Could This Be Cushings --

[blaze12]

or more specifically, should I ask my vet to test for Cushings?

To give you background while trying to be succinct, in mid-July, I noticed my 5 1/2 y/o Pit/GSD mix struggling to get up the steps and reluctant to get up on the bed. After doing a thorough physical exam, his vet diagnosed him with a soft tissue injury in his mid-back and prescribed a short (1 week w/ a second optional week) course of Rimadyl. He also ran a complete CBC and Chem panel to compare to the one we ran in April at Blaze's annual exam. Everything came back perfect except the Creatinine came back slightly elevated at 1.7. A rerun of the Chem panel a week later showed that even that had gone back down to 1.5, with everything else remaining within normal ranges. We also previously ran a full Thyroid panel in April that came back normal.

Meanwhile, I gave Blaze the week of Rimadyl, and stopped. He started having problems with the stairs again so I restarted him on it and right after that, he began waking me once or twice a night to let him out, which he has never done before. The vet stopped the Rimadyl and put him on Tramadol, which we stopped within the week b/c he couldn't tolerate it. He attributed the increased urination to a Rimadyl side effect. However, since about 8/6, he's been off all pain medication and his back seems to have healed, but the frequent urination has continued and gotten worse if anything. He is now also panting (even though we have AC). He has had two urinalyses, both of which came back negative for a UTI. (Three different vets have assured me that with the negative results and the urine not being dilute, a culture is not indicated..) He usually suffers from skin issues in the summer, which I believe are allergy related but they are always in one particular area, on his undercarriage. For the first time, He also now has a really bad, flaky skin issue occurring as well on his back that is very painful to the touch; it seems to be responding to Cortisone spray and medicated shampoos.

To summarize, Blaze has had all normal lab results but is currently experiencing a significant increase in urination, panting and skin issues, which may or may not be allergy-related. He is not drinking more water, nor does he have the pot belly appearance. Based on this, should I ask my vet to test him for Cushings or continue to look for other causes to explain the change in behavior. Thank you so much for taking the time to read this.

[Squirt's Mom]

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[Harley PoMMom]

Hi and welcome to you and Blaze!

I have only a moment to post but wanted to welcome you both. In my opinion, Blaze's symptoms do not scream Cushing's to me, however the cortisone spray has the ability to cause increases in drinking/urination.

Diabetes has been ruled out, correct? Could you tell us what his urine specific gravity (USG) is? I believe if this were me I would have an ultrasound done to see if there is anything going on with the internal organs.

Sorry this so short, I will try to get back later, I am sure the others will be by to welcome you and share their opinions as well. ;)

Hugs, Lori

[blaze12]

Thank you so much for your reply. I'm not sure the Cortisone spray is to blame as I only just started using it a few days ago to treat the back skin issue. The frequent urination pre-dates its use by several weeks.

I'm sorry I can't give you an answer on the specific gravity because I don't have the lab report. I have the blood tests but both urinalysis results were reported by phone. I intended to get the copies and of course forgot. I only know that he told me everything was normal, which I know is not helpful to your question.

He wasn't specifically tested for Diabetes, if there is a test for it, but wouldn't some of his labs have come back out of range, like glucose for example, to indicate there is a problem. I will raise this with the vet when we go back too.

I suspect it probably is something else too, as you stated. I've been to two vets and neither seemed too concerned when all the tests came back normal, despite the continued increase in urination. I'll have to go back again and insist the vet look further or find yet another vet. Thank you for your reply.

[lulusmom]

Hi and welcome to you and Blaze.

I am sorry for the circumstances that brought you here but I'm glad you found us. Blaze's case is certainly not the typical one we see here for a number of reasons, which I've commented on below.


I'm sorry I can't give you an answer on the specific gravity because I don't have the lab report. I have the blood tests but both urinalysis results were reported by phone. I intended to get the copies and of course forgot. I only know that he told me everything was normal, which I know is not helpful to your question.

You mentioned in your prior post that Blaze's urine was not dilute so I would suspect that urine specific gravity is normal. The fact that Blaze's urine is concentrated tells me that the one symptom that brought you here, his frequent urination, isn't being caused by the cushing's. Dogs with cushing's lose their ability to concentrate their urine which means it literally goes through them like water and looks like water. In order to stay hydrated, they must constantly drink water. Blaze is asking to go out outside more often but he isn't drinking more water so his problem is not the usual polyuria/polydipsia (pu/pd) that the vast majority of cushdogs have.


Thank you so much for your reply. I'm not sure the Cortisone spray is to blame as I only just started using it a few days ago to treat the back skin issue. The frequent urination pre-dates its use by several weeks.

Did your vet do a skin scraping or culture to determine the cause of Blaze's skin issue? Dogs with uncontrolled cushing's are at higher risk of skin problems due to a compromised immune system but with completely normal blood work, cushing's would not be my first suspect. Demodectic mange is one skin problem that is associated with cushing's. This is usually a problem in puppies and if an older dog is diagnosed with demodectic mange, a vet needs to figure out what underlying condition is suppressing the immune system. For some reason, otherwise healthy Pit Bulls can have chronic demodectic mange so make sure your vet rules this out. I'm not sure that is what you are dealing with as demodex would not respond to cortisone spray. If these problems persist, you may want to consider consulting with a veterinary dermatologist.


He wasn't specifically tested for Diabetes, if there is a test for it, but wouldn't some of his labs have come back out of range, like glucose for example, to indicate there is a problem. I will raise this with the vet when we go back too.

You are absolutely correct. Glucose is usually part of the blood chemistry so if all labs were normal, I suspect your vet easily ruled out diabetes.

Based on the information you have provided so far, cushing's isn't on my radar. I have an older female cockapoo with degenerative disc disease which has greatly affected her ability to hold her urine. Incontinence and increased urination is common in dogs with spinal issues. Your vet diagnosed soft tissue injury in Blaze. Soft tissue injury in a dog means a sprained or strained muscle, ligament or tendon. These injuries resolve whereas degeneral disc and joint disease does not. Did your vet rule these out by manipulation and imaging? Is Blaze active, showing any intolerance to exercise, hesitating to jump or go up steps? Pain is probably at the top of the list of reasons why a dog pants a lot so I just want to make sure your vet has ruled out the likely suspects in a middle aged larger breed.

It would be very helpful if you would please get copies of all of the tests that have been done by your vet and make sure that absolutely everything is within normal range. Please post any that are not and please include the normal reference ranges.

I know how frustrating it is to see our dogs in any level of discomfort and not know why. I'm sorry I couldn't be of more help but wow, I'm tickled pink that Blaze has normal blood and urine results. That's pretty awesome. If you can think of anything that you may have left out, post it now.

Glynda

[blaze12]

Thank you Glynda for your very thoughtful and comprehensive reply. I do have Blaze's blood test results but not a copy of his urinalysis. Part of my frustration is that everything is within normal ranges, making it nearly impossible to figure out what could be causing him to have this increased need to pee. With respect to the urinalysis results, the vet did say that both of those we ran were completely normal in every way -- no protein, good concentrating ability, not dilute. I will definitely get copies to complete my file but I don't think the specific gravity was off based on his oral reports.

His physical exam of Blaze revealed no neurological deficits, plus I previously had a dog with Intervertebral Disk Disease and I'm not seeing anything even remotely like that in the way he's acting. The pain, when Blaze had it, was more in the nature of a pulled muscle or possibly the start of something arthritic (or more serious, like tumor, but hopefully not). If it reoccurs, we already agreed we will definitely do a series of x-rays. Right now he is pretty much back to his normal self in that regard, running around, up and down the stairs, onto the bed, etc. No exercise intolerance at all, thank goodness for that at least.

As for the skin issues, you are correct that pits are notorious for skin problems and so far, I've been able to keep Blaze's under control with regular medicated shampoos. We've discussed doing allergy testing but it hasn't been necessary up to this point because it's been a seasonal issue that I've been able to address. This back thing is new within the past month and I'll most certainly ask the vet whether it could be dermodectic mange. If it doesn't fully respond to the Cortisone, I'll also ask him to do a skin scraping as it is very tender to the touch and I think it may need something more than I currently have at my disposal to treat it.

As you say, I too don't think this is Cushings but I wanted to run it by those of you who know the illness inside and out. I am grateful for your taking the time to help me analyze this situation. Thanks again.

Valerie

[molly muffin]

I'll just pop in and say welcome to the forum. It certainly is a mystery what is causing the increased urination with all these test results and urinalysis coming back in normal range and the concentration good too.

We'll certainly be interested in what further tests your vet may opt to do and what they think it might be. Luckily not every dog on here ends up with cushings, so that is good if that can be eliminated.

Sharlene and molly muffin

[blaze12]

Thanks Molly. It was suggested to me on another forum that I should consider having Blaze tested for Bladder or Kidney stones, which I think involves an x-ray, and maybe even having an ultrasound done of his bladder if all else fails. I will definitely discuss these tests with my vet.

I have also read that in a small percentage of cases, a urinalysis will appear normal even in the presence of a UTI and the only way to diagnose is with a culture and sensitivity test. I think I already mentioned I asked three different vets about this and was told this isn't the case. With the symptoms persisting as they are, however, it seems to me that unless there are a lot of risks involved with doing the culture (and I don't think there are -- just a needle directly into the bladder to get a sterile sample, but I believe it's fairly routine), I don't see any reason not to do it, before moving forward to the more expensive tests mentioned above.

Thanks for your welcome. Hopefully someday soon I'll be able to report back the answer to this mystery. Take care.

Valerie

[molly muffin]

These are all excellent options. I have been known to insist on culture and sensitivity even though the urine is concentrate. It won't hurt to have it done. An X-Ray and/or ultrasound is also a good idea. Infection or stones are all possible culprits.
I do hope you can get someone to figure it out. Maybe choose the vet most willing to work with you or even better a specialist.
Glynda though had made some good points about degenerative disc problems. An X-ray of the spine wouldn't hurt either

Sharlene and Molly muffin

[Squirt's Mom]

Another thought is DI, Diabetes Insipidus, a rather rare form of Diabetes that has nothing to do with blood sugars but rather with how the body processes water. The signs are similar to Cushing's with heavy drinking and urination. The test for DI is rather risky, called a Water Deprivation test, so most vets simply start treatment and if the signs clear up, there is the diagnosis of DI. It is worth discussing with your vet. ;)