Cushings yes or no?

[Clowe]

Hi all, this seems a very good forum and I wonder if you can help me.

I have a 10 year old black lab, who has been fit and healthy until recently. He has an abscess at his fore elbow that will not heal. He was on antibiotics when it first happened and while it looked normal after two weeks and antibiotics were stopped it returned after two months, with a vengeance. He got more antibiotics at the beginning of December.

They seemed to work in the beginning, but he then developed a rash on the back of his neck. We took him to a dermatologist vet and she seemed to think it is cushings. He has a potbelly, the boney triangle on his head is very pronounced and the new skin problem, that the vet said was definitely calcium deposits. We did the blood test and - no elevation or cortisol levels. They are normal. One of the liver enzymes (not sure which one) is slightly raised and his leukocytes are slightly low, but nothing that would worry the vet otherwise. However, there was some blood in the urine.

Here is my question: Tugboat (don't ask :)) has been on BARF for two years. He used to have hotspots that cleared well with that. However, due to him becoming slightly arthritic, we changed him to an expensive kibble fro about three months, but then changed him back after the skin condition appeared. Could it be that this change, changed the cortisol levels to normal, but not the other symptoms? Do you know any other conditions that look like cushings, but are not? And is it possible to treat cushings (albeit not diagnosis) with alternative remedies? I am trying neem oil for the skin, not sure if it is working yet.

Any advice would be really appreciated.

thanks

Claudia

[labblab]

Hello Claudia, and welcome to you and Tugboat! As you can see, I am a Lab-lover, too. ;) :)

Two quick questions for you. Can you tell us which blood test was performed that turned out "negative" (and also get us the actual numerical results)? The reason why I ask is because one of the two diagnostic tests, the ACTH, has a relatively high failure rate in identifying Cushing's in dogs that truly have the disease -- especially for dogs suffering from adrenal rather than pituitary tumors.

Secondly, did the vet actually biopsy one of the spots that appear to be a calcium deposit? If so, and the result was Calcinisis cutis, that it a strong indication that Tugboat does indeed suffer from Cushing's. If so, I would ask the vet to perform a different blood test: the LDDS. This test is more likely to return a "positive" result for a genuine Cushpup.

Also, has his thyroid function been evaluated thoroughly? Low thyroid can definitely cause skin and coat issues. However, to my knowledge, it does not cause Calcinosis cutis. That is why I am wondering whether the derm vet definitively diagnosed the CC. Are you still consulting with the derm vet, or is it your regular vet who is now ruling out Cushing's?

Marianne

[Clowe]

Hi Marianne

thanks a lot. I have not got the test results at the moment, but will go via the surgery on my travels today. I did not know that the failure rate is high.

Tugs is otherwise fine, there is no excessive drinking or peeing.

The vet did not biopsy any of the spots yet, as she was really sure that it was cushings. So she was very surprised it was not. She also did a urine test and there was some blood in it. With regard to the spots ... We also have a three year old GSD - Beano. He is absolutely fanatic about the bald spots. we cannot even leave them in the room together for two minutes - he will lick his neck instantly. There must be something in them that makes them very attractive ;)

Will come back to forum later and post the blood test results.

Thanks so much!

Claudia

[molly muffin]

Did they do a urine culture or just a urinalysis? I'm wondering with the blood in the urine, if there might be something that would be cultured that won't show up on a regular urinalysis.
Any time my dog has had blood, there has been an infection somewhere in there, so I'm curious about that. That could also cause the cortisol to be raised. It would be worth it to send out a skin scrapping to know for sure if it is calcium deposits or something else.

Welcome to the forum!

[Renee]

I think the only way to definitively diagnose CC is to have a punch biopsy done. If he has more than one spot, you can biopsy numerous spots to check. Cushings can't really be diagnosed with just a visual look at some sores. It is much more complex than that... and while CC is almost sure to be cushings, it can also result from elevated cortisol that is coming from something else, uncommon as that is.

Take a look at my album on here, it is public. I have posted many pictures of CC in their various stages. Then you can compare to Tug's sores.

In my experience, I have not heard of another dog licking the affected dog's CC. From what I have read here, and experienced with my own dogs, most dogs are not attracted to CC at all. In fact, my dogs turn away from it if they get a sniff of it.

[Clowe]

Hi all

thanks very much for all your interest.

We are, I think, pretty much at the beginning and nowhere near a diagnosis. That is the frustrating bit. The blood test, was only a simple blood test, but showed no raised cortisol levels. I still need to get the exact results, which they promised to print out for me.

There has not been any diagnosis of CC, but the derm vet said that it looks very much like it and that she would be surprised if it was not. Biopsy is next step.

It all started with the infection in his elbow though and that has not cleared yet, so he is still on strong antibiotics.

In your experience, were your dogs listless and demotivated before diagnosis? Tugboat is neither. He has weak legs, that we put down to arthritis (but maybe not), but he even went for a small run with hubby and one of the kids.

Just finding it very hard to deal with vets and making the right decision what to do next. I feel it would have been easier to have any kind of diagnosis :-(

Claudia

[labblab]

We are, I think, pretty much at the beginning and nowhere near a diagnosis. That is the frustrating bit. The blood test, was only a simple blood test, but showed no raised cortisol levels. I still need to get the exact results, which they promised to print out for me.

There has not been any diagnosis of CC, but the derm vet said that it looks very much like it and that she would be surprised if it was not. Biopsy is next step.

Hmmm...there is no way in which Cushing's can be either diagnosed or ruled out on the basis of a resting cortisol level alone. If this was your regular vet's method of testing, sadly it indicates that he/she is not familiar with the disease. This is why I was wondering which vet is overseeing the diagnostic process. It sounds as though you will be better served by placing the derm vet in the diagnostic lead right now. I do think an actual biopsy is important. If it is indeed positive for CC, then an actual diagnostic blood test is in order (either the ACTH or the LDDS). Both tests have pros and cons which we can talk about a little later. But they are both considered diagnostic tests whereas a resting cortisol level is not.

You really do want to push ahead so as to begin treatment quickly if Cushing's and CC are diagnosed. Calcinosis cutis can explode rapidly and become a primary quality of life issue. Not every dog exhibits the full range of Cushing's symptoms. But based on the abnormalities you've listed so far, if Tug does have CC and also tests positive on a diagnostic blood test, I would be "good to go" in terms of advancing to treatment if he were my own dog. In the absence of a history of being given supplemental steroids, Cushing's is by far the most likely cause of Calcinisis cutis in dogs.

Marianne

[Clowe]

Thanks Marianne

this is very helpful.

I do have a vet appointment today with the derm vet, who by the way did the blood tests. I will ask that we go ahead with the other tests for cushings.

He is not very well at all at the moment and is loosing his zest for life, which is not like him at all. He now has problems walking, he seems very unsteady on his feet. All that within a week - he went for a run still last Tuesday or so.

The antibiotics are all not making a huge difference to his elbow either, the lump is just not clearing and I wonder if that is what is making it sore to walk too. They are keeping it at bay, but I would have expected more at the dose he is getting at the moment.:(

Claudia

[Squirt's Mom]

I would push the vets to look at things other than Cushing's as well. Cushing's does not come on that fast nor cause the pup to decline that rapidly. It is a very slowly progressing condition taking years to cause damage or visible changes.

The change of feed would not have had any bearing on cortisol one way or the other tho we did have one member show up a couple of years ago who claimed his pup had food-dependent Cushing's. There is very little information on this and the member has disappeared so we don't know how his pup is doing nor what the subsequent testing and outcome were. If my memory holds, tho, cortisol levels will rise after a meal, then lower again putting the pup on a sort of cortisol roller coaster.

The feed change COULD have had a huge effect on his skin, tho. How long was he on the kibble? What kibble was he eating? Were the ingredients similar to or very different from the BARF he had been eating? Were there ingredients he had never been exposed to before in the kibble? How long has he been back on the BARF?

I'm glad you found us and look forward to hearing what the Derm vet has to say and seeing those test results as they come in.
Hugs,
Leslie and the gang