Dachshund's Xray shows Suspicious Spots

[Kaisersmom]

Hi Everyone.

This is new for me. I have an 8 1/2 year old miniature dachshund named Kaiser. He is my love. I took him to the vet Monday because he seemed unusually bloated. To condense this story, they did xrays and found two "suspicious" spots. The vet that talked to me that day had me in tears when I left and thinking he has cancer. I called the next day and spoke to the Medical Director, and she said they really don't know but suspect Cushings. They have recommended an ultrasound, which we are doing Monday April 9th. Today I talked to another vet there, and he told me the spots could be "nothing", could be enlarged adrenal glands pointing to Cushings, or could be worse...cancer, and concurred the recommendation of an ultrasound. Has anyone every started down the Cushings road this way? I've been trying to get these vets to test him for Cushings for about three months because he has a "pot belly" and has been urinating about every hour. And did I mention that he thinks he's starving all of the time? He had a dental about 4 weeks ago, and his bloodwork was "normal". They did bloodwork again this past Monday and all was "normal". They also did a urinalysis and said it was "a little dilute but probably because it was late in the day and he had been drinking.

I have cried all week. I love this little guy like my other child. Any comments/advice would be helpful. We are planning to have the ultrasound on Monday April 9th.

Thank you everyone.

[StarDeb55]

Welcome to you & Kaiser! A lot of the symptoms that Kaiser has do point a finger at Cushing's. Looking at this from strictly a Cushing's viewpoint, IMO, an ultrasound is jumping the gun in the diagnostic process for Cushing's. Now, with the questionable findings on the x-ray, I do think that an ultrasound is warranted sooner, rather than later, to figure out if what was on the x-ray is anything to worry about.

Let's talk about the diagnostic process for Cushing's. Normally, a vet will suspect Cushing's based on symptoms, & frequently, common abnormalities on routine bloodwork, such as what was done prior to the dental. In our babies, the liver function tests, especially the alkaline phosphatase will be elevated which is the big red flag for Cushing's. One of the easiest tests to do is a urine cortisol/creatinine ratio. You can collect the urine sample at home & take it to your vet. If the ratio, is normal, you are absolutely not dealing with Cushing's. Positive means that Cushing's is a possibility, further testing required. You would then proceed to either a low dose dex test or ACTH, then the ultrasound to confirm a positive results on either of those two tests. Cushing's is probably the most difficult of all canine disease to diagnose as its symptoms overlap with diabetes & hypothyroid, so you want to make sure that these 2 things have been ruled out. The other problem is there is no one single test for Cushing's that is 100% accurate. The low dose test that I mentioned is considered to be the gold standard to diagnose Cushing's, but it can show a false positive in the presence of non-adrenal illness.

Here's the issue Kaiser is facing right now. Until your vet/s can confirm that what was seen on x-ray is nothing to worry about, it would be pointless to initiate any Cushing's diagnostic testing. Any non-adrenal illness will elevate the cortisol levels in the pup's system as their body is under stress due to illness. If Kaiser were my pup, the first priority is to determine what the heck is on that x-ray. If it's nothing, then I would be telling the vet you want to do the urine screening test, (it's called a UCCR for short), & proceed from there.

I'm very glad you found us, but terribly sorry for the reason you're here. Please keep us posted as to what you find out. We're here to help in any we can, including helping you to understand how to proceed with diagnostics, if it comes to that.

Debbie

[frijole]

I agree with what Deb said. I noticed you had bloodwork two times recently and both times the readings were normal. Please confirm (go get a copy if you don't have one) that the liver enzymes (ALP and ALK) are normal. If they are then you can pretty much rule out cushings.

I wouldn't do any further testing for cushings at this time due to the blood work you mentioned being normal and because I fear you'd get false positive readings if something else is going on. (I had it happen to me)

As Deb indicated, probably doing the ultrasound will give you a greater idea of what is happening (what was on the xrays). Please keep us posted and we'll help however we can. Kim

[Kaisersmom]

Thank you for the quick respones Debbie and Kim. We are going for the ultrasound Monday, and I pray all is well with Kaiser. (I am certain he thinks I am crazy now because I cry so much.) I worry so much about him because just a routine trip to the vet puts him under stress. He starts crying when he can see the road that leads there! He did this at his previous vet also, so it isn't just this one. They told me they will have him all day, so it will be later in the day when I get the results. Thank you for the advice and suggestions. I will be sure to follow the recommendations you gave and keep you posted. Thank you so much for this site.

[StarDeb55]

I forgot in my initial post that if Kaiser has not had bloodwork to check his thyroid recently, you might want to start there, before even doing a UCCR. The usual thyroid screening test is a T4.

Debbie

[marie adams]

Welcome to you and Kaiser,

You have definitely come to the right place for advice and answers to your questions about Cushings.

I see Kim and Debbie have already been helping you. More of the experts will be along also.

You are in good hands and now part of the family.

Take care!!:)

[Squirt's Mom]

Hi Mom and welcome to you and Kaiser! :)

The ultrasound test saved my Sweet Bebe, Squirt's, life. It found a tumor on her spleen and once it was removed, her cortisol levels returned to normal. Squirt had tested positive on five Cushing's test but the stress of that tumor was the real cause of her elevated cortisol. So in view of the "spots" found on the Xray (which is useless in diagnosing Cushing's), the ultrasound would be my followup choice, too. With a bit of luck, they will be able to see both adrenal glands on the ultrasound and that will go a long way toward determining if Cushing's is what is causing the signs you are seeing in Kaiser. The ultrasound is non-invasive tho he may have his belly shaved and might require a bit of sedation in order to make sure he remains still. As one of our mods here says, this test gives you the biggest bang for the buck so it is well worth it.

It would really help if you can get copies of the tests done on Kaiser and post the actual results here, just the abnormal values, too high or too low. Like Debbie said, these tests often show the first indications of excess adrenal activity.

I want you to know two things today. First, Cushing's moves at a snail's pace, taking years before damage to organs begins. So there is usually plenty of time to make absolutely sure that it is indeed Cushing's you are dealing with. There is no need to rush into treatment even tho that is what your soul will be screaming for you to do starting today! ;):D We love our babies to distraction and want them to be as happy and healthy as possible every minute of every day but rushing is not the way to approach Cushing's and, thankfully, this disease, unlike many others, gives us time.

Second, and most importantly, I want you to know that you and Kaiser are not alone. You both are family here now and we stand by our family through thick and thin. We will walk every step of this journey with you. All you ever need to do is holler.

I am glad you found us and look forward to learning more about the both of you as time passes.

Hugs,
Leslie and the gang

[Kaisersmom]

Thank you so much Leslie and the gang. I am so glad I found this site. I will get copies of Kaiser's lab records Monday when I take him in for the ultrasound. I am also getting copies of the xrays and ultrasound results in the event I seek another vet. You are all wonderful on this forum to take the time to help people like me who love our fur babies as much as our children. Thank you all so much. I'll be in touch with the lab results and ultrasound results.

[Kaisersmom]

Thank you so much Marie.

[Kaisersmom]

Debbie, supposedly his thyroid was check with the blood work before doing his dental a month ago and again this past Monday. I will double check when I go in on Monday. I will post any abnormal findings as well.

Thank you so much for your help.

[Kaisersmom]

Good Evening Everyone. Kaiser went in for his ultrasound today, and the vet and radiologist now say that there is "no abnormality noted that warrants further testing." The only "problem" he (the vet) noted is that Kaiser has a kidney stone. I asked why the other vet told me there were "suspicious spots" on Kaiser's adrenal glands, and he said "because there are, but the radiologist said it doesn't appear to be anything to worry about." He said it could be "artifact or fat". Has anyone ever had anything like this to happen? I was so excited about the findings that I couldn't think about anything else. I forgot to get copies of the bloodwork, but I still plan to do that this week. Is there anything else I should ask or do from here? Should I still be concerned about Cushings?

Thank you so much everyone. I am so exhausted right now after a week of no sleep and lots of tears. Between worry about Kaiser and taking care of a toddler, I am worn out. Forgive me if I made typos. Thanks so much. Gina

[Kaisersmom]

Hi Kim.

I have Kaiser's bloodwork results:

ALB Normal at 3.900 with lab range 2.200-3.900
ALKP Normal at 57.000 with lab range of 23.000-212.000
ALT Normal at 59.000 with lab range of 10.000-100.000

AMYL, WBC, MCHC, and PLT all are below normal. This was checked on 3/9/12 and 4/2/12. Of the four listed here, all except MCHC have gone up between 3/9/12 and 4/2/12.

Is there something else I should have done? The radiologist ruled the ultrasound findings "normal".

Thanks for your help.

[Kaisersmom]

I previously posted this as a reply to my initial post; however, I am not certain I posted correctly because no one else replied. I have had so much on my mind with Kaiser that I probably did not post correctly.

Nonetheless, Kaiser had his abdominal ultrasound done on 4/9/12, and the vet told me that the Radiologist "found nothing that warranted further testing." He also told me that the Radiologist agreed that there is "something" there but they do not know what. The "something" is what led the first vet to believe the adrenal glands were enlarged. I am very confused now. I've gone through Kaiser's bloodwork results from early March and April 2nd, and the following have been below normal both times:

AMYL 446.000 4/2/12 420.000 3/9/12
WBC 5.170 4.000
MCHC 33.180 33.900
PLT 179.000 116.000

All tests were done while fasting on 3/9/12, and not fasting on 4/2/12


I have Kaiser's bloodwork results for his liver: (Someone asked for this).

ALB Normal at 3.900 with lab range 2.200-3.900
ALKP Normal at 57.000 with lab range of 23.000-212.000
ALT Normal at 59.000 with lab range of 10.000-100.000

AMYL, WBC, MCHC, and PLT all are below normal. This was checked on 3/9/12 and 4/2/12. Of the four listed here, all except MCHC have gone up between 3/9/12 and 4/2/12.

Is there something else I should have done? The radiologist ruled the ultrasound findings "normal".

Thanks for your help.
Gina

:confused:

Moderator's Note: I have merged your update on Kaiser with Kaiser's original thread. We, normally, prefer to keep all posts on a pup limited to a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[labblab]

Hi Gina, I'm so sorry that nobody had the chance to respond to you before! You definitely posted correctly, so I'm afraid it was just an oversight on our part that you received no replies.

I've relieved to hear that Kaiser's ultrasound did not reveal any problems that seem to warrant additional investigation. And thanks for posting the lab results. One question for you, could you please post the "normal" range for those four results that have been low? That way, we can tell how far below normal Kaiser's results really are. It is interesting that his liver results are all normal, because most Cushpups do have elevations in their liver studies.

You mention that a kidney stone was visualized on the ultrasound. Has your vet said anything about that stone? Stones do not necessarily cause problems, but of course, sometimes they do -- pain, bloody urine, frequent urination, etc. So I'm wondering whether your vet has commented at all about that stone.

Also, how is Kaiser doing in terms of those problems that you were seeing before the x-rays? Is the pot belly still evident? How about the excessive urination? Let us know how he's doing, and that can help us think about any additional steps for testing.

Thanks so much,
Marianne

[Kaisersmom]

Hi Marianne.

Thank you so much for the reply.

Here are the normal ranges, according to Banfield:

AMYL 500.000 - 1500.000
WBC 6.000 - 17.000
MCHC 34.000 - 38.000
PLT 200.000 - 500.000

The vet didn't seem too concerned about the kidney stone. He told me to watch for blood in Kaiser's urine. Kaiser still urinates frequently, and has somewhat of a "droopy pot-bellied" appearance that seems to worsen after he eats. He sleeps a lot. The only new issue is that he has bumps all over his body that had pus in them. Now they seem to be drying up a little. I don't know if this is a problem related to the other issues or if he just had a reaction to the gel used for the ultrasound or if that is even possible.

I have been trying to get in touch with the radiologist, but she will not call me back. I've left three voice mails for her. I would feel a lot better hearing the "no cause for worry" from her. I've asked her for a report of her findings in the voice mail, but again, I've heard nothing. Has anyone ever heard of Dr. Cynthia Godshalk?

Thanks so much for your help.
Gina

[apollo6]

Dear Gina
Welcome.
I have attached info on cushings for you. From some of the symptoms I would check about cushing the white spots are calcium deposits and the droopy belly and excess drinking can all be signs of Cushing's.
http://www.kateconnick.com/library/cushingsdisease.html
http://www.peteducation.com/article.cfm?c=2+1597&aid=416
My Apollo , 13.5 year old dachshund has had cushing for over two years.
We are here to help.
Hugs Sonja and Apollo

[Kaisersmom]

Thank you Sonja and Apollo. I will read and research the information from the links. Kaiser went back to the vet yesterday. It appears than now he has some type of "skin infection", and they put him on an antibiotic for 14 days 2X day.

Hugs to all.
Gina and Kaiser

[addy]

Hi Gina,

I hope the antibiotics help Kaiser. My pup had white spots but they were not filled with pus. The derm vet asperated them and they were plaque so he diagnosed calcinosis cutis. I could tell by looking at them that they were hard and solid.

Did the vet say what type of skin infection?

Hang in there,
addy

[Kaisersmom]

Hi Addy.

No, the vet did not say what type of skin infection. Kaiser has a checkup scheduled for the 14th of this month. The bumps seemed to be getting better until a couple days ago. Now, it seems he has little "lumps" everywhere. His hair just looks "lumpy" now. The bumps do have pus in them. I may take him before the 14th. I really want to be proactive with this, rather than having to be reactive later.

We lost one of our chocolate Labs, Molly, today. We were never sure of her age. My husband found her and one pup on 9/11/2001 and brough them home. She became weak a couple weeks ago, and did not respond to meds. Had to say goodbye today. Really sad.

Thank you for your help.
Gina

[CJandTucker]

So sad to hear about Molly

[Kaisersmom]

Can anyone tell me what calcium deposits look like? I've tried to find information on the internet, but have not found anything helpful. I'm wondering if Kaiser's "skin infection" is really a skin infection. His hair looks like he has little lumps/bumps all over. The hair falls out and leaves a white spot. Some of the bumps seem to have pus in them. Thanks again everyone for your help.

Gina & Kaiser

[StarDeb55]

Gina, try a "google" using calcinosis cutis pictures. I ran several searches using various search terms, didn't find a lot of pictures. When I used the above, about 7 or so pictures popped up on the search page. Just click on each picture to enlarge.

Debbie

[addy]

Gina,

If the white spots have pus in them, it could be a hair follicle infection. That was what our derm vet first thought Zoe had. Zoe had white hard spots that when asperated, plaque was inside, not pus. You could see they were hard. Derm vet said calcinosis cutis.
They were small spots. You can see a few of them on her album labled skin problems, or coat problems, forgot which I called it:o:o:o
The calcium deposts can end up being a problem. I have been told the plaque can go in their blood vessels and Zoe has calcium deposits in her eyes.:eek::eek::eek::eek::eek:

I dont mean to alarm you but I never knew that could happen so I was pretty shocked when we saw the ophthalmologist.

hugs,
addy



hugs,
addy

[Kaisersmom]

Thank you Addy and Debbie. I'm going to work on this tonight for a while. Kaiser has so many bumps, but they don't seem to bother him. The vet put him on Hydroxyzine 10mg for 2 weeks, so he's eating like crazy and sleeping. He told me it was flea dermatitis; however, there are no fleas on Kaiser. I am trying to find a "safe" flea preventative to put on him. I am cautious to use Advantix, Frontline, Sentinel, etc. due to his age and possible health problems. Any suggestions on that?

You guys are great. Thanks so much.
Gina & Kaiser

[humbleshadow]

You didn't say where the "spots" on the x-ray were from? His brain? His bladder? Bladder stones are sometimes a sign of Cushings. I am not a vet but I suppose they could show up as spots.