Puppy diagnosis

[jolmcmillan]

I have a 9 month old beagle/german shorthaired pointer mix that I adopted from our Animal Control facility in August. My vet suspects Cushings Disease mainly because he is overweight and has excessive thirst and urinates more often that most dogs. His urine is also clear with no odor most of the time. Although he is house broken for the most part, he has had accidents inside. He can be playing and suddenly run towards the door leaving a trail of urine. My main concern is that he has episodes where he becomes lethargic and shivers. He usually will vomit several times during these episodes, but not always. This usually lasts 2-4 hours, but has lasted longer, and usually happens about once a week. My question to anyone more knowledgeable with Cushings than I am is, do these symptoms sound familiar? From what I have been reading the disease isn't common in dogs under 2 much less a puppy. He has had these symptoms since I adopted him at four months. The first vet I took him to seemed to dismiss my concerns. He is going back to the vet on Tuesday for blood work so hopefully I will have more answers.

[labblab]

Welcome to you and your puppy. Bless you for adopting him, and I am so sorry that you are having these problems. You are correct that the excessive hunger, thirst and urination are consistent with Cushing's. However, your puppy's very young age and the episodes of vomiting with shivering are not. What you are describing almost sounds like some kind of seizure event to me. And if there is some type of organ/bodily dysfunction that is causing these vomiting events, it may also be causing the thirst and urination, as well.

One of the hard parts about Cushing's diagnostics is that the blood tests that are specific to the disease can render false positives in the presence of other illnesses, too. I absolutely agree that a basic blood and urine panel is the first place to start for your puppy, especially looking at results for thyroid function and blood glucose. But if there are no obvious abnormalities that show up, if possible, I would urge you to consult with an internal medicine specialist before launching into any more involved testing. If you have a vet school anywhere near you, this can be a very good option. The reason why I make this recommendation is both for your peace of mind and also to save money in the long run. I think it is unusual for a puppy of this age to exhibit this constellation of symptoms, and I think it would be very helpful to get a specialist's insight right from the get-go. This may turn out to involve only a single consultation and work-up, but the results may permit the specialist to guide your local vet regarding further testing or treatment.

Here's a link that explains more about the credentials of an "IMS" (Internal Medicine Specialist), and also how to locate one in your area. You will be looking for an internist who specializes in small animals ("SAIM").

http://www.k9cushings.com/forum/showthread.php?t=182

Marianne

[Renee]

I agree with Marianne - I would be concerned about some type of seizure activity, neurological disorder or chemical imbalance. Blood work and urinalysis is a great place to start.

[lulusmom]

Hi and welcome to the forum.

My own dog was diagnosed with cushing's at three years old and she is considered a rare case. A nine month old puppy? Cushing's doesn't even enter my mind and I'm wondering why your vet would even entertain the thought of cushing's before ruling out other more likely causes. After reading the symptoms and that they are intermittent, the first thing that came to my mind is Addison's, which is the opposite of cushing's. With cushing's the dog over secretes cortisol. With Addison's, the dog's adrenal glands are not producing enough or none at all. Symptoms can be intermittent and while not that common, puppies are diagnosed with Addison's. Also, German Shorthaired Pointers are a breed that seem to be genetically predisposed to Addison's. They call Addison's the great imitator because symptoms are shared with a lot of other conditions and while blood chemistry may help somewhat, an acth stimulation test should be done to diagnose or rule out Addison's. I highly recommend that you talk to your vet about this possibility.

Glynda

[jolmcmillan]

Thank you all! These replies are very helpful. I think what caused the vet to consider Cushing's was Jubal's body shape. He is overweight and a bit broad shouldered with a pot belly. I have two other dogs and neither of them are overweight. After googling pictures of dogs with Cushing's I understood his concern. I am taking Jubal in tomorrow morning for tests so I will ask the vet about Addison's. I wondered about a seizure disorder, but when Jubal has these bouts of shivering and vomiting he remains responsive to me. However he is lethargic to the point of remaining in the same spot. He will drink if I bring water to him but is uninterested in eating. I live a little over an hour from UT vet school, so I may call them to see if they can run some of the tests on him. Thank you all very much for the suggestions and advice. Hopefully I can find some answers as to what is making this puppy so sick.

[jolmcmillan]

Oh my! I just read up on Addison's disease and this could be a real possibility! Thank you so much for that suggestion! I will definitely bring this up with my vet in the morning!

[labblab]

Yes, Addison's is a great suggestion by Glynda! Many of the symptoms fit Jubal to a "T." It is such a goofy thing that both too much cortisol and too little cortisol can share many similar symptoms. But Jubal's inappetance, vomiting and shivering surely do fit Addison's and not Cushing's. One diagnostic "plus" is that the ACTH stimulation blood test is used to test for both diseases. No matter what you find out, please come back and let us know, OK? If it is Addison's, we have other folks here who are managing that condition with success, so we can still be here to support you!

Marianne

[jolmcmillan]

I took Jubal in for testing on Tuesday and am still waiting to hear the results. The testing involved blood work at 8 am, noon, and at 4pm. They also performed an ultrasound. He had another episode of shivering today that lasted for two hours. During this time he wanted on the couch, but wouldn't jump on it. I had to help him up. I think this is due to the lethargy. He didn't vomit this time. Just wanted to rest and sleep and be left alone. I don't know what is causing these episodes, but don't like leaving him alone. I hate to think something would happen and I wouldn't be here to help him. He is still drinking quite a bit and urinating often. I hope to hear something from the vet soon.

[labblab]

The 8-hour test was undoubtedly the LDDS which is one of the two diagnostic tests for Cushing's. Unfortunately, it cannot be used to diagnose Addison's if that is instead Jubal's problem. It is the alternative blood test, the ACTH, that can diagnose either of the two conditions and that is why we were hoping that would be the diagnostic test your vet would choose. Is he dismissing Addison's as a possibility? Given your description of Jubal's behavior, that still seems like such a strong possibility to me that I'm sorry that it sounds as though he was not tested for it.

Marianne

[jolmcmillan]

I specifically asked about Addison's and was told the tests could also be used to diagnose Addison's if that is the case. Addison's definitely looks like a possibility, but I did see that dogs with Addison's are generally underweight. Is this accurate? Because Jubal is definitely on the plump side. His shivering episode lasted right at two hours today and afterward he drank and ate, then back to the couch to sleep. He does seem to be feeling better though.

[labblab]

You are right that Addison's dogs are usually underweight rather than overweight. Since your dog's overall symptom profile is not totally consistent with either Cushing's or Addison's, it may very well be the case that it is something else entirely different that is at the root of his problems. So additionally, it seems as though the ACTH would have been the better test choice in this situation since the LDDS cannot diagnose Addison's, and also because it is more likely than the ACTH to return a "false positive" for Cushing's when the true source of the problem is actually a nonadrenal disease.

From what I have read, sometimes regular tests of blood counts and blood chemistries do not reveal any significant abnormalities for Addison's dogs (although I will warn you that Addison's is sometimes initially misdiagnosed as kidney problems because the two disorders can share a similar lab profile). So even if Jubal's current tests are all normal, I still think you would want to consider an ACTH (and returning to my original reply -- you may want to consider consulting a specialist in order to save money in the long run by making sure that the most appropriate tests are being performed).


ACTH: “Gold Standard” test to diagnose spontaneous hypoadrenocorticism (Addison’s disease). This is true whether the dog has primary or secondary hypoadrenocorticism or typical or atypical disease; the ACTH stimulation test is the only test to use for this diagnosis.

Marianne

[jolmcmillan]

I received a call from the vet today and he had the results of Jubal's blood tests. He said it isn't Cushing's or Addison's. He is not looking at Diabetes Insipidus. He is supposed to call back on Wednesday. I appreciate all the helpful comments.

[molly muffin]

That's great that at least two things can be ruled out. Now just have to figure out what the problem Is.

Hang in there. I know you'll get it figured out. Do let us know how things are going and what the vet comes up with.

Sharlene and Molly Muffin

[jolmcmillan]

Thanks for the support. I meant to post that the vet was NOW looking at diabetes insipidus, not that he was NOT looking at it. I would just like to find out what the problem is so we can treat it. He is such a young dog and was in such bad shape when I found him. Who knows what he had been through. He deserves a life free from pain and discomfort.

[labblab]

Can you ask the vet how he ruled out Addison's? Unless he performed an ACTH stim test, I don't see how he can rule it out with certainty.

Marianne

[Renee]

Has liver function been tested?

[jolmcmillan]

No, I don't think the liver functioning has been tested, but they did perform an ultrasound and he did say something about his liver being misshapen, but I may be recalling that incorrectly. The vet is supposed to be looking in to a few more possibilities and is supposed to call me back tomorrow. I am not exactly sure what test was used but they did three separate blood tests. One at 8 am, at noon, and the last at 4 pm. They told me that whatever test they did would test for both Addison's and Cushing's. I will ask if it was the ATCH test, but it sounds like it probably was.

[Renee]

No, I don't think the liver functioning has been tested, but they did perform an ultrasound and he did say something about his liver being misshapen, but I may be recalling that incorrectly. The vet is supposed to be looking in to a few more possibilities and is supposed to call me back tomorrow. I am not exactly sure what test was used but they did three separate blood tests. One at 8 am, at noon, and the last at 4 pm. They told me that whatever test they did would test for both Addison's and Cushing's. I will ask if it was the ATCH test, but it sounds like it probably was.

I highly recommend a bile acid test.

[labblab]

I am not exactly sure what test was used but they did three separate blood tests. One at 8 am, at noon, and the last at 4 pm. They told me that whatever test they did would test for both Addison's and Cushing's. I will ask if it was the ATCH test, but it sounds like it probably was.
The test you are describing is the LDDS (Low dose dexamethasone suppression test). Like the ACTH, it is a diagnostic test for Cushing's, but unlike the ACTH, it does not diagnose nor rule out Addison's.

Marianne

[jolmcmillan]

Thanks Marianne. I will definitely ask him about that. Fortunately he hasn't had an episode since Sunday.

[jolmcmillan]

I'm not sure what a bile acid test is, Renee, but I'll google it and ask the vet. Thanks! This is all new to me.