In Process of Diagnosis--help!

[Owen's Mom]

Hello,
I am brand new to this site and so happy to see this available for people like me.
Our dog Owen, 8.5 years old shepherd mix. He has been drinking a lot for awhile and have had to really push the vet to take this seriously because they have always maintained it is behavioral or within the normal limits. Last fall, he was at the lowest end of normal for a urine concentration test and had surgery for a lump where his bloodwork was very normal. Last week we had a senior panel and cortisol/creatinine ratio at my insistence. Anyway, his bloodwork and urinalysis is looking like cushings so they did an ACTH Stim test today. Here are all the results:
ACTH test: 18.8 (they say it is borderline and need a low dose dex test & bile acids test).

Bloodwork:

ALK PHosphatase=268
ALt (SGPT)=703
AST (SGOT)=251

Auto Platelet=538
Cortisol/Creat. ratio=38

The problem I have is all of this: Owen has been begging horribly, he was just diagnosed with about 20% cataracts, losing muscle mass and weight. In addition, he has had 3 seizures between 2009-2010, but hasn't had one since the fall of 2010.
To add to our concern, we had a cat that had cushings from a tumor on her adrenal gland, so we had it removed. Her health was much worse due to trusting a terrible vet. I know cushings is super rare in cats, but we had bloodwork done 5 times in a year--our fault for trusting the expertise of these vets. Eventually she went to an amazing specialist and lived with complications from cushings and diabetes for another 1.5 years.

I'm looking for some direction and any help anyone can give me. We are currently dealing with our other dog with terminal cancer and could use a clear head with this potential cushing diagnosis.

THANK YOU!

Owen's Mom

[frijole]

Wow you have had your hands full with sick loved ones haven't you? I encourage you to take your time and don't push the cushings diagnosis because it is very very often misdiagnosed as other illnesses have similar symptoms.

Things that make me question cushings as the culprit are the liver enzyme readings - the alk phos is really not very elevated at 268. Could you please post anything that was high or low as well as the range for normal from the lab? (there is some variation from lab to lab) Normally in cush dogs the alk phos is much higher than that (my dog was over 2000) and the alt is elevated but not much. In your case it is the opposite.

Also cushings dogs don't lose weight - they live for food and they gain weight and have rounded tummies.

You said Owen is begging - is it for food? What about water consumption? Often cush dogs drink buckets and buckets and have urination issues (in the house, frequent trips outside, waking you up at night to go out)

Did you do the Uc:cr urine test? What was the result? Was diabetes ruled out? Has the thyroid been tested? Is Owen lethargic? Leg tremors? Still able to jump up on furniture?

I would do the urine test again if you haven't to find out if he is concentrating his urine. If he is then you have ruled out cushings. If he is not then you have not ruled it out - doesn't mean cushings.

Then I would do an ultrasound vs the low dose test. I think it is a bigger bang for the buck - if something else is wrong it could cause a false positive on the LDDS (low dose) test. The ultrasound would give you a real good look at the organs and whether something is wrong whether cushings or not.

Feel free to add to Owen's story - but from what I have read I am not thinking it is cushings. My two cents. Glad you found us. Others will chime in for sure! Kim

[Owen's Mom]

Thank you for the quick reply.

Owen is drinking really, really a lot. He doesn't have accidents because we are managing another dog on prednisone, so we need to let him out more than normal and we let Owen out too. He does wake us up at night and in the morning he goes out three times before we go to work...he just now cried to go out and my husband just put him out 20 min. ago:(.

So, I am wondering what other illnesses/diseases cause this excessive drinking? They have ruled out diabetes as there has been no detectable glucose ever in his urine.

These are all the out of range results--all high.

ALK PHosphatase=268 (range 10-150 u/l)
ALt (SGPT)=703 (range 5-107 u/l)
AST (SGOT)=251 (range 5-55u/l)

Auto Platelet=538 (range 164-510 K/ul)
Cortisol/Creat. ratio=38 (greater or equal to 34=cushing possible)

His T4 was normal at 1.6 (range 1.0-4.0 ug/dl)

Everything else is normal--electrolytes, ketones, protein, glucose.

He is not lethargic, more anxious and always has been high energy. That hasn't changed. He had issues with his neck and we thought that might have been why periodically he won't jump up on the couch or bed.
What are leg tremors? When he was little, when he sat down his front legs would shake but that doesn't happen anymore.

I would love to do an ultrasound but our vet is saying that won't be helpful--I can't remember why she said this yesterday...so much to keep track with our two dogs having problems...:rolleyes:

Our vet also wants to do a bile acids test--do you think this would be helpful?
I have to tell you about the weight thing--I'm a little skeptical because that was odd with our kitty too because she was losing weight and muscle mass but you read that they have a pot belly too which she never did.
Owen isn't gaining because we haven't increased his intake. With cushings would he gain anyway (without increasing food calories)? We feed 2x a day and give treats when they come in from potty. We also feed scraps like raw carrots or broccoli when I am cutting it up for us to eat. He is kind of obsessed with eating worms outside lately--maybe we should feed him more...

Thanks again for the input.
I just told my husband we need to take him for an ultrasound--so we'll do that this weekend or Monday.

[frijole]

Leg tremors are frequent in cush dogs - their back legs are weak from muscle wasting and they actually tremble. Cush dogs eat huge amounts of food because they are getting signals that they are hungry despite having just eaten... they will head butt huge trash cans for food, they never stop walking around the floor looking for scraps. They gain weight from that. The other reason their tummies are round is from enlarged livers and sometimes hearts... caused by cushings... which is one of the reasons to do an ultrasound.

An ultrasound needs to be done on a high resolution machine not found at every vet's office as it gives the best quality images. You can see if there are any tumors on the spleen (which can result in false positives on cush tests), the adrenal glands. You look at both adrenal glands for enlargement, you also compare their size. If both adrenals are normal size there is no cushings. If they are both swollen and the same size it is likely pituitary cushings and if one is swollen and the other not it is likely adrenal cushings. I wonder why your vet said it would not help? I totally disagree.

You might want to read up a bit in our resource section on signs of cushings, testing etc. I'll post a link.

I had one dog that had cushings and was treated successfully and had another one later that was misdiagnosed with cushings. We even started the meds. She had an adrenal tumor that is very rare - it caused 7 false positives on cushings tests so I am slow to trust the tests. ;):)

Key is being an educated owner which you obviously are and having a vet with experience in these issues. Sometimes you have to go to a specialist - which I learned as you waste a lot of time testing unnecessarily stabbing in the dark.. I had a whole year of that.

That is the beauty of this forum - we don't charge and there are so many years of experience to share! Hang in there - you are doing a great job. Kim
http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Harley PoMMom]

Hi and welcome to you and Owen,

Issues with the liver can cause an increase in drinking and urination. A bile acid test is a good start in evaluating the function of the liver.

An ultrasound is a very useful tool as it can show abnormalities on the internal organs. My Harley's first ultrasound diagnosed pancreatitis which he never showed symptoms of.

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

Love and hugs,
Lori

[Squirt's Mom]

Hi and welcome to K9Cushings! :)

My Squirt was diagnosed with PDH (pituitary based Cushing's) based on five different tests - LDDS, HDDS, ACTH, UTK panel and ultrasound. After the second ultrasound, I was told about a tumor on her spleen. Once it was removed, her cortisol returned to normal.

Any stress, internal or external, can cause the cortisol to rise - it is one of the bodies natural defenses against stress. ;)

To answer the question as to what else could cause the signs you are seeing - excess drinking (PD), here is a link with some info:

http://www.petplace.com/article-printer-friendly.aspx?id=308

Cushing's is one of, if not THE, most difficult diseases to diagnose because so many other conditions share the same signs and other, non-adrenal, conditions can cause false-positives on the tests. So it is always best to be thorough in the testing phase as part of diagnosing Cushing's is ruling other things out. ;)

Hang in there!
Hugs,
Leslie and the gang

[Owen's Mom]

I am going to have him taken to a specialist--one that our cat went to.

These forums are truly awesome. One of our cats was diabetic and I went on a feline diabetes forum and actually was able to get her glucose regulated and off insulin. The vet was not happy that I did this on my own, but our cat was very happy!:)

For some reason there is a disconnect from owners actually going through things with their pets and some vets out there.

I'll will post more info when I get it.

Thanks to all!

[labblab]

Hello and welcome from me, too!

Just wanted to tell you that my own Cushpup didn't read the book about weight gain/loss either. Even though he had a hearty appetite, he lost weight for several months prior to his diagnosis. He did not have a pot belly, either. Like you, though, even though he was hungry we did not give him any additional food or treats. So I wonder whether the high levels of circulating cortisol were just causing him to burn up calories faster. I dunno.

Anyway, I agree with the helpfulness of an ultrasound. I also think your vet's suggestions to perform an LDDS and also a bile acids test are very reasonable, too. As Lori said, the bile acids test helps evaluate liver function (and liver issues can mimic some Cushing's symptoms). And with that borderline ACTH, I believe I'd like to see the results of an LDDS. The ACTH more frequently "misses" diagnosing Cushing's in a dog who truly has the disease. The LDDS is less likely to do so, and a negative LDDS is pretty much a "rule-out" for Cushing's. So I think those additional testing results would be very useful to you.

Like the others, I'm so glad you've found us and I'll be really anxious to hear how the additional diagnostics turn out.

Marianne

[Owen's Mom]

Hello,
Owen had his ultrasound Tuesday June 5th. They found what is likely liver cancer. The dr. said she had not seen a liver like this before. The gall bladder also showed a lot of debris?? They gave us three options for obtaining a biopsy and were going to do the laparoscopic so that it was least invasive, but yet would give at least a view of the liver. After taking our other dog to the teaching hospital in Madison for his chemo, we found out that there is a study going on for liver disease and Owen would be eligible. This would consist of a contrast dye injection and three total ultrasounds to assess the dye migration and would potentially give us information of how extensive the cancer may be as well as a biopsy to confirm cancer. I'm a little confused because I think he still could have cushings. A lot of what I read, Owen doesn't act sick right now. Maybe we are just catching this early. Has anyone here had a preliminary diagnosis of liver cancer, but yet their pup had cushings instead? I'm not reacting to this yet because I'm more confused than anything. I guess it will hit me if the biopsy comes back for cancer. Poop pup.

[Steph n' Ella]

Awe poor Owen! I was in tears a few weeks ago when Ella had a fine needle aspiration (FNA) of her liver. I hate waiting for those tests to come back...but luckily cancer was ruled out for us.

Ella has lots of debris in her gall bladder too but our IMS said that could be caused by her low thyroid. When did you have the T4 that you posted above done? My Ella went from 1.0 in March (low end of normal) to .4 in May!

We are going to get a biopsy too...when she gets spayed.