Waiting on results from ACTH test

[leighangela]

Hi all!

I have a 12 year old (I think) Catahoula Leopard Dog, 60 pounds. Ironically, my ex's dog (who was my dog from the day she was born, but we broke up and he kept her) was diagnosed with Cushing's last year so I looked it up last month to read about it. The symptoms did not scream to me as anything my dog had.

But, I took him to the vet to have lumps checked out and I mentioned that he pees on the couch at night when we leave. It's only on the couch where he sleeps, so I thought it was a weak bladder. His liver enzymes were up and his urine was diluted. The phone should ring any moment now with news. I have the blood test results at home; I can post them later.

Now I see that he has had some Cushing's symptoms, but for YEARS. The first time he ever urinated on the couch was while I was away on vacation 5 years ago. It only recently became more common (twice a month)? My pet sitter informed me of the incident way back then and also told me she'd never seen a dog pee so much and for so long. But his blood work has always been pretty normal except for elevated liver enzymes once while he was on Rimadyl, so we removed that.

I've never noticed him drinking too much water. He is always hungry, however recently he started going through the trash and eating things while we were away at night. Again I thought this was just behavioral, boredom, getting old, whatever.

His back legs shake but I've had him for 7 years and they have always been shaky. He's a big muscular boy. Only recently has he started having trouble with stairs and getting up on the bed.

2 years ago he lost 10 pounds. Blood work was normal so we increased his food portions and he gained the weight back. He's been fed Natures Variety raw for about 2-3 years. No grains or dry.

He has not lost any fur. Is that always a present symptom?

Sometimes he shifts his body while laying down as if his tummy is uncomfortable.

Very weird symptom, it happens rarely, maybe once every two months and it happened last night after his stim test: He'll be laying down, all is well, then suddenly he jumps up as if he saw a spider. The fur on his back raises and he runs around in circles like a nervous nelly. We let him outside to "freak" and it calms down in about 30-60 seconds.

My question is what should be the next step if the vet calls and says the stim test points to cushings? Ultrasound to determine what kind? Urine test? What if the vet says the test doesn't point to cushings?

Last thing, he gets daily multivitamin, glucosamine, probiotic and slippery elm. I'm scared to wean him off the slippery elm, he's been on it for over a year due to one bout of colitis and one anal sack rupture. Since the liver enzymes showed up last week, I now have him on milk thistle and SAM-e too.

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[molly muffin]

Hello and welcome.

Post the lab results when you get home and I'm sure that some of our members that are familiar with those meanings can tell you more about those.
An ultrasound if possible isn't a bad idea, as it could show if problems with kidneys, liver, adrenal glands etc.
Not all dogs get the exact same symptoms with Cushings. My molly has almost none of the symptoms and yet she still is diagnosed with cushings.
Hang in there you're doing the best you can and being proactive in trying to figure this out.

Hugs,
Sharlene and Molly Muffin

[leighangela]

The vet didn't call; I guess they'll call tomorrow.

Here are my dog's blood levels from last week. Before looking at the urine test results, the vet said somehow my Bluie is getting or producing steroids. Then he looked at the urine test, saw that the only issue was it was diluted, and said "I'm thinking Cushingoid. Why else would he producing steroids AND have diluted urine?" Which made me laugh, because yeah, why else?? :rolleyes:

I'm only listing things that are out of normal range, is that OK?

HIGH Alk Phosphatase (10-150 U/L): 312
HIGH ALT (SGPT) (5-107 U/L): 254
HIGH CIALP (0-35 U/L): 224
HIGH Chloride (105-115 mE/L): 115
HIGH MCHC (32-36 g/dL): 38.4
LOW Neutrophil SEG (60-77%): 56 (Absolute is normal, 5488 out of 3000-11500)
HIGH Lymphocytes (12-30%): 37 (Absolute is normal, 3626 out of 1000-4800)
LOW NA/K Ratio (27-40): 26

[frijole]

I'm glad you posted those blood results. Deb hopefully will see them - she's our inhouse expert med tech.

I will tell you that the alk phos is actually so close to normal I would not consider it abnormal. Any form of infection could cause that small of an increase. We normally see ranges more like 800 to over 2000 in cush dogs (vs 312). The ALT is actually more elevated than ALKPH and that is also not normally what we see with cush dogs.

I will warn you - we ask oodles of questions - and we do it because we've been here for years and we see hundreds of cases every year of dogs who are misdiagnosed. Cushings is tough to diagnose and it takes multiple tests to diagnose. Can you tell me if there was a glucose reading on that test? (trying to rule out diabetes) Also has your vet tested the thyoid? Hypothyroidism mimics cushings.

The episodes where your dog jumps up and does circles sounds strange and I assume you shared that info with your vet. It isn't a cushings thing - being hyper is but not as you described it. ;)

Kim

[leighangela]

Thanks Kim! I love lots of questions because I don't want to miss anything :D

The glucose is normal. 99 our of 60-125 mg/dL

The thyroid has not been tested.

No, I didn't tell the vet about the weird "freak outs" that my dog does. As I said it happens so rarely that I didn't even think about it.

I shouldn't have said he does "circles." He doesn't do ACTUAL circles. He just suddenly jumps up and walks around swiftly with his hair raised. He'll go to the door, to us, we'll let him out, he'll pee, maybe run around a little, then calms down.

[leighangela]

I am looking at Blue's bloodwork from April 2011. I think the reason the vet was concerned is because the Alk Phosphatase and CIALP both increased a lot in one year.

ALK PHOS last year: 93, this year 312
CIALP last year: 48, this year 224.

The vet did note his gums were inflamed on one side. He had a teeth cleaning last July and needs it done again.

[jmac]

Hi there and welcome to you and Blue!

You have already gotten some good help, but I wanted to mention that an infection in the mouth can cause liver values to be "out of whack." My parents adopted a dog with bad teeth and after her second dental to pull some bad ones, her liver values returned to normal, even without Denosyl, which she was taking for months. That could be the reason the liver values are a little off. When my dog was diagnosed (from yearly blood work before a dental) her ALKP was over 1700 and that is what clued my vet in. Her ALT has always been normal.

I hope you will hear something from your vet soon, and I'm confident you'll get lots of good advice and information from this forum. We'll be here to support you however we can!

Julie & Hannah

[frijole]

Julie is right - a tooth infection could cause pain which makes the body create cortisol to fight the pain. It is a natural thing. Even if your acth test comes back with high cortisol - I would do additional testing - but I"d get the teeth cleaned first.

There is absolutely no rush to treat a cush dog just so you know. It is way more serious to give these specialized drugs to a dog that doesn't even have cushings. I know cuz it happened to me. :(

Take your time and get it right and don't feel rushed to treat. Keep us posted! Kim

[leighangela]

Thank you Kim, that's good to know. What happened to your dog? It didn't have cushings??

[frijole]

Thank you Kim, that's good to know. What happened to your dog? It didn't have cushings??

Nope, Annie had 7 tests that were positive for cushings but it wasn't until we did an ultrasound at a teaching vet school (K State) that they figured it was a very very rare adrenal tumor. It caused some cushing like symptoms but it was not cushings. She fought it for 2 yrs and just passed Feb 25th. :(

My other girl Haley DID have cushings - and that's how I found this group over 7 yrs ago. I treated her successfully for 4 1/2 yrs. She died over 2 yrs ago at the ripe age of 16 1/2 unrelated to cushings.

Through being here this long and from personal experience of throwing money away on testing that led to no answers I strongly encourage everyone to do exactly what you are doing - investigate the disease, ask questions, challenge your vet (I wasted alot of time being nice) and just be sure before treating. It wastes time, stresses you out and costs alot of money too.

The good thing is you aren't alone on this journey so ask questions and know this group is just fantastic. Kim

[Squirt's Mom]

Hi and welcome to you and Blue! :)

My Sweet Bebe, Squirt, is another one who has a similar story to Annie. Squirt tested positive for PDH (pituitary based Cushing's) on five different tests. After the second ultrasound, I was told about a tumor on her spleen. Once the tumor and 1/2 her spleen were removed, Squirt's cortisol returned to normal and remained within range until last summer - over 3 1/2 years.

Cortisol is one of the bodies natural defenses against stress - from any source. So if there is a non-adrenal illness (Cushing's always involves the adrenal glands) the cortisol can elevate and cause false positives on the testing. So I am with Kim in always recommending that parents take their time and do as intense a job testing as possible, educate themselves on the disease and it's treatments, ask many questions, and be sure your vet is working with you as a team before starting any treatment. I am ever so grateful that we had an extremely cautious vet when we first started this journey because if I had started Squirt on treatment as early as most folks wanted me to, she would have died from that tumor plus faced serious risk by taking a strong drug she did not need at the time. ;)

Cushing's moves at a snail's pace so taking time to be thorough isn't usually a problem. In your shoes, I would want the liver checked out for sure. We typically see elevations in ALP - very high elevations up to and exceeding 10x the norm. But when more than the ALP is elevated that could indicate an issue with the liver itself. Insist that hypothyroidism and diabetes be ruled out - both can be done with a superchem panel if it hasn't been done.

Keep reading and asking questions. We will be here to help in any way we can. I'm glad you found us and look forward to learning more as time passes,

Hugs,
Leslie and the gang

[leighangela]

OMG if it is a problem with the liver itself I will be beside myself. I lost two cats in two years to liver tumors. They were about 16 years old, but still... I feel like I'm doing something wrong!

Is it the raw food? I don't smoke or use a lot of cleaning products, aerosols or bleach in the house. We don't fertilize our lawn. We do use outdoor bug treatments. Am I ruining all my pets livers somehow??

[Squirt's Mom]

Oh, honey, I doubt you are doing anything to cause problems for your babies - cats or dogs. It sounds like you are very conscientious and aware...and that goes a very long way in helping our babies have the best possible life.

I am not a fan of raw feeding but many are and their pups do just fine on it. Having experienced salmonella from handling raw chicken, that is one reason I just cannot bring myself to risk that with my babies. I also don't subscribe to the theory that dogs are descended from wolves which is why many folks feel that raw is best - ancestral feed and all. ;)

Don't fret, honey. The liver is a very forgiving organ and has the potential to heal itself. These levels can be elevated due to a variety of reasons. So just try to relax for now and we will see what the testing shows.

You are doing fine. Hang in there!
Hugs,
Leslie and the gang

[leighangela]

Well they have my test results but the vet we saw isn't there today so they wouldn't tell me anything. Grrr. Tomorrow.

I feed raw because my cat had green bloody diarrhea for months and nothing was helping - not antibiotics, not "sensitive stomach" foods, blood tests were normal, vet ordered more tests. I said first let me try a diet change. Switched to raw and the diarrhea was gone in less than 24 hours, never to return again for the rest of his life (two more years).

With my dog, raw changed his big, huge, smelly poops into smaller, firmer, less offensive poops. So I feel like his body is processing the nutrients better. Yet, 3 pets in a row with liver issues, oy.

I feel that cats are carnivores and dogs are omnivores, but I like that the raw is not overprocessed, high in protein, and low carb with fresher fat.

[leighangela]

Got our ACTH results back and they don't really tell us anything.

Pre: 8.6
Post: 6.3

Vet was baffled and suggested doing the other test (Low Dose thing?) and I told him I will probably find a place to do an ultrasound since they don't do them there.

Any ideas?

[frijole]

No way would I pay bucks for a low dose test - given the blood panel info (low alk phos) results and the acth test - as far as I'm concerned you have ruled out cushings. Now it's time to figure out what it is.

Ultrasound could be helpful.

Tell us again what you consider the symptoms to be. What is daily water consumption? Is food consumption an issue? Sorry I am in a hurry and can't go back right now and read. Just trying to figure out what could be happening.

Hopefully someone else will pick up where I left off as I head out the door ;) Thanks for the update. Kim

[Squirt's Mom]

Do you have the normal ranges for each of those values?

[leighangela]

Sorry I don't have the ranges, but the vet said "normal" goes up to 6. I have an ultrasound scheduled for next week. He shifts his body when he is laying on his belly, so I think something in there is bothering him.

His symptoms are:

Pees a lot, but always has. Dilute urine. We don't think he drinks a lot. Pees indoors sometimes but always on the couch where he sleeps and always when we are gone, so I thought it was bladder or behavioral. (He never pees in the house when we are home.)

Starting to have trouble with stairs and jumping on bed. He's been on glucosamine/chondroitin for probably 2 yrs. His legs shake but I've had him 7 years and they have always done that, whether he is standing or sleeping.

Only looks pot bellied when laying down.

Gained about 2 pounds in one year, but 2 years ago he lost about 8 pounds so we upped his food. He weighs 60 pounds and eats raw Natures Variety.

He's a couch potato but has zest for walks, cuddling, play. The only reason I took him to the vet was to have lumps checked out. Two were fatty, one filled with fluid on his neck by his throat. That one should be looked at probably.

Oh and he needs his teeth cleaned, gums inflamed. So for now the plan is we'll do the ultrasound, then teeth cleaning, then check liver again.

[Squirt's Mom]

I could be wrong, without the normal ranges it is hard to be sure, but it looks to me as if Addison's might should be looked at. Addison's is the opposite to Cushing's - ie, the pup isn't producing enough cortisol.

The normal ranges for an untreated pup that I am used to seeing will go up to around 18 for the post number, and 6 sounds low. The post number is the only one that really matters. ;) We have sadly seen over and over and over that vets often don't know how to read these test results; they aren't aware that there are different ranges for untreated pups VS treated pups nor that the two drugs have different acceptable ranges. So we always like to see what the vet is seeing. ;)

Hugs,
Leslie and the gang

[leighangela]

Well, I looked up what it means when the post number is lower than the pre, and they say either the samples were mislabeled or the kit used was old or useless. Retesting is needed. So the results for my dog are useless.

I did find this: "Resting cortisol should range from 1-4 ug/dl in the average dog, and should be significantly higher, in the range of 6-20 ug/dl, post-stimulation. (These numbers may vary depending on the lab.) If resting cortisol is low and the dog has no or a low response to the stimulation, the diagnosis is Addison's disease."

However, my vet said he pre number was "high" according to his chart, because it was over 6.

The only symptom of Addison's he has is the shaking, which he has always done.

His blood work doesn't completely match for Addison's, but it is close. Addison's blood work will be Low Sodium, High Potassium, and Low Ratio between the two. My dog has normal Sodium, Potassium on the high end of normal, and a low Ratio (26 out of 27-40).

We'll see what the new vet has to say next week :-) Thanks all for your insight!