked in the room, her next comment to me was about Cushings, and had I thought about it LOL. She said that her symptoms present themselves correctly, but that her liver enzymes showed normal in her testing. With that said, she wanted to do the ACTH test. She drew blood, gave an injection and we went back an hour later for another draw. Now we wait for a couple of days until the results come back. I've read about the different tests that are run for Cushings - is the ACTH relatively accurate?

Here are her lab results from two weeks ago. Since I have no idea which are important and which aren't, I'm going to list them all. Please forgive me for those that aren't necessary:

CBC

WBC - 8.5 Range: 4.0-15.5 10^3/mL
RBC - 7.76 Range: 4.8-9.3 10^6/mL
Hemoglobin - 19.8 Range: 12.1-20.3 g/dL
Hematocrit - 55.8 Range: 36-60%
MCV - 72 Range: 58-79 fL
MCH - 25.5 Range: 19-28 pg
MCHC - 35.5 Range: 30-38 g/dL
Platelet Count - 234 Range: 170-400 10^3/mL
Platelet EST - Adequate
Neutrophils - 63 Range: 60-77%
Bands - 0 Range: 0-3%
Lymphocytes - 26 Range: 12-30%
Monocytes - 4 Range: 3-10%
Eosinophils - 6 Range: 2-10%
Basophils - 1 Range: 0-1%
Absolute Neutrophils - 5355 Range: 2060-10600 /uL
Absolute Bands - 0 Range: 0-300 /uL
Absolute Lymphocytes - 2210 Range: 690-4500 /uL
Absolute Monocytes - 340 Range: 0-840 /uL
Absolute Eosinophils - 510 Range: 0-1200 /uL
Absolute Basophils - 85 Range: 0-150 /uL

Superchem

Total Protein - 7.8 Range: 5.0-7.4 g/dL
Albumin - 4.7 Range: 2.7-4.4 g/dL
Globulin - 3.10 (test run after clearing lipemia by centrifugation) Range: 1.6-3.6 g/dL
Albumin/Globulin Ratio - 1.5 Range: 0.8-2.0 Ratio
AST (SGOT) - 26 Range: 15-66 U/L
ALT (SGPT) - 44 Range: 12-118 U/L
Alk Phosphatase - 59 Range: 5-131 U/L
GGTP - 6 Range: 1-12 U/L
Total Bilirubin - .2 Range: 0.1-0.3 mg/dL
Urea Nitrogen - 17 Range: 6-31 mg/dL
Creatinine - 1.10 Range: 0.5-1.6 mg/dL
BUN/Creatinine Ratio - 15 Range: 4-27 Ratio
Phosphorus - 4.6 Range: 2.5-6.0 mg/dL
Glucose - 98 Range: 70-138 mg/dL
Calcium - 11.7 (TEST RESULTS SHOW HIGH) Range: 8.9-11.4 mg/dL
Magnesium - 2.0 Range: 1.5-2.5 mEq/L
Sodium - 149 Range: 139-154 mEq/L
Potassium - 3.8 Range: 3.6-5.5 mEq/L
Na/K Ratio - 39
Chloride - 107 Range: 102-120 mEq/L
Cholesterol - 316 Range: 92-324 mg/dL
Triglycerides - 457 (TEST SHOWS HIGH) Range: 29-291 mg/dL
Amylase - 603 Range: 290-1125 U/L
Lipase - 693 Range: 77-695 U/L
CPK - 71 Range: 59-895 U/L
Comment: Hemolysis 2+ No significant interference.

Total T4

T4 - 2.3
Note new Canine reference range

Urinalysis

Color - yellow
Appearance - Clear
Specific Gravity - 1.0250
pH - 8.5 (TEST SHOWS HIGH)
Protein - Negative
Glucose - Negative
Ketone - Negative
Bilirubin - Negative
Blood - Negative
WBC - 4-10
RBC - None
Casts - None Seen
Struvite (MgNH4PO4) Crystals - 11-20
Bacteria - None Seen
Squamous Epithelia - 2-3

Urine Microalbumin

Microalbuminuria - 2.4

Whew...now wasn't THAT fun! :)

Just to note: After this test, she was put on meds for UTI.

Thanks again everyone!

[Harley PoMMom]

For the superchem and CBC, could you edit your post and add the reference ranges?

[DCMuffin]

I edited the ranges above for both.

[labblab]

Thanks for giving us those results, Aimee. As you already know, we would have expected to see elevations in those liver enzymes. So that's contrary to "form." But in answer to your question about the ACTH, both it and the LDDS can give "false positives" in response to other illnesses or conditions besides Cushing's. However, the ACTH is less likely than the LDDS to return a "false positive." The flip side of the coin is that the LDDS is less likely to mistakenly return a "false negative" (that is, miss diagnosing Cushing's in a dog who truly does have the disease). So as we said earlier, there are pros and cons to each test.

Regardless of the outcome of the ACTH, I would also recommend that you discuss an abdominal ultrasound with your vet. It can reveal a lot of helpful information about the adrenal glands and other internal organs. And since there are some puzzle pieces missing in terms of Kona's presentation, an ultrasound may be especially valuable to you.

Marianne

[DCMuffin]

Thanks, Marianne. I really do appreciate your insight.

We did also discuss ultrasound and should this test come back inconclusive, that's our next step. As sad as it sounds, I am hoping we do get a positive result, only because I SO want to get our little girl back into good health and want answers. The next two days will be horrible having to wait.

As a side note - the friend I mentioned in my first post had a dog with Cushings. They had a terrible time diagnosing him because they weren't able to get their vet to listen and do diagnostics. His liver enzymes came back normal each and every time, as well, which is one of the largest reason her vet wouldn't move forward with any of the testing. He had the other symptoms but the vet just wasn't quite as forward thinking as she'd hoped. Ultimately, she moved on to a specialist, who did the LDDS test, which came back with positive results. He lived a long and happy life. :)

[DCMuffin]

Woke up this morning to a 90 lb. dog having had peed on our office carpet. She has never peed on the floor before, even as a puppy. :( Maybe she's upset with me that we had to go back to the vet again yesterday?

Anyway, I have a question. Have any of you ever seen a change in personality with your dogs? Like aggression or fearfulness? I guess a better way to explain it would be like a heightened response to people and things? Just curious if there are personality changes that sometimes go along with the behavioral and physical changes?

Also...what are we looking at in terms of cost and time should we get a positive result for Cushings? Is this going to put our dog through the wringer? Will it hurt her? Will it make her sick? And for things like lethargy, weight gain, etc., how quickly do you begin to see changes and improvements?

[lulusmom]

Hi Aimee and a belated welcome to you and Kona.

I don't have to comment at the moment but wanted to bump up your thread in case anybody else may want to chime in. I'll try to post later this evening. I do have opinions about everything and usually get around to expressing them. :D

Glynda

[DCMuffin]

Hi Glynda! Thanks for the welcome!

Looking forward to hearing your comments! Thanks so much for bumping this up for me. :)

[Sabre's Mum]

Welcome Aimee,


Have any of you ever seen a change in personality with your dogs? Like aggression or fearfulness?

This may have no link at all but I wanted to comment on this in relation to high doses of prednisone. Our Flynn was placed on high doses of prednisone for a long duration. We found him to have MAJOR heightened awareness and quite fearful and would bark at any tiny noise. Perhaps with the increased levels of cortisol ... some dogs have a similar behavioural change. Once we had him weaned off ... he was back to normal.

Angela and Flynn

[DCMuffin]

I wondered about this after reading about the effects of cortisol in the body. Thanks for the input. It may just be our dog, but I'm certainly a bit more curious now. She has definitely had a change in personality, corresponding to when we began seeing changes in her other behaviors and appearance. Definitely curious.

[DCMuffin]

Well, just got the call from the vet. Kona's ACTH test was negative. While we know there is a chance that it as a false negative and could run the LDDS test, we've opted to do an ultrasound so that we can cover all our bases. We should have done it a long time ago so I'm feeling just a bit of guilt over this. At any rate, we're scheduled tomorrow at 1 pm and will then have a conversation with our vet on Saturday.

[labblab]

Aimee, good luck with the ultrasound today. I do think that's a smart move, and we'll be anxious to learn the results!

Marianne

[DCMuffin]

Thanks so much, Marianne. Nervous, of course, but I know we should get more definitive results this way. Looking back, I'm sure this is one of the first things we should have done for Kona. But her symptoms were presenting so much like hypothyroidism, so we went with it and moved from there. Hindsight is 20/20, of course. I only hope we are given some good answers now. I'll keep you posted!

[Squirt's Mom]

Hi Aimee,

How did the ultrasound go? Learn anything interesting/helpful?

Hugs,
Leslie and the gang