Chloe (Chocolate Lab) - suspected Cushings

[Chloes_Momma]

Good Morning,

I found this group while looking for information about Cushings. We suspect our Chocolate Lab Chloe may have it. We rescued Chloe from a high kill shelter last August (2012). We do not know her age but she is suspected to be between 5-8years old.
Since bringing Chloe home she has suffered from inter digital cysts caused by bacterial infections.
2 months ago (May 2013) Chloe developed a severe bladder infection - frequent urination, urinating blood. We started antibiotics and prescription diet. After 2 weeks she was no better in fact she was worse. She began to leak urine occsasionally, still frequent urination.
We did more antibiotics and no change.
Last weekend we brought her to a different vet for a second opinion as she was now leaking urine almost daily and her water consumption was significantly increased and excessive panting... After a urinalysis and blood work we found that her Urine Specific Gravity was off... indicating Cushings Disease. Since Saturday she has been leaking urine more often, panting more and drinking more. We are on MORE antibiotics as her bladder infection is very bad still... we begin additional testing in 2 weeks (trying to clear infection first)... We are praying for the best, but preparing for the worst... Any advice is appreciated...

[frijole]

Glad you found us. Frequent urination can be from other diseases and cushing's is often misdiagnosed so multiple tests are usually required to confirm. So - here goes the questions

Have you had a blood panel done? If so what enzymes were high/low?

Is anything else going on besides the UTI/urination? Does your dog exhibit any other of the many cushing's symptoms (excessive water intake - like buckets, hind leg muscle loss/weakness, hair loss, increase in food consumption - always hungry, doesn't chew food - inhales it, skin issues)

Start with the blood panel as you want to first rule out the easy stuff like diabetes, hypothyroidism which have same symptoms.

Kim

[Chloes_Momma]

She inhales her food so fast we have had to start feeding small amounts at a time so she doesnt vomit it all back... she drinks so much water I cannot keep the bowls full - she has 3 large bowls I fill up multiple times a day... she sheds like crazy - but I am not sure how much a lab sheds normally as she is my first... muscle loss... I am not sure... not that I notice, but as I mentioned we rescued her almost a year ago her appearance has not changed too much... she had bloodwork done, but I am not sure what the enzymes are... I can let you know which results were off :
Globuline - 38 (high)
Glucose - 3.0 (low)
Differential - Absolute
Specific Gravity - 1.011 (low)

I am not sure if these values mean much as I am new to this and unsure which values would correlate with cushings. Hopefully they help a bit.

[Chloes_Momma]

I forgot to mention Skin Issues: dry brittle fur, inter digital cysts, she also gets a skin rash which has gotten infected twice on her tummy, frequent eye infections
Her skin is a bit saggy also we call her turkey neck (not sure if this is relevant)

[spdd]

You've come to the right place to help with Chloe's diagnosis. The people here are marvellous and their knowledge is way beyond anything I could have imagined.
I don't know all the answers matter of fact they are helping me along with my own journey for suspected Cushings, but everyone here is more then willing to help.
Welcome to the forum... and Chloe is in very good hands here.

[goldengirl88]

Hello:
I just wanted to welcome you. Sorry your lab is having issues. Here a the best pointers I have. Get the best Vet or IMS that has experience with Cushings if your dog in fact has it. You need to get all the proper testing done first to find this out. Just a urine test will not work. This will save you time, money and heartache if you get a competent vet. Keep a daily diary on all your dog does, you will need it. Get copies of all your test results and post them on here so others can help you with it. Educate yourself with information that comes from a reliable source. You will be the best advocate for your dog, so you need to know what to do. This dog will depend on you to make good decisions. After the initial testing the price of things does drop dramatically. It is the initial phase that is pricey. We all have gone thru it on here, so you will to. Good luck and I hope your baby gets a correct diagnosis, and does well. Blessings
Patti

[FemaleK9]

Hi,

I'm new here, too, what you're going through sounds a lot like my experience with my beagle, Rosie.

I was fearing the worst, but Rosie has improved dramatically in the first week of treatment for Cushing's.

I'm no expert, but I'm learning fast, and the first thing is that you've found the right place for help and support. Don't despair, and let the experienced and knowledgeable folks here guide you in what to ask your vet.

Best of luck to you and Chloe as you find solutions to her problems.

Karen

[Trixie]

Welcome to the board but sorry for what you're going through with Chloe. The experts will be chiming in to offer knowledge and advice. I'm not one of them...(still too new) but hoping that infection clears up soon so you can start to figure out what might be going on.

Barbara

[Chloes_Momma]

Thank you to everyone who has welcomed me <3 I am trying to remain positive since we do not yet have a complete diagnosis for her, but the more research I do and the more people I speak with the more I fear it is Cushings.
Thank you <3

[mytil]

Hi and welcome from me too,

What antibiotic was prescribed? You mentioning that she was actually worse while on the antibiotics and it was then she started leaking urine made me wonder about antibiotic failure. This is becoming more common due to increasing bacterial resistance to antibiotics.

The symptoms you mentioned are consistent with Cushing's but they are also consistent with these others - diabetes (I see you indicated the Glucose was low), thyroid problems.

What condition was she in when you adopted her? Sorry for these questions.

Terry

PS - Globulin (high) means her antibodies are fighting an infection.

[Chloes_Momma]

When we adopted Chloe almost 1 year ago she was very overweight, her fur was brittle and falling out and very very dull. She had a rash all over her belly that was infected. She has since lost weight due to a diet and lots of exercise and her coat is better but not much... still sheds excessively and quite brittle.

[Chloes_Momma]

Question - Which tests should we request to have performed on Chloe for the most accurate diagnosis and treatment plan?? (we are in Ontario, Canada - in case that makes any difference)

Thank you!

[molly muffin]

Welcome to the forum :)
I'm in Ontario, Canada also.

First things first. As long as she has a bacterial infection this bad, that has to be cleared up prior to any cushings test since it can cause the results to be inaccurate. I think you can have a simple UC;CR urine test for cushings, which could rule it out, but it wouldn't confirm that it is cushings, but I'd want to check and make sure with the others that this too wouldn't be affected by the infection.

She could be leaking due to the infection, was a culture done to distinguish which bacteria it is and make sure she has the right antibiotics for it?
Can you edit and add in what the normal range was for those items abnormal on the blood tests?

There was no high ALT, AST, ALP on the blood tests? Usually those are things we see with cushings as being off. I'd rule out a diabetic issue first and was there a T4 test on the results you have? (for thyroid)

I will say, cushings is not a death sentence. It can be controlled with proper medication and a knowledgable vet and owner. They can live our their normal life spans. We have many members who can tell you that as they have been through it.

We just have to figure out first what is going on with Chloe and how to get her back to the best of health, so she can be the joy, that I am sure she wants to be in her new forever home.

Usually an LDDS and an ACTH are the tests of choice for diagnosing cushings, but you don't want to test or medicate while she has this infection. Has she been checked for any crystals or stones?

Sharlene and Molly Muffin

[Chloes_Momma]

Thank you for the reply!
There was no high ALT, AST, ALP on the blood tests.
No crystals were present and no stones could be felt. We did not do a culture... perhaps I will suggest this to my vet. No one ever mentioned that to us. This is also her third round of antibiotics in the past 2 months for this infection... plus she is on prescription SO food... I am really hoping this is just a simple infection...
The vet mentioned that the SPECIFIC GRAVITY was a concern and that is an indicator of Cushings? her Specific Gravity was 1.011

[molly muffin]

It can be an indicator. That she is on the SO food usually means they suspect a problem with crystals previously maybe? My Molly is on the SO food due to crystals. The culture should be done as soon as possible so that the right antibiotic can be found for it.

Did the vet mention anything about the low blood sugar?

The specific gravity means her urine is dilute but that is not a definite for cushings. I'd have a full kidney panel done to check for AK ration, creatine, bilirubin, proteins etc.

I am not saying this isn't cushings, just that cushings is a lot harder to get a firm diagnosis for than even vets think sometimes. Everything else has to be practically ruled out.
Another thing to think about would be an ultrasound to see whats what.

Just thoughts I'm throwing out for you to consider here.

Sharlene and Molly Muffin

[frijole]

It would be very very rare for a dog to have normal ranges on both liver enzymes and have cushings. I think rather than do a cushings test (and risk a false positive due to the UTI) I would further explore the urine testing and/or do an abdominal ultrasound to see if something else is going on. Kim

[Chloes_Momma]

She did have a problem with crystals previously yes and that is why the SO food.

I will call my vet tomorrow regarding the culture. Thank you!

[Chloes_Momma]

Thank you Kim! This makes me feel much better!!!

[Chloes_Momma]

I posted a few weeks ago about my lab Chloe and possible cushings. We just received more results from a cortisol test and the levels were above normal (23). However, her liver is normal (according to a blood test), but she seems to be getting worse, frequetn urination, frequent leaking urine in the house, increased thirst, hair loss... she has had a recurring bladder infections for the past 3 months... has anyone seen a case of cushings where the liver was normal in blood tests? I am not sure if we should continue with expensive testing for cushings or look in a different direction..?

[Roxee's Dad]

Moderators note: I have merged your threads.

:)

[Trixie]

I'm sure others will post regarding your findings. If you could post all Chloe's numbers (along with the normal ranges) from her test then the "experts" will be able to advise you better.
All dogs are different--my dog has liver numbers in the sky-high range but maybe that is not a given for all dogs. I'm glad Chloe does not have abnormal liver numbers, that's a good thing!!

Try and post the test results right off the sheet..it will help those with knowledge see the whole picture. ;)

Barbara

[Chloes_Momma]

So my baby Chloe is going in on Thursday for her ACTH testing. I was wondering if anyone could share their experience with this test? Will she be in any pain? Will she be very stressed? Will she be allowed to eat at any point... she is a lab and she acts like she is dying if dinner is even 10 minutes late... I am so worried about this any advice is appreciated! :confused:

Moderator's Note: I have merged your latest post on Chloe's ACTH test into Chloe's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[Gizmo]

I'm new to the board and don't know a whole lot about all the testing since I'm still going through that too, but I wanted to wish you luck with the test. I believe that my vet told me that the ACTH was a shorter test than the low dose dexamethasone test that we did (8 hours) and I think it gives more specific results, but that's really all I know. I'll keep my fingers crossed that it all goes well!

[Chloes_Momma]

CHloe's Lab Results:

Total Protein: 71 Normal 50-74
Albumin: 33 Normal 27-44
Globulin: 38 Normal 16-36 HIGH
A/G Ratio: 0.9 Normal 0.8-2.0
AST: 39 Normal 15-66
ALT: 52 Normal 12-118
ALK Phosphatase: 94 Normal 5-131
GGTP <5 Normal 1-12
Bilirblin Total: 2.0 Normal 0-5.1
BUN: 3.5 Normal 2.1-11.1
Creatine: 74 Normal 44-141
Bun/Creatine Ratio: 47 No Normal Range Provided
Phosphorus: 1.02 Normal .81-1.94
Glucose: 3.0 Normal 3.9-7.7 - LOW
Calcium: 2.54 Normal 2.23-2.85
Magnesium: 0.8 Normal 0.7-1.3
Sodium: 145 Normal 139-154
Potassium: 5.1 Normal 3.6-5.5
Sodium/Potassium: 28 Normal 27-38
Chloride: 110 Normal 102-120
Cholesterol: 7.07 Normal 2.38-10
Triglycerides: 2.42 Normal 0.33-3.32
Amylase: 471 Normal 290-1125
CPK: 349 Normal 59-895
Lipase: 349 Normal 77-695
WBC: 7.2 Normal 4-15.5
RBC: 5.9 Normal 4.8-9.3
Hemoglobin: 141 Normal 121-203
Hematocrit: 40 Normal 36-60
MCV: 68 Normal 58-79
MCH: 24 Normal 19-28
MCHC: 353 Normal 300-380
Platelet Count: 302 Normal 170-400
Platelet Estimate: Adequate
Differential: Absolute
Neutrophilis: 4.46 Normal 2.06-1-.60
Bands: 0.00
Lymphs: 2.02 Normal 0.69-4.50
Monocytes: 0.36 Normal 0-0.84
Eosinophils: 0.36 Normal 0-1.20
Basophils: 0.00 Normal 0-0.15

Urinalysis:

Colour: Yellow
Appearance: Clear
Specific Gravity: 1.011 Normal 1.015-1.050 LOW
PH: 6 Normal 5.5-7
Protein, Glucose,. Ket one, Bilirubin, Blood - Negative
WBC 0-1 Normal 0-3
RBC: None
Casts: None
Crystals: None
Bacteria: Rods > 100 Normal: None


Cortisol from Urinalysis: 23 Normal 13



Chloe has also lost 4 pounds in a month even with increasing her food, she is urinating frequently, been treated for her bladder infection 3x with 3 different antibiotics, she also suffers from bacterial induced cysts on her feet, losing her fur on her tail, panting and drinking water excessively

[Squirt's Mom]

Thanks for the lab results. Would you mind editing the post to include the normal ranges? Different labs use different norms and units of measurements (the little letters after the numbers) so it helps if we can see what that lab calls normal. Thanks!

[Chloes_Momma]

Thank you - I have included the 'normal' ranges

[molly muffin]

Wow, all of that and the only thing off in her blood work is a minor elevation in Globulin and the Glucose is low.
I have to tell you that looking at this, even with a dilute urine. I'm just not seeing cushings.
So some reasons on why Glucose could be low:

Low levels can indicate liver disease, tumors or abnormal growth on pancreas, an underactive adrenal gland.
I think rather than a cushings test would could get it wrong if there is anything else going on, what about an ultrasound to take a look at the organs, specifically the pancrease and adrenal glands. Her liver values are all normal, so I don't think it is liver disease, but I'm not convinced of cushings either and with anything else going on cushings test resutlts could be incorrect.

What do the rest of you think in light of these lab results?

Sharlene and Molly Muffin

[Harley PoMMom]

I'm not seeing a Cushing's diagnosis either. I believe an urine culture and sensitivity test needs to be done so Chloe can get rid of that nasty bladder infection for good, the bladder infection can be the reason for Chloe's increased drinking/urination.

Love and hugs, Lori

[Squirt's Mom]

I don't see overt Cushing's indications either, on the labs nor in the signs reported. If I were you, I would follow Lori's suggestion and first get rid of all the infection present. The infections alone could be causing the abnormal values we are seeing on the lab work. Once the infections are gone, then if Chloe is still having issues, we can look further. But I think she may have a long-term chronic infection or two that simply has not been cleared from her system that is causing a lot of what she is experiencing.

Infections can require specific antibiotics - different infections need different ABs. If Chloe hasn't been tested to determine exactly what type of infection(s) she has, it could be that the ABs she has been on are not strong enough or not the right kind to address her issues. So for now, this would be my focus - getting rid of once and for all the infection(s). ;)

Hugs,
Leslie and the gang