fearful of another dog with cushings

[maureenb]

Hi I am new here. 10 years ago my wire fox terrier fought adrenal gland cancer after a valiant fight with surgery, chemo and then to find out it had metastisized to the other adrenal gland. Now I have another wire fox terrier from the same breeder who is hypo thyroid and has started similar sxs.....excessive urination and peeing. 2 weeks ago ihad the vet check his glucoxe which was normal. Then I returned him to the vet to test for what I feared....cushings. his ot was normal. Pt was 264 and alk. Phos was 2011. What test should we do next?

[maureenb]

Just me again. My vet is ordering meds for acth test tomorrow, but I am thinking she should be running a deximethasone test first. Is that correct?

[Harley PoMMom]

Hi and welcome!

I have manually approved your membership so now all your posts will be seen right away.

I am sorry for the reasons that brought you to us but glad you found your way here.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing it and other non-adrenal illnesses share the same symptoms as Cushing's.

I see from your post that your furbaby was diagnosed with hypothyroidism, is thyroid medication being given? If so when were the thyroid levels checked? Increased drinking and urination symptoms can be caused if the thyroid medication dose is too high which is known as Hyperthyroidism.

Besides the excessive drinking/urination does your furbaby have any other symptoms? I did see that you posted some lab results but I don't recognize some of the abbreviations, particularly the ot and Pt. Hopefully another member may help me out but if not could you find out from the vet what those abbreviations stand for? Also was an urinalysis done, and if so, could you post those results?

We will help in any way we can so do not hesitate to ask all the questions you want, ok? ;)

Hugs, Lori

[maureenb]

Hi the tests are as follows: SGOT is the old name for AST and SGPT is the old name for ALT.

So Buster's ALT is 264 and his AST is normal. however, his alkaline phosphotase is 2011.

Yes, Buster has been on thyroid meds for about 5 years now. His thyroid levels are checked yearly. he is due in April.

Other sxs are strange behavior - going off by himself and hiding in my closet for the night. The vet noticed a heart murmur just 2 weeks ago. He has a very roly poly tummy. He gets very winded when walking.

What tests should we do next? Thanks for all your help!

[molly muffin]

Hello and welcome to the forum. Everyone had their preference as to whether to run the ACTH first or the LDDS. I prefer the LDDS and then if that is positive check the ACTH. If the LDDS is negative then it is quite likely that cushings is not the culprit. However, there could be high cortisol for some other reason in the body.

Sharlene and Molly Muffin

[maureenb]

Thank you for that advice. My vet wants to do the acth test. Oh yes I took buster's urine in and the vet did a routine urinalysis. She said he had a few white cells. Isn't that an indication of cushings?

[molly muffin]

It could also be a sign of an infection somewhere too.
I'll let one of the others answer about white blood cells. I don't usually think of that with cushings though. Normally you'll see high ALKP, maybe high ALT, cholesterol can go up, not always though.

What was a the specific gravity on the urine? Normally with cushings they have a very dilute urine.

Sharlene and Molly Muffin

[maureenb]

Hi, i will ask about the urine S.G. tomorrow. Buster is going to have his ACTH stim test tomorrow. Hope he does well.

[maureenb]

Another question - once the dogs get on meds, do they stop peeing all the time?

[molly muffin]

It does usually get under control as their cortisol levels come down.

Sharlene and Molly Muffin

[lulusmom]

A good number of dogs with cushing's have a urinary tract infection at the time of diagnosis and yes, white blood cells are found in the urine. Cushdogs usually have dilute urine which reduces the number of bacteria in a specimen so a routine urinalysis doesn't pick up the true number of white blood cells. For this reason, a urine culture should be done to identify the bacteria so an appropriate antibiotic can be prescribed.

A blood chemistry often includes T4 which is a thyroid hormone. Can you check your copy of the blood tests to see if T4 is listed? If so, can you please post the result as well as the normal reference range?

Most specialist and experienced gp vets prefer the LDDS test over the acth stim test for two reasons. The acth stim tests is more likely to yield a false negative result so a fair number of dogs with cushing's, especially a dog with an adrenal tumor, will have a normal result. The LDDS can often tell you that a dog has pituitary dependent cushing's, whereas the acth stim test doesn't, which requires additional differentiation test like an abdominal ultrasound or an endogenous acth test.

[maureenb]

Hello, Buster had his ACTH stim test and it came back completely normal. The vet tells me that he has no pituitary or adrenal gland issues then. So why does he have an Alkaline phosphotase of 2011? She suggested doing a bile salt test or ultrasound of the liver. She also suggested i take him to the U of Mn veterinary clinic for further testing. Can anyone give some direction or advice? Thank you.

Another thought - i happened to see warnings about jerky treats for dogs. I give Buster one of those every day. Could that be the cause of his increased Alk. Phos. ?

Thanks for listening.

[Harley PoMMom]

If the jerky treats were made in China than there's a big chance that they could be the culprit.

Could you post those ACTH stim test results?

A bile acid test is a good way to check how the liver is functioning.

Hugs, Lori

[molly muffin]

Another reason for high ALKP can be gall bladder sludge, which I think only shows up on an ultrasound, but is something the specialist can look into and as Lori mentioned, the bile acid test.

Sharlene and Molly Muffin