New here, my Alaskan Malamute suspected of having Cushing's

[Blade's Mama]

Hi Everyone,

I'm new to the site and there is a lot of helpful information here. Maybe if I tell our story, someone can guide me to the right steps and testing.

My Blade is a 5 year old Alaskan Malamute. I got him at 8 weeks. He has had digestive issues since the day I brought him home. Diarrhea despite keeping him on the same food he was on at his birth home. He continued to thrive and gained weight, never showed a problem, just diarrhea. Through his first year, I tried everything, every kind of food, allergy formulas, cooked food and he was tested for everything tried rounds of antibiotics, no success. Before deciding on a full thickness biopsy of his intestine to get a better idea of what was going on, I tried my last resort, a raw diet. Believe it or not, this completely cured the diarrhea! It was amazing! He had been on a raw diet and did fine ever since. Last year he started panting a lot in the summer, he gained a lot of weight, about 40+ pounds and was around 170 pounds and he was not very energetic. He also had a terrible smell about him despite numerous baths. I took him to the vet and they checked thyroid levels and also sedated him to get a good look at anal glands. He said the anal glands were fine, but he seemed to have poor sphincter tone and had some fecal "leakage" that spills out onto the fur in the perianal region that causes him to smell. The thyroid panel came back low normal. I was told to switch to a grain free dog food and get him off of raw so it would be easier on his stomach. He did well with that, but still "leaks". I have learned artic breeds need to have their thyroid levels on the upper end of normal so we started him on thyroid meds. He dropped nearly 30 pounds and started looking better. But then began the panting in the summer/fall, way more than normal. They tested for heartworm. It was normal. The season changed and the panting seemed to stop. Blade gained about 20 pounds back. In December he started drinking excessively and has me up 2 or 3 times a night to go out. I catch him outside gulping snow. He doesn't pant anymore. He has some bare patches where it looks like someone shaved him down to the skin, that are itchy, around 3 inches in diameter. I took him to the vet last week and he was tested for a regular urinalysis, thyroid panel and urine Cushing's screen. He is 161 pounds despite only eating 2 cups a day. Urinalysis came back normal. Thyroid results still pending. Cushing's screen positive. My vet says we need to do the cortisol blood test (which is $406). I cannot afford this right now, but I have scheduled him today to get a CBC and chem panel. I feel we should be absolutely sure of everything else before I try to scrape together the money for the Cushing's test. Plus I'd like the thyroid results back first as well. Can anyone out there make sense of my story and recommend anything for my boy? He is a huge part of our family and my best friend. I love him so much and can't imagine life without him. Thank you in advance for your help!!

[Blade's Mama]

Also is it good to have an ultrasound and the cortisol test? Which one is more expensive? They quoted me at $406 for the blood test. Thanks everyone!

[Renee]

Hello and welcome. Malamutes are such beautiful creatures. My brother had one growing up, and he struggled with many of the same digestive issues your Blade had. I think these dogs can be more sensitive than people think!

As for the test - I would assume your vet wants to do an ACTH? There is another test, LDDS, which is used for diagnosing cushings as well.

The thing with the ACTH test is that it is the cortrosyn that is very expensive, and at Blade's size, I am not surprised the test is so expensive. The ACTH for my pug (19 lbs) is $250, of which $150 is the cortrosyn alone.

I think you are smart to wait on the results of all the other tests before moving forward with the cushings testing.

[labblab]

Hello and welcome from me, too! I'm afraid I have only a moment to post, but I "second" Renee in terms of agreeing that I would most definitely await the results of the other tests, especially the thyroid monitor. I do think that many of Blade's symptoms could be explained by a thyroid level that is too high. So before pursuing Cushing's I would want the other results to be in place.

Marianne

[Blade's Mama]

Thanks for the welcome and the tips! I took him today for the CBC and chem panel. We will get results tomorrow. It will take another week for the thyroid panel. I am so praying we find something that is fixable and explains things so we don't have to worry about Cushing's or the expensive test.

[molly muffin]

Hello and welcome from me too. I agree with Renee and Marianne so I don't have a lot to add in that department, but I did want to say welcome.

It seems that Malamutes have some very fine tweaking to do with their thyroids, high but not too high, so I would definitely be looking at that first. The other thing to know is that while the urine cortisol screening can say if there is cortisol, they can't say that it is there due to cushings. Anything going on can cause the cortisol to rise, so that is another reason to rule out other things first.

Sharlene and Molly Muffin

[Blade's Mama]

We're still praying its a thyroid issue and not Cushing's. The CBC and chem panel came back today with elevated cholesterol of 385, triglycerides 243 and specific CPL (pancreas) 388. The vet is not hopeful that its anything else. We're waiting on the thyroid results due in next week before tackling on the expense of the ACTH. Meanwhile, what kind of diet is good for Cushing's? I had him on raw for years and swore by it. The vet told me to take him off so he's been on the Taste of the Wild for 6 months. If its Cushing's, he is definitely worse. I'm thinking of returning to raw. Any thoughts? Thanks so much for your help and support. I'm a mess about today's results.

[Renee]

Is it possible Blade has pancreatitis? That can go on for months.

I think food discussions can get quite heated, as everyone has their personal opinion. In regards to cushings, I do not believe there is any diet that will have a specific and direct impact on cushings itself, since no food product can lower cortisol. That said, the food you feed can impact overall health and be supportive to the immune system (good food) or a detriment (bad food). Some say that a lower fat diet is better for cushings, simply because cush dogs tend to gain weight and be prone to pancreatitis. Again though, a low fat diet has no impact / bearing on the cushings itself.

I feed The Honest Kitchen, and swear by it. I also home cook. These diets have served my pugs the best, whatever their other health issues may be. I have done raw in the past, and I think raw is a wonderful diet, and I admire people that do raw diets long-term. But, it won't cure cushings, nor even diminish it, as far as I know.

[Harley PoMMom]

Hi and a belated welcome to you and Blade from me as well!

With a spec cPL result of 388 it is very possible that Blade does have pancreatitis. My boy, Harley, had chronic pancreatitis which I could never get quite under control. Any non-adrenal illness such as pancreatitis can create false postive results on all tests for Cushing's. If this were me, I would hold off on doing any tests for Cushing's until pancreatitis can either be ruled in or out.

Dogs with Cushing's should be on a high quality protein, moderate fiber, and low fat diet. If Blade is doing well on his diet right now I see no reason to switch him to anything else.

I see from your post that Blade's urinalysis came back normal, does that mean his urine specific gravity (USG) was within the normal limits? Dogs with Cushing's have a low urine specific gravity because the excessive cortisol causes the kidneys to work harder, thus the dog has to drink a lot more to keep up with the urine output.

I believe before any more tests are performed for Cushing's, the results for his thyroid need to be known and also I would recommend having another spec cPL test done to see if pancreatitis is in the picture.

Here's a link with info about the spec cPL test: Spec cPL® Test (canine pancreas-specific lipase) (http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf?SSOTOKEN=0)

If you have any questions please feel free to ask them and know we are here to help in any way we can.

HUgs, Lori

[Blade's Mama]

Thanks so much for all of your advice. I too am concerned about pancreatitis. From what I read, pancreatitis commonly goes along with Cushing's, which is I guess why my vet is more insistent on the ACTH. But the symptoms of pancreatitis alone do not involve excessive drinking and urinating. I'm still awaiting the thyroid panel to see if that is the culprit there. I palpated Blade's chest and abdomen last night. At one spot, he growled quietly. He never growls. This concerns me. I am heading to the vet today to get copies of his labwork and ask about a more detailed pancreatic panel. He had the chem panel and CBC and it did include the spec CPL of 388. I don't know if they will be willing to repeat it.

[Harley PoMMom]

Another thought, Arctic breeds are predisposed to zinc deficiency, in which diarrhea is a symptom. Has Blade been checked for a zinc deficiency?

Link to article about this: Canine zinc-responsive dermatosis (http://veterinarynews.dvm360.com/dvm/DVM+InFocus/Canine-zinc-responsive-dermatosis/ArticleStandard/Article/detail/162405)

Regarding the spec cPL, I would wait at least 2 weeks before repeating this test.

[lulusmom]

Lori has already asked you about the urine specific gravity (USG). You mentioned that urinalysis that was done and that it was normal. A dog with cushing's who is drinking and peeing buckets does not have a completely normal urinalysis. USG is almost always low and almost half of dogs at diagnosis have a urinary tract infection. A urine culture should be done to identify the bacteria so that an appropriate antibiotic can be prescribed. Can you please round up all of the testing your vet has done thus far in confirming a cushing's diagnosis and post the results here? I see that you posted a few values from the blood chemistry already but would appreciate seeing the normal reference ranges. Were these the only values that were abnormal? Most dogs with cushing's have some elevations in liver values, more specifically alkaline phosphatase. You mentioned that a complete blood count (CBC) was done. Were there any high and/or low values and if so, can you please post those for us?

Excessive drinking and peeing is common in any number of diseases and before you launch into full blown diagnostics, your vet should have determined if your dog's drinking and peeing is truly polyuria/polydipsia (PU/PD) caused by cushing's. Is your dog's urine like water, as in clear and odorless? You mention that he gulped snow when you let him out. Are you withholding water from him? If so, please don't because if his kidneys are not concentrating, he needs to drink more to keep up with the loss of water. Dehydration can happen rather quickly and it can be life threatening.

I'm sorry for asking so many questions, but honestly, based on the information you have shared with us, your dog doesn't present as a cushingoid dog so I'm trying to figure out what else could be going on. I look forward to your answers.

Glynda

P.S. Has your vet ruled out Leptospirosis?

[Blade's Mama]

You guys are so very helpful thank you! Harley PomMom, I don't know if he has been tested for zinc, unless its in the regular panel and I'm not seeing it. I will look at the site you provided and keep that in mind, thanks!

Lulusmom, thanks also for your questions and help! Blade's urinalysis was normal. His specific gravity is 1.008. His urine cortisol is 6.6 (no normal range given on my report). Urine creatinine 48.0 (also no normal range given). Urine cortisol/creatinine ration 43. It says <34 Hyperadrenocorticisim highly unlikely. > or = 34 Hyperadrenocorticism possible. His urine when I collected it for the specimen was clear and golden yellow. He peed for well over a minute at the time of this specimen. There was no odor that I could detect.

As for his blood levels, the thyroid panel from Michigan State came back all normal today. TT4 36 (normal 11-60). TT3 0.9 (normal 0.8-2.1). FT4 11 (normal 6-23). FT3 4.9 (normal 1.2-8.2). TSH 0 (normal 0-30). They did a CBC and Chem 27. Abnormal levels were: Amylase low at 231 (normal 337-1459). Cholesterol high at 386 (normal 131-345). Potassium high at 5.6 (normal 4.0-5.4). Triglycerides high at 243 (normal 20-150). NA/K ratio low at 27 (normal 28-37). Spec cPL midrange high at 388 (normal 0-200; 201-399 serum spec cPL concentration increased. May have pancreatitis and should be reevaluated; > or = 400 Serum spec cPL concentration is consistent with pancreatitis. It also says for the blood slide reviewed microscopically RBC morphology appears normal. No parasites seen. Everything else in the CBC, liver, kidneys was normal.

Blade has a 1-1/2 gallon bucket of water with him at all times, I never withhold it. He drinks at least this bucketful through the course of the day and then approx. another one through the night.

I spent a great deal of time talking with the vet today and he also feels after all the tests came back that he does not sound like a Cushing's dog. He also doesn't look like one according to him. He believes without anything else being elevated, that he is not in pancreatitis at the moment at least. He is concerned that maybe there is an infection in the urinary tract somewhere that is not showing up in the testing and we have a urine culture scheduled for Monday. After this has returned, I guess there will be no other way to tell other than the ATCH. If you have any other advice or tips feel free to share. I am open to anything anyone can think of. I am at a loss and have been racking my brain and researching what else could be wrong with my boy. He and I both are in need of an answer for less stress, better health and SLEEP! We are up every 2-3 hours to go out to pee. Thanks again for all of your help and support. This site is amazing. God Bless you All.

[Harley PoMMom]

These articles may help: Diagnostic Approach to PU/PD: Urine Specific Gravity (http://endocrinevet.blogspot.com/2011/01/diagnostic-approach-to-pupd-urine.html) and Diagnostic approach to polyuria and polydipsia (Proceedings) (http://veterinarycalendar.dvm360.com/avhc/content/printContentPopup.jsp?id=581757)

[Renee]

I just want to say... it is entirely possible to have cushings even if the dog has totally normal blood work. My pug is one of the rare cushings dogs that does not, and never has had, elevated liver values (alk phos). Her initial blood work did not support cushings. But, the results of an ACTH, LDDS, and biopsy confirming positive for calcinosis cutis, along with her symptoms, was enough to confirm.

I know this is opposite of what most of us have been saying, that cushings may not be the case, but I did want to make sure you knew that there are exceptions to every rule.

A urine culture & sensitivity is an excellent idea!

[Harley PoMMom]

I just want to say... it is entirely possible to have cushings even if the dog has totally normal blood work. My pug is one of the rare cushings dogs that does not, and never has had, elevated liver values (alk phos).

I'm pretty sure that Glynda's sweet Lulu was a prime example of that, so yes, we are very aware that a small percentage of dogs with Cushing's do not have high elevations in the ALP. ;)

[Renee]

I'm pretty sure that Glynda's sweet Lulu was a prime example of that, so yes, we are very aware that a small percentage of dogs with Cushing's do not have high elevations in the ALP. ;)

Oooh, I didn't know that her Lulu was one of those dogs. I'm excited to find her thread and read it now! Thanks!

[Blade's Mama]

I agree, we could still be dealing with Cushing's despite the results from the bloodwork and urine. I will say that I took him off of Taste of The Wild and back on his raw diet Friday night. There has been a decrease in drinking and peeing. We're still getting up, but its a small improvement. We're doing the urine culture today.

[Renee]

I agree, we could still be dealing with Cushing's despite the results from the bloodwork and urine. I will say that I took him off of Taste of The Wild and back on his raw diet Friday night. There has been a decrease in drinking and peeing. We're still getting up, but its a small improvement. We're doing the urine culture today.

A raw diet is much, much more hydrated. My pugs are on a dehydrated raw, and hardly ever drink water. Feeding kibble requires much more water intake in order to be digested. I am glad his water drinking is decreasing.

[Blade's Mama]

Still not drinking quite as much, but still peeing! Awaiting the culture results coming in tomorrow.

[Blade's Mama]

The urine culture showed no growth. Lulu'sMom, any advice regarding the lab results I gave you?

[lulusmom]

Hi Blade's Mama and sorry for being MIA.

I will give you my very unprofessional layperson's opinion of the abnormalities you posted. Please see my comments in blue below:


Blade's urinalysis was normal. His specific gravity is 1.008.

The USG is part of the urinalysis and 1.008 would not be considered normal. It is low, or at least according to most of the lab reference ranges I've seen over the years. The USG can vary throughout the day so I'm wondering if prior urinalyses were done and if they were also low???

His urine cortisol is 6.6 (no normal range given on my report). Urine creatinine 48.0 (also no normal range given). Urine cortisol/creatinine ration 43. It says <34 Hyperadrenocorticisim highly unlikely. > or = 34 Hyperadrenocorticism possible.

That is definitely a high ratio and as such, it could be cushing's or it could be any non-adrenal illness or it could be that the specimen was taken by cystosentesis, meaning sticking a needle into the abdomen directly into the bladder. I would be shocked if results were not high if this were the case. If specimen was collected by you at home, then results would be an indicator that additional testing should be done but in my opinion, only if symptoms warrant.

His urine when I collected it for the specimen was clear and golden yellow. He peed for well over a minute at the time of this specimen. There was no odor that I could detect.

My cushpup was definitely not concentrating his urine...not even after stabilizing on treatment and it was clear like water....no color and no odor. Your pup's kidney may still be able to concentrate a bit but may become worse as time goes by. Looking at the results of any prior USG might help.

As for his blood levels, the thyroid panel from Michigan State came back all normal today. TT4 36 (normal 11-60). TT3 0.9 (normal 0.8-2.1). FT4 11 (normal 6-23). FT3 4.9 (normal 1.2-8.2). TSH 0 (normal 0-30).

Those results look great. Was the blood drawn four hours after dosing with thyroid med on an empty stomach? If not, the results are not accurate and hyperthyroidism cannot be ruled out and excessive drinking a peeing is the hallmark symptom of hyprethyroidism.

They did a CBC and Chem 27. Abnormal levels were: Amylase low at 231 (normal 337-1459).

You would think that with such a high CPL result, that amylase, a pancreatic enzyme, would be elevated. However, that's not always the case. The results of one particular study "concluded that determination of serum amylase activity without knowledge of serum lipase activity was of little value to diagnose pancreatitis. High amylase activity was not specific for pancreatitis and low amylase activity could not rule out the disease. The results of this study also showed that low serum lipase values almost always eliminated the possibility of pancreatitis and that high values were often, but not always, diagnostic for pancreatitis. Abstract for that study can be found at http://www.ncbi.nlm.nih.gov/pubmed/6175256

Cholesterol high at 386 (normal 131-345).

This would be considered an insignificant elevation and while common in cushing's, it can also be due to a diet higher in fat and/or a recent meal.

Potassium high at 5.6 (normal 4.0-5.4).

A raw food can cause this mild elevation or if blood sample has not been handled correctly causing hemolysis. Is there any mention of hemolysis on the labwork?

Triglycerides high at 243 (normal 20-150).

This elevation goes hand in hand with fat in the blood caused by diet or other underlying problems...cushing's is one. It can also be caused by hemolysis.

NA/K ratio low at 27 (normal 28-37).

This ratio is low because the Potassium is elevated.

Spec cPL midrange high at 388 (normal 0-200; 201-399 serum spec cPL concentration increased. May have pancreatitis and should be reevaluated; > or = 400 Serum spec cPL concentration is consistent with pancreatitis.

I believe that pancreatitis is a very good possibility, even though your dog is not showing any outward symptoms and amylase and lipase are not elevated. ALKP is a a liver enzyme that has different isoenzymes that triggered outside of the liver. The gut is one of those areas and pancreatitis can cause some pretty high elevations in ALKP.

It also says for the blood slide reviewed microscopically RBC morphology appears normal. No parasites seen. Everything else in the CBC, liver, kidneys was normal.

There are usually some cbc abnormalities if a dog has cushing's. Most cushing's dogs have what is called a "stress leukogram" which refers to a specific white blood cell distribution in the blood. This distribution includes a high total white blood cell count with increased numbers of neutrophils and monocytes and decreased numbers of lymphocytes and eosinophils. Can you recheck your labwork and make sure these are normal?

http://www.petplace.com/dogs/hyperadrenocorticism-cushing-s-syndrome-in-dogs/page4.aspx


It appears that the only symptom your dog has that is commonly associated with cushing's is the excessive drinking and peeing. I believe you mentioned that the drinking subsided some after switching diet and this is not typical of cushing's. Diet cannot restore the solute that is lost in the kidneys which is what it takes to start concentrating the urine, thereby reducing the huge amount of clear urine, which in turn reduces the amount of drinking. With all the blood work that has been done, did the vet shave any area on the legs? If so, is the coat growing back in. Dogs with uncontrolled cushing's have what is called post clipping alopecia, meaning the once shaved, the coat usually does not return and if it does, it takes a very long time.

Sorry for all the questions but aside from the drinking and peeing, I don't see a dog who presents as being cushingoid. :confused:

Glynda