New to the Forum and need some help with ATCH results

[Buddy'sMom]

Hello everyone...I am new to the forum and am in need of some help understanding the ACTH result my vet just gave to me. His ACTH test was last week, they reviewed his results and diagnosed him with Cushings. He was on Vetoryl for four days with horrible side effects. Buddy broke out in a red rash on his tummy, started to get open sores on his rear, wouldn't eat or drink, and was howling as if he was in terrible pain. :( We took him off the medicine and besides the irritation of some of the sores, he is back to himself. I am wondering if there is a possibility of a misdiagnosis. The results she gave me are:

pre- 16.5

4 hour - 1.4

8 hour - 3.7

Would anyone be kind enough to help me understand these numbers.

[Roxee's Dad]

Hi and welcome to you and your pup,

I am sorry for your bad experience :( Please tell us more about what led up to the diagnosis of cushings. I have to run out for a bit but many will stop by to welcome you and help you out with those numbers.

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[Budsters Mom]

Hello and welcome from me too. :) My pup's name is Buddy also. That has to be a good omen!:):DI am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. Others will be popping in to welcome you also. So again welcome to you and Your sweet Buddy.

Hugs,
Kathy

[Buddy'sMom]

Thanks for the welcome :) Buddy is an 11 year old Dachshund who is our first born. We have been blessed, as he has been very healthy.

We took Buddy into the vet about two weeks ago because he was limping. It seems as if he has a slight case of arthritis in his left front shoulder. While doing the x-ray on his leg they decided to do a second x-ray on his tummy, because they said it was slightly distended. All organs looked good, but they still wanted to run a Low Dex test, which if I'm not wrong is the ACTH stimulation test. Not sure though, since they have run so many tests. Once this test was complete, they gave him the Cushings diagnosis. Buddy's only symptom is a pot belly, which I always attributed to his love of table scraps and my son's love of feeding him table scraps :) His appetite is good (always has been), he doesn't drink large amounts of water (in fact most days he only drinks one bowl. A little in the morning and the rest at dinner), he's not losing any hair, only pants when he is hot and can hold his bladder for twelve hours. Last Wednesday the Vet put him on 60mg of vetoryl, 30 mg in the morning and 30 mg at night. I forgot to mention he is 25 pounds, slightly overweight :eek:

On Thursday I began to notice that he wasn't acting himself. By Friday evening he didn't want to eat, began panting continuously, and started scratching his tummy to the point of causing it to bleed. Saturday I noticed the open sores on his rear, back by his tail. He began howling, crying and unable to control. We took him into the Vet Saturday afternoon. We were told that it couldn't be the medicine and that he had to be allergic to something he had eaten. The problem was, he hadn't eaten since Wednesday. The doctor gave me some cream for the sores and sent us home. As the day went on Buddy began to calm down. Then that evening, about 30 minutes after his vetoryl he began his symptoms all over again. Needless to say, I didn't get any sleep that night. Sunday morning my husband and I decided to stop the medicine and he has been fine since. Not sure what to do at this point. I ordered some alternative medicines but if he doesn't have Cushings or is in the very early stages, I'm not sure if I should even give him the alternatives.

[Buddy'sMom]

Kathy...Hugs to you too and thanks for the welcome! I'm looking forward to sharing my information and learning from all those on this forum who are dealing with this disease.

[molly muffin]

Hello and welcome from me too.

Okay, first the test Buddy had was the LDDS test, not the ACTH test. There should be some normal ranges next to the results also. Can you please post the range, just click edit and add the information and then save. Tada, edited.
Were regular blood tests also done? like a cbc and a urinalysis? If so could you post the abnormal high/low with range from those too?
Next vetoryl. The current recommendation for dosage is 1mg/1lb. It has been found that you start low and then move up if you need to, but you never start high, that is how you get into trouble. The old dosage use to be higher, and that appears to be what your vet used, but it absolutely is no longer true, based upon numerous studies since the release in the states of the drug. At the most 30mg per day, not twice a day and I probably would have started lower than that to tell you the truth. Bad things can happen when you overdose a dog.
Did the vet say why he wanted to start Buddy on treatment when no classic symptoms were present?
The main thing to know now is to stop any vetoryl/trilostane. Review what you have in the labwork, to make sure this is a correct diagnosis. Cushings is one of the hardest diseases to diagnosie, because things like diabetes, thyroid, even kidney/renal can mimic the same symtpoms. Tests can also be misleading for cushings when any other non-adrenal illness is present. Everything has to be ruled out.

If you don't have copies of the testing, then the best thing is to get copies of all tests to keep for your own records. It will come in handy.

I know this is a lot of information. For now, though, no more vetoryl until this is all straightened out. Cushings is Not a death sentence and is a slow progressing disease. If that is what he has. Then you do have time to figure things out first. There is no need to rush in right away until you know whats what.

Sharlene and Molly Muffin

[molly muffin]

I will just add, some vets are quick to jump on the cushings bandwagon for some reason. A pot belly is no reason to diagnose cushings with no other symptoms or even blood test to back it up. That would be very irresponsible. And yes, a dog can have a reaction to any drug. They can also be overdosed with dire results. I'm a bit skeptical of your vets knowledge of cushings, the drugs and treatment.

Sharlene and Molly Muffin

[Budsters Mom]

Hi,
I can't see that your Buddy has any Cushings symptoms. He's a little rounded because he likes his table scraps, that doesn't mean he has Cushing's. I am a little rounded because I like a few table scraps now and then, That doesn't mean I have Cushing's! Vetoryl is a very heavy duty drug. It is used to reduce cortisol to manage symptoms. If Buddy isn't having any symptoms, he doesn't need the Vetroyl. Having said that, the dosage was way too high. It should be no more no more than 1 mg per pound total per day. Please post any and all test results that you have. If you don't have them, please ask your vet for copies. I was a little nervous to ask at first.;) Now they automatically have the copies ready when they see me, because they know I'm going to ask! I know all of this sounds confusing and overwhelming. I know this because that is exactly how I felt when I started my journey with my buddy. Please do not fret. We will do all we can to help you sort all of this out.

Hugs,
Kathy

[Buddy'sMom]

Hi Sharlene! Thanks for the welcome :) Unfortunately I don't have hard copies of the results. These numbers were given to me over the phone. she did tell me that all other tests came back normal. What tests she is referring to I'm not sure, but will find out. I will be sure to ask for copies of all the test results when I go in tomorrow to return the medicine. Once I have them in hand I will be sure to post them.

The Vet told us on Wednesday that it was urgent we begin treatment. Then today on the phone she told me there are many dogs who live a full life after diagnosis without treatment, it depends on the progression of the disease. Then my question is, what is the hurry to get him on this medicine? After reading through the forum and doing some research, I too am shocked that she wanted him on such a high dose of medicine with no real symptoms.

Buddy is back to his normal self today and boy am I relieved! Your help and advice is truly appreciated and has given me a sense of peace knowing that I did the right thing by taking him off the medicine.

[Roxee's Dad]

Just catching up and you definitely did the right thing by withholding the meds. Good job !!! So glad that Buddy is feeling better.

I couldn't agree more with the previous comments from Sharlene and Kathy, We are looking forward to seeing the test results posted.

[Buddy'sMom]

Kathy

I've only been dealing with this for less then a week and I feel overwhelmed and stressed. I'm just so glad I found this forum! I will be sure to post the results tomorrow. Until then, I too will continue to work on my pot belly :) Thank you for your support!

[Buddy'sMom]

Thanks John. It warms my heart to see him up and playing with his toys :-)

[molly muffin]

I'm not even going to talk about my pot belly. :D:D

Definitely get those test results, they can tell us a lot about what is and isn't going on. :)

Sharlene and Molly Muffin

[Concernedmom]

Welcome Buddy's mom
I too am glad you decided to stop the vetoryl. Boy what a story.
I'm having such a hard time wrapping my head around the fact that you brought Buddy in for limping and because his tummy was distended slightly your vet felt the néed to run a low dose dex test to dx cushings?? With one symptom of a pot belly (that you even felt was questionable) the vet prescribes vetoryl. And then when he gets sick you're told it couldn't possibly be the medicine.
I'm sorry but that makes me so upset. I totally agree with Sharlene's statement that some vets are quick to diagnose cushings. Kudos to you Sharlene for finally saying it out loud. I've read so many threads lately and it seems there's more and more vets diagnosing this way. I wish I understood why???? This is very dangerous for our animals. These drugs can be dangerous if not used properly. Sorry but I had to finally vent here. This is just driving me crazy.
I am just so glad that Buddy is okay. I'm sure you're stressed but I hope the people here have helped put your mind at ease. They know a lot about cushings. Hugs to Buddy

[Buddy'sMom]

Just returned from the vet with results. They are as follows...

Hematology Results

Test / Result / Reference Range

BASO 0.0% 0 - 1
EOS 7.4% 2 - 10
HCT 48.4% 37 - 55
HGB 17.5% g/dL 12 - 18
LYMPHS 14.5% 12 - 30
MCH 22.1% 19.5 - 26.0
MCHC 36.2% g/dL H 32 - 36
MCV 61 fl. 60 - 77
MONOS 2.3% L 3 - 10
NEUT SEG 75.8% 60 - 77
PLATELETS 416 K/uL 164 - 510
RBC 7.19 M/uL 5.5 - 8.5
RETIC CNT 1%
WBC 10.7 K/uL 5.7 - 16.3
ABS BASO 0 /uL 0 - 100
ABS EOS 792 / uL 100 - 1250
ABS LYMPHS 1552 /uL 1000 - 4800
ABS MONOS 246 /uL 150 - 1350
ABS NEUTS 8111 /uL 3000-11500
ABS RET 79 K/uL 10 - 110

ALB 4.1 g/dL H 2.4 - 4.0
ALKP 284 U/L H 10 - 150
ALT 113 U/L H 5 - 107
AMYL 866 U/L 450 - 1240
ANION GAP 21 mEq/L 12 - 24
AST 48 U/L 5 - 55
BICARB 20 mEq/L 17 - 24
BUN/UREA 15 mg/dL 7 - 27
Ca 11.1 mg/dL 8.2 - 12.4
Chloride 112 mEq/L 105 - 115
CHOL 254 mg/dL 112 - 328
CREA 0.9 mg/dL 0.4 - 1.8
DBIL 0.0 mg/dL 0.0 - 0.2
GLU 92 mg/dL 60 - 125
IBIL 0.0 mg/dL 0 - 0.3
LIPA 323 U/L 100 - 750
PHOS 3.7 mg/dL 2.1 - 6.3
Potassium 5.0 mEq/L 4.0 - 5.6
TBIL 0.0 mg/dL 0.0 - 0.4
TP 7.2 g/dL 5.1 - 7.8
Sodium 148 mEq/L 141 -156
A/G Ratio 1.3 0.6 - 1.6
B/C Ratio 16.7
Na/K Ratio 30 27 - 40
GLOB 3.1 g/dL 2.1 - 4.5
CK 200 U/L 10 - 200

I believe these are his urinalysis results:

Bacteria None Seen HPF
Bilirubin Negative
Blood Negative
CASTS None Seen HPF
Clarity Cloudy
Crystals None Seen
EPI Cell None Seen
Glucose Negative
Ketones Negative
Mucus None Seen
PH 5.5
Protein Negative
RBC 0-2 HPF Normal is 0 - 5
SP Gravity 1.030
UROB Normal
WBC 0-2 HPF Normal is 0 - 5

Notes from ultra-sound:

SWO-U/S largely normal, possible pancreatitis, but has no V/D anorexia, would not pursue further DX.

Endocrinology Results:

Pre-Dex 16.5 ug/dL Range is 1.0 - 6.0
4 Post-Dex 1.4 ug/dL
8 Post-Dex 3.7 ug/ dL

[Buddy'sMom]

I'm sorry if these results are difficult to read. I wasn't sure how else to enter them. I listed the name of the test, Buddy's result, and then the range. Those highlighted in red were the only elevations and they weren't significant according to the doctor. She also said that those slight elevations may have to do with the fact that he was on doggie aspirin for three weeks prior to the test.

[frijole]

Wow that looks like one healthy dog to me! Kim

[molly muffin]

Was there anything else written with the LDDS results?

I'd say based on this that there is nothing alarming in the blood work. Anything can be off a bit sometimes, especially in light of there having been an issue with the right shoulder prior to these tests.

With no symptoms of cushings, I'd probably wait and retest regular blood work in a few months to see how it is doing.

I know the LDDS Seems to be consistent with possible cushings, but in light of no symptoms and no other blood work supporting it I don't think most vets would have pursued having an LDDS test done. If the blood works shows liver enzymes continuing in an upward trend going forward you could then elect to retest and have an ACTH test done. Lets see what some of the others think.

Sharlene and Molly Muffin

[Budsters Mom]

I'm with you Sharlene. I stand by my original comment earlier in the thread. Vetoryl is used to manage symptoms. Your Buddy is symptom-free, so I still would not treat. Retesting regular bloodwork in a few months is an excellent idea though. I would be jumping for joy if my Buddy's blood work came up with the numbers your did! :)
Hugs,
Kathy

[Buddy'sMom]

It has been over a week since stopping the vetoryl and he is back to his normal self. Talked with the Vet and she agrees with our decision of not treating Buddy right now and wants to check his blood work in four to six months. I started him on milk thistle because his liver enzymes were slightly elevated and I also began feeding him a meat, chicken, vegetable diet. Thanks for all the great advice!

[Trixie]

So happy to hear your Buddy is back to normal. yay for Buddy! :D
Barbara

[molly muffin]

This is wonderful news that he is back to being himself. I test Molly about every 3 months, full blood work, to see where her liver and other numbers are at. As we don't have any symptoms either, monitoring is our choice for now.

hugs,
sharlene and molly muffin

[Budsters Mom]

Go Buddy, Go Buddy!!!! YAY :D I'm thrilled that Buddy is doing so well! I'm glad that you decided to delay treatment and reevaluate in a few months. ;)
Hugs,
Kathy