Question on Symptoms - (Saddie) 11 y/o female lab mix just diagnosed

[llengland]

My dog Saddie is an 11 year old female lab mix. She was diagnosed with Cushings Disease yesterday. I have since been all over the internet looking for information. Saddie displays many of the diseases symptoms however she does not drink excessively nor does she have an increased appetite. She actually has a decreased appetite. She has not started any treatment yet. I realize that she will not display all of the symptoms but these two symptoms seem to be predominant with Cushings. Has anyone else experienced this? Also, any suggestions on where to go from here? Thanks, Loree

[gpgscott]

Hi Loree and welcome to you and Saddie,

Cushing's is often mis-diagnosed.

Please tell us more about her age, weight, symptoms. And then about the tests used to come to the diagnosis of Cushing's with the results of the tests.

Saddie is of the group which is prone to Atypical Cushing's, where hormones other than cortisol are out of range.

We need to know more.

Scott

[frijole]

Glad you found us. Scott is right. We see alot of dogs who were misdiagnosed.. do you have copies of the test results? If not it is helpful to keep them on file for future reference.... It is helpful to us to know the names of the tests done and the numbers/results from them.

Don't fear - there is usually no need to rush treatment so take your time and do it right. You don't want to treat if you aren't 100% its cushings.

So tell us your story!

Kim

[llengland]

Saddie was born in September of 1998. She weighs about 80 lbs. I took Saddie in to see the vet for her yearly vaccinations, heart worms, etc. This vet had never seen Saddie before and suggested we test her for Cushings because of her belly and bumps. She has over the past year or two developed a saggy, bloated belly, weight gain of appx. 11 lbs, lumps all over her body (which we were told were fatty tissues), hind leg weakness, weight redistribution (mostly on the topside of her rump), and she often pants excessively. She is currently on Thyroid medication and the supplement Lipoform. She was given a blood test and then another blood test two hours later. I believe this tested her ACTH which he said was in the 1000's. We all thought that most of Saddie's symptoms were due to aging. I was most concerned when she quit telling me that it was time to eat. Some days she will eat two meals as usual and other days like today she didn't eat all day until about 4pm when I sprinkled Parmesan cheese on her food. Some days, not at all. We did acquire another dog and attributed her change in eating possibly to this. Another strange behavior is that Saddie noticeably seeks out cool tile to lie on. Around 3/08 Saddie developed a staff infection (scaly sores all over her belly) and the vet put her on medication and it went away. The infection came back again, same treatment again. It came back and we went to another vet and he put her on Cephalexin and Thyroid medication. The infection never came back. During this time Saddie would dig holes in the dirt and lay in them, I assume they were cool. I could not get her to come in at night with out a fight and this was not like her. Now when she goes outside before bed she doesn't want to come in again. She actually spent her first whole night outside about a week ago. She would never have done this in the past. Also her eyes are becoming cloudy. Past numbers that may mean something to you:
9/21/07 ALKP=1635, ALT=121, CHOL=266, PHOS 6.3,
3/25/08 ALK PHOS=2310 10/28/08 ALKP=1228, ALT=98, T4=4.3, In 3/08 a wellness exam showed abnormal levels of PATLETS=440 H, EOSINOPHILA=1, MAGNESIUM=2.6H, A/G RATIO=.9L, ALK PHOS 2310, TRIGLYCERIDES 240H, CANINE T4=.73L. I don't have the test results from yesterday yet but he did say that her ACTH was in the 1000's. Thanks for your help. Loree

[frijole]

Loree, Thanks for all of the information. Alot of the symptoms you describe ARE similar to cushings but the eating thing is not normal at all. Cushings dogs are little pigs. :D They are in a constant state of starvation (in their minds).

The test numbers you quoted - do you have the test handy? Do you have the normal ranges printed on the report? Can I ask if you are posting from outside the US? The numbers appear to be higher than we usually see and I think it is the measurements being used.

Thanks
Kim

[gpgscott]

Hi Loree,

You are no doubt in England and if the ACTH is in the thousands, that is over 32 in our measurment and very high.

There is an issue here about prevailing chronic infection, which can cause elevated cortisol. Your pup seems a likely candidate given the history you have posted.

Also as has been mentioned, a cushpup, rarely refuses a meal.

I doubt the diagnosis at this point.

I think you need more bloodwork, I would suggest ACTH full panel done by UTK (university of Tennessee@KnoxvvilleUSA) I do not know if this panel is done by anyone in the UK. It measures cortisol and five other hormones all of which can cause Cushing's symptoms.

I also think you may have an issue other than Cushing's

Scott

[AlisonandMia]

The lack of appetite is strange in a Cushing's dog - very often a Cushing's dog's appetite will be absolutely voracious or at least normal so a poor appetite does bring the diagnosis into doubt. However it is possible that she does have Cushing's and the effect on her appetite is different from usual though.

How long has her appetite been off - does it date from around the time you started noticing her liking cool spots etc - how many weeks or months would you say her appetite has been decreased - and has she lost weight as a result?

A poor appetite in a Cushing's dog can be related to a large pituitary tumor (macroadenoma) which presses on the appetite-regulating part of the brain. However we have seen just a few dogs that are sort of "back to front" with their appetite in relation to Cushings and these dogs have had a poor appetite when their cortisol was high (before treatment) and their appetite has actually improved and becomes normal when their cortisol is brought a healthy level with treatment. It is as if the high cortisol upsets their stomach. One dog even gets extra hungry if her cortisol is too low - which is the exact reverse of what is usual as usually the higher the cortisol the hungrier the dog and very low cortisol makes them nauseated and not want to eat. So occasionally you do get a dog that "hasn't read the book".



Alison

[llengland]

Kim and Scott, I must have misquoted what the vet said to me yesterday regarding the ACTH number. I will get those results on Tuesday. The other numbers I've given are done right here in the USA. I will include the ranges that are recorded:
3/08 wellness exam lab report from HPA Laboratories in Ashland VA showed abnormal levels of:

PATLETS=440 H - Units K/uL - Reference Range 170-400, EOSINOPHILA=1 L - Units % - RR 2-10,
MAGNESIUM=2.6H - Units mg/dL - RR 1.5-2.5,
A/G RATIO=.9L - Units Ratio - RR 1.1-2.5,
ALK PHOS 2310 H - Units U/L - RR 5-131,
TRIGLYCERIDES 240H Units mg/dl - RR 44-166,
CANINE T4=.73L Units ug/dl - RR 1.00-4.00
The other numbers in the previous post showed no ranges.

[AlisonandMia]

Some labs in the US also use nmol/l like they do in the UK so that is probably what has happened here.

If you could get hold of the actual numbers and post them (along with the units of measurement used) that would be great though.

Alison

[llengland]

Alison, I would have to say her appetite changed a little more than a year ago and it would have been about the same time she started finding cool spots to lie on. She has not lost weight as a result and has actually gained weight. About 11 lbs. On 3/21/08 she weighed 71 lbs. We attributed this to getting older and just slowing down. I have always used Science Diet appropriate to her age. One scooping cup at 8 and 5. Saddie never had any health issues known to us until 7/07. We took her to the vet because she would go out to go to the bathroom but she couldn't. However, she would keep squatting and trying. She also had a decreased appetite at that time and may have been drinking more than normal. She was diagnosed and treated for Cystitis and Intestinal inflammation. Records state her x-ray showed very thickened intestine walls. On 9/21 vet reports state her kidneys were ok on the blood work and the vet recommended a Renal Diet due to liver elevations and ERD positive. In 12/07 she acquired a hematoma on her ear which would fill up and had to be drained several times before healing. Then 3/08 is when the staff infections started. After the staff infections were under control no other serious issues have come up. She does sometimes throw up clear liquid usually after she drinks a lot of water and almost always has a yellowish reddish loose stool when we go for walks. As far as eating, she won't turn down a piece of meat ( which she rarely gets) nor will she turn down her thyroid pill which I wrap in a tiny piece of cheese. She also likes her 1/2 of a small milk bone when an important family member comes home. However her food can sit in her dish and she wont touch it.

[labblab]

Hi Loree,

Welcome from me to both you and Saddie. I must agree with you and the others that Saddie's lack of appetite and her normal thirst level are unusual characteristics for a Cushpup. Yet she does exhibit so many other typical Cushing's symptoms -- I can certainly understand why your vet wanted to proceed with Cushing's testing.

Given Saddie's somewhat puzzling profile, I am glad that she was given the ACTH test. It is less likely to result in a "false positive" than the LDDS, which is the other recommended diagnostic blood test for Cushing's. However, just as is the case with the LDDS, the ACTH can still result in an elevated reading due to issues other than Cushing's. That is why it is not wise to proceed with Cushing's treatment on the basis of one test alone, especially when the symptom profile is unusual.

Has your vet talked with you yet about additional testing to further validate the diagnosis? I am thinking that an abdominal ultrasound could be especially useful in Saddie's case. Visualizing the adrenal glands can be very helpful in advancing the Cushing's diagnosis, and the ultrasound can also give you valuable information about the state of Saddie's other internal organs. Because it may be the case that, not only might Saddie have Cushing's, but there may be some other issue at work as well that is affecting her appetite. You would want this type of ultrasound performed on a high resolution machine by a professional who is specifically trained to offer diagnostic impressions. So it may require a referral to an Internal Medicine Specialist for a consultation -- which could be a good thing for several reasons. These are vets with additional training related to more complicated illnesses, and having specialized input on Saddie's case could be of great value and save you money in the long run. It doesn't mean you would "lose" your regular vet at all, just that the specialist could examine Saddie and then consult with your regular vet regarding treatment recommendations.

I think that Alison is right on the money with her thoughts about Saddie. As she says, we do know of at least one other Lab here who has always been totally "backwards" as far as appetite issues and Cushing's. Also, appetite disruption can occur if a pituitary tumor is enlarging. But the fact that Saddie is gaining weight seems odd to me if she is not eating normally :confused:. I wonder if she might be retaining fluid...?

Last but not least, as far as the GI issues, I can tell you that my own Cushpup (also a Lab) also had intestinal problems prior to diagnosis. And my specialist told me that chronically elevated cortisol levels can be associated with intestinal irritation. So that may be an issue that could resolve for Saddie with treatment. All in all, though, I think you will want to talk with your vet about some additional diagnostic testing, regardless of the results of Saddie's ACTH.

Marianne

[llengland]

Marianne,
Thank you for your reply. After all of the feedback I am convinced that additional testing is where we need to start. I also agree with you about the abdominal ultrasound. Many of her issues seem to focus around her belly. Not wanting to eat, lying on cool surfaces, and even the staff infection was mainly in this area. I will speak to the vet on Tuesday and keep you all informed. Thanks to everyone for their input. I am very glad to have found this site.
Loree

[Squirt's Mom]

Hi Loree,

A belated welcome to you and Saddie! :) I am glad to have you join our family.

Not much I can add to what the others have said, they are on the mark about everything as usual. I do want to emphasize the importance of the ultrasound, tho. My Squirt had one last May as part of the diagnostic phase, then another was recommended after a test she had done. The second one was done in Sept. and I learned of a splenic tumor which was removed a few weeks later. Squirt's first cortisol level was 18.2 ug/dl, the second was 32.8ug/dl and the one 3 mos. after the surgery was 14.2 ug/dl (with normal ranges up to 20ug/dl). I tell you this so you will understand that things other than Cushing's can cause cortisol to raise and so you will not underestimate the value of the U/S.

Not only should they be able to see the adrenals, which is one of the best ways to determine which type Saddie may have plus confirm the diagnosis of Cushing's, they will also be able to see other organs like the spleen, gall bladder, stomach, reproductive organs, kidneys, liver and parts of the intestines. It is the best test for the money, IMHO. So I applaud your decision to have one done on Saddie! :D YEAH!!

Do keep us informed and keep up the good work! I have a list of links on Cushing's in general if you are interested.

Hugs,
Leslie and the girls

[labblab]

... I also agree with you about the abdominal ultrasound. Many of her issues seem to focus around her belly. Not wanting to eat, lying on cool surfaces, and even the staff infection was mainly in this area. I will speak to the vet on Tuesday and keep you all informed. Thanks to everyone for their input. I am very glad to have found this site.
Loree
Loree, you may already know this, but seeking out cool surfaces and being vulnerable to infections (regardless of location) are both symptoms commonly associated with Cushing's. But it's the lack of appetite that's really the wild card. Definitely do let us know what you and your vet decide after your appointment on Tuesday.

((Hugs)) to both you and Saddie!
Marianne

[Squirt's Mom]

Hi Loree,

It has been ages since we heard anything about Saddie! How are things going with the two of you?

Would love an update when you can...I am big worry wart. :eek:

Hugs,
Leslie and the girls